Acute Care

Question 1

What parameters can be adjusted to improve oxygenation

Answer 1

• FiO2
• PEEP

Question 2

What parameters can be adjusted to improve ventilation

Answer 2

• minute ventilation (RR)
• tidal volume

Question 3

Defn spinal shock vs neurogenic shock

Answer 3

spinal shock: loss of muscle tone and reflexes immediately after spinal cord injury; muscles can’t help constrict blood vessels (think about the flaccid part of UMN injury before they become hypertonic) (also its not really a type of shock - think of like spinal cord concussion)

neurogenic shock: must occur T6 and higher, loss of vasomotor tone due to loss of sympathetic innervation to the heart resulting in hypotension and bradycardia (UNABLE to mount tachycardia response). NOT reversed with fluid alone

Question 4

What is a brown sequard lesion

Answer 4

• Hemi-transection of cord - injury on one side
• Often penetrating trauma
• Ipsilateral motor and position sense loss
• Contralateral loss of pain & temperature 1-2 levels below injury site
  -Can be associated with Horner’s syndrome if above T2 (ptosis, anhidrosis, miosis)

Question 5

What is a chance fracture

Answer 5

• thoracic spinal fracture
• often from MVC inappropriately worn lap belt with forward flexion motion
• requires internal fixation (unstable fracture)
• often other internal organ injuries

Question 6

Acute management of splenic sequestration in SCD

Answer 6

fluid resus for hypotension
blood to stop the sequestration - small 5ml/kg transfusions of RBCs and/or post-transfusion target of 80
avoid post transfusion hgb of 100 (risk hyperviscosity syndrome)

Question 7

DDX wheezing in young children (CPS)

Answer 7

Infectious:
- bronchiolitis
- pneumonia

Inflammatiory:
- asthma
- allergic reaction
- cystic fibrosis

Structural:
- laryngotracheomalacia
- foreign body aspiration
- GERD
- TEF
- Vascular Ring
- Mediastinal Mass

Cardiac:
- CHF

consider alternate ddx if severe resp distress, no viral URTI dynptoms, and/or frequent recurrences

Question 8

Diagnostic studies in suspected bronchiolitis ( CPS)

Answer 8

tests often unhelpful! no evidence to support diagnostic testing in typical cases of bronchiolitis

• CXR: non specific, patchy hyperinflation and areas of atelectasis, often misinterpreted as consolidation with increased innappropriate use of abx. consider cxr if diagnosis of bronchiolitis is unclear, rate of improvement is not as expected, or severity raises concern of bacterial pna
• NPA: dont alter management, not routinely recommended unless for infection control patients or in high risk patients (ex. if it will impact performing additional tests, hospitalization, or using tamiflu for influenza)
• CBC: not useful in predicting SBI
• Bacterial cx: incidence of SBI in febrile infants with bronchiolitis is low, UTI is the most likely SBI in infant with bronchiolitis but is still low. don’t routinely screen for SBI (urine or blood) in patients with bronchilitis
• blood gas: only if concerned about potential respiratory failure

Question 9

Risk factors for higher risk severe bronchiolitis (CPS)

Answer 9

prematurity <35 weeks
<3 mo of age at presentation
hemodynamically significant cardiopulmonary disease
immunodeficiency

Question 10

Phases of iron toxicity

Answer 10

Phases (5)
1. GI Phase (30min-6hr post)
- Abdo pain, vx/dx, melena
2. Latent Phase (6hr- 24hr)
3. Shock/Metabolic acidosis (6-72hr)
4. Hepatoxcity/hepatic necrosis (12-96hr)
5. Bowel obstruction (2-8wks)
- Strictures/scarring

Question 11

Antidote for Iron toxicity

Answer 11

Deferoxamine (specific chelator of iron) is the antidote for moderate to severe iron intoxication.

○ Indications: serum iron concentration >500 μg/dL or moderate to severe symptoms of toxicity (e.g., acidosis)
○ Preferably given by continuous IV infusion at 15 mg/kg/hr.
○ S/E: Hypotension → managed by slowing rate of infusion, fluids, vasopressors
○ If >24H of deferoxamine → ARDS and Yersinia sepsis
○ Discontinue when clinical symptoms and acidosis resolve.

