It is an unusually warm weekend afternoon in early summer.You are dispatched to a local lookout site that is a popular spot for family gatherings and picnics. The call came in by cellular phone. The caller stated her husband was violently ill with abdominal distress.

On arrival you are waved over by a 30-year-old female in the parking lot. She directs you a grassy area by the park­ing lot where you observe a male leaning over the trash can, vomiting. His wife reports they had been spending the day in the park with their two toddlers, having arrived on bikes. They ate lunch, played a bit and were ready to head home when her husband suddenly developed acute abdominal pain, diarrhea and vomiting. Unable to ride his bicycle home, they called for an ambulance. His wife reports his vomiting has gotten increasingly worse over the past 30 minutes.

The 35-year-old male sinks to the ground as you approach and sits holding his head in his hands. He is alert and orientated and breathing at an appropriate rate and depth. His pulse is somewhat elevated but strong and regular. His skin is warm, diaphoretic and pale. His head, neck and chest are unremarkable, with no trauma noted. His abdomen is extremely tender and he is guarding. It appears non-distended. His pelvis and extremities are unremarkable. He denies any past medical history or medications.

The patient reports he suddenly developed acute abdominal cramping and pain. He has had four episodes of diarrhea in the past hour and has started vomiting violently in the past 45 minutes. He states neither the vomiting nor diarrhea have relieved the abdominal pain at all. He reports he now feels weak and slightly dizzy.

The patient reports he ate the picnic lunch approximately two hours ago. He ate two egg salad sandwiches, some cold chicken and a fresh peach. His wife reports the rest of the family ate the same food although in smaller quantities. She is beginning to feel somewhat nauseated herself.

Pulse	100 strong, regular
Blood pressure	134/78
Respiration	22 non-laboured, equal air entry, no adventitioussounds
Skin	warm, diaphoretic, pale
Chemstrip	9mmol/L
Pulse Oximetry	98 per cent
Level of Consciousness	awake, alert, orientated
E.C.G.

1. The most appropriate tentative diagnosis for this patient is: A. flu B. gastritis C. food poisoning D. esophagitis 

2. The food most likely to cause food poisoning in this case is: A. egg salad B. chicken C. peaches D. any of the above E. A and B only 

3. Transporting leftover food samples with the patient may help in making a laboratory analysis. A. True B. False 

4. Botulism is the most common form of food poisoning in Canada. A. True B. False 

5. Salmonella infection may cause: A. nausea and vomiting B. electrolyte imbalances C. paralysis D. All of the above E. A and B only 

6. Food sources which may be infected with S. aureus include: A. canned fruits B. smoked fish C. milk and dairy products D. bread 

7. Dehydration and electrolyte imbalances are more likely to occur in adults than children who have contracted food poisoning. A. True B. False 

8. The symptoms of S. aureus infection commonly last approximately: A. 4-8 hours B. 24-48 hours C. 7-14 days D. none of the above 

9. The innermost layer of the G.I. tract is the: A. cilia B. muscularis layer C. submucosa D. mucosa 

10. This bacterium is commonly found in soil and untreated water. A. clostridium botulinum B. S. aureus C. E. coli D. salmonella 

11.Bacterial forms of food poisoning can be transmitted through: A. improper hand washing B. undercooked meats C. improper preserving D. all of the above 

12. The first portion of the small intestine is the: A. jejunum B. duodenum C. transverse colon D. ileum 

13. The stomach secretes A. hydrochloric acid B. mucus C. pancreatic juice and enzymes D. chyme to protect the surface of the stomach wall.

14. The major site of absorption in the G.I. tract is the: A. stomach B. small intestine C. large intestine D. none of the above 

15. The E.C.G. is:

16. Intravenous therapy for this patient is unnecessary. A. True B. False 

17. Hospital treatment for this patient may include: A. surgery B. gastric lavage C. charcoal administration D. antibiotic therapy 

18. En route your patient develops unifocal P.V.Cs at a rate of two per minute. The patient’s pulse rate remains at 100 beats per minute and he denies any change in symptoms. You should: A. increase the oxygenation B. cardiovert C. administer sodium bicarbonate D. administer lidocaine 

19. Personnel protection on food poisoning calls should include: A. gloves B. protective eye wear C. thorough hand washing after the call D. all of the above 

20. Pharmacologic intervention for food poisoning should include: A. narcan B. morphine C. ipecac D. all of the above E. none of the above 

21. Most outbreaks of food poisoning occur in: A. big cities B. hot weather (summer) C. Christmas season D. none of the above 

22. Ingestion of hallucinogenic mushrooms is considered to be food poisoning. A. True B. False 

23. Fresh fruits and vegetables may cause food poisoning due to contamination of the clostridium botulinum. A. True B. False 

24. Intubation and ventilation may be required in cases of botulism. A. True B. False 

25. You can increase your effectiveness on food poisoning calls by: A. reviewing your protocols B. reviewing case histories C. checking with local health officials on recent outbreaks D. all of the above 

Heather Mackenzie-Carey is the Vice President of Turning Point Group Inc. – an Emergency Management consulting firm – and manages its Calgary office.

Heather has nineteen years experience in the Health Care Industry as an emergency practitioner, educator, and consultant.Heather has workedin public, private, rural, urban, Mountain Park and multidisciplinary clinical settings.Heather has been an educator / facilitator for the Aberdeen Hospital, Jasper School District, and the Southern Alberta Institute of Technology.

Heather has graduated from Dalhousie University with a Degree in Health Education.She has a diploma in Paramedicine from Northern Alberta Institute of Technology, and a Certificate of Social Work from the University of Waterloo.Heather is completing a Masters of Science in the Study of Risk, Crisis, and Disaster Management from the University of Leichester.

Heather has been widely published in the areas of prehospital medicine, crisis communication, and emergency first aid.She publishes regular columns for Canadian Emergency News, has developed various guidebooks for Quick Books Publishing Ltd., and produces distance delivery curriculum for Southern Alberta Institute of Technology.

Canadian Emergency News and the author of this quiz grant permission for readers to copy it for departmental and educational purposes.All other reproduction and republication without written consent is prohibited.  She can be reached at geomac@cadvision.com or www.turningpointgroup.com.

This Article is reprinted by permission from the author (Heather MacKenzie-Carey) and the Canadian Emergency News. It originally appeared in the December 1998 / January 1999 issue (volume 21, number 6).