Podcast
Questions and Answers
What is the name of the individual who recorded the fitness log?
What is the name of the individual who recorded the fitness log?
Yvette Gillam
During Week 1, Yvette walked for _____ hours across three sessions.
During Week 1, Yvette walked for _____ hours across three sessions.
3
How many times did Yvette do stretching with her crew during Week 2?
How many times did Yvette do stretching with her crew during Week 2?
7
What was the duration of each barre session in Week 2?
What was the duration of each barre session in Week 2?
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How many walking sessions did Yvette complete in Week 3?
How many walking sessions did Yvette complete in Week 3?
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Yvette did more barre sessions than stretching sessions in Week 4.
Yvette did more barre sessions than stretching sessions in Week 4.
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In Week 4, for how many minutes did Yvette walk on the treadmill during each session?
In Week 4, for how many minutes did Yvette walk on the treadmill during each session?
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What is the primary treatment for chlorine gas inhalation?
What is the primary treatment for chlorine gas inhalation?
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What is a lethal dose of salicylic acid (ASA) in adults?
What is a lethal dose of salicylic acid (ASA) in adults?
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In cases of acetaminophen poisoning, a toxic metabolite overwhelms normal ____________________.
In cases of acetaminophen poisoning, a toxic metabolite overwhelms normal ____________________.
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TCA poisoning results in symptoms only after 6 hours.
TCA poisoning results in symptoms only after 6 hours.
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Match the following drug classes with their potential effects:
Match the following drug classes with their potential effects:
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What are the primary symptoms of organophosphate poisoning?
What are the primary symptoms of organophosphate poisoning?
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Cholinergic effects can be remembered with the acronym __________.
Cholinergic effects can be remembered with the acronym __________.
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Anticholinergic poisoning decreases the strength of acetylcholine at the muscarinic junction.
Anticholinergic poisoning decreases the strength of acetylcholine at the muscarinic junction.
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What should be done before initial medical management in poisoning cases?
What should be done before initial medical management in poisoning cases?
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What agent can be used for treating acetaminophen poisoning if administered within 8 hours?
What agent can be used for treating acetaminophen poisoning if administered within 8 hours?
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What is a poison?
What is a poison?
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What is an overdose?
What is an overdose?
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Which of the following are routes of entry for poisons? (Select all that apply)
Which of the following are routes of entry for poisons? (Select all that apply)
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What factors affect the degree of poisoning?
What factors affect the degree of poisoning?
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Delirium tremens may occur after withdrawal from chronic alcohol use.
Delirium tremens may occur after withdrawal from chronic alcohol use.
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What is the primary concern with cocaine use?
What is the primary concern with cocaine use?
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Which of the following is a common source of methanol?
Which of the following is a common source of methanol?
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___ binds to hemoglobin 210 times more than oxygen.
___ binds to hemoglobin 210 times more than oxygen.
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What treatment is used for carbon monoxide poisoning?
What treatment is used for carbon monoxide poisoning?
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What are the symptoms of opiate withdrawal?
What are the symptoms of opiate withdrawal?
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Which of the following is a symptom of marijuana overdose?
Which of the following is a symptom of marijuana overdose?
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Match the following substances with their effects:
Match the following substances with their effects:
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Study Notes
Week 1
- Yvette Gillam completed three 1-hour walks during week 1
- The period for week 1 was September 4 to 12
Week 2
- Yvette Gillam completed 7 days of stretching with her crew at 20 minutes per session
- Yvette Gillam completed 7 days of Barre at 20 minutes per session
- Yvette Gillam completed 3 days of 1-hour walking during week 2
- The period for week 2 was September 5 to 11
Week 3
- Yvette Gillam completed 7 days of stretching with her crew at 20 minutes per session
- Yvette Gillam completed 4 days of Barre at 20 minutes per session
- Yvette Gillam completed 3 days of 1-hour walking during week 3
- The period for week 3 was September 12 to 18
Week 4
- Yvette Gillam completed 6 days of stretching with her crew at 20 minutes per session
- Yvette Gillam completed 4 days of 25-minute walking on a treadmill during week 4
- The period for week 4 was September 19 to 25
Poisoning/OD Definitions
- Poison: Any substance that impairs metabolic processes, altering organ and tissue function. Dose is crucial.
- Overdose: Excessive drug use causing acute adverse physical or mental effects. Deliberate or accidental.
- Routes of Entry: Inhalation, absorption, injection, ingestion.
