221.A 47-year-old man is brought to the ED by EMS after being found
wandering in the street mumbling. His BP is 150/75 mm Hg, HR is 110 beats
per minute, temperature is 100.5°F, RR is 16 breaths per minute, oxygen sat-
uration is 99% on room air, and fingerstick glucose is 98 mg/dL. On exami-
nation, the patient is confused with mumbling speech. His pupils are dilated
and face is flushed. His mucous membranes and skin are dry. Which of the
following toxic syndromes is this patient exhibiting?
a. Sympathomimetic syndrome
b. Anticholinergic syndrome
c. Cholinergic syndrome
d. Opioid syndrome
e. Ethanol syndrome
222.A 25-year-old man is carried into the ED by two of his friends who
state that he is not breathing. The patient has a history of heroin abuse. His
vital signs are BP 115/70 mm Hg, HR 99 beats per minute, temperature
98.9°F, RR 3 breaths per minute, and oxygen saturation 87% on room air.
You notice fresh needle marks and miotic pupils. You begin bag-valve-mask
ventilation and his oxygen saturation increases to 99%. Which of the fol-
lowing is the most appropriate next step in management?
a. Continue bag-valve-mask ventilation until he breathes on his own
b. Endotracheal intubation of the patient
c. Administration of naloxone
d. Administration of flumazenil
e. Place a nasogastric tube and administer activated charcoal
223.A 42-year-old man who is actively seizing is brought to the ED by
EMS after a massive ingestion of an unknown substance. The man is known
to have a history of acquired immunodeficiency syndrome (AIDS). An intra-
venous (IV) line is established and anticonvulsant therapy is administered.
After high doses of diazepam, phenobarbital, and phenytoin, it is deter-
mined that the seizures are refractory to standard anticonvulsant therapy.
Which of the following substances did this patient most likely ingest?
a. Cocaine
b. Diphenhydramine
c. Tricyclic antidepressant
d. Camphor
e. Isoniazid (INH)
238 Emergency Medicine