Question 12

Hyperkalemia management

Answer 12

Stop all administration of potassium containing drugs/fluid
If K > 6.5, get an ECG
If ECG changes - goals to stabilize heart to prevent arrhythmia and to reduce K+
1. Calcium Gluconate (60mg/kg) IV over a few minutes (give slowly over 30 minutes if patient is on digitalis) (stabilizes cell membrane, works within a few minutes)
2. Bicarbonate (shifts K+ intracellularly, effective in patients with metabolic acidosis)
3. Insulin plus Glucose (shifts K+ intracellularly, works within 30 min)
4. Nebulized albuterol (ventolin) (stimulates B1 adrenergic receptors to shift K+ intracellularly, rapid)
5. Lasix (loop diuretic) (heps remove K+ from the body)
6. Kayexalate (Sodium polystyrene sulfonate) exchange resin to poop out K+

Question 13

Hyperkalemia ECG changes

Answer 13

peaked T waves → prolonged PR interval → prolonged QRS → arrhythmia

Question 14

Differentiating serotonin syndrome and NMS

Answer 14

both have same effect on vitals (high everything)

NMS:
- lead pipe rigidity
- hyporeflexia
- really high CK
- normal pupils

Serotonin syndrome
- hyperreflexia and clonus
- hypertonic but not as rigid
- small pupils

Question 15

Serotonin syndrome diagnosis

Answer 15

exposure to serotonergic agents + one of the following
- spontaneous clonus
- inducible/ocular clonus AND agitation or sweating
- inducible/ocular clonus AND hypertonia AND high temp
- tremor and hyper-reflexia

Question 16

Serotonin syndrome typical symptoms

Answer 16

SHIVERS mnemonic
- shivering
- hyper-reflexia
- increased
- vitals (HR, RR, BP, Temp)
- encephalopathy
- restlessness
- sweating

Question 17

higher risk features of button battery ingestion

Answer 17

Highest risk batteries:
Larger diameter >20mm (more likely to get impacted)
Lithium cell (higher voltage)
Newer battery
age<5yr

Question 18

Esophageal button battery

Answer 18

immediate endoscopy to remove within 2 hours

Question 19

gastric button battery

Answer 19

Gastric or further down tract

If high risk (Age <5 AND button battery >/=20mm) then likely endoscopy within 24-48hr

If low risk Age >/= 5 and/or battery <20mm, consider outpatient observation only
- repeat xray in 48hr if >20 mm
- repeat xray in 10-14 days if <20mm if not found in stool

Question 20

Button battery with esophageal injury on scope - next steps

Answer 20

NPO, IV abx, admit
CT angiogram to look at aorta
consider MR chest to look at distance from aorta

Question 21

Splenic sequestration signs and symptoms

Answer 21

Signs and symptoms:
Rapid spleen enlargement
Left sided abdominal pain
Drop of hemoglobin at least 20 from baseline
+/- signs of hypovolemia (trapping blood in the spleen)
+/- severe anemia (<30)
+/- drop in WBC and platelets

Question 22

Splenic sequestration acute management

Answer 22

1. fluid resus with isotonic fluid if needed
2. PRBC 5ml/kg transfusion - it may rise the Hgb quite a bit, risk of hyperviscosity symdrome

Question 23

Splenic sequestration chronic management

Answer 23

Prophylactic splenectomy: perform after an acute episode has resolved, only effective strategy to prevent future life-threatening episodes (blood transfusions have been tried in the past to present sequestration, but evidence suggests that transfusions DO NOT reduce risk of recurrence compared to no transfusion therapy). Transfusions may be used as a short course bridge to splenectomy

Question 24

Brain dead criteria

Answer 24

1. Cause consistent with brain death
2. Absence of confounding conditions: Paralysis, sedatives/significant drug tox, hypothermia (</= 34 degrees), extreme electrolyte derangement, un-resuscitated shock
3. Absence of response to deep painful stimulus
4. Absence of brainstem reflexes: Fully dilated pupils, absence of corneal, pupillary, gag, cough, suck/root, doll’s eyes, vestibulo-occular (COWS)
5. Apnea test
   - Increase CO2 >= 60, and increase by 20, absence of resp effort, pH <= 7.28
6. Ancillary testing if unable to do apnea test: Brain perfusion scan

