Flashcards in Emergency Medicine Deck (142):
1
gastric lavage useful in....
1 hour of ingestion
2
ALL types of gastric emptying are dangerous in
1. caustic ingestion
2. altered mental status
3. acetaminophen overdose
3
ALWAYS WRONG ANSWER GIT emptying...
1. ipecac
2. cathartics
3. diuresis: fluids and diuretics
4. whole bowel irrigation
4
ipecac
prior to coming to hospital
5
cathartic agents=
sorbitol
does NOT eliminate ingestion without absorption
6
diuresis=
pulmonary edema
7
only times whole bowel irrigation is correct
1. massive iron ingestion
2. lithium
3. swallowing drug filled packets
8
not clear what cause of OD is, go with..
acetaminophen or
aspirin
(since mcc death from OD)
9
patient with altered mental status and unknown cause order of steps
1. naloxone and dextrose
2. intubation
3. gastric lavage
10
chronic benzo user given flumazenil
INSTANT WITHDRAWAL--> seizures
11
first time benzo use and TCA
benzos PROTECT from TCA induced seizures
12
first time benzo use and TCA and give flumazenil
flumazenil removes the protection from seizures by benzzos--> SEIZURES
13
opiate OD vs benzo OD
opiate= fatal
benzos= non fatal (DO NOT GIVE FLUMAZENIL)
14
charcoal use
ANYONE with pill OD, not dangerous, and not specific
15
charcoal in comparison
BETTER than lavage and ipecac
16
don't know what to do in toxicology give....
CHARCOAL
17
what scenario when less acetaminophen is needed to cause toxicity
ALCOHOLICS
18
toxic amount of acetaminophen ingested (8-10grams)
N-A-C
19
OD acetaminophen more than 24hrs ago
NO TX
20
amount of ingestion of acetaminophen is unclear
DRUG LEVEL
21
ok to give both NAC and charcoal
YESSS it is
22
PC aspirin OD
- tinnitus
- hyperventilation
- resp alkalosis ---> metabolic acidosis
23
why metabolic acidosis in aspirin OD
aspirin messes with ox phos--> anaerobic--> lactic acidosis
24
blood gases for aspirin OD
low O2
low bicarb
HIGH PH
25
best initial test for someone with TCA ingestion after given antidotes...
EKG
26
what are you looking for on EKG with TCA OD
TdP---> WIDENING of QRS
27
serious consequences of TCA OD
seizures
arrhythmia
28
bicarb use in TCA OD
protects from arrhythmias
DOES NOT increase urinary excretion
29
caustics
acids and alkalis (drain cleaner)
30
caustics cause....
mechanical damage to oropharynx, esophagus, stomach--> PERFORATION
31
reversal with caustics
1. flush out caustics
2. endoscopy: assess degree of damage
32
steroids with caustics
NOOOOOPE-- does nOT prevent injury
33
MCC death in fires
CO poisoning
34
PC CO poisoning
SOB
CONFUSION
MI (since LV cannot tell difference between anemia, carboxyhemoglobin, stenosis in CAD)
35
O2 levels in CO and methHb
FALSELY NORMAL WITH OXIMETRY
36
most accurate test CO poisoning
carboxyhaemoglobin level
37
acid base disturbance in CO poisoning
low bicarb
low pH
(metabolic acidosis)
38
tx of CO poisoning
100% oxygen
39
PC severe CO poisoning
- CNS symptoms
- cardiac symptoms
- metabolic acidosis
40
causes of methhb
- benzocaine/anaesthetics
- nitrites and NG
- dapsone
41
PC methHb
- SOB, cyanosis
- headache, confusion, seizures
- met acidosis
42
tx MethHb
methylene blue
43
blood CO poisoning
BRIGHT RED
44
blood MethHb poisoning
BROWN
45
nerve gas vs organophosphate poisoning
NERVE GAS= FASTER
46
death in nerve gas and organophosphate poisoning
RESP ARREST
47
antidote for nerve gas and organophosphate poisoning
atropine
pralidoxime
48
pralidoxime
reactivates AChE
49
what predisposes to digoxin toxicity?
