Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PGY2 EM > yaya > Flashcards

yaya Flashcards

1
Q

Adult seizure abortive

A
  • Midazolam (versed) IM 10 mg (> 40 kg), 5mg (13-40 kg), or 0.2 mg/kg
  • Lorazepam (ativan) IV: 4 mg, rpt once (0.05-0.1 mg/kg in peds)
  • Diazepam (valium) IV 0.15-0.2 mg/kg (up to 10 mg), rpt once
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pediatric seizure abortive meds

A
  • Lorazepam (Ativan) 0.1 mg/kg IV (max 4 mg) if IV/IO access
  • Diazepam (valium) 0.2 mg/kg IM (max 10 mg)

No IV:
- IM midazolam (Versed): 0.2 mg/kg (max 10 mg)
- Rectal diazepam (valium/diastat): 0.5 mg/kg (max 20 mg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Roccuronium dose and C/I

A

(70) 0.6 to 1.2 mg/kg
C/I when neuro exam needed, and liver pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Airway checklist

A

SOAP ME
suction
oxygen
airways (age/4 +4 (-1/2 if cuffed)
Positioning
monitor/meds
ET CO2
other- bougie, VL, LMA, oral airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

H’s ant T’s (7 and 5)

A

Hypovolemia
Hypoxia
Hydrogen ion excess (acidosis)
Hypoglycemia
Hypokalemia
Hyperkalemia
Hypothermia
Tension pneumothorax
Tamponade - Cardiac
Toxins
Thrombosis (pulmonary embolus)
Thrombosis (myocardial infarction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Modified Sgarbossa criteria

A

OMI w LBBB
≥ 1 lead with ≥1 mm of concordant ST elevation
≥ 1 lead of V1-V3 with ≥ 1 mm of concordant ST depression
≥ 1 lead anywhere with ≥ 1 mm STE and proportionally excessive discordant STE, as defined by ≥ 25% of the depth of the preceding S-wave.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

4 options for peds agitation

A
  • Haldol 0.1 mg/kg IM
  • Zyprexa 1.25, 2.5, 5 mg IM
  • Thorazine 12.5-50 mg IM
  • Versed 1-2 mg IM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Midazolam agitation dosing

A

5mg IM
1-2mg IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Toxic dose of lidcoaine

A

w/epi: 0.7mg/kg
w/o epi: 0.5mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

WOBBLER

A

WPW
obstructed AV
bifascicular block
brugada
LVH
epsilon wave
repolarisation - QT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Keppra loading dose

A

adult: 60 mg/kg IV over 10 min (Max dose: 4500 mg) (4 grams!!)
peds: 60 mg/kg IV over 10 min (Max dose: 4500 mg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

sedation drips

A

propofol: 5-50mcg/kg/min (20)
versed: 0.02-0.2 mg/kg/min
precedex 0.2-0.7mcg/kg/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Second line adult seizure abortives

A
  • keppra 60mg/kg max 4.5g
  • Phenytoin IV 18 mg/kg
  • Fosphenytoin IV 20-30 mg/kg at (may also be given IM)
  • Valproic acid IV 20-40 mg/kg, max 3g
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Post partum hemorrhage

A
  • pitocin: 20 IU in 1LNS
  • misoprostol /cytotec: 600 or 1000 rectal
  • consider TXA 1g
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Ketamine sedation dose

A

1-2 mg/kg (150)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Etomidate dose

A

0.2-0.4 mg/kg (20)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Propofol RSI dose

A

1.5mg/kg (100)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Succinylcholine dose and C/I

A

1.5mg/kg (100mg)
C/I hyperK, burns, neuromuscular disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Code stroke activation

A

LKW <4.5 with neuro deficit

LKW 4.5 - 24 hours, FANG-D positive- field cut, aphasia, neglect, gaze preference, dense hemiparesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

RBBB EKG

A

Positive QRS in V1
RSR’ in V1 and V2 with R’ > R
V6 with slurred terminal negative S wave

Slurred S wave in lead I, aVL, V5, and V6 (Depolarization moving away from these leads
(Depolarization moving toward these leads) (bunny ears/M shape)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

LBBB EKG

A

Deep Negative QRS in V1
Tall notched S wave in V6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Ketamine agitation dose

A

4-5 mg/kg IM, max 500
(try 300)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

severe asthma exacerbation

A
  • continuous albuterol: <35 kg 10 mg/hr, >35kg 20
  • 125 methylpred or 10 dex (0.6mg/kg kids)
  • Mag 2 gm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Warfarin reversal dosing

A

PCC (1500 to 2000 units generally)
- INR 2-4: 25 units/kg
- INR 4-6: 35 units/kg
- INR >6: 50 units /kg

+ vit K 10mg IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Analgesia drips

A

fentanyl 0.7-10 mcg/kg/hr
hydromorphone 0.5-3mg/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Pediatric dextrose containing fluids

A

Infant: D10, 5cc/kg IV (neonate- 2cc/kg)
Toddler: D25, 2cc/kg
Adolescent: D50, 1cc/kg

