EM Flashcards by Mike Baird

What are almost never used in ingestions?

Ipecac (only used at home)
Cathartics (speeding up GI transit time doesn’t help)
Diuretics (can cause pulmonary edema)
Whole bowl irrigation (only for iron/lithium/drug smuggling)

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What are the 2 most common and thus the “When in doubt” answers for overdose?

APAP

ASA

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What is the best initial treatment for AMS of unknown etiology?

opiate antagonist and glucose (opiates/DM are very common)

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What is the NOT treatment for benzo overdose?

NOT flumazenil because it can cause seizures in acute withdrawal

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Which overdose patients get charcoal?

All of them (it is benign)

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What are the toxic levels of APAP?
How do you treat APAP OD? >24 hours?
How do you measure APAP ingestion?
Does charcoal inactivate APAP?

8-10g (10-15g is fatal)
N acetylcysteine –> nothing
Drug level
No

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What are the keys to diagnosing ASA overdose?

How do you treat it?

Tinnitus, RespAlk, MetAcid (from lactate)

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What % is gastric lavage useful?

50% at 1 hour, 15% at 2 hours

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What is the danger of using Flumazenil on a patient who you suspect had a TCA OD?
What is the initial test for this patient?

BZs prevent seizures in these patients

EKG (wide QRS)

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What are the signs of a TCA OD?

How is it treated?

Dry mouth/constipation/urinary retention

NaHCO3 (protects the heart from arrhythmia but does not increase urinary excretion like in ASA)

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What do you give and what do you not give in caustic OD?

Give fluids

Do not give opposite caustics

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What is the most common cause of death in fires?

CO poisoning

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What are the pH and pO2 in CO poisoning?

Acidic (lactic acidosis)

Normal (does not detach from Hb)

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What is the best initial treatment for CO poison?

How do you treat severe CO poison?

100% O2

Hyperbaric O2

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Which drugs can cause methemoglobinemia?

Anesthetics (benzocaine)
Nitrates
Dapsone

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What color is the blood in methemoglobinemia

Brown

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Cyanosis + normal pO2 = ?

Treatment?

Methemoglobinemia

Methylene blue

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What do organophosphates/nerve gas cause, how are they absorbed, and how are they treated?

ACh increase (wet)
Skin
Pralidoxime (AChE inactivator) + Atropine (blocks ACh effects)

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What predisposes to Digoxin toxicity and why?

HypoK

K and Dig compete for same site on Na/KATPase (less K bound=more Dig bound)

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What are the Sx of Digoxin toxicity?
What are the tests for Dig toxicity?
How do you treat?

HyperK + yellow halos + rhythm disturbance
Initial: K+ level + EKG (any arrhythmia)
Accurate: digoxin level
Treat: dAb + K

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What are the initial and accurate lead poisoning tests?

Initial: free erythrocyte protoporphyrin
Accurate: lead level (sideroblastic anemia seen on Prussian Blue stain)

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How do you treat lead poison orally or parenterally?

Oral: Succimer
Parenteral: EDTA, Dimercaprol

What are the 2 types of Mercury poisoning and how do you reverse each of them?

Neuro: nervous/jittery/hallucinate –> Dimercaprol/Succimer
Lung: interstitial fibrosis –> nothing

What are the similarities of Methanol and ethylene glycol poisoning?

AG MetAcid
Osmolar Gap
Tx: fomepizole + dialysis

Differences in methanol and ethylene glycol?

Metabolites: formaldehyde vs oxalate Presentation: ocular toxicity vs renal toxicity Initial dx: retinal inflammation vs oxalate crystals/low Ca

What is the Osmolar Gap?

Difference in measured and calculated serum osmolalality | Serum=2*Na + BUN/2.8 + Glucose/18

Name 3 beneficial treatments of snake bites

Pressure Immobilization Antivenom

What medication is given for dog/cat/human bites?

Amox + Clavulanic Acid

What lab value is abnormal in a black widow bite

Low Ca

What is the best initial test for detecting a head bleed

NonCon CT

How do you manage a large hematoma in the brain?

Intubate/hyperventilate (decreases pCO2) Mannitol (decrease intravascular volume) Drainage

What is stress ulcer prophylaxis and who gets it?

PPI | Head trauma > Burns = ET intubation > Coagulopathy w/respiratory failure

What is the most common causes of death in burns? | What is the initial burn treatment?

smoke inhalation/CO poison > volume loss | 100% O2

What fluid do you give burn victims and how do you calculate?

Ringers (NS 2nd choice) | 4mL x %burned x Kg body weight --> 1/2 1st 8 hrs, 1/4 next 8

What is the most common cause of death for burn victims several weeks later? How do you prevent this?

``` Infection Topical Abx (silver sulfadiazine) ```

What is the most common cause of death from hypothermia? | First initial step in hypothermia?

``` Cardiac arrhythmia (J point elevation) EKG ```

What is different in salt vs fresh water drowning?

Salt: acts like CHF with wet heavy lungs Fresh: hypotonic causes hemolysis

What is the treatment for Asystole

CPR + Epi (or Vasopressin)

Which rhythms are shockable with unsynchronized cardioversion? What is the role of medications (E/pressors)?

VF + VT without a pulse | Make defibrillation more likely to succeed

What other medications can be given if E/vasopressin do not help?

Amiodarone > Lidocaine

How is VTach managed?

Entirely based on hemodynamics Pulse less: same as VF Hemodynamically stable: Amiodarone > Lidocaine > Procainamide > Cardioversion Unstable: cardioversion frequently >>> meds

What are the qualities of hemodynamic instability?

Chest pain Dyspnea/CHF HypoTN Confusion

How do you diagnose PEA with EKG

Normal EKG but no pulse

Which afib patients receive anticoagulation and which do not?

Chronic afib does, acute does not

Therapy for Afib/Flutter

1) rate control (Beta blockers/Ca2+/Dig) to

What is the definition of major bleeding from Warfarin?

intracranial hemorrhage | Requires a transfusion

How do you calculate a CHADS score? | What score is treated with ASA only?

CHF/Cardiomegaly, HTN, Age>75, DM, Stroke/TIA (2pts) | 1

What are the initial treatments for SVT?

Vogal maneuvers > Adenosine > BBlock/Ca2+/Dig

What are 3 reasons that WPW would be the most likely dx?

SVT alternating with VTach SVT gets worse after Diltiazem or Dig Delta wave

What is the most accurate test for WPW? What is the acute tx? Chronic tx? Dangerous drugs?

Electrophysiology studies (EP) Procainamide = Amiodarone RF ablation Dig/Ca2+ blockers

What is multimodal atrial tachy associated with and what should you avoid?

chronic lung disease (COPD) | Beta blockers

What is the next step in a patient who develops an arrhythmia

Angiography for angioplasty or bypass

What test is used to determine the risk of recurrence for a ventricular arrhythmia?

Echo

When are EP studies useful?

To detect the source of a ventricular arrhythmia