Emergency Medicine Flashcards by Stacy Hennick

when can gastric lavage be done for OD

if within 2 hrs and it is NOT caustic, acetaminophen, or altered mental status

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what is whole bowel irrigation good for

iron, Li, drug smuggling - usually WRONG answer

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is charcoal dangerous

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next best step in altered mental status of unclear etiology

naloxone and glucose

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alcoholism increases/decreases the amount of aceaminophen to cause toxicity

decreases

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next step, >8-10g of aceteminophen injested

N-acetylcystein

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next step, acetaminophen OD >24 hrs ago

no tx

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next step, unknown amount of acetaminophen injested

drug level

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N-acteylcysteine given for acetaminophen OD, can you give charcoal

yes, not contraindicated, does not make N-acetylcysteine ineffective

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Tinnitus, hyperventilation, Renal toxicity and altered mental status

aspirin OD

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blood gasses in aspirin OD

respiratory alkalosis (low pCO2) → metabolic acidosis (low bicarb). metabolic acidosis from lactate

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tx of aspirin OD

alkalinize urine (sodium bicarb) to increase rate of aspirin excretion

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drug that can prevent seizures from TCA toxicity

Benzos, so if coinjested dont give flumazenil!

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next step, suspected TCA OD

EKG (widening of QRS –> torsades)

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tx of TCA OD

sodium bicarb (protects heart against arrhythmia does not increase urinary excretion)

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most common cause of death in fires

carbon monoxide poisoning

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Dyspnea, lightheaded, confused, seizures → death from MI

carbon monoxide poisoning

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blood gases in CO poisoning

Normal pO2, lactic acidosis (low bicarb, low pH)

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most accurate test for CO poisoning

level of carboxyhemoglobin

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best initial tx for CO poisoning

remove from exposure, give 100% O2, hyperbaric O2 if severe

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drugs that can cause methemoglobinemia

benzocaine, other anesthetics, nitrites, nitroglycerin, dapsone

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cyanosis + normal pO2

methemoglobinemia

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blood gases in methemoglobinemia

Normal pO2, Metabolic acidosis

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most accurate test for methemoglobinemia

methemoglobin level

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best initial tx for methemoglobinemia

100% O2

most effective tx for methemoglobinemia

methylene blue

MOA of nerve gas

increase level of acetylcholine by inhibiting its metabolism

MOA of atropine

blocks effects of acetylcholine that is already increased in body

tx of organophosphate toxicity

atropine

MOA of pralidoxime

reactives acetylcholinesterase, takes longer than atropine to work

what predisposes to digoxin toxicity

hypokalemia

GI (N/V, abdominal pain), hyperkalemia, confusion, yellow halos, rhythm disturbances

digoxin toxicity

most accurate test for digoxin toxicity

digoxin level

best initial test for digoxin toxicity

K level and EKG (downsloping of ST in all leads)

tx for digoxin toxicity

control K and digoxin specific antibodies

Abdominal pain, acute tubular necrosis, sideroblastic anemia, peripheral neuropathies (wrist drop), CNS (memory loss, confusion)

lead poisoning

most accurate test for lead poisoning

lead level

best initial test for lead poisoning

increased level of free erythrocyte protoporphyrin

tx of lead poisoning

chelators (succimer is oral, EDTA and BAL are parenteral)

mercury ingestion causes

neurologic problems (nervous, twitchy, jittery, hallucinations)

mercury inhalation causes

lung toxicity → pulmonary fibrosis

tx of mercury exposure

chelators (dimercaprol and succimer)