Question 25

Brain dead defn

Answer 25

Brain death = Irreversible loss of the capacity for consciousness Irreversible loss of all brainstem function, including the capacity to breathe

Question 26

Cholinergic toxidrome

Answer 26

Cholinergic toxidrome - diarrhea, diaphoresis, hypersalivation, miosis Muscarinic sx: SLUDGE = salivation, lacrimation, urination, diarrhea, GI upset, emesis Nicotinic sx: Killer B’s = bronchorrhea, bronchospasm, bradycardia (muscarinic) Example drugs: - Organophosphates (insecticides, nerve agents) - Nicotine/vape - carbamates (physostigmine, neostigmine, pyridostigmine) - alzheimer medications - myasthenia treatments

Question 27

Cholinergic toxicity antidote

Answer 27

atropine

Question 28

CATCH CT Head rule

Answer 28

CATCH = Canadian Assessment of Tomography for Childhood Head Injury CT head is required for children with a minor head injury plus any one of the following findings: High risk (need for neurologic intervention): - GCS < 15 at 2 hours after injury - Suspected open or depressed skull fracture - History of worsening headache - Irritability on exam Medium risk (brain injury on CT scan): - Any sign of basal skull fracture - hemotympanum, racoon eyes, CSF otorrhea or rhinorrhea, battle's sign - Large boggy scalp hematoma - Dangerous mechanism of injury - MCV, fall from 3 or more feet/5 stairs, fall from bicycle with no helmet

Question 29

PECARN CT Head rule <2yo

Answer 29

High risk criteria: CT recommended if any single criterion present. (4.4% risk ciTBI): - GCS 14 (<14 excluded from rule) - Altered mental status (agitation, somnolence, slow response, repetitive questioning) - Palpable skull fracture Low risk criteria: Observation vs CT recommended if any single criterion present. (0.9% risk ciTBI): - Non-frontal hematoma - Not acting normally per parent - Severe mechanism: Fall >3 ft, MVC with ejection, death of passenger, or rollover, Unhelemeted pedestrian or bicyclist struck by vehicle, Head struck by high impact object Avoid CT if no criteria present. (<0.02% risk ciTBI) Sensitivity 100%

Question 30

PECARN CT Head >/= 2 yo

Answer 30

High risk criteria: CT recommended if any single criterion present. (4.3% risk ciTBI): - GCS 14 (<14 excluded from rule) - Altered mental status (agitation, somnolence, slow response, repetitive questioning) - Signs of basal skull fracture Low risk criteria: Observation vs CT recommended if any single criterion present. (0.9% risk ciTBI): - history of Loss of consciousness - history of vomiting - severe headache - Severe mechanism: Fall >5 ft, MVC with ejection, death of passenger, or rollover, Unhelemeted pedestrian or bicyclist struck by vehicle, Head struck by high impact object Avoid CT if no criteria present. (<0.05% risk ciTBI) Sensitivity 96.8%

Question 31

Differences PECARN CT Head rule <2 or >/=2 yo

Answer 31

<2 - frontal hematoma - not acting themself per parents - palpable skull fracture - fall >3ft >/= 2 - loss of consciousness - history of vomiting - severity of headache - signs of basal skull fracture - fall > 5 ft

Question 32

Pneumothorax size

Answer 32

For children >12 yrs only, a pneumothorax is considered ‘large’ based on the following measurements: Measurement of the vertical distance between the lung and thoracic cage at the apex on CXR. If >3 cm, pneumothorax is large OR Measurement of the distance between the lateral lung edge and chest wall at the level of the hilum; >2 cm = (at least 50%)

Question 33

Pneumothorax management

Answer 33

Small and asymptomatic: conservative Small and any symptoms (chest pain, SOB): oxygen - helps resorb faster Any resp distress/compromise or large - chest tube