Inhalation
- Airborne substances enter the body through breathing.
- Rapid absorption.
- Most frequent route of entry.
- Includes gases, vapors, smoke, fog, dusts, mists, fumes.
Absorption
- Occurs through skin and mucous membranes, including the eyes.
- Slower absorption than inhalation.
- Intact skin serves as a barrier to some poisons.
- Absorbed into systemic circulation.
- Absorption rate influenced by blood flow and temperature.
- Some areas absorb faster than others (skin folds vs. soles of feet).
- Lipid-soluble chemicals (e.g., organophosphates) readily absorbed.
Ingestion
- Requires patient to be conscious.
- Slow absorption.
- Intentional (suicide, poisoning by others).
- Unintentional (improper hand washing, smoking, eating, swallowing concentrated solids or liquids, inhaling aerosols).
- More common in children.
Injection
- Subcutaneous, intramuscular, intravenous.
- Includes IV drug use, accidental high-pressure injection, laceration exposure, prescribed medication.
Degree of Poisoning
- Factors influencing the degree of poisoning:
- Concentration of substance.
- Exposure time.
- Substance affinity for tissues.
- Sensitivity of exposed tissues.
- Route of entry.
- Age.
- Liver function.
Alcohol
- Isopropanol, methanol, ethanol (ETOH), ETOH withdrawal.
Alcohol ADME
- Primarily administered orally.
- Can be absorbed parenterally through inhalation, rectal administration, or IV.
- Distributes equally throughout all water-carrying potential spaces.
- Metabolized primarily in the liver via alcohol dehydrogenase and aldehyde dehydrogenase.
- Excreted via sweat, urine, and respiration (approximately 5%).
Alcohol Mechanism of Action
- Binds to GABA receptors, causing CNS depression.
- Continuous stimulation of GABA receptors increases the stimulus threshold.
- More alcohol is needed for the same effect as tolerance increases.
- Subclinical symptoms result from depression of specific brain areas involved in coordination, memory, logic, consciousness, respiration, and airway protection.
Isopropanol
- Common sources: rubbing alcohol, antifreeze, skin lotions, cleaning products.
- Death is uncommon.
- Two to three times more potent than ethanol, causing more cellular damage.
Methanol
- Industrial solvent found in cleaning supplies (windshield washer fluid).
- 30 ml (1 mg/kg) can be fatal.
- Metabolized to formaldehyde by alcohol dehydrogenase, causing irreversible tissue damage to eyes (blindness), CNS, kidneys, GI tract, and liver.
Methanol Treatment (Prehospital)
- Standard care.
- Rapid transport.
Methanol Treatment (Clinical)
- Ethanol administration to compete for alcohol dehydrogenase.
- N-acetylcysteine (NAC) to counteract the effects of formaldehyde.
Ethanol
- Common sources: alcohol, aftershaves, perfumes, mouthwashes.
- Treatment: standard care, recovery position, assessment for head injuries.
Alcohol Withdrawal
- Results from the imbalance between excitatory and inhibitory neurotransmitters due to chronic alcohol use.
- Cells lose GABA receptors, leading to excess excitatory stimulation when alcohol is removed.
- Symptoms progress over time, from mild to moderate to severe (delirium tremens).
Alcohol Withdrawal Symptoms
- Mild (8 hours): Anxiety, increased autonomic activity, pallor, diaphoresis, tremors, insomnia, abdominal pain, mood swings, palpitations.
- Moderate (24-72 hours): Worsening mild symptoms, seizures, hypertension, hyperthermia, mild confusion.
- Severe (over 7 days): Seizures, agitation, delirium, hallucinations, delirium tremens.
Alcohol Withdrawal Symptoms
- Delirium tremens can manifest as hallucinations, agitation, and complete detachment from reality.
- Severe symptoms can lead to death.
- Treatment often involves benzodiazepines to suppress excitatory neurotransmission.
Sympathomimetics
- Includes cocaine, methamphetamine, MDMA (Ecstasy).
Cocaine
- Can be snorted, injected, inhaled, or taken orally.
- Increases serotonin, norepinephrine, and dopamine in the CNS, leading to euphoria, excitement, and energy.
- Primary concern: cardiotoxicity and agitation.
Cocaine Signs and Symptoms
- Increased sympathetic tone: tachycardia, tachypnea, mydriasis, hyperthermia, diaphoresis, chest pain, bruxism, hypertension.
- Stimulus hypersensitivity.
- These symptoms are subclinical findings of "normal" cocaine use.
