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Step 2 CK > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

When do you use gastric lavage for ingestion?

A

Within the first hour or 2 of ingestion

Do not use if altered mental status or caustic ingestion

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2
Q

What amount of acetaminophen is generally toxic?

A

> 8-10 grams

Fatal if 12-15 grams

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3
Q

What treatment do you use if a clear toxic amount of acetaminophen has been ingested?

A

NAC

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4
Q

What do you do if acetaminophen ingestion was > 24 hours ago?

A

NOTHING

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5
Q

What do you do if the amount of acetaminophen ingested is unclear?

A

Draw a level

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6
Q

Can you use charcoal with NAC?

A

YES

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7
Q

Presentation and Tx of ASA Overdose

A

Tinnitus

ARDS

Inc prothrombin time

Hyperventilation –> respiratory alkalosis

Renal toxicity, AMS

Inc anion gap metabolic acidosis (anaerobic glucose metabolism –> lactose)

Tx = alkaline urine; give bicarb

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8
Q

Blood Gas Values in ASA Overdose

A

Low PCO2 (hyperventilation)

Low Bicarb (metabolic acidosis)

PH = about 7.45

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9
Q

Carbon Monoxide Poisoning v. Methemoglobinemia

A

Both - similar presentation to anemia because dec oxygen to tissues; normal pO2

CO - binds to oxygen so not delivered, 100% oxygen or hyperbaric oxygen if severe (CNS sx, cardiac sx, metabolic acidosis)

Methe - HgB in ferric state that will not carry oxygen, start with 1–% oxygen, most effective is methylene blue

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10
Q

Relationship between digoxin and potassium

A

Hypokalemia –> digoxin toxicity because more binding sites open for digoxin not bound by K+

Dig toxicity then results in HYPERkalemia because Na-K ATPase is blocked

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11
Q

Osmolar Gap

A

2 (Na) + BUN/2.8 + glucose/18

Measured - calculated = gap

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12
Q

Snake Bites (complications and effective treatments)

A

Local tissue damage via proteases and lipases in venom

Neuro toxin - respiratory paralysis, ptosis, dysphagia, diplopia

Hemolytic toxin - hemolysis and DIC

Tx = pressure to wound, anti-venin, immobilization to decrease movement of the venom

DO NOT USE ice, tourniquet, incision/suction

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13
Q

Black Widow v. Brown Recluse Spider Bites

A

Black - ab pain, muscle pain, hypocalcemia (give Ca)

Brown - local skin necrosis, bullae, blebs (debridement, steroids, dapsone)

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14
Q

When should you intubate in burn injuries?

A

Stridor

Hoarseness

Wheezing

Burns inside nasopharynx or mouth

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15
Q

Burn Fluid Replacement Calculation

A

4 mL x %SA x kg

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16
Q

What abx do you use for burns?

A

TOPICAL silver sulfadiazine

17
Q

EKG Finding in Hypothermia

A

J point elevation

18
Q

Heat Exhaustion v. Heat Stroke

A

Exhaustion = normal body temp and normal labs, oral fluids

Stroke = elevated body temp, elevated K+ and CPK, IV fluids and evaporation

19
Q

High Altitude Pulmonary Edema

A

Dx = 2 sx and 2 signs

Sx - dyspnea, cough, weakness, chest tightness

Signs - crackles, wheezing, cyanosis, tachypnea, tachycardia

Tx = oxygen, rapid descent, steroids, nifedipine, sildenafil

Like pulmonary edema with normal EF

Unlikely under 5000 ft elevation

20
Q

How do you treat jellyfish stings?

A

Hot water to inactivate toxin

Vinegar to prevent toxin release

Remove nematocysts

Topical steroids and anti-histamines for symptomatic relief

21
Q

Mercury v Lead Poisoning

A

Lead - ab pain, ATN, sideroblastic anemia, wrist drop, memory loss/confusion

Tx = succimer, EDTA/dimercaprol (IV)

Mercury = nervous/twitch/hallucinations and lung fibrosis if inhaled

Tx = succimer or dimercaprol for neuro toxicity; CANNOT reverse lung fibrosis

22
Q

4 Causes of Pulselessness (how do you treat each?)

A

1 - asystole (CPR and epi)

2 - V fib (CPR, UNSYNC defibrillation and epi)

3 - V tach (treatment based on HD status - hypotension/confusion/CHF)

  • if pulseless UNSYCN just like VF
  • if unstable SYNC cardiovert first then amio, lidocaine, procainamide
  • if stable do amio, lidocaine, procainamide first then SYNC cardiovert if needed

4 - PEA aka normal EKG no pulse (oxygen, fluids, glucose, chest tube, etc)

23
Q

Causes of PEA (11)

A

H’s

  • hypovolemia
  • hypo/hyperkalemia
  • hypoxia
  • hypothermia
  • hypoglycemia
  • H+ (acidosis)

T’s

  • tension pneumo
  • thrombosis (AKA PE or coronary)
  • tamponade
  • trauma
  • toxins
24
Q

CHADSVASC (when is it used?)

A 
C - CHF or cardiomyopathy
H - HTN 
A - age (>75) - 2 points
D - DM 
S - stroke or TIA - 2 points 
V - vascular disease
A - age 65-74 - 1 point 
S - sex (female)

Use if someone has a fib and trying to decide if they need anti-coagulation (use if 2 or more, not needed if 0 or 1)

25
Q

SVT that gets worse w/ diltiazem or digoxin

A

WPW

Dangerous to use these meds because they block normal AV node

26
Q

Tx of WPW

A

Acute - treat acute arrhythmia with procainamide or amiodarone

Chronic - radiofrequency catheter ablation for cure; use EP studies to detect exact location

27
Q

What is multifocal atrial tachy associated with? Tx?

A

COPD

So do not use beta blockers

Use other rate control (calcium channel blocker - diltiazem or dignoxin)

28
Q

Pacemaker Indications

A

Symptomatic bradycardia (hypoperfusion)

Mobitz second degree type II even if asymptomatic

3rd degree complete heart block

29
Q

What is the most common cause of death w/in 72 hours of an MI? How do you treat this complication? How do you determine risk of recurrence?

A

arrhythmia 2/2 ischemia

Tx = revascularize so do angiography for angioplasty or bypass

ECHO - will tell you risk of recurrence (LV function)

30
Q

Mgt of syncope + abnormal EKG v. syncope + normal EKG

A

Abnormal - go right to implantable defibrillator

Normal EKG - must do EP (electrophysiology) studies first

31
Q

What head imaging findings are associated with carbon monoxide poisoning?

A

globus pallidus enhancement on MRI because hypoxic brain injury

Step 2 CK (28 decks)

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