Question 34

Pediatric GCS

Answer 34

Motor 6 - Obeys commands 5- Localizes pain 4- Withdraws from pain 3- Decorticate (flexion) 2- Decerebrate (extension) 1- None Voice 5- Oriented, answers questions 4- Confused 3- Inappropriate words 2- Incomprehensible sounds/groans 1- None Eye response 4- Spontaneous 3- To speech 2- To pain 1- None

Question 35

Indications for synchronized cardioversion

Answer 35

V-tach with a pulse unstable SVT begin with 0.5-1J/KG. can increase to 2J/KG Sedate if needed but don't delay cardioversion

Question 36

Drug used to treat SVT

Answer 36

Adenosine 1st dose 0.1mg/kg (max 6mg) 2nd dose 0.2mg/kg (max 12mg) Maxes out at 60kg

Question 37

Acute managemenet hypercalcemia

Answer 37

Initial therapy of severe hypercalcemia includes the simultaneous administration of 1. Intravenous (IV) isotonic saline, 2. Lasix 3. Calcitonin SC 4. Bisphosphonate The administration of calcitonin plus saline hydration should result in substantial reduction in serum calcium concentrations within 12 to 48 hours. The bisphosphonate will be effective by the second to fourth day and provide a more sustained effect, thereby maintaining control of the hypercalcemia.

Question 38

Parkland formula

Answer 38

If TBSA >20% burn 4ml x weight (kg) x % Second degree or worse burns = total fluid volume over 24 hr Ringers Lactate Divide by 2. Give first half of volume within 8 hours of the burn, the other half spread over the remaining 16 hr For children <30kg, add maintenance fluids 4-2-1 rule with dextrose

Question 39

Fluid replacements for mild/moderate/severe dehydration

Answer 39

Mild: ORS 50ml/kg over 4h Mod: ORS 100ml/kg over 4h Severe: IV 20-40ml/kg x1h OR Fluid deficit = 10 * weight * % dehydration

Question 40

Treatment of agitate tox patient

Answer 40

Psychomotor agitation is treated with benzos as first line

Question 41

Anaphylaxis criteria

Answer 41

Anaphylaxis criteria (need only one of three) 1. Acute onset after exposure to allergen with involvement of skin or mucosa and one of: resp compromise, hypotension, end-organ dysfunction 2. Two or more of: skin or mucosal involvement, resp compromise, hypotension or GI symptoms 3. Hypotension

Question 42

Anaphylaxis management

Answer 42

0.01mg/kg IM epi (1:1000) every 5-15 mins as needed Give up to 3 doses then do epi infusion 0.05mcg/kg/hr and titrate

Question 43

Treatment high ICP

Answer 43

ABCs Rapid treatment of hypoxia, hypercarbia, hypotension Isotonic fluids to maintain MAP and CPP If hypertensive, do not drop BP too quickly or will lose CPP (CPP = MAP – ICP) Elevated head of bead 15-30 degrees Maintain head midline Get a glucose and correct hypoglycemia Maintain normothermia Correct anemia Prophylactic anticonvulsants if high risk of seizures (ex. severe TBI) Pain control Neurovitals q1-2h Hypertonic saline 3ml/kg Osmotic diuresis: mannitol 1g/kg

Question 44

Uncal herniation

Answer 44

Cushing triad = late sign of impending herniation Hypertension Bradycardia Respiratory depression Other signs of herniation: headache, altered LOC, anisocoria, Cheyne Stokes respirations, hemiplegia, decorticate or decerebrate posturing, coma Impending herniation management: Secure airway with RSI (FIRST STEP) IV 3% saline 5ml/kg Hyperventilation to PaCO2 30-35mmHg Baseline stabilization Emergency CT head

Question 45

Bacterial tracheitis presenting features

Answer 45

Bacterial tracheitis = acute bacterial infection of upper airway that is potentially life threatening, mucosal swelling at level of cricoid cartilage with copious, thick, purulent secretions +/- pseudomembranes Staph aureus = most common bug Others: Strep pneumo, Strep pyogenes, Moraxella, non-typeable H. flu, anaerobes Avg 4-8yrs old Often follows a viral respiratory infection (esp laryngotracheitis) More common than epiglottitis in vaccinated populations Clinical manifestations: BT can be distinguished from croup as patients are often older and toxic appearing Brassy cough High fever “Toxicity” with respiratory distress either immediately or after a few days of apparent improvement Can lie flat, does not drool, no dysphagia (compared to epiglottitis) Epi nebs ineffective

Question 46

Tetanus indications

Answer 46

Tetanus toxiod booster (Td or Tdap) should be given if Immunization status unknown or <3 doses >10 years since last tetanus booster and minor wound >5 years since last booster and major wound For children under 7yrs, DTap should be given as choice booster, for children >7, Tdap is preferred method Tetanus immune globulin should be given if someone has a serious wound and incomplete immunizations

Question 47

Activated charcoal uses

Answer 47

ACE inhibitors Antiepileptics ASA Beta blockers Digoxin NSaids Tylenol Antidiabetics Neuroleptics Opiates

Question 48

Iron overdose pathophys

Answer 48

corrosive to the GI mucosa, leading to hematemesis, melena, ulceration, infarction, and potential perforation *Iron-induced hypotension* is caused by volume losses, increased permeability of capillary membranes, and vasodilation mediated by free iron Iron accumulates in tissues, including the Kupffer cells of the liver and myocardial cells, leading to *hepatotoxicity, coagulopathy, and cardiac dysfunction* *Metabolic acidosis* develops in the setting of hypotension, hypovolemia, and iron's direct interference with oxidative phosphorylation and the Krebs cycle Moderate to severe toxicity is typically seen with ingestions *>60 mg/kg*

Question 49

Management croup CPS

Answer 49

The clinical benefit of corticosteroids in croup is well established and should be considered for treating all children presenting with croup and symptoms ranging from mild to severe. Improvement generally begins within 2 to 3 hours after a single oral dose of dexamethasone and persists for 24 to 48 hours The dexamethasone dose used in most clinical trials is *0.6 mg/kg/dose*

Question 50

Timing of bloodwork for tylenol ingestion

Answer 50

must wait 4 hours before obtaining labs, then do ASAP

Question 51

Acute management presumed metabolic new diagnosis

Answer 51

Bottom line for acute treatment of metabolic problems is Dextrose 10% (to prevent catabolism) and saline fluids (to prevent hyponatremia and dehydration) NPO is safest to avoid adding more substrate when you don’t know what type yet (organic aciduria/amino acidopathies/urea cycle, do not want to consume proteins; fatty acid oxidation- avoid lipids)

Question 52

Pancreatitis diagnosis and initial management

Answer 52

NASPGHAN Guidelines Diagnosis: INSPPIRE criteria- at least 2 of : (1) abdominal pain compatible with AP (2) serum amylase and/or lipase values >=3 times upper limits of normal, (3) imaging findings consistent with AP Management: Early IV fluids- crystalloid volus then 1.5-2 x maintenace Pain control- non-opioid and opioid if needed No antibiotics unless concern for infected necrosis Re: NPO- Evidence for early EN (within 48-72h) to prevent gut translocation of bacteria

Question 53

What is Electromechanical dissociation

Answer 53

Pulseless electrical activity

Question 54

PARDS severity cutoffs

Answer 54

 Mild: OI 4-8  Moderate: 8-16  Severe: OI > 16 (high morbidity)

Question 55

Differences between ARDS and PARDS

Answer 55

- PF ratio in adults instead of OI in peds - Adults require bilateral opacities (kids can have unilateral opacity on imaging) remember: ARDS is a disease of decreased lung compliance

Question 56

Lung protective ventilation for PARDS

Answer 56

*Low tidal volume (4-6ml/kg) *P-plat <28 or PIP <32 *Permissive hypercapnia pH >/= 7.25 *Permissive hypoxemia SpO2 88-92% *Open-lung ventilation strategy (PEEP optimization) *Early chemical paralysis to meet above goals *Strict avoidance of fluid overload

Question 57

Adjunct treatments for ARDS

Answer 57

Lung protective ventilation for everyone Paralysis Prone Nitric oxide Non-conventional ventilation (ex. HFO) Restrict fluids Steroids (controversial – likely not the right answer) ECMO (not great evidence but if they are going to die, can choose ECMO)