HYPOkalaemia (since less K bound to ATPase= more digoxin can bind)
50
most common PC digoxin toxicity
nausea
vomiting
51
other complications from digoxin toxicity
- HYPERkalaemia
- yellow halls around objects
- ARRHYTHMIA ANY KIND
- NEURO--confusion
52
when to give digi-bind
cardiac and cns INVOLVEMENT
53
EKG findings of digoxin toxicity
downsloping of the ST segment
54
don't forget the renal complication of lead poisoning....
ATN
55
most accurate test for lead poisoning
lead level
56
best initial test for lead poisoning
FEP increased
57
most accurate test for sideroblastic anaemia
prussian blue stain
58
tx of lead poisoning
- succimer
- dimercaprol
- EDTA
59
PC mercury poisoning
- nervous
- jittery
- twitchy
- hallucinatory
60
2 big complications from mercury poisoning
- irreversible lung fibrosis
- neuro problems
61
tx of mercury poisoning
- succimer
- dimercaprol
62
wood alcohol, cleaning solutions, paint thinner....
METHANOL
63
toxic metabolite of methanol
formic acid/formaldehyde
64
toxic metabolite of ethylene glycol
oxalic acid/oxalate
65
osmolar gap increased by
- methanol
- ethylene glycol
- ETHANOL=ALCOHOL
66
best initial tx for methanol and ethylene glycol toxicity
fomepizole (inhibits alcohol dehydrogenase)
67
most effective tx for methanol and ethylene glycol toxicity
dialysis
68
most common injury from snake bites
local wound
69
when snake bites get into bloodstream, death by:
- hemolysis
- DIC
- resp arrest
70
dangerous/ ineffective tx snake bite
- tourniquet
- ice
- incision and mouth suction
71
beneficial tx snake bite
- pressure
- immbolization (decrease movement of venom)
- antivenin
72
black widow bite PC
abdo pain and muscle pain
73
lab tests for black widow bite
HYPOcalcemia
74
tx of black widow bite
calcium
antivenin
75
brown recluse bite PC
local skin necrosis
bullae
blebs
76
lab tests for brown recluse bite
none
77
tx brown recluse bite
debridement
steroids
dapsone
78
human bites
MORE DAMAGING
Eikenella corrodens
79
LOC .... what next?
CT!!!!!!
no matter how minor the trauma is
80
normal CT and LOC=
concussion
81
ecchymoses CT (blood mixed in parenchyma) and LOC=
contusion
82
lucid interval found in....
BOTH BOTH BOTH BOTH
epidural and subdural haematomas
83
concussion tx
HOME-- check for development of lucid
84
contusion tx
HOSPITAL-- check for development of lucid
85
LARGE subdural or epidural haematoma
1. intubation and hyperventilation (bridge to surgery)
2. mannitol
3. drainage
86
moa hyperventilation in RICP
hyperventilation= decrease CO2= vasoconstriction brain blood vessels= decrease blood volume= BIG decrease ICP
87
what prophylaxis when hx of
- head trauma
- burns
- endotracheal intubation
- coagulopathy with rest failure
PPI's, to prevent curling stress ulcers
88
steroids with intracranial bleeding?
do NOT benefit, just DECREASE EDEMA around mass lesions
89
second most common cause of death from burns
only if there has been airway injury-- INSIDE nasopharynx or mouth
90
second mcc death in burns is
hypovolaemia
91
volume fluid replacement in burns
RINGER LACTATE
or normal saline
92
calculation for fluid replacement
4ml x % BSA burned x weight (kg)
93
patchy burns
each hand width= 1% BSA
94
mcc death from burn immediately
lung injugry
95
mc death from burns few days later
infection
96
prophylactic antibiotics for burns
TOPICAL not iv
97
hypothermia seen in
INTOXICATED PATIENTS
98
mcc death in hypothermia
CARDIAC ARRHYTHMIA
99
ECG finding in hypothermia
ELEVATED J WAVE= osborn wave
100
tx for drowning
airway
POSITIVE pressure ventilation
101
salt water drowning
like CHF
102
fresh water drowning
HAEMOLYSIS
103
wrong answers for drowning
steroids
antibiotics
104
precordial thump the answer when...
