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Flashcards in Emergency Care Deck (63):
1

Which type of snake bites do you have to worry about?

Pit vipers - triangle shaped head, elliptical eyes, pit between each eye and nostril

2

How do you treat snake bites?

Initially, immobilize body part and keep it above the level of the heart. Then can give antivenom if its a viper

3

Brown recluse bite

bite is painless, but pain at site 2-8 hours later, hemorrhagic blister with large ulceration. No antivenon

4

Black widow spider bite

Neurotoxic, muscle cramps, abdominal pain, chest tightness, hypertension, Supportive care with pain meds and benzos, antivenim for severe cases

5

first degree burns

superficial, red, blanches with pressure, dry minor swelling and pain, resolve in 5-7 days

6

Second-degree burns

partial thickness - red, wet, very painful often with blisters or blebs. The tissue underneath is stillw ell perfused, may take 2-5 weeks to heal

7

third-degree burns

dry leathery, waxy, no pain, require grafting

8

How to measure burn surface for >14yo

Rule of 9s, palm rule for

9

When do you need IVFs for burns?

When >15% BSA

10

Which toxic substances cross the placenta easily?

lead, mercury (enhanced by placenta), insecticides

11

For which substances is activated charcoal a poor choice?

alcohol, lithium, cyanide, heavy metals

12

When should coins be removed?

When they have not passed through the stomach within 24 hours, even if the child is asymptomatic. All coins in the proximal esophagus should be removed. If in the mid - lower esophagus can observe for 12-24 hours

13

Which coins do you worry about if swallowed

pennies made before 1982 because they have zinc in them which is corrosive to the esophagus - patient needs endoscopy quickly

14

What is the most important predictor of outcome regarding acetaminophen toxicity?

the 4 hour post ingestion level - if >150 = moderate hepatotox, if >300 = severe toxicity

15

What is management of tylenol ingestion?

1) activated charcoal 2) 4 hour level and plot on nomogram, 3.) If within 8 hours of ingestion give NAC

16

For what amount of acetaminophen should NAC be given empirically without waiting for a level?

>150mg/kg

17

When do transaminases rise in tylenol toxicity?

3-4 days out

18

Management of salicylate toxicity

activated charcoal, salicylate level, sodium bicarb to alkalinize the urine

19

depressed mentation, constricted pupils, profuse sweating, tearing, abdominal pain, wheezing and respiratory distress

organophosphate toxicity

20

anasarca, asymmetric pupils, agitated and violent

PCP ingestion

21

What is the MOA of organophosphates?

Inhibits acetylcholinesterase therefore the effect is due to AcH overload - both muscurinic (pulmonary - bronchospasm and increased secretions - can give atropine) and nicotinic effects ( salivation, sweating, urination, diarrhea, emesis, miotic pupils,and cns depression - can give pralidoxime.)

22

When is the hyperbaric chamber indicated for CO toxicity?

pregnancy, acidosis, signs of cardic involvement, signs of neurologic involvement

23

How do cyanide poisoned patients present?

Similar to CO toxicity, but do not improve with 100% oxygen. Any smoke exposure can cause CN toxicity

24

treatment of cyanide toxicity

hydroxocobalamin, sodium thiosulfate or nitrate used previously

25

What dose of iron is toxic?

>40mg/kg of elemental iron. IF level of Iron is >500, need chelation

26

What can iron toxicity cause?

phase 1 : vague GI symptoms, pain, vomiting, phase 2: deceptive improvement 6-24 hours phase 3: metabolic acidosis, coagulopathy, CV collapse phase 4: GI strictures

27

Management of iron toxicity

Levels at 4 hours. If serum iron > 350, WBC > 15 or glc > 150 this is significant and need chelation. Should do KUB,

28

which substances decrease lead absorption.

Calcium, iron, and vitamin C reduce lead absorption, therefore diets rich in these nutrients should be encouraged for patients at risk for lead toxicity

29

Management of causic ingestions?

symptomatic - EGD immediately, asymptomatic, ok to observe for 6 hours

30

What kind of household substances are caustic?

toilet bowl cleaners, laundry detergents, stain and mildew removers, floor cleaners, oven cleaners, rust removers, phenol-based disinfectants, swimming pool products, and batteries

31

Most commonly reported form of abuse

neglect

32

the most commonly reported manifestation of physical abuse

soft tissue injury

33

The most commonly reported cause of death due to physical abuse

head injury

34

Which type of fractures are concerning for abuse?

posterior rib fractures, metaphyseal chip fractures, spiral fractures of the long bones (especially if too young to ambulate)

35

When does a soft callus of bone form?

7-14 days

36

oil of wintergreen

is ASA

37

Which systems dose salicylate toxicity affect?

CNS - tinnitus, vertigo, agitation, confusion, coma, Resp - tachypnea, respiratory alkalosis, ARDS, GI - abdominal pain, nausea, vomiting

38

What is Reye syndrome?

hepatitis and encephalitis associated with ingestion of large doses of ASA in the setting of a recent viral illness

39

What are the cardiac effects are TCAs

hypo or hypertension, tachycardia including VT, widened QRS, prolonged QT, rightward axis. *A tall R wave in avR is specific

40

When do you treat with sodium bicarb in TCA overdose?

When have ECG abnormalities. Titrate dose to QRS widening

41

symptoms of an anticholinergic syndrome

dry skin, low UOP, flushing, mydriasis, agitation, sz, hyperthermia

42

What is akathisia?

a subjective feeling of restlessness and impulse to move. Associated with antipsychotics

43

What is acute dystonic reaction and how do you treat?

wry (twisted) neck, protruding tongue or deviated gaze. Side effect of antipsychotics. Treat with benztropine or diphenhydramine.

44

Ibuprofen toxicity

If >400mg/kg can cause seizures and coma

45

What does cherry red skin suggest?

CO toxicity

46

How do patients with cyanide toxicity present?

Interferes with oxygen utilization by the mitochondria. Pts have histotry of smoke inhalation, shock and profound lactic acidosis. Or exposed to nitroprusside. A venous blood gas has high PaO2 suggests oxygen is not being extracted by tissues

47

Management of hydrocarbon exposure

Get CXR, may be normal and still need to be observed in ED. Need to externally decontaminate

48

treatment of methanol ingestion

sodium bicarb, fomepizole, folate enhances metabolism of formic acid, hemodialysis if severe

49

Management of organophosphate toxicity

decontaminate (can't only use latex gloves and mask (need full protective clothing)), give activated charcoal. Atropine, pralidoxime. Symptoms persist for weeks without treatment.

50

What are the effects of foxglove, lily of the valley, oleander?

digitalis effect

51

What are the effects of jimson weed, deadly nightshade?

atropine effects (anticholinergic)

52

What are the effects of pear and apple seeds, peach pit, bitter almond?

cyanide like

53

What are the effects of pilodendron and dieffenbachia?

oral pain

54

What are the effects of poinsettia, mistletoe, holly

mild GI upset

55

Which substances are particularly important to decontaminate topically?

corrosives and organophosphates

56

Amanita mushroom has what effect?

anticholinergic

57

Which alcohol causes gastritis?

isopropyl

58

Which alcohol causes pancreatitis?

methanol

59

vertical nystagmus, hallucinations, psychosis

PCP

60

Altered perception, seeing smells and hearing colors, tachycardia, dilated pupils

LSD

61

Antidote for CCB ingestion

calcium chloride

62

What age is skeletal survey the most helpful for?

<3yo

63

For which ingestion is it important to avoid epinephrine?

Hydrocarbon ingestion as can induce ventricular fibrillation