NREMT Paramedic Level Flashcards: Toxicology And Overdose Management

What this deck covers

This deck focuses on Toxicology And Overdose Management, giving you a quick way to review the definitions, rules, and examples that matter most for NREMT Paramedic Level.

How to use these flashcards

Work through these flashcards in short sessions. Try to answer each prompt before flipping the card, then revisit any cards you miss until the explanation feels automatic.

Flashcard 1: Which antidote is used for methemoglobinemia with hypoxia and chocolate-brown blood?

Answer: Methylene blue. Methylene blue acts as an electron donor, accelerating methemoglobin reduction to functional hemoglobin via enzymatic pathways.

Flashcard 2: What medication reactivates acetylcholinesterase in organophosphate poisoning if given early?

Answer: Pralidoxime (2-PAM). Pralidoxime regenerates acetylcholinesterase by removing the bound organophosphate, restoring normal enzyme function when given timely.

Flashcard 3: What is the primary therapeutic goal of naloxone administration in overdose?

Answer: Restore adequate ventilation, not full arousal. Naloxone competitively antagonizes opioid receptors to reverse life-threatening respiratory depression without needing complete consciousness.

Flashcard 4: Which antidote treats carbon monoxide poisoning and what is the key initial therapy?

Answer: No antidote; give 100% oxygen and consider hyperbaric oxygen. High-flow oxygen displaces CO from hemoglobin, accelerating elimination; hyperbaric therapy enhances this in severe cases, as no specific antidote exists.

Flashcard 5: Which ECG finding is most characteristic of tricyclic antidepressant toxicity?

Answer: Widened QRS complex. TCAs block sodium channels, delaying ventricular depolarization and prolonging the QRS duration on ECG.

Flashcard 6: Identify the antidote for ethylene glycol or methanol poisoning that blocks toxic metabolite formation.

Answer: Fomepizole. Fomepizole inhibits alcohol dehydrogenase, preventing conversion of these alcohols into their toxic acidic metabolites.

Flashcard 7: Which toxidrome is classically associated with bradycardia, miosis, bronchorrhea, and diaphoresis?

Answer: Cholinergic toxidrome (organophosphates/carbamates). Inhibition of acetylcholinesterase leads to acetylcholine excess, causing parasympathetic overstimulation with these hallmark symptoms.

Flashcard 8: Which antidote is used for significant beta-blocker overdose with bradycardia and hypotension?

Answer: Glucagon. Glucagon stimulates cardiac adenylate cyclase independently of beta receptors, increasing heart rate and contractility.

Flashcard 9: Which toxidrome is most consistent with hallucinations, hypertension, tachycardia, and vertical nystagmus?

Answer: Dissociative (PCP/ketamine) toxidrome. Dissociative agents disrupt glutamate signaling, inducing perceptual dissociation with sympathetic activation and specific nystagmus patterns.

Flashcard 10: Which initial priorities should guide care for any suspected poisoning or overdose patient?

Answer: Scene safety/BSI, ABCs, oxygen/ventilation, circulation, then tox-specific care. This protocol prioritizes provider protection and stabilization of vital functions before addressing the specific toxic exposure.

Flashcard 11: Which antidote is indicated for acetaminophen overdose to prevent hepatic injury?

Answer: N-acetylcysteine (NAC). NAC replenishes glutathione, enabling detoxification of the hepatotoxic metabolite NAPQI produced in acetaminophen overdose.

Flashcard 12: Which intervention is contraindicated in caustic acid or alkali ingestion?

Answer: Inducing vomiting or neutralization attempts. These actions risk re-exposure of tissues to corrosives or generate heat/exothermic reactions, potentially worsening mucosal injury.

Flashcard 13: What is the first-line medication class for agitation, seizures, or hyperadrenergic toxicity from stimulants?

Answer: Benzodiazepines. Benzodiazepines enhance GABAergic transmission, effectively managing sympathetic overstimulation and associated complications.

Flashcard 14: Which toxidrome presents with hyperthermia, mydriasis, dry skin, urinary retention, and delirium?

Answer: Anticholinergic toxidrome. Muscarinic receptor blockade inhibits parasympathetic responses, leading to sympathetic dominance and altered mental status.

Flashcard 15: What clinical triad most strongly suggests opioid toxidrome?

Answer: CNS depression, respiratory depression, and miosis. Opioid receptor activation suppresses central nervous system activity, reduces respiratory drive, and constricts pupils via parasympathetic effects.

Flashcard 16: What is the most reliable field assessment for carbon monoxide exposure severity?

Answer: Carboxyhemoglobin level by CO-oximetry (not standard pulse oximetry). CO-oximetry specifically quantifies carboxyhemoglobin, providing accurate severity assessment unlike standard oximetry which is unreliable in CO poisoning.

Flashcard 17: Which core supportive treatment is prioritized for severe hyperthermia from toxicologic causes?

Answer: Rapid active cooling plus benzodiazepines and supportive airway/ventilation. Active cooling mitigates heat-induced organ damage, while benzodiazepines control contributing factors like agitation, with ventilatory support as required.

Flashcard 18: Which toxidrome is suggested by CNS depression with normal vital signs and nystagmus?

Answer: Sedative-hypnotic toxidrome. Sedative-hypnotics potentiate GABA-mediated inhibition, causing central depression without marked autonomic instability, often with ocular signs.

Flashcard 19: What is the antidotal therapy for tricyclic antidepressant toxicity with wide QRS or hypotension?

Answer: Sodium bicarbonate. Bicarbonate alkalinizes serum and provides sodium, reducing TCA affinity for sodium channels and stabilizing cardiac membranes.

Flashcard 20: What is the preferred prehospital decontamination method for liquid chemical exposure on skin?

Answer: Remove clothing and irrigate skin with copious water. Immediate removal of contaminants and dilution with water minimize chemical absorption and tissue damage in prehospital settings.

Flashcard 21: What is the most important immediate intervention for opioid overdose with hypoventilation?

Answer: Ventilate with BVM and oxygen; support airway before or with naloxone. Respiratory failure is the primary life threat in opioid overdose, requiring immediate ventilatory support to maintain oxygenation.

Flashcard 22: Which antidote is indicated for cyanide poisoning with severe hypoxia and cardiovascular collapse?

Answer: Hydroxocobalamin. Hydroxocobalamin binds cyanide to form non-toxic cyanocobalamin, rapidly restoring cellular respiration in acute poisoning.

Flashcard 23: Which medication is the antidote for calcium channel blocker overdose with hypotension and bradycardia?

Answer: Calcium (e.g., calcium chloride or calcium gluconate). Administering calcium overcomes channel blockade by increasing extracellular calcium gradient, improving cardiac conduction and contraction.

Flashcard 24: What is the antidote for organophosphate nerve agent poisoning that reverses muscarinic effects?

Answer: Atropine. Atropine competitively blocks muscarinic receptors, counteracting the excessive cholinergic activity from organophosphate exposure.

Flashcard 25: Which toxidrome is most consistent with diaphoresis, mydriasis, tachycardia, agitation, and seizures?

Answer: Sympathomimetic toxidrome. Sympathomimetic agents enhance catecholamine effects, resulting in hyperstimulation of the sympathetic nervous system.