EM/Toxicology

Question 1

Treatment of subdural and epidural hematoma

Answer 1

subdural = crescent
epidural = lens
both:
1. intubation + HYPERVENTILATION
2. Mannitol
3. Mannitol

Question 2

When can you do a percordial thump?

Answer 2

1. <10 min aka you saw them drop
2. no pulse
3. no AED around

Question 3

what is the CHADS2 score?

Answer 3

criteria to give anticoags for A-fib

CHF, HTN, Age>75, DM, Stroke/TIA , 2+ gets anticoag w/goal INR 2-3

Question 4

In the case of toxicology when do you do “gastric emptying/gastric lavage”?

Answer 4

only if within 1hr after overdose & OD was not with acids or bases

Question 5

In the case of toxicology when do you do “whole bowel irrigation”?

Answer 5

iron ingestion, lithium, drug filled packets(butt cocaine)

Question 6

In the case of toxicology when do you do give “naloxone, thiamine & dextrose”?

Answer 6

anytime there is acute mental status changes of unclear etiology = naloxone wont hurt anyone so give this first

Question 7

In the case of toxicology when do you do give “charcoal”?

Answer 7

most cases. this wont hurt anyone

Question 8

1 cause of OD in the USA? whats #2?

Answer 8

Acetaminophen, #2 is ASA

Question 9

SX of Acetaminophen tox?

Answer 9

first 24hrs = nausea and vomiting

>24 hrs(48-72) = hepatic failure

Question 10

Antidote for Acetaminophen

when do you give this?

Answer 10

N-Acetylcysteine = give to ANY patient with acetaminophen OD before you check levels; only give if within 24 h

Question 11

Toxic acetaminophhen levels? deadly?

Answer 11

10g = toxic; 15g = deadly

Question 12

Antidote for ASA

Answer 12

Bicarbonate to alkalinize the urine

Question 13

Antidote for Benzodiazepines

when do you give this?

Answer 13

Flumazenil = only give if you know for sure the person isnt a chronic user. if you give to a chornic user can get a seizure = better to just let them ride it out. benzos wont kill you

Question 14

Antidote for Carbon monoxide poisoning

Answer 14

100% O2, Hyperbaric o2 if severe

Question 15

Antidote for digoxin

Answer 15

digoxin-binding antibodies

Question 16

Antidote for Ethylene glycol

Answer 16

fomepizole or ethanol; same as methanol

Question 17

Antidote for methanol

Answer 17

fomepizole or ethanol; same as ethylene glycol

Question 18

Antidote for Methemoglobinemia

Answer 18

methylene blue

Question 19

Antidote for Neuroleptic Malignant Syndrome

Answer 19

bromocriptine, dantrolene

Question 20

Antidote for Opiates

Answer 20

naloxone

Question 21

SX of ASA poisoning? what labs would you see?

Answer 21

• this is a brain stimulant and a toxin to the lungs =
• metabolic acidosis = lactic acidosis from hypoxic metabolism
• respiratory alkalosis = hyperventilation
• renal insufficiency = anion gap
• elevated prothombin time
• CNS: confusion
• Fever
• Tinnitus***

normal pH, low PCO2(rep. alk), low HCO3(met acid)

Question 22

can you overdose on benzos and dies? why is this important when considering antidote?

Answer 22

nope! not fatal by itself so dnt give flumazenil for OD unless you kn`ow the person isnt a chronic user. if they are a chronic user it can precipitate seizures

Question 23

MCC of death in fires?

Answer 23

CO poisoning

Question 24

sx of CO poisoning?

Answer 24

**looks like anemia w/cherry red blood = blood unable to release O2 into tissue

• SOB, lightheadedness, HA, disorientation, metabolic acidosis(tissue hypoxia), fatigue
  tx: 100% O2

Question 25

Digoxin Tox sx? tx?

Answer 25

yellow "halos" around objects, arrhythmia w/downsloping of ST segments, Encephalopathy, Hyperkalemia tx: dig. antibodies

Question 26

Whats up with potassium and digoxin

Answer 26

K & Dig compete for the same spot on NaK. so Hypokalemia can trigger dig toxicity(recent use of lasix) but dig tox causes hyperkalemia

Question 27

Sx of Ethylene Glycol/Antifreeze poisoning

Answer 27

renal insufficiency = envelope shaped oxalate crystals, hypocalcemia, kidney stones, hypocalcemia, kidney stones

Question 28

sx of Methanol poisoning

Answer 28

* wood alcohol, cleaning solutions, pain thinner | sx: visual disturbances(ocular toxic = retinal inflammation), retinal hyperemia

Question 29

sx of Methemoglobinemia

Answer 29

* Hg locked into the oxidized state = cant pick up oxygen * like anemia but w/o oxygen - cyanosis, SOB, Dizziness, Confusion, HA, Seizures

Question 30

What should you look for in the history for methemoglobinemia?

Answer 30

hx of nitrate use, anethetics, dapson, or other oxidants or drugs that end with -caine

Question 31

tx of methemoglobinemia

Answer 31

100% O2 & Methylene blue

Question 32

Sx of Organophosphate/Nerve Gas

Answer 32

* blocks AChE so will have sx of increased ACh | - salivation, lacrimation, urination, diarrhea, wheezing from bronchospasm, constricted pupils

Question 33

tx of organophosphate/nerve gas

Answer 33

1. atropine 2. pralidoxime 3. remove clothes & wash the rest of hte patient

Question 34

sx of TCA overdose

Answer 34

Coma, Cardiac(arrhythmias = wide QRS), Convulsions(seizures) | + anticholinergic sx = dilated pupils, dry mouth, constipation, urinary retention

Question 35

tx of TCA overdose

Answer 35

NaHCO3 to protect the heart & give IVF to flush out

Question 36

Hypothermia sx? tx?

Answer 36

cardiac shit = this is what kills! | ***EKG = J-waves of Osborn***