NEVER
105
sudden loss of pulselessness
- VF
- VT
- PEA
- asystole
106
tx for all forms of pulselessness
CPR
107
unsynchronized cv=
defib
- VF
- VT pulseless
108
tx pulse VT
amiodarone
109
tx VF
1. defib
2. epinephrine or vasopressin
3. amiodarone> lidocaine
110
order of mgmt for vf
SHOCK-cpr-drug-SHOCK-cpr-drug-SHOCK-cpr-drug
111
intracardiac mgmt is...
ALWAYS THE WRONG ANSWER
112
PEA
- normal ECG- electrical
- NO PULSE-motor contraction
113
tx of PEA/ asystole
- CPR
- epinephrine or vasopressin
114
causes of PEA
- tamponade
- tension pneumothorx
- hypovolaemia, hypoglycemia
- massive PE
-hypoxia, hypothermia, met acidosis
- POTASSIUM increase or decrease
115
afib vs. aflutter
SAME MGMT
irregular rhythm- afib
regular rhythm- aflutter
116
tx afib/aflutter unstable or less than 48hours
synchronized cardioversion
117
tx stable more than 48hrs/chronic a fib
rate-bb and cab
rhythm-amiodarone
anticoag- CHADS2V
118
what % of people with a fib will revert to fibrillation
90%
119
rhyme for a fib treatment
slow the rate and anticoagulate
120
does rate control convert the patient into sinus rhymth?
NOOOOO
121
without warfarin, how many embolic strokes would there be per year
6/100 patients
122
anticoagulation for afib
less than or equal to 1 chad: aspirin
greater than or equal to 2: warfarin first
UNLESS there is already a clot in atrium, in which case give heparin
123
diseased/cardiomyopathic heart and a fib
atria are shot from the excess dilation/stretching of conduction pathways, atria have to work harder to contribute to CO (from 10% to 30-50%), and will eventually fail--> ACUTE PULMONARY EDEMA
124
major bleeding from warfarin
intracranial hemorrhage
requiring transfusion
125
tx SVT
1. vagal
2. adenosine
126
WPW gets worse after
- CCB
- BB
- Digoxin
since all work on the AV node
127
acute tx WPW
1. procainamide or amiodarone
128
long term tx WPW
radio frequency catheter ablation
129
most accurate test for WPW
electrophysiology studies--since give exact location of where the anatomic defect is
130
MAT on EKG
3 different morpholopgies of P waves
131
MAT associated with
lung disease, thus treat lung disease treat the MAT
132
tx of MAT same as a fib except...
NO BETA BLOCKERS--since lung disease
133
isoproterenol
NEVER THE RIGHT ANSWER
134
sinus bradycardia symptomatic
- atorpine= best initial
- pacemaker= most effective
135
sinus bradycardia asymptomatic and first degree AV block
NO TX
136
second degree AV block mobitz I=
= wenckebach block
NORMAL AGING
137
tx of second degree block mobitz I
NO TX if asymptomatic
138
mobitz II tx
PACEMAKER for BOTH asympt and sympt
139
patient experiences VTac after MI 72hrs, what is best next step
angiography for angioplasty or bypass-- BECAUSE ischema is causing the arrhythmia, tx ischemia, tx the arrhythmia
140
above patient who experiences VTac after MI 72hrs, how to determine recurrence?
ECHO-- because can tell what the LV function is like
141
if cause is known for Vtach...
DEFIB
142