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Flashcards in Emergency Medicine Deck (286):
1

Class of drugs that may cause syndrome of muscle rigidity, hyperthermia, autonomic instability, EPS

Antipsychotics- neuroleptic malingnant syndrome

2

Side effect of corticosteroids

Acute mania, immunosuppression, thin skin, easy bruising, myopathies

3

Tx DTs

BDZ

4

Tx acetaminophen OD

N-acetylcystein

5

Tx opiod overdose

Naloxone

6

Tx BDZ OD

Flumazenil

7

Tx NMS and hyperthermia

Dantrolene

8

Tx malignant HTN

Nitroprusside

9

Tx afib

Rate control, rhythm conversion, anticoagulation

10

Tx SVT

Stable: rate control with carotid massage or other vagal stimulation
Unsuccessful: adenosine

11

Causes drug induced SLE

INH
Penicillamine
Hydralazine
Procainamide
Chlorpromazine
Methyldopa
Quinidine

12

Macrocytic megaloblastic anemia with neuro Sx

B12 def

13

Macrocytic megaloblastic anemia w/o neuro Sx

Folate def

14

Burn pt with cherry red, flushed skin and coma. SaO2 normal but carboxyhemoglobin elevated. Tx

CO poisoning- 100% O2 or hyperbaric O2 if poisoning severe or pt pregnant

15

Blood in urethral meatus or high riding prostate or perineal ecchymosis or blood in scrotum or pelvic fx

Bladder rupture or urethral injury

16

Test to r/o urethral injury

Retrograde cystourethrogram

17

Radiographic evidence of aortic disruption or dissection

Widened mediastinum (>8 cm), loss of aortic knob, pleural cap, tracheal dev to right, depression L main stem bronchus

18

Radiographic indications for surgery of acute abdomen

Free air under diaphragm, extravasation of contrast, severe bowel distention, space occupying lesion on CT, mesenteric occlusion on angiography

19

Most common organism in burn related infection

Pseudomonas- look for fruity smell or blue green color

20

Method of calculating fluid replacement in burn pts

Parkland formula: 24 hr fluid = 4 x kg x % BSA
50% over first 8 hrs and rest over 16 hrs

21

Acceptable urine output in trauma pt

50 cc/hr

22

Acceptable urine output in stable pt

30 cc/hr

23

Signs neurogenic shock

Hypotension and bradycardia

24

Signs of increased ICP (Cushing's triad)

HTN
Bradycardia
abnormal respirations

25

Dec CO, Dec PCWP, inc PVR

Hypovolemic shock

26

Dec CO, Inc PCWP, Inc PVR

Cardiogenic or obstructive shock

27

Inc CO, Dec PCWP, Dec PVR

Septic or anaphylactic shock

28

Tx septic shock

Fluids and broad spectrum abx
Give fluid until CVP=8
Pressors- NE or DA
Cultures before abc

29

Tx cardiogenic shock

Identify cause, pressors like dopamine if hypotensive or dobutamine if not hypotensive

30

Tx hypovolemic shock

Identify cause, isotonic (LR or NS) fluid and blood repletion in 3:1 ratio
NO PRESSORS

31

Tx anaphylactic shock

Diphenhydramine or epi 1:1000
Consider steroids

32

Supportive Tx ARDS

CPAP

33

Signs of air embolism

Pt with chest trauma who was previously stable suddenly dies

34

Sign of cardiac tamponade

Distended neck veins
Hypotension
Diminished heart sound (Beck's triad)
Pulsus paradoxus

35

Absent breath sounds, dullness to percussion, shock, flat neck veins

Massive hemothorax

36

Absent breath sounds tracheal deviation, shock, distended neck veins, hyperresonance

Tension pneumothorax

37

Tx for blunt or penetrating ABD trauma in hemodynamically unstable pts

Immediate exploratory laparotomy

38

Inc ICP in alcoholics or elderly following head trauma. Can be acute or chronic, crescent shape in CT

Subdural

39

Head trauma with immediate loss of consciousness followed by lucid interval then rapid deterioration, Convex on CT

Epidural

40

ABCDE

Airway
Breathing
Circulation
Disability
Exposure

41

4 reasons to intubate

GCS <8
Apnea
Significantly depressed mental status
Impending airway compromise- maxillofacial trauma, inhalation injury

42

Tx tension pneumothorax

Immediate needle decompression w/ thoracostomy tube

43

CXR tension pneumo

Hyperlucent on affected side, flattening and inferior displacement of diaphragm on that side, shift of mediastinum away

44

Amount of blood for massive hemothorax

>1500 cc

45

Replacement of fluids

3:1 ratio of fluid to blood loss
Use 16 gauge IV in both arms
Isotonic-LR or NS
Fluid bolus 1-2 L first, recheck vitals, continue repletion
Consider PRBC if hypotension

46

Triad cardiac tamponade

JVD
Hypotension
Muffled heart sound

47

Tx cardiac tamponade

Immediate pericardiocentesis

48

FAST scan

Focused abdominal sonography for trauma

49

New murmur 2/2 chest trauma

Aortic dissection

50

Rapid deceleration injury can cause...

Coup contrecoup (bleeds where 2 impacts)
Diffuse axonal injury

51

Punctate hemorrhage at gray white matter junction

Diffuse axonal injury

52

Lucid interval

Epidural hematoma

53

Crosses suture lines

Subdural

54

Does not cross suture lines

Epidural

55

Middle meningeal artery

Epudural

56

Dural bridging veins

Subdural

57

Most common cause aortic disruption

decel injury

58

CXR shows wide mediastinum, loss of aortic knob, pleural cap, deviated esophagus and trachea to R, depression L main stem bronchus

Aortic disruption

59

Gold standard for evaluation of aortic disruption

Aortography

60

Define flail chest

3+ adjacent ribs fx at 2 places

61

Fever
Tachypnea
Tachycardia
Conjuctival hemorrhage
UE petechiae
Trauma

Fat emoblism

62

Kehr's sign

Referred shoulder pain due to diaphragmatic irritation (usu on left due to spleen rupture)

63

Possible causes of pulseless electrical activity

Hypovolemia
Hypoxia
Hydrogen ions - acidosis
Hyper/Hypo K+ and others
Hypothermia
Tablets: Drug OD
Tamponade: Cardiac
Tension pneumo
Thrombosis: coronary
Thrombosis: PE

64

Peritoneal lavage

Saline infused by catheter into ABD and removed and examined- find blood or fecal matter

65

When to do exparatory lap

Penetrating abd trauma
Intra-abd bleeding or visceral damage
Retroperitoneal hematoms in upper abdomen

66

SVT

Unstable: synchronized electrical cardioversion
Stable: control rate (Valsalva, carotid sinus massage, cold stimulus)
Resistant to maneuvers: adenosine followed by other AV nodal blocking agents - CCB or Beta blockers

67

Afib/aflutter

Unstable: synchronized electrical cardioversion 120-200J
Stable: control rate with diltiazem or Beta blockers and anticoagulate if >48 hrs duration
Elective cardioversion if <48 hrs; otherwise must anticoagulate or do TEE
NO NODAL BLOCKERS- WPW; procainamide is better

68

Bradycardia

Sx: atropine
Ineffective: transcutaneous pacing, dopamine, epi

69

Abdominal pain that is sharp and focal with tenderness and guarding
Pts do not want to move

Parietal/peritoneal

70

Abdominal pain that is dully, crampy, achy, midline or diffuse
Pt unable to lie still

Visceral/organ

71

Abrupt, excruciating pain

Biliary colic- RUQ
MI: substrnal
Perforated ulcer: epigastric
Ureteral colic: LQ
Ruptured aneurysm: umbilical

72

Rapid onset of severe, constant pain

Acute pancreatitis: epigastric
Mesenteric thrombosis, strangulated bowel- umbilical
Ectopic pregnancy- deep LQ

73

Intermittent colicky pain crescendo with free intervals

Early pancreatitis-epigastric
SBO-umbilical
IBS-suprapubic and middle of LQ

74

Gradual steady pain

Acute cholecystitis, acute cholangitis, acute hepatitis: RUQ
Appendicitis, acute salpignitis: RLQ
Diverticulitis: LLQ

75

Positive beta hCG with shock

ruptured ectopic until prove otherwise

76

Abdominal pain + syncope or shock in older pt

AAA until proven otherwise

77

Cervical motion tenderness

Consider PID

78

Sudden onset of diffuse, severe abdominal pain w/ abdominal rigidity

Perforation

79

Acute onset of severe radiating colicky pain
Obstipation (not pass stool or gas)
Bilious emesis

Obstruction

80

Constant, ill-defined pain with gradual onset over 10-12 hrs

Inflammation

81

Associated Sx of anorexia, N/V, changes in bowel habits, hematochezia, melena suggest what etiology?

GI

82

Fever and cough suggest what etiology

Pneumonia

83

Hematuria, pyuria, CVA tenderness suggest what etiology?

GU

84

Assocaited with meals

Mesenteric ischemia-elderly or w/ CAD or PAD
PUD
Biliary disease
Pancreatitis
Bowel pathology

85

FH of abdominal pain

Familial Mediterranean fever
Acute intermittent porphyria

86

Hx AF or recent AAA repair, bloody stool,sudden onset abdominal pain out of proportion to physical findings

Ischemic colitis

87

Psoas sign

Passive extension of hip leads to RLQ pain

88

Obturator sign

Passive IR of flexed hip leads to RLQ pain

89

Rosving's sign

Deep palpation of LLQ leads to RLQ pain

90

Hamburger sign

Pt wants to eat- consider something other than appendicitis

91

Pt populations with atypical S/S during acute appendicitis

Children
Elderly
Pregnant
Retrocecal appendices

92

Dx tests for appendicitis

CT with IV and PO contrast- highly sensitive for periappendiceal stranding or fluid
US: enlarged noncompressible- kids and preggers

93

How to estimate BSA in burn patients
Adults vs kid

Rule of 9's
Adult:
Head and each arm = 9%
Back and chest each: 18%
Each leg = 18%
Perineum =1%

Kids:
Head 18%
Arm- 9% each
legs-14% each
trunk and back: 18% each

94

Second leading cause of death in kids

Burns

95

First degree burn

Epidermis only
Painful, erythematous
NO BLISTERS,
Good cap refill

96

Second degree burn

Epi and partial dermis
Painful w/ blisters

97

Third degree

Epi and full dermis, potentially deeper
Painless, white, cleared

98

Major complications of burns

Shock
Compartment syndrome
Superinfection- Pseudomonas or Gram P cocci
Stress ulcer-Curling
Aspiration
Dehydration
Ileus
Renal insufficiency- 2/2 rhabdomyolsysis
Epithelial contractions

99

6 W of Postop fever

Wind: atelectasis, pneumonia
Water: UTI
Wounds: infection/abscess
Walking: DVT
Wonder drug
Womb: endometritis

100

Fevers before postop day? usually not infectious
Exception?

Post day 3
Clostridium or Beta hemolytic strep

101

Cause malignant hyperthermia

Halothane

102

CAuse NMS
S/S, labs

Neuroleptic agents
Mental status change, inc creatinine phosphokinase

103

What measure is not beneficial in CO poisoning?

O2 sat- measure carboxyHg as normally saturated = not reflect low arterial PO2 levels

104

Bees and wasps stings
Complication
Tx

Anaphylaxis
Tx: antihistamine, steroid, IM epi for anaphylaxis

105

Black widow bites
Complication
Tx

Mm pain and spasms, localized diaphoresis, ABD pain, inc ANS = ileus, CV collapse, hemolytic anemia, DIC, rhabdo
Tx: antivenin, wound care, BDZ

106

Scorpions
Complication
Tx

CN dysfcn (severe), excessive motor activity, resp compromise, acute pancreatitis, myocardial toxicity
Tx: Support w/ BDZ/phenobarb and analgesics, atropine for hypersalivation and resp distress, IV ab, Antivenin

107

Snakes bites
Complications
Tx

Progressive dyspnea, DIC 2/2 toxin
Tx: Antivenom
Elevate affected limb

108

Dogs and cats bites
Complications
Tx

Infection, rabies, tetanus= Staph, Pasteurella multocida possible infection
Tx: amoxicillin, clavulanate; saline irrigation, debridement, tetanus and rabies prophy

109

Humans bites Tx

Amoxicillin clavulanate, saline irrigation, debridement

110

Rodents bite Tx

Local wound care- low risk infection
May carry rabies

111

Rabies
What carries
Prophy

BATS
If animal showed signs rabies give 1 dose human rabies Ig and 4 doses rabies vaccine over 14 d; if vaccinated need 2 dose vaccine

112

Tetanus Tx

Previous dose /=3:
-Clean, minor: vaccine only if last was >/= 10 yrs prior
-All other: vaccine only if last >/= 10 yrs ago

113

Normal levels carboxyHg smoker vs non

Smoker <5%

114

Induction of P 450

Queen Barb Steals Phenphen and Refuses Greasy Carbs
Quinidine
Barbs
St Johns Wort
Phenytoin
Rifampin
Griseofulvin
Carbamazepine

115

Inhibition P450

Cimetidine
Ketoconazole
INH
Grapefruit
Erythromycin
Sulfonamides

116

Metabolism by _ 450

BDZ, barbs
Amide anesthetics
Metoprolo, Propranolol
Nifedipine
Phenytoin
Quinidine
Theophylline
Warfarin

117

Increased risk dig toxicity

Quinidine
Cimetidine
Amiodarone
CCB

118

Competition for albumin binding sites

Warfarin
ASA
Phenytoin

119

Blood dyscrasias

Ibuprofen
Quinidine
Methyldopa
Chemotherapeutic agents

120

Hemolysis in G6PD def

Sulfonamides
INH
ASA
Nitrofurantoin
Primaquine
Pyrimethamine
Chloramphenicol

121

Gynecomastia

Some Excellent Drugs Create Awesome Knockers
Spironolactone
Estrogens
Digitalis
Cimetidine
chronic Alcohol use
Ketoconazole

122

SJS

Anticonvulsants
sulfonamides
Penicllins

123

Photosensitiviy

Tetracycline
AMiodarone
Sulfonamides

124

Drug induced SLE

Procainamide
Hydralazine
INH
Penicillamine
Methyldopa
Quinidine

125

Antidote acetaminophen
Sx OD

N-acetylcysteine
Sx: N, hepatic insufficiency

126

Antidote acid or alkali ingestion

Upper endoscopy for stricture

127

Antidote anticholinesterase
SX

Physostigmine
Sx: Dry mouth, urinary retention, QRS widening

128

Antidote arsenic, mercury, gold
Sx

Succimer
Dimercaprol
Sx: renal insuff, tremor, mental status changes

129

Antidote Beta blockers
Sx

Glucagon, calcium, insulin, dextrose
Sx: bradycardia, hypotension, hypoglycemia, pulmonary edema

130

Antidote Barbs (phenobarb)

Urine alkalinization
Dialysis
Activated charcoal
Support

131

Antidote BDZ
Sx

Flumazenil- can precipitate withdrawal
Sx: Sedation, resp depression

132

Antidote Black widow bite

Calcium gluconate, methocarbamol

133

Antidote CO

100% O2/hyperbaric

134

Antidote Copper, arsenic, lead, gold

Penicillamine

135

Antidote cyanide

hydroxycobalamin
Amyl nitrate
Na nitrate
Na thiosulfate

136

Antidote digitalis
Sx

Normalize K but avoid giving Ca or Mg or lido (for torsade)
anti-digitalis Fab
Sx: N/V, changes vision, arrhyhtmias

137

Antidote heparin

Protamine sulfate

138

Antidote INH
Sz

pyrodoxine (B6)
Sx: neuropathy, hepatoxicity

139

Antidote iron salt
Sx

Deferoxamine
Sx: nausea, constipation, hepatotoxicitiy

140

Antidote Lead
Sx

Succumer
CaEDTA
Dimercaprol
Sx: peripheral neuropathy, anemia

141

Antidote methanol/ethylene glycol
Sx

EtOH
Fomepizole
Dialysis
Ca gluconate for ethylene glycol
Sx: HA, vision changes, dizziness- methanol
Sx: ataxia, hallucinations, seizures, SWEET BREATH- ethylene glycol

142

Antidote methemoglobin

Methylene blu

143

Antidote Opiods
Sx

Naloxone
Sx: pinpoint pupils, resp depression

144

Antidote Salicylates
Sx

urine alkinization, dialysis, activated charcoal
Sx: N/V, tinnitus, hyperventilation, anion gap, metabolic acidosis

145

Antidote TCA
Sx

Na bicarb for QRS prolongation
Diazepam or lorazepam for seizures
Cardiac monitor for dysrhythmias
Sx: Tachycardia, dry mouth, urinary retention, QRS widening

146

Antidote Theophylline

Activated charcoal
Consider repeat doses

147

Antidote tPA, streptokinase

Aminocaproic acid

148

Antidote warfarin

Vit K
FFP

149

Side effect ACEI

COUGH
Rash
Proteinuria
Angioedema
Taste changes
TERATOGEN

150

Side effect amantadine

Ataxia
LIVEDO RETICULARIS (lace like purplish discoloration of skin 2/2 venule inflammation)

151

Side effect Amiodarone

Acute: AV block, hypotension, bradycardia,
Chronic: pulm fibrosis, peripheral deposits leading to bluish discoloration, arrhythmias, hypo/hyperthyroidism, corneal deposits

152

Side effect Amphotericin

Fever/ rigors, nephrotoxic, bone marrow suppression, anemia

153

Side effect antipsychotics

SEdation, acute dystonic reaction, akathisia, parkisonism, tardice dyskinesia
NMS