  • Glucagon —
    peds < 20 kg 0.5 mg
    > 20 kg or adult 1 mg IV or IM
  • Sulfonylurea overdose: Octreotide 100 mcg IV, then 50 mcg subQ q6h
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

MI criteria

A

New ST Elevation in the J point of at least 1mm in two contiguous leads (except for V2-3)

New ST Elevation at the J point in V2-3 of at least two contiguous leads
≥2mm in men (2.5 in men <40)
≥1.5mm in women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Ekg distributions and reciprocal leads

A

Anterior/Septal
V1-V4
II, III and AVF

Lateral
V5-6, I and AVL
II, III and AVF

Inferior Leads
II, III And AVF
I and AVL

Posterior
V7, V8 and V9
V1-V4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Pediatric: trauma blood dose

A

10-20cc/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Pediatric hypertonic dose

A

3-5cc/kg

30
Q

Peds trauma TXA dose

A

< 12, 15mg/kg
> 12, 1g

31
Q

Pediatric ancef dose

A

17-30mg/kg

32
Q

Meningitis treatment

A

<1 mo: amp and gent
1mo-50yo: rocephin and vanc
>50: vanc, rocephin, amp
Healthcare associated: cover pseudomonas with cefepime, mero, ceftazidine + vanc

Most to least: strep pneumo, n meningititis, h flu, listeria

33
Q

Factor Xa inhibitors, MOA, reversal

A

Prevent prothrombin to thrombin
Apixiban//eloquis
Rivaroxaban//xarelto
4F PCC, 25-50u/kg or 2,000 u

34
Q

LMWH drugs, MOA and reversal

A

Enoxaparin//lovenox
bind to antithrombin which inactivates Xa
Protamine: 1mg/100u heparin, max 50mg

35
Q

medications for acute angle closure glaucoma

A

pilocarpine and timolol, alternate
IV acetazolamide
Pilocarpine (constricts)
timolol and acetazolamide (Decrease production)

36
Q

Fascicular blocks

A

LBBB splits into LAF and LPF
- LAFB: left axis deviation
- LPFB: right axis deviation

37
Q

LAFB vs LPFB

A

LAFB:
LAD
small q wave in I and AVL
small r in II, III and avF
intrinsicoid deflection in aVL

LPFB:
RAD
small r in I and AvL
small q in II,III and avF
intrinsicoid deflection in avF >45sec

38
Q

WPW tachydysrythmia treatment

A

Procainamide 100mg q5m max 17mg/kg
Synchronized cardioversion

39
Q

Le Fort fractures

A

One: separation of the hard palate from the upper maxilla due to a transverse fracture running through the maxilla and pterygoid plates at a level just above the floor of the nose

LeFort II fractures transect the nasal bones, medial-anterior orbital walls, orbital floor, inferior orbital rims and finally transversely fracture the posterior maxilla and pterygoid plates.

LeFort III fractures result in craniofacial disjunction. This is the highest level LeFort fracture and essentially separates the maxilla from the skull base.

40
Q

Toxic dose of acetaminophen

A

150cc/kg

therapeutic: 15cc/kg
toxic dose at 4 hours 150
dose NAC 150

41
Q
A
42
Q

STEMI equivalents (4)

A

Posterior STEMI
LBBB or ventricular paced rhythm with scarbossa
de winters
hyper-acute T waves (broad)

43
Q

de winters sign

A

Stemi equivalent

tall prominent, symmetrical t waves arising from uplosping ST segment depression >1mm at J point in precordial leads

may see elevation in aVR

44
Q

Indications for cath in NSTEMI

A
  • refractory angina
  • hemodynamic instability
  • electrical instability (VT/VF)
  • signs or symptoms of HF
45
Q

Anticholinergic toxicity

A

Red, blind, retention, hot and dry
TCA, antihistamines, atropine

46
Q

TCA ekg toxicity

A

Sodium channel blockade + anticholinergic
QRS prolongation with terminal r wave in AvR
Sodium bicarbonate infusion

47
Q

Calcium chloride
Vs
Gluconate

A

Chloride: 1g IV generally, central unless peri code

Gluocnate: 3g ish, more tissue necrosis

48
Q

Code acronym

A

A- airway
B- bagging/ventilation
C-cpr, backboard!
D- defib, pads!
E- Epi

49
Q

Epi dosing

A

Anaphylaxis:
0.01 mg/kg of 1:1,000 concentration (ie 0.5mg for 50 kg)

Code:
1 mg = 10 mL of 1:10,000 concentration

Dirty Epi drip
Amp of Epi, inject 1 mg into 1L bag= 1mcg/mL
- start at 1mcg/ min and titrate

50
Q

which beta blockers cause EKG changesm (4)

A

Propranolol- Na channel blockade, QRS
Sotalol - K blockade, QT prolonged
Carvedilol and acebutalol- Na channel blockade

