Emergency Flashcards

Question

**What are the steps in managing acetaminophen toxicity** ⁉️

Answer 1

🔹 **ABC stabilization** 🕐 **Activated charcoal** (within 1 hour) 🧪 Check: **ALT, AST, PT, bilirubin** 🧪 Measure **4-hour level** 💊 **Start NAC** if indicated

Answer 2

💊 **N-acetylcysteine (NAC)** • Oral: 140 mg/kg loading ➕ 70 mg/kg q4h ×17 doses • Total: 72 hours

Answer 3

👏 **C. Within 8 hours of ingestion**

Answer 4

👂 **Tinnitus** (early clue) 🤢 **Nausea, vomiting** 🌬️ **Hyperventilation** → leads to **respiratory alkalosis** 🧪 Later: **metabolic acidosis** 🔥 **Hyperthermia, seizures, coma**

Answer 5

👏 **B. Respiratory alkalosis**

Answer 6

⚠️ **200 mg/kg** → toxic ⚠️ **300 mg/kg** → significant toxicity ⛔ **>500 mg/kg** → potentially fatal

Answer 7

👏 **D. 500 mg/kg**

Answer 8

🛑 **ABCs stabilization** 🕐 **Activated charcoal** (if early) 💧 **Volume resuscitation** 🧪 **Urinary alkalinization** using **sodium bicarbonate** 🎯 Goal: keep **urine pH > 7.5**

Answer 9

👏 **D. To increase renal excretion of salicylates**

Answer 10

🧠 **Delirium, agitation** 👅 **Dry mouth, urinary retention** 🔥 **Hyperthermia** 💓 **Tachycardia, hypotension** ⚠️ **Seizures, cardiac arrhythmias**

Answer 11

👏 **C. Tricyclic antidepressants**

Answer 12

📈 **QRS duration > 100 ms** ⚡ May lead to **ventricular dysrhythmias**

Answer 13

👏 **C. Ventricular arrhythmias**

Answer 14

💊 **Sodium bicarbonate** is indicated if: • QRS duration **>100 ms** • **Ventricular dysrhythmias** • **Hypotension**

Answer 15

🛑 **Airway, Breathing, Circulation (ABC)** 🩺 **ECG monitoring** 🕐 **Activated charcoal** (if early) 💉 **Sodium bicarbonate** if indicated

Answer 16

🔥 **Oral pain, drooling, vomiting** 🍽️ **Difficulty or refusal to swallow** 📉 **Stridor, respiratory distress** ⚠️ **Abdominal pain** if gastric involvement

Answer 17

👏 **C. Drooling and refusal to swallow**

Answer 18

⚠️ **Acids → Coagulation necrosis →** mainly **gastric injury** ⚠️ **Alkalis → Liquefaction necrosis →** deeper injury to **mouth & esophagus**

Answer 19

👏 B. Alkali

Answer 20

❌ **Do NOT induce emesis or perform gastric lavage** 🕒 **Endoscopy** within **12–24 hours** if symptomatic 🔁 **Repeated dilation** or **surgical correction** may be needed for strictures

Answer 21

👏 **C. Gastric lavage**

Answer 22

💩 **D** – Diarrhea 🚽 **U** – Urination 👁 **M** – Miosis 💓 **B** – Bradycardia 🌬 **B** – Bronchospasm 🤮 **E** – Emesis 😢 **L** – Lacrimation 😴 **L** – Lethargy 💧 **S** – Salivation (plus seizures)

Answer 23

👏 **C. Organophosphate poisoning**

Answer 24

🛑 **ABC support** 🧼 **Remove contaminated clothing and wash skin thoroughly** 💧 Replace fluids and electrolytes 💉 Antidotes: • **Atropine** (for secretions & bradycardia) • **Pralidoxime** (reactivates acetylcholinesterase)

Answer 25

👏 **B. Reduces secretions and treats bradycardia**

Answer 26

👏 **C. Reactivates acetylcholinesterase**

Answer 27

🛢️ **Gasoline, kerosene, motor oil, mineral spirits** 🧴 **Turpentine, toluene, solvents, benzene** 🧪 Also found in **glue, rubber cement, spot removers**

Answer 28

🌬️ **Cough, dyspnea, wheezing** ⚠️ Risk of **chemical pneumonitis** 💓 May cause **arrhythmias** → sudden death 🧠 CNS depression, seizures in severe cases

Answer 29

👏 **B. Chemical pneumonitis**

Answer 30

🛑 **ABC support only** ❌ **Do NOT** induce vomiting ❌ **No gastric lavage** ❌ **No activated charcoal** ⏱️ If asymptomatic: **observe for 4–6 hours** in the ER

