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Flashcards in EM Deck (181):
1

Unidentified pills ingested within 1hr w/ no changing MS, next best step

Gastric lavage

2

When is gastric lavage dangerous

Altered MS
Caustic injestion
Acetaminophen OD

3

How much does gastric lavage remove

50% at 1 hr
15% at 2hrs

4

What is always the wrong answer w/ response to poisoning

Ipecac
Cathartics
Forced diuresis
Whole bowel irrigation

5

Cause of OD is unclear

Acetaminophen
Aspirin

6

MCC death by OD

Acetaminophen
Aspirin

7

Best initial management of OD >1hr w/ Altered MS

Naloxone
Dextrose
Thiamine

8

Is benzo OD fatal

No, but acute withdrawal causes seizures

9

When is charcoal given

Anyone w/ pill OD

10

How much acetaminophen is toxic

8-10 grams

11

How much acetaminophen is fatal

12-15 grams

12

Lab changes in acetaminophen OD

Elevated AST, Bili
Abd pain and vomitting

13

Clearly toxic amount of acetaminophen ingested, next best step

NAC

14

Acetaminophen OD >24hrs, what now

Nothing

15

Can't tell how much acetaminophen was ingested

Get level

16

Charcoal in acetaminophen OD

Give it w/ NAC even if vomitting

17

Features of Aspirin OD

Resp alk → Tinnitus
Metab acid → Hyperventilation
Renal tox and altered MS
Increased anion gap

18

How does aspirin OD affect lungs

ARDS

19

Rx aspirin OD

Alkalinize urine w/ bicarb

20

ABG in aspirin OD

↓ pCO2
↓ HCO3
↑ pH

21

Fatal consequences of TCA OD

Seizures
Arrhythmias

22

What can prevent seizures in TCA OD

Benzos

23

Best initial test in TCA OD

EKG

24

What is seen on EKG in TCA OD

Wide QRS

25

Main sx in TCA OD

Dry mouth
Constipation
Urinary retention

26

Rx TCA OD

Na bicarb

27

MCC death in fires

CO poisoning

28

Only way to rx caustic ingestion

Water in high volumes to flush out
Endoscopy to assess degree of damage

29

Hx clues for CO poisoning

Gas heaters, wood burning stoves
Automobile exhaust

30

Presentation of CO poisoning

Dyspnea, lightheadedness, confusion, seizures

31

How does CO poisoning kill you

MI

32

ABG picture in CO poisoning

May be normal
Lactic acidosis
- Low bicarb
- Low pH

33

Most accurate test for CO poisoning

Carboxyhemoglobin level

34

Soot around mouth and nose but not inside

Don't intubate

35

Burns inside mouth

Intubate
4mL NS per % body surface affected

36

Best initial therapy for CO poisoning

Give 100% O2
Hyperbaric O2 if severe

37

What is severe CO poisoning

CNS sx
Cardiac sx
Metabolic acidosis

38

MCC death from burns

Infection

39

What is methemoglobinemia

Hb locked in ferric state
Brown, will not carry O2

40

What can cause methemoglobinemia

Benzocaine and other anesthetics
Nitrites and nitroglycerin
Dapsone

41

Sx methemoglobinemia

Dyspnea and cyanosis
HA, confusion, seizures (altered MS)
Metab acid

42

Most accurate test for methemoglobinemia

Methemoglomin level

43

Best initial therapy for methemoglobinemia

100% O2

44

Most effective therapy for methemoglobinemia

Methylene blue

45

What predisposes digoxin toxicity

Hypokalemia

46

MC presentation of digoxin toxicity

GI issues (N/V)

47

Other sx of digoxin tox

Hyperkalemia
Confusion
Visual disturbance
Rhythm disturbance
Gynecomastia (rare)

48

What else causes hyperkalemia

ACEIs, ARBs, BBs, Spironolactone

49

Most accurate test for digoxin toxicity

Digoxin levels

50

Best initial test for digoxin tox

K level and EKG

51

EKG finding in dig tox

Downsloping ST

52

Most common arrhythmia in dig tox

Atrial tachy w/ variable AV block

53

Rx Dig tox

Control K
Digoxin Ab

54

Strongest indication for digoxin Ab

CNS and cardiac involvement

55

Presentation of organophosphate/nerve gas poisoning

Salivation
Lacrimation
Polyuria
Diarrhea
Bronchospasm (resp arrest if severe)

56

Rx organophosphate/nerve gas poisoning

Atropine immediately

57

Presentation of Pb poisoning

Abd pain
ATN
Sideroblastic anemia
Wrist drop
Memory loss, confusion

58

Best initial test for Pb poisoning

Increased free erythrocyte protoporphyrin

59

Most accurate test for Pb poisoning

Lead level

60

Most accurate test for sideroblastic anemia

Prussian blue stain

61

Rx Pb poisoning

Succimer (oral)
EDTA, Dimercaprol (IV)

