Emergency Med Flashcards by Kelly Humble

Gram stain of strep pneumonia

Gram positive diplococci

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atropine use

Severe Bradycardia

MOI: Inhibits vagal response (stops PNS so SNS takes over with epi/norepi naturally)

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Black Widow bite characteristics

two fang marks
Systemic reaction= Latrodectism: Muscle spasm, tachycardia, N/V
tx: antivenom (can cause serum sickness, III hypersensitivity)

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Brown Recluse bite characteristics

Midwest and central US
local NECROTIC lesion
systemic reaction= Loxoscelism: hemolysis
tx corticosteroids, hydration, analgesics

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Coral snake features

red on black, venom lack
red on yellow, kill a fellow
if bite: neurologic sx, tremors, diplopia, fixed pupils
Tx. antivenin (No ice, tourniquet, suction, etc.)

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Lyme disease features

Borrelia burgdorfi
deer tick spread
flu like sx, fever, weakness, joint pain
Characteristic rash: erythema migrans, "bulls eye" rash
tx. doxy

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ITP

Usually after viral illness in kids
autoimmune disease
labs with thrombocytopenia, prolonged bleeding time, normal PT/PTT
Tx with prednisone if platelets

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Drugs that cause secondary ITP

Sulfonamides, Thiazides, Cimetidine (H2 blocker), Heparin (HIT)

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TTP diagnostic pentad

Hemolytic anemia (schistiocytes, elevated bili)
Low platelets
Fever
Neurologic manifestation (HA, confusion, seizure)
Renal manifestation (hematuria, proteinuria, increased BUN/Cr)

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HUS

more renal less neuro than TTP

precipitated by a diarrhea illness, especially E Coli

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Supplements needed for sickle cell patients

Folic acid (at 1 year age) and PCN V (at 2 months)

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Cushing reflex (triad) of head trauma (increased ICP)

progressive hypertension
bradycardia
decreases respiratory rate

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Diffuse axonal injury

deceleration methods transmit sheering forces diffusely

MOI of shaken baby syndrome

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Subdural vs epidural hematomia imaging

SDH: crescent shaped that crosses suture margins
EDH: lens shaped that does not cross sutures

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Treatment of cluster HA

100% oxygen

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1st line medication for actively seizing patient

Lorazapam (Ativan)

give thiamine before glucose if alcoholic

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Peripheral vertigo

Causes: BPPV, vestibular neuritis, herpes zoster, meniere’s, labyrinthitis, acoustic neuroma, OM
S/Sx: N/V, HORIZONTAL nystagmus, tinnitus, vision changes

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Central vertigo

Causes: Migraine, brainstem ischemia, CVA

S/Sx: Gait disturbance, Vertical nystagmus, NO tinnitus, no vision changes

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Myasthenic Crisis

severe enough bulbar weakness to produce dysphagia and aspiration that may lead to respiratory failure.
Patient has generalized weakness.
Tx intubation and IVIG

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***Where do 90% of nose bleeds arise?

Keisselbach’s plexus

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Peritonsillar abscess

Severe pain, “hot potato voice”, drooling, dysphagia, uvular deviates away
CT of neck
OR for I&D
start IV abx pcn, augmentin or clindamycin

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Ludwig’s angina

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Hx of recent dental procedure or poor dental hygeine
cellulitis of sub lingual area
pain, swelling, trismus, dysphagia, “bull’s neck”

Painless unilateral vision loss, suspect…

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CRAO

PE: pallor of optic disc, cherry red fovea (macula), boxcar segmentation of retinal veins

Painless vision loss with a curtain across visual field suspect…

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Retinal detachment
IOP is normal or low, pupil exam unremarkable
retina appears gray with white folds

Cremasteric reflex and Phren's sign absent in...

Testicular torsion (present's with high riding teste, swelling, tenderness)

Epididymitis

tender posterior and lateral to testes positive phren's sign (elevate testicle and pain relieved) etiology: 35 prsotatitis (Doxy)

Blue dot sign seen in

torsion of appendicieal testes (7-14)

Paraphimosis

Foreskin is retracted behind glans and cannot be returned to normal position Can be from foley that didn't have foreskin replaced after

White cell casts seen in

Pyelonephritis (tx IV ceftriaxone, PO FQ)

Imaging if suspect nephrolithiasis

NON contrast CT

Opiod/Narcotic Intoxication overdose (heroin, oxy, morphine)

CNS depression miosis respiratory depression Treat with Narcan

Activated charcoal does not bind

Potassium Alcohol Iron Lithium (PAIL)

Anticholinergic antidote

Physostigmine

***Benzo antidote

Flumazenil

Methanol/Polyethylene glycol antidote

Alcohol, because it has a higher binding affinity

Acetominophen toxicity

toxic dose is >140 mg/kg Treat with acetylcystine (mucomist) Best level is 4 hours after ingestion

Stimulants (Cocaine/amphetamine) overdose

dilated pupils, hypertension, euphoria treat with Benzos DO NOT GIVE BB (unopposed alpha)

***Cyanide toxicity

bitter almonds

**Arsenic toxicity

Garlic odor breath

Menengitis Triad

Fever, nuchal rigidity, mental status changes | (also petichial rash

LP of bacterial meningitis

``` (DO NOT perform if papilledema) WBC: 1000-10,000 Neuts: >80% Glucose: Low Protein: High Gram Stain: + (TREAT with Rocephin) ```

LP of Fungal Meningitis

WBC:

LP of viral meningitis

WBC:

Impetigo causative agent

Strep (Rarely staph) | small vesicles with honey colored crusts

Botulism characteristics

Cranial neuropathy with descending weakness Gram positive, rod-shaped spore-forming anaerobe absence of fever

Leading cause of death in children under 5

Drowning

Difference between heat exhaustion and heat stroke

Heat exhaustion has normal mental status and heat stroke does not Heat stroke= core temp above 105 F( 40.5 C), Heat exhaustion is

neuroleptic malignant syndrome treatment

SE of anti psychotic drugs See intense rigidity, hyperthermia and mental status changes Treat with DANTROLENE

Difference between primary and secondary adrenal insufficiency

Primary= addison's from autoimmune destruction or dysfunction of renal cortex (hyperpigmentation, low aldosterone, hyponatremia, hyperkalemia, decreased BP) Secondary=stimulation of adrenal cortex by ACTH from exogenous steroids or pituitary tumor

Adrenal crisis

life threatening presents with flank/abdominal pain hypotension that is resistant to catecholamine and IV fluid administration need to replace missing cortisol with IV glucocorticoids seen in elderly with chronic disease or post operation

Pheochromocytoma

tumor of neural crest cells which release catecholamines cause EPISODIC palpitations, sweating, syncope and hypertension Tumor of renal medulla

Myxedema coma

presents in elderly with hypothyroidism, hypothermia and confusion EKG with sinus brady, and possible QT prolongation Treat with levothyroxine and glucocorticoids

Pericardial Tamponade EKG

low voltage sinus tachy, PR depression, electrical alternans, height of QRS changes

Emergency Med Flashcards

(53 cards)