Answer 31

👏 **D. Observe for 4–6 hours in the ER**

Answer 32

🧠 **Coma, hypoglycemia, hypothermia** 🧪 **High anion gap metabolic acidosis** 💉 Requires **urgent correction of acid-base & electrolyte status**

Answer 33

👏 **D. High anion gap metabolic acidosis**

Answer 34

👁️ **Visual disturbances → blindness**

Answer 35

🧪 **Hypocalcemia** 🧊 **Renal failure** due to **calcium oxalate crystal deposition**

Answer 36

👏 **D. Methanol**

Answer 37

💊 **Fomepizole** (first-line) 🍷 **Ethanol** if fomepizole is not available 💧 Also give **IV fluids, bicarbonate, glucose** as needed

Answer 38

👏 **C. Fomepizole**

Answer 39

🧠 Mild: **Headache, malaise, nausea** ⚠️ Moderate: **Confusion, ataxia, syncope, tachycardia, tachypnea** 🚨 Severe: **Coma, seizures, acidosis, myocardial ischemia, CV collapse**

Answer 40

👏 **C. Headache and nausea**

Answer 41

🧪 **Arterial blood gas (ABG)** with COHb level 🩸 Check **creatine kinase** in severe cases (muscle damage) 🫀 **ECG** if any cardiac symptoms

Answer 42

👏 **B. Carboxyhemoglobin level**

Answer 43

💨 **100% oxygen** via non-rebreather mask until: • COHb < 10% • Symptoms resolve ⛑️ **Hyperbaric oxygen** if: • **COHb > 25%** • **Significant CNS symptoms** • **Cardiac dysfunction**

Answer 44

👏 **C. Enhances CO elimination from hemoglobin**

Answer 45

🤢 **Nausea, vomiting, abdominal pain** 💉 **Hematemesis, metabolic acidosis** 🫀 May progress to **liver failure** ⚠️ Chronic effect: **GI scarring** , possible obstruction

Answer 46

👏 **C. Vomiting and hematemesis**

Answer 47

🩻 **Abdominal X-ray** (radiopaque tablets) 🩸 **Serum iron level > 500 mcg/dL** = toxic threshold

Answer 48

👏 **B. >500 mcg/dL**

Answer 49

🛑 **No activated charcoal** (iron is not adsorbed) 💉 **IV deferoxamine** if iron >500 mcg/dL or severe symptoms 🩺 Supportive care for GI and liver complications

Answer 50

👏 **B. Deferoxamine**

Answer 51

🟤 **Battle sign** (retroauricular ecchymosis) 🐼 **Raccoon eyes** (periorbital ecchymosis) 💧 **CSF otorrhea & rhinorrhea**

Answer 52

👏 **B. CSF rhinorrhea**

Answer 53

🚨 **Cranial Nerve III compression** ➡️ Sign of **uncal herniation**

Answer 54

⚠️ **Pinpoint pupils**

Answer 55

🔘 **Mid-position, non-reactive pupils**

Answer 56

👏 **B. Uncal herniation compressing CN III**

Answer 57

🧠 **GCS < 15** 🌀 **Amnesia, loss of consciousness > 5 mins** 🤢 **>1 episode of vomiting** 📉 **Progressive headache** 🔍 **Anisocoria, seizures, basilar skull fracture signs** 🔪 **Penetrating injury, multiple trauma instability**

Answer 58

👏 **A. One-time mild headache**

Answer 59

🚨 **Multiple injuries of different ages** 🚨 **Inconsistent or changing history** 🚨 **Injuries in non-ambulatory children** 🚨 **Delay in seeking care** 🚨 **Pathognomonic injury patterns**

Answer 60

👏 **B. Posterior rib fractures and retinal hemorrhage in an infant**

Answer 61

🔥 **Cigarette burns** 🦴 **Rib fractures** (esp. posterior) 🧠 **Subdural hemorrhage** 👁️ **Retinal hemorrhage** 🩸 **Human bite marks, loop-shaped bruises** 🚿 **Immersion burns** (buttocks, soles, genitals)

Answer 62

👏 **C. Burns on the soles of the feet with sharp demarcation**

Answer 63

👀 **Avoids eye contact** 🧍 **Withdraws from physical touch** ⚠️ **Inappropriate response to pain** (too little or exaggerated) 🧒 May **protect the abuser** due to fear

Answer 64

🧠 **Brain CT** → for intracranial hemorrhage 👁️ **Dilated fundus exam** → check for **retinal hemorrhages** 🦴 **Skeletal survey** → screen for fractures at different healing stages