Question 58

Most likely causes of PARDS

Answer 58

Pulmonary: pneumonia Non-pulmonary: sepsis

Question 59

Risk factors for fatal asthma

Answer 59

o Previous attack with rapid/severe deterioration o Prior picu admission +/- mechanical ventilation o Syncope or seizure during previous attack o >1 hospitalization or ED visit in past year o >/= 1 cannister per month rescue o Poor knowledge/compliance of disease management o Social issues o Comorbid illness (including obesity, chronic lung disease, food allergy)

Question 60

How does heliox work in asthma

Answer 60

reduces airway resistance to improve air flow Improves laminar airflow helium is less dense than air (increases velocity of flow)

Question 61

Persistent lactic acidosis in burn patient

Answer 61

carbon monoxide or cyanide poisoning until proven otherwise

Question 62

inhalational injury + altered LOC

Answer 62

carbon monoxide or cyanide poisoning until proven otherwise

Question 63

Which paralytic is contraindicated in burn patients

Answer 63

succinylcholine

Question 64

3 causes lactic acidosis from house fire

Answer 64

1. Carbon monoxide poisoning 2. Cyanide poisoning (everything synthetic burning) 3. Tissue damage, decreased CO, hypovolemic shock, necrosis

Question 65

Septic Shock

Answer 65

sepsis + severe cardiovascular dysfunction (hypotension, need for pressors, high lactate > 2xULN, CRT > 5 s)

Question 66

SIRS Criteria

Answer 66

Require 2 of the following 4 (of which 1 MUST BE either Temp or WBC): - T>38.5 or <36 - HR > 2SD above normal for age w/o other stimuli - Bradycardia for infants <1year w/ HR <10% for age - RR > 2 SD above normal for age - WBC<5 or >15 or >10%bands

Question 67

Warm shock pressor choice

Answer 67

norepinephrine PALS starting dose 0.1-2 mcg/kg/min

Question 68

Cold shock pressor choice

Answer 68

epinephrine PALS starting dose 0.1-1 mcg/kg/min

Question 69

Cold shock features

Answer 69

- low cardiac output - high SVR Use epinephrine to: - increase CO - increase SVR works through *Beta 1 and Beta 2* agonism at high dose also increases alpha Dosing: 0.01-0.05 mcg/kg/min High dose: 0.06-0.1 mcg/kg/min

Question 70

Warm shock features

Answer 70

++ increased cardiac output decreased SVR increased SVO2 Use norepi - increases SVR - increases CO - increases HR Works on - low dose *alpha 1* - high dose Beta 1 and Beta 2 Dosing Low 0.01-0.05 mcg/kg/min High 0.06-0.1 mcg/kg/min PALS: starting dose 0.1-2

Question 71

Milrinone function

Answer 71

increases cardiac output decreases SVR acts as PDE inhibitor

Question 72

Bruising red flags for NAT (CPS statement)

Answer 72

- Bruises in babies who are not yet cruising / babies (<4mo) - Bruises on the ears, neck, feet, buttocks or torso (torso includes chest, back, abdomen, genitalia) - Bruises not on the front of the body and/or overlying bone - Bruises that are unusually large or numerous/extensive - Bruises that are clustered or patterned (patterns may include handprints, loop or belt marks, bite marks) - Bruises that do not fit with the causal mechanism described

Question 73

Medical investigations for bruises concerning for NAT (CPS statement)

Answer 73

- Complete blood count (CBC) (including platelets) - Peripheral blood smear - INR and PTT - Fibrinogen - Von Willebrand studies - Blood group (for interpretation of vW levels) - Factor VIII level - Factor IX level - Liver function tests (for secondary platelet dysfunction) - Renal function tests (for secondary platelet dysfunction)

