Emergency Medicine

Question 1

Gastric lavage can be done up to ____ hours?

Answer 1

2

Question 2

Gastric lavage removes _____ % at 1 hour

____ % at 2 hours

Answer 2

50% pills 1 hour

15% pills 2 hours

Question 3

_____ is always the wrong answer in the emergency apartment when it comes to toxic ingestion?

Answer 3

Ipecac (delays admin of antidotes)

Cathartics like sorbitol (speeding up GI transit time does not block absorption)

Fluids + Diuretics- does more harm (pulm edema)

Question 4

When might gastric lavage be dangerous?

Answer 4

AMS - can cause aspiration

Caustic Ingestion- causes burning of esophagus and oropharynx

Question 5

best initial management of altered mental status of unclear etiology in ED is?

Answer 5

opiate antagonist and glucose

Naloxone and glucose work instantaneously and have no adverse effects

Question 6

Toxicity of acetaminophen occurs with ___ - ____ grams. Fatality may occur with ____ - ____ grams?

Answer 6

8-10: toxic

12-15: fatal

Question 7

If a clearly toxic amount of acetaminophen has been ingested (8-10 grams) what do you give?

Answer 7

N-acetylcysteine

Question 8

If overdose of acetaminophen was over 24 hours ago what can you do?

Answer 8

no therapy

Question 9

If amount of acetaminophen ingestion is unclear- what should you do?

Answer 9

get a drug level

Question 10

Is charcoal contraindicated with N-acetylcysteine?

Answer 10

NO

Question 11

Tinnitus, resp alkalosis and metabolic acidosis are the key to diagnosing?

Answer 11

ASA toxicity

Question 12

Treatment for ASA tox?

Answer 12

Alkalinize urine- increases rate of ASA excretion

Question 13

When you reverse benzo ingestion, you remove suppression of _____ drug toxicity?

Answer 13

TCA (Benzos have a protective effect on TCA toxicity)

Question 14

Treatment of TCA toxicity?

Answer 14

sodium bicarb. Bicarb protects heart against arrhythmia.

Question 15

Does bicarb increase urinary excretion of TCA as it does for ASA?

Answer 15

NO

Question 16

Most common cause of death in fires?

Answer 16

CO poisoning

Question 17

CO poisoning presents like what other pathology?

Answer 17

anemia (functionally the same thing)

Question 18

What type of blood gas would you see with CO poison?

Answer 18

carbon monoxide prevents release of oxygen to tissues so you see a lactic acidosis

Question 19

Most accurate test for CO poison?

Answer 19

level of carboxyhemoglobin (routine oximetry will be falsely normal)

Question 20

treatment for CO poison?

Answer 20

100% O2. severe treated with hyperbaric O2.

Question 21

Treatment when CO poision presents with CNS symptoms, cardiac symptoms, metabolic acidosis (any of these)?

Answer 21

hyperbaric oxygen

Question 22

What drugs can cause oxidized hemoglobin (methemoglobinemia) (Hgb locked into the ferric state)?

Answer 22

benzocaine, other anesthetics, nitrites, nitroglycerin, dapsone

Question 23

CO poison: blood is abnormally _____

Methemoglobinemia: blood is abnormally ____

Answer 23

• Red

- Brown

Question 24

Best test for methemoglobinemia

Answer 24

methemoglobin level. PO2 is normal on blood gas!

Question 25

Best initial therapy for methemoglobinemia? Most effective therapy?

Answer 25

- 100% oxygen | - Methylene blue

Question 26

how does methylene blue work?

Answer 26

decreases half life of methemoglobin

Question 27

cyanosis + normal PO2 =

Answer 27

methemoglobinemia

Question 28

What is the first step in management of a patient with nerve gas poisoning?

Answer 28

Atropine

Question 29

what is the antidote for organophosphate poisoning?

Answer 29

pralidoxime

Question 30

Why does hypokalemia predispose to digoxin toxicity?

Answer 30

potassium and digoxin compete for binding at the same site on Na/K ATPase. When less K binds, more Dig binds

Question 31

Most accurate test for dig toxicity? Best initial test for suspicion of dig toxicity?