Answer 65

💊 **Amoxicillin-Clavulanate** (Augmentin) – covers **Staphylococcus, Pasteurella, Eikenella**

Answer 66

💉 **Ampicillin-Sulbactam**

Answer 67

👏 **B. Amoxicillin-Clavulanate**

Answer 68

💊 **Clindamycin + Trimethoprim/Sulfamethoxazole (TMP-SMX)**

Answer 69

👏 **C. Clindamycin + TMP-SMX**

Answer 70

🦠 **Rabies virus** – especially with unprovoked bites by stray or wild animals

Answer 71

🔺 **Diamond-shaped head** → likely **venomous** ⭕ **Oval-shaped head** → likely **non-venomous**

Answer 72

👏 **C. Diamond-shaped head**

Answer 73

🛑 **ABC stabilization** 💍 Remove **jewelry or tight clothing** 🦵 **Immobilize the limb** ❌ Do **not** incise, manipulate, or suction the wound 🏥 Most envenomated patients require **admission** (often PICU)

Answer 74

👏 **C. Oral suction of the wound**

Answer 75

🚨 **Severe swelling or pressure > 30–40 mmHg** 🔪 May require **fasciotomy**

Answer 76

🧪 CBC, CMP, **PT, PTT, INR, fibrinogen** , D-dimers 🔬 Peripheral smear, UA 🩸 Blood typing 🩻 CXR and X-ray to rule out **retained fang or foreign body**

Answer 77

💉 **FabAV (antigen-binding fragment antivenom)**

Answer 78

⏱️ **Seizures lasting ≥ 30 min or recurrent seizures without regaining consciousness**

Answer 79

🔴 **ABC** 💨 Administer **100% oxygen** 🧪 Check **glucose** , obtain **IV access** 🧫 Send labs: **CBC, CMP, tox screen, AED levels** 💧 Start **IV fluids**

Answer 80

💉 **IV Lorazepam** 0.05–0.1 mg/kg ↩️ Repeat once if needed ⚠️ If no IV: use **rectal diazepam** or **buccal midazolam**

Answer 81

💉 **Fosphenytoin** 20 mg/kg IV (or phenytoin)

Answer 82

💉 **Phenobarbital** , then 💊 **Midazolam drip** or **Pentobarbital drip** 🛏️ Admit to ICU & begin **continuous EEG**

Answer 83

🚩 **0 min** : ABC, oxygen, glucose 🚩 **5 min** : **Lorazepam** IV/IO 🚩 **15 min** : **Fosphenytoin** or **phenytoin** 🚩 **25 min** : **Phenobarbital** if seizures persist 🚩 **45 min** : **Anesthesia** (thiopental/RSI) for refractory cases

Answer 84

👏 **B. Administer rectal diazepam**

Answer 85

👏 **B. Start fosphenytoin 20 mg/kg IV**

Answer 86

⚠️ **Tachycardia, hypotension, altered mental status** ❄️ **Cold, mottled skin, poor perfusion, delayed cap refill** 🧠 **Confusion, restlessness, lethargy, oliguria**

Answer 87

🍼 **Term neonates (0–28 days)** : SBP < 60 mmHg 👶 **Infants (1–12 months)** : SBP < 70 mmHg 👧🏼 **Children (1–10 years)** : SBP < 70 + (age × 2) mmHg 👦🏼 **>10 years**: SBP < 90 mmHg

Answer 88

👏 **B. <80 mmHg [70 + (5×2)]**

Answer 89

📍 **Position (Trendelenburg if needed)** 💨 **Oxygen** 💉 **IV access + fluid bolus (20 mL/kg crystalloid)** 💊 Consider **PRBC** if not improving after 2–3 boluses ⚠️ **Use less fluid in cardiogenic shock** 🩺 Add **vasopressors** if refractory

Answer 90

1️⃣ **Cardiogenic** – heart pump failure 2️⃣ **Hypovolemic** – fluid/blood loss 3️⃣ **Septic** – infection/sepsis 4️⃣ **Anaphylactic** – allergic reaction 5️⃣ **Neurogenic** – CNS injury

Answer 91

👏 **C. Neurogenic shock**

Answer 92

🔥 **Warm (septic) shock → Norepinephrine + antibiotics** 🟰 **Normotensive shock → Dopamine** ⬇️ **Hypotensive shock → Epinephrine** 💥 **Adrenal insufficiency → Hydrocortisone** ⚡ **Anaphylactic shock → Epinephrine, diphenhydramine, steroids, H2 blockers**