51
Q

Antitodes to Acetampinophen

A
  • NAC: 150mg/kg IV then 15mg/kg/hr x23 hours (or 140mg/kg po load)
  • Fomepizole: if cross product >10,000 - - give 15mg/kg (blocks cytochrome 2E1)
    Vit K
52
Q

5 treatments for CCB and BB overdose

A
  • charcoal
  • atropine
  • Calcium (CCB)
  • glucagon
  • high dose insulin (ccb>bb)
53
Q

Anti-arrhythmic Drug class

A

I: Na channel blocker
II: beta blocer
III: K channel blockade - prolongs APD
IV: CCB

54
Q

metabolic and laboratory changes with aspirin

A

EARLY respiratory alkalosis
metabolic acidosis- lactate and ketones
- hypokalemia
- hypoglycemia (very early hyperglycemia)
- falsely elevated chloride
- elevated INR

55
Q

aspirin treatment (A-G and K)

A

A: alkilinization- BICARB: goal urine pH 8: a few amps bicarb and then 3 amps in 1L with 40 KCl
B: breathing is fast, avoid intubation
C: charcoal - bezoars possible
D: dialysis
E: electrolytes: K >4
F: frequent labs
G: hypglycemia
K: Vit K if INR >2

56
Q

Sulfonylurea toxicity management

A
  • blocks K channels in pancreas -> insulin release regardless of BG
  • ends in “ide” - glipizide, glimeperide
  • one pill can kill peds

OCTREOTIDE 50-100mg SC

57
Q

Anticholinergic toxidrome

A

mad, blind, red, hot, dry
benadryl

58
Q

cholinergic toxicity

A

dumbells- diarrhea, urination, miosis, bradycardia, emesis, lacrimation, lethargy, salivation
pesticides

59
Q

diphenhydramine effects

A

antimuscarinic effects, it can produce blurred vision, dry mouth, urinary retention, tachycardia, nausea, and constipation. EKG changes can occur including widening of QRS from sodium channel blockade and tachycardia.

60
Q

metformin OD management

A
  • causes lactic acidosis via inhibition of gluconeogenesis and mitochondrial complex
    charcoal
    bicarb
    HD (decreased mortality if dialysis <6 hrs)
61
Q

Toxic alcohol management, indications, dosing (4)

A

Fomepizole
Osm Gap / HAGMA with toxic alcohol >20 or high suspicion
15 mg / kg followed by 10 mg/kg q12h

NaHCO3 (most useful in methanol)
Folic acid (methanol)
Thiamine (B1) and pyridoxine (B6) and Mg (ethylene glycol)

HD: definitive

62
Q

ethylene glycol presentation

A

intoxication with more rapid (RENAL) elimination
- nephrotoxicity
- urine fluorescence
- lactate gap (False VBG lactate)

Antifreeze

63
Q

isopropyl alcohol presentation

A

ketosis without acidosis
significant inebriation with AMS, resp depression, obtunded

64
Q

methanol vs ethylene glycol vs isopropyl alcohol

A

methanol: windshield wiper fluid, AGMA, mild and prolonged intoxication, snowfield vision

ethylene glycol: antifreeze, AGMA, quicker and renally elimination intoxication

isopropyl alcohol: rubbing alcohol, ketosis without acidosis, obtundation

65
Q

3 mechanisms of CO

A
  1. hgb shift to left
  2. myoglobin binding- decreased cardiac contractility
  3. displaces NO -> hypotension
66
Q

MOA CN toxicity

A

sudden collapse in fire -> from burning of furniture
blocks cytochrome oxidase -> lactic acidosis

67
Q

options for management of CN

A

Hydroxycobalamin (cyanokit): standard, more severe cases

Hydrogen cyanide kit: amyl nitrate, sodium nitrite and sodium thiosulfate (traditionally - but causes methemoglobinemia and worsens hypotension)

Nithiodote: amyl nitrate, sodium nitrite and sodium thiosulfate

Sodium thiosulfate- only option available or for less severe cases

68
Q

Presentation of Dig toxicity

A

Nonspecific: fatigue, confusion, N/V, HA, anorexia

CARDIAC: anything, bradycardia, heart block, v tach, hypotension

Pathognomonic - bidirectional V tach

69
Q

EKG finding of TCA overdose

A

widened QRS
terminal R wave in avR

70
Q

MOA, presentation, treatment methemoglobinemia

A

Fe2+ -> Fe 3+ -> left shift and thus functional anemia and los SpO2

methylene blue reduces it: 1-2 mg/kg over 5 min

71
Q

Intranasal fentanyl
- dose
- onset

A

1-2mcg/kg
Max 100 mcg
10-15 min

72
Q

Intranasal versed anxiolysis
- dose
- onset

A

0.2-0.3 mg/kg
Max 10mg
5-10 min

73
Q

Intranasal ketamine, sub dissociative
- dose
- onset

A
  • 1-1.5 mg/kg
    Max 100-200mg
  • 5-10 min

PGY2 EM (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions