Master the board step 3

Master the Boards: USMLE Step 3
You can never perform gastric emptying when caustics (acids and alkalis) have
been ingested.
Ipecac can never be used in a patient with altered mental status because the
patient will aspirate (and you will fail). Ipecac is always wrong in children.
Intubation and lavage can rarely be performed if the patient has ingested the
substance within the last 1–2 hours and there is no response to naloxone, dextrose,
and thiamine.
When do I answer “naloxone, thiamine, and dextrose”?
These medications are used for an acute mental status change of unclear etiology.
When do I answer “charcoal”?
Charcoal will not harm anyone. In other words, give it. Charcoal can help in
most overdose cases. If you have a toxicology case and do not know what to
do—give charcoal.
CCS Tip: In overdose cases, do multiple things simultaneously. If there is a
change in mental status from an overdose, give naloxone, thiamine, and dextrose at
the same time as checking a toxicology screen, giving oxygen, and checking routine
labs.
Following is the overdose case “menu”:
··
Specific antidote if the etiology is clear
··
Toxicology screen
··
Charcoal
··
CBC, chemistry, urinalysis
··
Psychiatry consultation if the overdose is the result of a suicide attempt
··
Oxygen for carbon monoxide poisoning or any dyspneic patient
The following table lists specific antidotes for various kinds of poisoning.
Substance
Acetaminophen
Aspirin
Benzodiazepines
Carbon monoxide
N-acetyl cysteine
Antidote
Bicarbonate to alkalinize the urine
Do not give flumazenil; it may
precipitate a seizure
100 percent oxygen, hyperbaric in
some cases
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