62

Sx in Mercury poisoning

Oral - CNS
Inhaled - Lung fibrosis

63

Specific CNS sx in mercury poisoning

Nervous, jittery, twitchy, hallucinatory

64

Can lung damage in mercury poisoning be reversed

No

65

Rx Mercury poisoning

Dimercaprol, Succimer

66

Effects of methanol and ethylene glycol poisoning

Intoxication
Metabolic acidosis
Increased anion gap

67

Rx methanol and ethylene glycol poisoning

Fomepizole
Dialysis

68

Source of methanol poisoning

Wood alcohol
Cleaning solutions
Paint thinner

69

Source of ethylene glycol poisoning

Antifreeze

70

Metabolite in methanol poisoning

Formic acid/ Formaldehyde

71

Metabolite in ethylene glycol poisoning

Oxalic acid/ Oxalate

72

Presentation of methanol poisoning

Ocular toxicity

73

Presentation of ethylene glycol poisoning

Renal toxicity

74

Initial diagnositic abnormality in methanol poisoning

Retinal inflammation

75

Initial diagnositic abnormality in ethylene glycol poisoning

Hypocalcemia
Enveloped shaped crystals in urine

76

Calculation of serum osmolality

2xNa + BUN/2.8 + Glc/18

77

MC injury from snake bite

Local injury

78

What damages local tissue in snake bites

Proteases and lipses

79

How does snake hemolytic toxin kill you

Hemolysis and DIC

80

How does snake neurotoxin kill you

Resp paralysis

81

Ineffective snake bite remedies

Tourniquets
Ice
Incision and suction

82

Effective snake bite remedies

Pressure
Immobilization
Antivenom

83

Presentation of black widow bite

Abd pain
Muscle pain

84

Presentation of brown recluse bite

Local skin necrosis
Bullae
Blebs

85

Lab tests in black widow bite

Hypocalcemia

86

Lab tests in brown recluse bite

None

87

Rx black widow bite

Calcium
Antivenom

88

Rx brown recluse bite

Debridement
Steroids
Dapsone

89

Management of dog, cat, human bites

Amoxicillin/Clavulanate
Tetanus vaccine booster if >5yrs since last

90

Organisms in dog/cat bites

Pasteurella multocida

91

Organisms in human bites

Eikenella corrodens

92

What's worse dog/cat bites or human

Human

93

When is rabies vaccine given

Animal has altered MS
Attack was unprovoked by stray that cannot be observed

94

Management of any head trauma causing altered MS or LOC

Head CT first

95

Best initial test in head trauma

Head CT without contrast to look for blood

96

Difference between concussion and contusion

Normal CT in concussion
Ecchymoses in contusion

97

Can you differentiate between subdural/epidural hematomas and concussion without a CT

No

98

Which hematoma types have a lucid interval

Epidural
Subdural

99

Rx concussion

Nothing, wait 24hrs before returning to sports
Observe at home for changes in MS

100

Rx contusion

Nothing

101

Rx Subdural/epidural hematoma

Small - nothing
Large - Intubation, hyperventilation, mannitol, drainage

102

What is the benefit of hyperventilation in hematoma management

Decreases pCO2
Constricts vessels thereby decreasing pressure
Bridge to surgery

103

Definition of large intracranial hemorrhage

Compression
Herniation
Worsening MS or focal findings

104

Who gets PPX for stress ulcers

Head trauma
Burns
Intubated
Coagulopathy

105

Best initial therapy for anyone trapped in a fire

100% O2 for smoke inhalation and CO poisoning

106

Second most common cause of death from burns

Airway burn

107

When to intubate a pt caught in a fire

Stridor
Hoarseness
Wheezing
Burns inside mouth or nasopharynx

108

2nd MCC of death if no airway burn

Fluid loss

109

Burn fluid replaced with

Ringer lactate (NS if it's not there)

110

Body percentages in burns

Head - 9
Arms - 9 each
Legs - 18 each
Chest/back - 18 each
Hand - 1 each

111

How much fluid is given to burn pts

4mL*%body*kg
Biggest number in answer choices

112

Routinely given to burn pts

Topical abx for infection PPx

113

Risk factors for heat disorders

Exhaustion - Hot outside temperature, Exertion
Heatstroke - Hot outside temperature, Exertion
NMS - Antipsychotics
Malignant hyperthermia - Anesthetics