- Unexplained sympathetic tone should prompt questions about drug use.
- Cocaine toxicity peaks around 4 hours.
Cocaine Clinically Significant Signs and Symptoms
- Cardiovascular: arrhythmias, significant chest pain.
- Central Nervous System: encephalopathy (seizures and coma), excited delirium.
- Blood/Musculoskeletal: rhabdomyolysis, renal failure, significant hyperthermia.
- Excited delirium with hyperthermia is associated with high mortality rates, often due to airway management difficulties.
Crack Cocaine
- Freebase form of cocaine, produced by removing hydrochloride.
- Smoked, melts at 98°C and vaporizes at higher temperatures.
- Similar effects to IV cocaine.
Amphetamines
- Includes methamphetamine (meth) and MDMA.
- Mechanism of action and presentation similar to cocaine.
- Increase CNS and PNS levels of epinephrine, norepinephrine, and dopamine.
Methamphetamine
- Longer duration of action than cocaine (up to 20 hours).
- Releases higher levels of dopamine, making it highly addictive.
MDMA (Ecstasy)
- Duration of action: 4-6 hours.
- Seizures often result from hyponatremia (low sodium) due to excessive water intake.
- Increased water intake is related to hyperthermia, physical activity, and vasopressin release specific to MDMA.
Depressants - Opiates
- Examples: codeine, fentanyl, morphine, Demerol, heroin.
Opiates
- Stimulate Mu, Kappa, and Delta receptors in the CNS.
- Mimic the effects of endogenous opioids (enkephalins).
- Effects: analgesia, decreased level of consciousness, respiratory depression, miosis, hypotension, decreased gastric motility.
Opiate Withdrawal
- Chronic opiate use requires higher doses for the same effect.
- Euphoria tolerance develops faster than respiratory depression tolerance.
- Sudden opiate discontinuation or Narcan administration precipitates withdrawal syndrome.
Opiate Withdrawal Symptoms
- 6 hours: Flu-like symptoms, anxiety.
- 72 hours - 1 week: Nausea, vomiting, diarrhea, severe abdominal cramps, severe anxiety.
Opiate Tools for Safe Injection
- Safe injection tools are designed to reduce the risk of infection and overdose.
- These tools can include needles, syringes, and other items.
Opiates - Pharmacological Treatment
-
Naloxone (Narcan): A competitive opioid antagonist.
- Shorter duration of action than opioid narcotics.
- Reverses opiate effects and can cause abrupt withdrawal symptoms.
-
Methadone: A long-acting opioid agonist (24-36 hours).
- Used to decrease withdrawal symptoms and allow patients to participate in tapering detox programs.
- Administered daily.
-
Suboxone (Buprenorphine + Naloxone): A partial opioid agonist.
- Long-acting.
- Does not produce euphoria or respiratory depression.
- Naloxone is added to prevent euphoria or apnea with high doses of IV use.
Depressants - Benzodiazepines
- Sedative-hypnotic agents.
- Used for various purposes including seizure control, anxiety, alcohol withdrawal, insomnia, and managing drug-associated agitation.
- Examples: Valium, Ativan, Versed, Rohypnol.
Benzodiazepine Mechanism of Action
- Mimic GABA (gamma-aminobutyric acid), the major inhibitory neurotransmitter in the CNS.
- Enhanced GABA neurotransmission results in: sedation, striated muscle relaxation, anticonvulsant effects, vasodilation.
Benzodiazepine Signs and Symptoms
- Nystagmus.
- Hallucinations.
- Slurred speech.
- Ataxia.
- Coma.
- Weakness.
- Altered mental status, impaired cognition.
- Amnesia.
- Respiratory depression.
- Hypotension.
Depressants - GHB (Gamma-Hydroxybutyrate)
- GABA B receptor antagonist (different from ethanol and benzodiazepines).
- Very narrow margin of safety (5:1 ratio).
- 1.5 g (1 g/ml): euphoria.
- 5-10 g: respiratory arrest.
- Onset: 30 minutes.
- Duration: 4-6 hours.
GHB Signs and Symptoms
- Subclinical: euphoria, disinhibition, amnesia.
- Clinically Relevant: coma, seizures, apnea, hypotension, bradycardia.
Depressants - Huffing
- Involves inhaling volatile chemicals for a mind-altering effect.
- Includes solvents, aerosols, adhesives, fuels, dry-cleaning agents, tape-head cleaners, correction fluid, and propellants.