Answer 93

👏 **C. Norepinephrine + antibiotics**

Answer 94

🚨 Sudden **coughing, choking, wheezing** , or **stridor** ⚠️ **Unilateral decreased breath sounds** 🗣️ Voice changes, cyanosis, or difficulty speaking

Answer 95

👏 **C. Foreign body aspiration**

Answer 96

🗣️ **Encourage coughing** 👀 **Observe closely for deterioration**

Answer 97

🚼 **Infant (<1 yr)** : • 5 **back blows** • 5 **chest thrusts** 🚸 **Child (>1 yr)** : • 5 **back blows** • 5 **abdominal thrusts (Heimlich maneuver)**

Answer 98

👏 **C. Abdominal thrusts**

Answer 99

1️⃣ Open airway 2️⃣ Give **5 rescue breaths** 3️⃣ If ineffective → **Start CPR** 💡 Check airway between cycles for visible obstruction

Answer 100

👏 **C. Open airway and give 5 breaths**

Answer 101

🧠 **Eye Opening (E)** → 4 🗣️ **Verbal Response (V)** → 5 ✋ **Motor Response (M)** → 6 ✅ **Total Max Score** = 15 ⛔ **Min Score** = 3

Answer 102

✅ **Mild** : 13–15 ⚠️ **Moderate** : 9–12 🚨 **Severe** : ≤8 ➡️ **Intubation indicated**

Answer 103

🧠 **Decorticate (flexion)** → lesion **above red nucleus** 🧠 **Decerebrate (extension)** → lesion **below red nucleus**

Answer 104

👏 **C. 1** ## footnote ➡️ **E2 + V1 + M5 = GCS 8**

Answer 105

📏 **(Age in years ÷ 4) + 3** ✅ Example: 8 years ➡️ (8 ÷ 4) + 3 = **5 mm** tube

Answer 106

📏 **(Age in years ÷ 4) + 4** ✅ Example: 8 years ➡️ (8 ÷ 4) + 4 = **6 mm** tube

Answer 107

👏 **C. 4.0 mm** ➡️ (4 ÷ 4) + 3 = 4 mm

Answer 108

📏 **ETT tube size × 3** ✅ Example: 4 mm tube ➡️ **4 × 3 = 12 cm**

Answer 109

👏 **B. 15 cm**

Answer 110

👶 **Infants** : ≥ **220 bpm** 🧒 **Children**: ≥ **180 bpm** 💓 **Narrow QRS, no visible P waves, sudden onset, regular rhythm**

Answer 111

🩸 **4 H’s** : 1️⃣ Hypovolemia 2️⃣ Hypoxemia 3️⃣ Hypothermia 4️⃣ Hypo/hyperkalemia 💥 **4 T’s** : 1️⃣ Tension pneumothorax 2️⃣ Tamponade (cardiac) 3️⃣ Toxins 4️⃣ Thromboembolism

Answer 112

1️⃣ **Vagal maneuvers** (e.g., ice pack to face, Valsalva) 2️⃣ 💉 **Adenosine 0.1 mg/kg IV push** (max 6 mg) 3️⃣ If ineffective: **Adenosine 0.2 mg/kg** (max 12 mg)

Answer 113

⚡ **Synchronized cardioversion** 💥 Start at **0.5–1 J/kg** , may increase to **2 J/kg**

Answer 114

👏 **C. Try vagal maneuvers first**

Answer 115

👏 **B. Give 0.2 mg/kg IV push (max 12 mg)**

Answer 116

🧠 Key Features: ✅ **Abrupt onset, no rate variability** ✅ **No P waves, narrow QRS** 📈 **HR >220 bpm** in infants 📈 **HR >180 bpm** in children

Answer 117

🔹 **Regular narrow complex tachycardia** 🔹 **No visible P waves** 🔹 **Sudden rate change** , not responsive to activity or crying

Answer 118

👏 **C. Vagal maneuvers (e.g., ice pack)**

Answer 119

💉 **Adenosine 0.1 mg/kg IV push** (max 6 mg) ➡️ If not effective: **0.2 mg/kg** (max 12 mg), followed by flush 💡 **Always attach pads & monitoring first**

Answer 120

❄️ **Ice pack to the face (infants)** 🎈 **Blow into a syringe (older kids)** 🚫 Avoid covering the mouth or nose

Answer 121

🚨 **Signs of shock** : hypotension, poor perfusion, altered LOC 🚨 **Signs of heart failure** : hepatomegaly, crackles, edema

Answer 122

⚡ **Synchronized cardioversion** 🔹 **Start at 0.5–1 J/kg** , increase to **2 J/kg** if needed 💤 **Sedation required** if time allows and child is conscious