Wood alcohol, cleaning solutions, paint thinner toxicant

methanol

antifreeze intoxicant

ethylene glycol

methanol toxic byproduct

formic acid

ethylene glycol toxic byproduct

oxalic acid

toxicity of methanol

ototoxicity

toxicity of ethylene glycol

renal toxicity

envelope shaped crystals in urine indicate

ethylene glycol intoxication

best initial therapy for methanol intoxication

fomepizole + dialysis

best initial therapy for ethylene glycol intoxication

fomepizole + dialysis

osmolar gap is seen in

alcohol intoxication

Serum osmolality =

2xNa + BUN/2.8 + glucose/18

hemolytic toxin in snake venom causes

hemolysis and DIC

neurotoxin in snake venom causes

respiratory paralysis

most common injury in snake bite

local injury from proteases and lipases in venom

Sudden sharp pain, Abdominal pain, muscle pain, Hypocalcemia

black widow bite

tx for black widow bite

calcium and antivenom

sudden sharp pain, local skin necrosis, bullae, blebs

brown recluse bite

tx for brown recluse bite

debridement, steroids, dapsone

antiobiotic tx for animal bites

amoxicillin/clavulanate

venous, crescent shaped bleed on CT

subdural hematoma

arterial, biconvex bleed on CT

epidural hematoma

which hematoma is more likely d/t skull fracture

epidural hematoma

tx for large brain hematomas

intubation, hyperventilation, mannitol, drainage

MOA of hyperventilation for head trauma

decreases pCO2

MOA for mannitol in head trauma

decreases intravascular volume

stress ulcer prophylaxis is indicated in

Head trauma, burns, endotracheal intubation, coagulopathy with respiratory failure

prevents stroke after subarachnoid hemorrhage

nimodipine

is there a benefit of steroids in intracranial bleeding

best initial tx for burns

100% O2

intubate after burn if

stridor, hoarseness, wheezing, burns inside nasopharynx or mouth

fluid replacement after burn

Ringers lactate Replacement = 4ml * %BSA * weight (kg) Give ½ in 1st 8 hrs, ¼ in next 8 hrs, then ¼ in 3rd 8 hrs

prophylactic topical antibiotic for burns

silver sulfdiazine

From exertion in heat. Normal body temp, CPK, and K

heat exhaustion

tx of heat exhaustion

oral fluids and electrolytes

From exertion in heat. Elevated temp, CPK and K

heat stroke

tx for heat stroke

IV fluids and evaporation cooling

From antipsychotic meds. Elevated temp, CPK and K

NMS

tx for NMS

dantrolene or dopamine agonists (bromocriptine, cabergoline)

From anesthetics administed systemiccaly. Elevated temp, CPK and K

malignant hyperthermia

tx for malignant hyperthermia

dantrolene

most common cause of death from hypothermia

cardiac arrhythmia

best initial step in hypothermia

EKG (J pt elevation)

tx of near drowning

airway with positive pressure ventilation

what type of drowning causes wet lungs (CHF like)

salt water

what type of drowning causes hemolysis

fresh water

when is precordial thump indicated

if witnessed (<10 mins) and no defibrillator

best initial management in pulselessness

CPR

tx of asystole

CPR< epinephrine, vasopressin

unsynchronized cardioversion is only used for

V fib and T tach

tx for V fib

unsynchronized cardioversion, amiodarone (then lidocaine)

bretyllium is right when

NEVER

tx of V tach and hemodynamically stable

amiodarone → lidocaine → procainamide → cardioversion

tx of V tach and hemodynamically unstable

cardioversion → meds

direct intracardiac meds are used

NEVER

normal EKG but no pulse

PEA

sawtooth pattern on EKG

A flutter

tx of A flutter and hemodynamically unstable

synchronized cardioversion

tx of atrial fib/flutter

control rate (beta blocker, CCB, digoxin) to <100, then anticoagulate (warfarin, dabigatran, rivaroxaban)

what should be done before cardioversion in chronic a fib

anticoagulate

anticoagulant that does not need INR monitoring

dabigatran

atrial rhythm problems cause

acute pulmonary edema

CHADS stands for

CHF or cardiomyopathy, HTN, Age >75, DM, Stroke or TIA (=2 pts)

if CHADS <1

give aspirin

if CHADS 2+

warfarin, dabigatran, rivaroxaban

best initial tx for SVT

vagal maneuvers, adenosine, BB (metoprolol), CCB (diltiazem) or digoxin

SVT alternating with V tach

WPW

SVT worsens after diltiazem or digoxin

WPW

delta wave on EKG

WPW

acute tx for WPW

procainamide or amiodarone

most accurate test for WPW

cardiac electrophysiology (EP) studies

chronic tx for WPW

radiofrequency catheter ablation (curative). EP tells you where anatomic defect is

avoid what drug in MAT

beta blockers

what drugs are dangerous in WPW

digoxin and CCB

MAT is associated with what condition

lung disease (COPD)

Isoproterenol is right when

NEVER

asymptomatic bradycardia tx

none, but don't forget to do EKG

best initial tx for symptomatic bradycardia

atropine

most effective tx for symptomatic bradycardia

pacemaker

which type of AV block is a sign of normal aging

Mobitz I (wenckeback)

tx for asymptomatic mobitz I

none

tx for mobitz II

pacemaker

progressively lengthening PR on EKG then dropped beat

mobitz I (wenckeback)

Emergency Medicine Flashcards

(124 cards)