Answer 31

- Dig level | - potassium (look for hyperkalemia) and EKG

Question 32

EKG findings in DIG toxicity?

Answer 32

downsloping of ST segment

Question 33

indications for Dig binding antibodies?

Answer 33

CNS and cardiac involvement

Question 34

Best initial test for lead toxicity? most accurate?

Answer 34

increased level of free erythrocyte protoporphyrin. lead level is most accurate.

Question 35

most accurate test for sideroblastic anemia?

Answer 35

Prussian blue stain

Question 36

Treatment of methanol and ethylene glycol toxicities?

Answer 36

fomepizole (inhibits alcohol dehydrogenase) and dialysis

Question 37

ocular toxicity is a presentation of?

Answer 37

methanol poison (found in wood alcohol, cleaning solution, paint thinner)

Question 38

renal toxicity and envelope shaped oxalate crystals?

Answer 38

ethylene glycol

Question 39

Serum Osm =

Answer 39

2XNa + BUN/2.8 + Glucose/18

Question 40

What causes death in snake bites?

Answer 40

hemolytic toxin: hemolysis and DIC Neurotoxin: respiratory paralysis

Question 41

Spider bite with abdmonial pain, hypocalcemia?

Answer 41

black widow

Question 42

spider bite with local skin necrosis, bullae, blebs

Answer 42

brown recluse

Question 43

treatment for brown recluse bite

Answer 43

debridement, steroid, dapson

Question 44

treatment for black widow

Answer 44

calcium, antivenin

Question 45

Treatment for dog, cat, human bites?

Answer 45

amoxicillin/clavulanate | Tetanus vaccination if more than 5 years since last injection

Question 46

When is rabies vaccine indicated?

Answer 46

animal has AMS/bizzare behavior | attack was unprovoked by a stray that cant be observed/diagnosed

Question 47

Management of large hematoma?

Answer 47

intubation, hyperventilation, (decreases PCO2-constricts cerebral circulation), mannitol, drainage

Question 48

only clear indications for stress ulcer prophylaxis with PPI are?

Answer 48

head trauma, burns, endotracheal intubation, coagulopathy with resp failure

Question 49

What fluid should you choose for burn victims?

Answer 49

ringers lactate

Question 50

Fluid replacement equation

Answer 50

4ml X %BSA burned X weight in kg

Question 51

What prophylactic treatment for infection is typically given for burn victims?

Answer 51

topical antibiotic (silver sulfadiazine)

Question 52

most common cause of death from hypothermia? best initial test in hypothermic patient?

Answer 52

cardiac arrhythmia EKG

Question 53

What characteristic finding is seen on EKG for hypothermia?

Answer 53

I waves. QRS hits ST segment

Question 54

What are 2 answers that are ALWAYS wrong for drowning?

Answer 54

antibiotics | steroids

Question 55

When is "precordial thump" the answer?

Answer 55

very recent onset of cardiac arrest with no defibrillator available. (You saw it happen)

Question 56

best initial management of all forms of pulselessness?

Answer 56

CPR

Question 57

Only 2 types of arrhythmias without a pulse where difibrillation or unsynchronized cardioversion should be used?

Answer 57

VT and VF

Question 58

Patients with asystole should receive?

Answer 58

Epi or vasopressin

Question 59

How to diagnose PEA?

Answer 59

look for normal EKG and no pulse

Question 60

when is heparin necessary vs not before starting a patient with afib on warfarin

Answer 60

only need to use heparin when there is a current clot in the atrium

Question 61

Do vagal maneuvars convert afib?

Answer 61

no

Question 62

SVT with alternating VT SVT that gets worse with dilt or digoxin delta wave these are signs of?

Answer 62

WPW

Question 63

What anti-arrhythmics should you use if WPW is currently presenting with an arrhythmia?

Answer 63

Procainamide or amiodarone

Question 64

What drugs are dangerous in WPW? why?

Answer 64

Dig and CCB- block the normal AV node and force conduction into abnormal pathway

Question 65

Multifocal atrial tach is associated with? How do you ID it on EKG?

Answer 65

COPD at least 3 diff P-wave morphologies

Question 66

what test would you do to determine risk of arrhythmia recurrence following an MI?

Answer 66

Echo- Assess LV EF