114

Difference between heat exhaustion and other heat disorders

Heat exhaustion has normal body temp, CPK, K

115

Rx heat exhaustion

Oral fluids and electrolytes

116

Rx heat stroke

IV fluids
Evaporation

117

Rx NMS

Dantrolene or DA agonists
Bromocriptine, cabergoline

118

Rx malignant hyperthermia

Dantrolene

119

When to suspect hypothermia

Intoxicated person with low body temp

120

MCC death in hypothermia

Cardiac arrhythmia

121

Best initial step in hypothermia

EKG

122

EKG in hypothermia

Elevation at J point

123

Management of drowning

Manage airway and administer positive pressure ventilation

124

What happens in salt water drowning

Acts like CHF with wet heavy lungs

125

What happens in fresh water drowning

Causes hemolysis

126

First step in potential cardiac arrest patient

Make sure they're unresponsive
Call 911, activate EMS

127

Next step after confirming cardiac arrest pt is unresponsive and EMS activated

Open airway
Rescue breaths
Check pulse and give compressions

128

When is precordial thump the answer

Very recent onset (

129

Cause of sudden loss of pulse

Asystole
V-fib
V-tach
Pulseless electrical activity (PEA)

130

What is the role of CPR

Keep pt alive until cardioversion

131

Best initial management of all forms of pulselessness

CPR

132

Therapy for asystole

CPR
Epi

133

MCC sudden death

V-fib

134

Best initial therapy for V-fib

Unsynchronized cardioversion then resume CPR

135

What is unsynchronized cardioversion

Defibrillation

136

Which cardioversions do not have to be synchronized

V-fib
Pulseless V-tach

137

Complete management of V-fib

Shock
Shock
Epi/vasopressin every 3-5min
Shock
Amiodarone
Shock

138

First choice medication for V-fib

Amiodarone

139

Management of pulseless V-tach

Same as V-fib

140

Management of stable V-tach

Amiodarone then lidocaine then procainamide
Cardiovert if fails

141

Management of unstable V-tach

Cardiovert several time then meds

142

Features of V-tach

Rate 160-240
QRS all look identical

143

Definition of hemodynamic instability

CP
SOB
Hypotension
Confusion

144

What is pulseless electrical activity

Heart electrically normal but no motor contraction
Normal EKG, no pulse

145

Causes of PEA

Tamponade
Tension PTX
Hypovolemia, hypoglycemia
Massive PE
Hypoxia, hypothermia, metab acid
K disorders

146

Rx pulseless electrical activity

Fluids
Correct underlying cause

147

Sx atrial arrhythmias

Palpitations, dizziness, lightheadedness
Exercise intolerance or dyspnea
Embolic stroke

148

Irregularly irregular heartbeat

A-fib

149

MC arrhythmia in USA

A-fib

150

Difference between flutter and fibrillation

Flutter is regular, goes back to sinus or deteriorates to fib

151

Rx unstable atrial arrhythmias

Synchronized cardioversion
- Prevents deterioration into v-tach or v-fi

152

Difference in cardioverting chronic vs acute a-fib

Chronic needs anticoagulation first

153

What is chronic a-fib

Lasting > 2 days

154

Best initial therapy for fib and flutter

Control rate with BBs, CCBs, or digoxin

155

Most appropriate next step in fib and flutter after rate control

Warfarin, digatraban or rivaroxaban

156

Only CCBs that can block the AV node in atrial arrhythmias

Diltiazem
Verapamil

157

What can atrial rhythm problems cause

Acute pulmonary edema

158

Pt w/ CHADS 1 or less management

Aspirin only

159

CHADS

CHF/Cardiomyopathy
HTN
Age >75
DM
Stroke or TIA (2pts)

160

What does CHADS indicate

What to anticoagulate with
1 or less = aspirin
2 or more = warfarin

161

Presentation of SVT

Palpitations in a pt who is hemodynamically stable

162

Best initial therapy of SVT

Vagal maneuvers
Adenosine
BBs, CCBs, digoxin

163

Cure for SVT

Radiofrequency catheter ablation

164

When to consider WPW

SVT alternating with V-tach
SVT getting worse after diltiaze, or digoxin
Delta wave on EKG

165

Most accurate test for WPW

EP studies

166

Acute therapy for WPW

Procainamide or amiodarone only if WPW currently presenting with arrhythmia

167

Chronic therapy for WPW

Radiofrequency ablation is curative

168

What is multifocal atrial tachy associated with

Chronic lung disease like COPD

169

Rx MAT

Treat underlying disease
Treat MAT like A-fib but no BBs

170

Next step in asymptomatic brady

EKG - differentiate from pathologic

171

Rx asymptomatic sinus brady

None

172

Best initial therapy for symptomatic brady

Atropine

173

Most effective therapy for symptomatic brady

Pacemaker

174

Management of first degree AV block

Same as sinus brady

175

Who gets Mobitz I

Sign of normal aging

176

Management of Mobitz I

No Rx if asymptomatic

177

Management of Mobitz II

Pacemaker, just like type III block

178

MCC death 72hrs surrounding acute MI

Ventricular arrhythmia

179

Test for recurrence of ventricular arrhythmia after MI

Echo

180

Pt with multiple syncopal episodes has v-tach, EKG shows v-tach, stress test NL, next step

Pacemaker

181

Best test for detecting source of ventricular arrhythmia

EP studies