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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

unknown source of ventricular arrhythmia, what next

EP studies