Question 74

Systemic illnesses causing increased predisposition to bruising

Answer 74

- hematologic problems (ex. ITP, von willebrand disease, hemophilia, platelet disorders, Glanzmann's thromboasthenia) - Systemic infections (ex. Meningococcemia) - Malignancy (ex. Leukemia, neuroblastoma) - Nutritional deficiencies (ex. Vitamin K or C) - DIC - Connective tissue disorders (Ehlers-Danlos, Osteogenesis imperfecta) - Autoimmune/inflammatory (ITP, HSP, Gardner-Diamond)

Question 75

ingestion causing mixed respiratory alkalosis and metabolic acidosis

Answer 75

salicylate toxicity (ASA) Treat with sodium bicarb infusion (alkalinization of urine to help with excretion)

Question 76

TCA ingestion pearls

Answer 76

looks like anticholinergic but high mortality risk GET AN ECG - its TCA if QRS >100 (wide complex tachycardia) don't use physostigmine often present sedated and hypotensive (fluid refractory) and seizures ex amitriptyline give sodium bicarb!

Question 77

ABCs of tox

Answer 77

ABC D - decontamination E - elimination F - find the antidote

Question 78

sympathomimetic vs anticholinergic

Answer 78

both have mydriasis but non-reactive in antichol vs. reactive in sympathom dry in antichol, sweaty in sympatho

Question 79

antihypertensive drug to avoid in sympathomimetic overdise

Answer 79

beta blockers

Question 80

antidote for cholinergic toxidrome

Answer 80

atropine (use q 5 mins until secretions stop) atrovent pralidoxime also used for cholinergic intoxication but only helps nicotinic effects (weakness, fasciculations)

Question 81

drugs that don't work with activated charcoal

Answer 81

Alcohols Caustics: alkalis and acids Cyanide Heavy metals (e.g., lead) Hydrocarbons Iron Lithium

Question 82

toxic dose of tylenol ingestion

Answer 82

>200 mg/kg in children and >7.5-10 g in adolescents and adults. Repeated administration of APAP at supratherapeutic doses (>90 mg/kg/day for consecutive days) can lead to hepatic injury or failure in some children,

Question 83

Kings Criteria for Liver Failure Transplant

Answer 83

These criteria include acidemia (serum pH <7.3) after adequate fluid resuscitation, coagulopathy (INR >6), renal dysfunction (creatinine >3.4 mg/dL), and grade III or IV hepatic encephalopathy

Question 84

Toxic causes of hot and altered

Answer 84

 Sympathomimetic toxidrome  Anticholinergic toxidrome  Neuroleptic Malignant Syndrome  Serotonin Syndrome  Malignant Hyperthermia  Substance Withdrawal  ASA

Question 85

Toxic rigidity syndromes

Answer 85

NMS - triggered by antipsychotics - d/t too little domamine - lead pipe rigidity, slower onset over days - antidote: bromocriptine or amantadine Serotonin syndrome - too much serotonin usually d/t SSRI OD - hyper-reflexic, lower>upper extremitiies - antidote: cyproheptadine Malignant hyperthermia - triggered by anesthetics with genetic predisposition, usually inhaled gasses or succinylcholine - antidote: dantrolene

Question 86

Toxins causing mydriasis (big pupils)

Answer 86

1. anticholinergic 2. sympathomimetic 3. withdrawal

Question 87

Toxins causing miosis (small pupils)

Answer 87

1. opioids 2. cholinergics 3. sedative-hypnotics 4. phenothiazine (old antipsychotic)

Question 88

physostigmine vs pralidoxime

Answer 88

pralidoxime - for cholinergics (atropine is 1st line, pralidoxime only treats nicotinic effects ie weakness) physostigmine - for anticholinergics (NOT in TCA)

Question 89

radio opaque drugs in OD

Answer 89

COINS -chloral hydrate -pioid packets -iron and other heavy metals -neuroleptics (if early) -sustained release taboets/salicylates (early)

Question 90

ketosis without acidosis

Answer 90

isopropyl alcohol

Question 91

hypothermia associations

Answer 91

hypoglycemia hypocalcemia hypokalemia metabolic acidosis

Question 92

metabolic acidosis following house fire

Answer 92

cyanide toxicity treat with cyanocobalamin

Question 93

Rotary nystagmus is pathognemonic for what toxidrome?

Answer 93

PCP