Answer 123

💉 Fentanyl: **1 mcg/kg IV** 💉 Midazolam: **0.05–0.1 mg/kg IV** 💉 Etomidate: **0.1–0.2 mg/kg IV** 💉 Ketamine: **1 mg/kg IV** (⚠️ Relative CI: <12 months) 💉 Propofol: **1 mg/kg IV**

Answer 124

✅ Wide QRS complex ✅ Monomorphic rhythm ✅ Very high rate (often >200 bpm) 🧠 “Regular wide complex tachycardia = VT until proven otherwise”

Answer 125

🔹 Try **adenosine** if rhythm is regular and monomorphic 🔹 If not effective ➡️ use **amiodarone** or **procainamide** ## footnote 💊 Amiodarone or procainamide are **not to be given together**

Answer 126

⚡ **Synchronized cardioversion** ➡️ Initial dose: **0.5–1 J/kg** ➡️ If ineffective: **increase to 2 J/kg**

Answer 127

💉 **IV Magnesium sulfate 25–50 mg/kg** (max 2 g) ➡️ If unstable: **defibrillation starting at 2 J/kg** , increase to 4 J/kg if needed 🌀 ECG: oscillating amplitudes

Answer 128

👏 **B. Adenosine**

Answer 129

👏 **B. 0.5–1 J/kg, then 2 J/kg if needed**

Answer 130

🔹 **PR interval > 200 ms** (or > 95th percentile for age/HR) 🔹 Every P wave is followed by a QRS 🧠 Often asymptomatic

Answer 131

🔁 Progressive **PR interval prolongation** ➡️ Then **dropped QRS** 🧠 Usually benign and may occur with sleep or vagal tone

Answer 132

➡️ **Constant PR interval** 🚫 Periodically **dropped QRS** ## footnote 🚨 More dangerous – may progress to complete heart block

Answer 133

❌ No relationship between P waves & QRS complexes ➡️ **Atria and ventricles beat independently** 🔁 Regular but separate rhythms

Answer 134

👏 **C. Third-degree AV block**

Answer 135

🔹 ✅ **Observation** only 🔹 Often benign and asymptomatic ## footnote 🧠 No pacing or meds needed unless symptomatic

Answer 136

🚨 **Transcutaneous or transvenous pacing** ⚠️ **Atropine** can be used for Mobitz II ⛔ **Avoid atropine** in complete heart block—it may worsen the block ✅ **Permanent pacemaker** often required

Answer 137

👏 **D. Permanent pacemaker**

Answer 138

🚩 **Shout for help + Activate emergency response** 🚨 **Start CPR immediately** 💨 **Give oxygen** 📉 **Attach monitor/defibrillator**

Answer 139

✅ **Ventricular fibrillation (VF)** ✅ **Pulseless ventricular tachycardia (pVT)** ⛔ **Asystole & pulseless electrical activity (PEA) are non-shockable**

Answer 140

➡️ 1st shock: **2 J/kg** ➡️ 2nd shock: **4 J/kg** ➡️ Subsequent: **≥4 J/kg, max 10 J/kg** or adult dose

Answer 141

💉 **Epinephrine** : 0.01 mg/kg IV/IO every 3–5 min 💉 **Amiodarone** : 5 mg/kg IV/IO bolus for refractory VF/pVT (repeat x2)

Answer 142

🔁 **CPR for 2 min** 💉 **Epinephrine q3–5 min** 🛑 **No shocks** 🔍 **Search for reversible causes (H’s & T’s)**

Answer 143

🔹 H’s: • Hypovolemia • Hypoxia • Hydrogen ion (acidosis) • Hypo-/Hyperkalemia • Hypothermia 🔻 🔹 T’s: • Tension pneumothorax • Tamponade • Toxins • Thrombosis (coronary/pulmonary)

Answer 144

👏 **B. Perform CPR for 2 minutes**

Answer 145

✅ **IV Calcium Gluconate** 🚨 **Stabilizes myocardial cell membranes** 💉 Dose: **10 mL of 10% Ca gluconate IV over 10 min** ## footnote 🧠 This is the **priority step before shifting or removing potassium**

Answer 146

👏 **B. IV Calcium Gluconate**

Answer 147

و إلى هنا تنتهي مسيرتنا لهذه المادّة 👑 إن كان هناك أي خطأ فذلك من جهلنا وسبحان من علّم الإنسان ما لم يعلم ! سبحانك اللهمّ وبحمدك نشهدُ أن لا إله إلَّا أنت نستغفرلك ونتوب إليك 🔻

Emergency Flashcards

(173 cards)