- Most common among adolescents (10-15 years old).
Huffing Effects
- Most inhalants are CNS depressants.
- Adverse effects on all bodily systems.
- Acute neurological symptoms: euphoria, auditory and visual hallucinations, slurred speech, ataxia, diplopia, painful burns, tremulousness, ataxia (often due to hypoxia).
- Short-term effects: diplopia, memory impairment, slurred speech, seizures, death from cardiac arrhythmias.
- Long-term chronic effects: permanent ataxias, sensorimotor peripheral neuropathies.
Marijuana
- Most commonly inhaled (onset within minutes) or absorbed orally (onset within 1-2 hours).
- Overdoses in adults are generally well-tolerated, but may cause hypoventilation, coma, and aspiration risk in children.
- Accidental ingestion is more common in states where marijuana is legalized.
Marijuana Signs and Symptoms
- Euphoria.
- Relaxation.
- Amnesia.
- Altered perception of time.
- Enhanced tactile experiences.
- Tachycardia.
- Anxiety (possible).
Cannabinoid Hyperemesis Syndrome
- Can develop in long-term chronic marijuana users.
- Characterized by cyclical vomiting and intense abdominal cramping.
- Home remedy: hot showers.
- Generally resolves within 10 hours of stopping marijuana use.
- Haldol has been found to be effective treatment.
Common Poisonings
- Household products.
- Plants.
- Petroleum products.
- Industrial products.
- Agricultural products.
- Organophosphates.
- Acids and alkalis.
Household Poisons - Acids and Bases
- Commonly found in cleaning agents (bleach).
- Damage is dose-dependent.
- Acids cause burns, ulceration, and GI irritation, but are chemically buffered by HCl in the duodenum.
- Bases cause liquefaction of tissue, lasting for hours, and are harder to buffer in the gastrointestinal tract.
Acids and Bases Treatment
- Supportive care.
- Transport.
- Do not induce vomiting.
Household Poisons - Petroleum Products
- Examples: brake fluid, gasoline, oil.
- Cause direct tissue damage, leading to widespread trauma and potential multi-organ dysfunction syndrome (MODS).
- Treatment: similar to acids and bases.
Household Poisons - Carbon Monoxide and Cyanide
-
Carbon Monoxide:
binds to hemoglobin 210x more strongly than oxygen, preventing oxygen transport to the mitochondria.
- Result: failure of aerobic respiration, lactic acidosis, cell death, MODS, and death.
-
Cyanide:
- Inhibits mitochondrial ATP production from oxygen.
- Sources: combustion of certain plastics.
Carbon Monoxide and Cyanide Treatment
-
Carbon Monoxide:
- High-flow oxygen (reduces CO effects from 6 hours to 2 hours).
- Hyperbaric chamber (reduces CO effects to 30 minutes by increasing blood PO2).
-
Cyanide:
- Cyanocobalamin (Vitamin B12) binds and inactivates cyanide.
Household Poisons - Food Poisoning
- Bacterial contamination of food.
- Causes gastroenteritis, usually self-limiting.
- Risk of hypovolemia (low blood volume) from vomiting may require IV fluids.
Household Poisons - Blister Agents
- Examples: ammonia cleaner, chlorine bleach.
- Chlorine gas is an acid that causes direct trauma to the respiratory system.
- Mechanism: Inhalation → inflammation → pulmonary edema → hypoxia → death.
- Treatment: high-flow oxygen and rapid transport.
- Do not enter unsafe scenes until the area has been cleared by firefighters or the patient is moved outside.
Prescription Drugs - Salicylates
- Used to treat inflammation.
- Examples: aspirin (ASA), Bengay, oil of wintergreen, Pepto Bismol.
- For a 14-kg toddler, ingestion of the following can be lethal:
- 21 adult ASA tablets.
- 1 teaspoon of oil of wintergreen.
- 1 bottle of Pepto Bismol.
Salicylates Toxicity
- Damage through two primary mechanisms:
- Directly poisonous to neural tissue.
- Increases metabolism and fuel breakdown while inhibiting aerobic respiration.
Salicylates Signs and Symptoms
- Nausea
- Vomiting
- Tinnitus
- Fever
- Headache
- Confusion
- Hyperventilation
- Seizures
- Coma
- Death
Salicylates Treatment
- Induce vomiting (in appropriate cases).
- Gastric lavage.
- Activated charcoal.
- Supportive care, including IV fluids, and respiratory support.
- Consider bicarbonate infusion for acidosis.
