226.A 35-year-old agitated man presents to the ED in police custody. He
denies any past medical history and takes no medication. He admits to
using some drugs today. His BP is 195/90 mm Hg, HR is 121 beats per
minute, temperature is 100.1°F, RR is 18 breaths per minute, and oxygen
saturation is 99% on room air. On examination, he is diaphoretic, and has
pupils that are 8 mm in diameter, along with 3+ patella reflexes bilaterally.
Electrocardiogram (ECG) reveals sinus tachycardia with a rate of 123.
Which of the following toxic syndromes is this patient exhibiting?
a. Anticholinergic
b. Cholinergic
c. Sympathomimetic
d. Opioid
e. Serotonin
227.A 31-year-old woman with a known psychiatric history presents to
the ED after ingesting an unknown quantity of pills from her medication
vial. In the ED, she complains of nausea, abdominal cramping, and feels
unsteady on her feet. On physical examination you observe that she is
tremulous, ataxic, and exhibits dystonia. Which of the following substances
willnotbe adsorbed by activated charcoal?
a. Digoxin
b. Diphenhydramine
c. Amitriptyline
d. Lithium
e. Acetaminophen
228.A 27-year-old man presents to the ED extremely agitated complain-
ing of mild chest pain and dyspnea. He states that he was snorting cocaine
all afternoon. You place him on a monitor and get his vital signs. His BP is
215/130 mm Hg, HR is 112 beats per minute, temperature is 100.1°F, R R
is 17 breaths per minute, and oxygen saturation is 98% on room air. An
ECG reveals sinus tachycardia at a rate of 116. Which of the following is
the most appropriate medication to administer?
a. Haloperidol
b. Labetalol
c. Esmolol
d. Diltiazem
e. Diazepam
240 Emergency Medicine