- Hemodialysis in severe cases.
Acetaminophen Poisoning
- Acetaminophen poisoning is a serious medical condition.
- The toxic metabolite is created when large amounts of acetaminophen overwhelm normal metabolism.
- Acetaminophen poisoning is easily treated with minimal damage if treated within 8 hours of ingestion.
- The toxic metabolite causes liver damage.
- N-acetylcysteine (NAC) is given at the hospital within 8 hours to join with the toxic metabolite to create a safe metabolite to be excreted by the body.
- The lethal dose is 150mg/kg or 10g for adults.
- Symptoms of Acetaminophen poisoning may not appear before 12 hours after ingestion.
- Symptoms of Acetaminophen poisoning: RUQ pain, Nausea, Vomiting, Liver failure, Jaundice, Hepatic encephalopathy, Hypoglycemia, Coagulation dysfunction.
Tricyclic Antidepressants (TCA)
- TCAs cause the overwhelming majority of antidepressant poisoning resulting in morbidity and mortality.
- A lethal dose of a TCA is only 8 times the prescribed dose.
- TCAs are called tricyclic because they are metabolized three times by the liver each time making a new/different metabolite.
- TCAs were originally one of the first major anti-depressants but are now considered a “last resort” due to safer alternative options.
- Less severe symptoms of TCA poisoning are primarily caused by anticholinergic effects of TCAs. These effects are commonly known by the mnemonic “Dry as a bone, Red as a beet , Mad as a hatter, Hot as a hare, Blind as a bat”.
- Peak toxicity occurs within 4 hours of ingestion.
- Symptoms of TCA poisoning: Coma, Convulsions, Cardiac arrhythmias, Acidosis
- Treatment for TCA poisoning: Sodium Bicarbonate
Organophosphates
- Organophosphates are most commonly found in pesticides and weapons of war.
- Organophosphates can be readily absorbed through the skin.
- Organophosphates inhibit acetylcholine esterase (AchE) which increases the amount of Ach in the synaptic cleft.
- Organophosphates cause two main effects: muscarinic and nicotinic.
- Muscarinic effects: Salivation, Lacrimation, Urination, Defecation, Gastroenteritis, Emesis, Miosis, Bradycardia and Bronchospasm.
- Nicotinic effects: Mydriasis (pupil dilation), Tachycardia, Weakness, Hypertension, Hyperglycemia and Fasciculations.
- The most immediate danger of organophosphate poisoning is respiratory paralysis and seizure.
- Treatment for Organophosphate poisoning: Standard care, airway management, Oxygenation, Aggressive fluid bolus, Atropine, Versed.
Anticholinergics
- Anticholinergics decrease the strength of Ach at the muscarinic junction by either increased AchE or competitive inhibition.
- Anticholinergic poisoning causes the opposite effects of Ach. These effects are commonly known by the mnemonic “Dry as a bone, Red as a beet , Mad as a hatter, Hot as a hare, Blind as a bat”.
General Poisoning Treatment
- Ensure scene safety.
- Decontamination should begin before any other medical treatment.
- Decontamination involves removing all clothing and irrigating exposed areas.
- Care is required to prevent secondary casualties. Maintain appropriate barrier protection and ventilation.
- Airway management.
- Oxygen therapy.
- Contact poison control.
- IV therapy.
- ECG.
- ALS backup.
- Notifying receiving treatment center to prepare secondary decontamination area.
- Decontaminate yourself and your equipment
Overdose Patient Management
- Scene safety.
- Level Of Consciousness (LOC)
- Airway management.
- Oxygen therapy.
- IV therapy.
- ECG.
- Continual reassessment.
- Treatment of any additional injuries.
- Comprehensive history.
- ALS backup.
Special Considerations
- Age.
- Gender.
- Underlying risk factors.
- Previous health considerations.
- Always have a differential diagnosis
History Taking
- What was taken, when it was taken, how it was taken and how much/what concentration.
- Why was it taken?
- Was there any vomiting after ingestion?
- How many times did the individual vomit?
- Are there any pill bottles or samples of what was taken?
- For recreational drugs: Was the amount, dose or route used usual for the individual? Was the drug supplied by the usual supplier or someone new?
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Description
This quiz covers the weekly fitness activities of Yvette Gillam over four weeks, detailing her walking, stretching, and Barre sessions. Each week highlights different durations and completion rates, providing insights into her fitness journey. Test your knowledge on the specific activities and timeframes associated with Yvette's fitness regime.