154

Side effect azoles

Inhibit P450

155

Side effect AZT

thrombocytopenia, megaloblastic anemia

156

Side effect beta blockers

AStham exacerbation, masking hypoglycemia, importence, bradycardia, AV block, CHF

157

Side effect BDZ

sedation, dependence, respiratory depression

158

Side effect Bile acid resin

GI upset, malabsorption vit and minerals

159

Side effect Carbamazepine

Induction P450, agranulocytosis, aplastic anemia, liver toxicity

160

Side effect CCB

peripheral edema, constipation, cardiac depression

161

Side effect Chloramphenicol

GRAY BABY SYNDROME
aplastic anemia

162

Side effect Cisplatin

Nephrotoxic, acoustic nerve damage

163

Side effect clonidine

dry mouth
SEVRE REBOUND HA AND HTN

164

Side effect clozapine

Agranulocytosis

165

Side effect corticosteroids

mania, hyperglycemia, immunosuppression, bone mineral loss, thin skin, easy bruising, myopathy, cataract

166

Side effect cyclophosphamide

HEMORRHAGIC CYSTITIS
myleosuppression

167

Side effect digoxin

YELLOW VISUAL CHANGES
ARRHYTHMIAS
GI

168

Side effect doxorubicin

CARDIOTOXIC-CMP

169

Side effect ethyl alcohol

Acidosi, renal dysfunction, CNS depression

170

Side effect fluoroquinolones

Cartilage damage in kids
Achilles tendon rupture adults

171

Side effect furosemide

Ototoxic
Hypokalemia
Nephritis
Gout

172

Side effect gemfibroxzil

Myositis, reversible inc LFT

173

Side effect halothane

MALIGNANT HYPERTHERMIA
hepatotoxic

174

Side effect HCTZ

HypoK, hypoNa, hyperuricemia, hyperglycemia, hypercalcemia

175

Side effect statin

Myositis, reversible inc LFT

176

Side effect Hydralazinw

Drug induced SLE

177

Side effect hydroxychloroquine

Retinopathy

178

Side effect INH

Peripheral neuropathy (prevent pyridoxin/B6), hepatotoxic, inhibit P450, seizure in OD, hemolysis in G6PD def

179

Side effect MAOI

HYPERSENSITIVE TYRAMINE REACTION
SEROTONIN SYNDROME (w/ meperidine)

180

Side effect Methanol

Blindnes, ion gap metabolic acidosis

181

Side effect Methotrexate

Hepatic fibrosis, penumonitis, anemia

182

Side effect Methyldopa

+ Coombs, drug induced SLE

183

Side effect metronidazole

Disulfuram reaction, vestibular dysfucntion, metallic taste

184

Side effect Niacin

FLUSHING

185

Side effect penicillamine

Drug induced SLE

186

Side effect penicillins/beta lactam

Hypersensitivity

187

Side effect Phenytoin

Nystagmus, diplopia, ataxia, arrhythmia, GINGIVAL HYPERPLASIA, hirsutism, teratogen

188

Side effect prazosin

First dose hypotension

189

Side effect procainamide

drug induced SLE

190

Side effect propylthiouracil

Agranulocytosis
Aplastic anemia

191

Side effect quinidine

cinchomism (HA, tinnitus), thrombocytopenia, arrhythmia- TORSDAES

192

Side effect Reserpine

Depression

193

Side effect rifampin

induction P450 enzymes
ORANGE RED BODY SECRETIONS

194

Side effect salicylates

Fever, hyperventilation wit RESPIRATORY ALKALOSIS AND METABOLIC ACIDOSIS, dehydration, hemorrhagic gastritis

195

Side effect SSRI

Anxiety, 5HT syndrome with MAOI

SEXUAL DYSFUNCTION

196

Side effect succinylcholine

MALIGNANT HYPERTHERMIA
HyperK

197

Side effect TCA

Sedation, comia, antichol, seizures, arrhythmia
QRS PROLONGATION

198

Side effect Tetracycline

Tooth discoloration, photosensitivity, Fanconi's, GI

199

Side effect Trimethoprim

Megaloblastic anemia, leukpenia, granulocytopenia

200

Side effect Valproic acid

Teratogen- neural tube defect
Rare fatal hepatotoxicity

201

Side effect Vancomycin

Nephrotoxic, ototoxic
RED MAN SYNDROME- histamine release

202

Side effect Vinblastine

Severe myelosuppresion

203

Side effect Vincristine

Peripheral neuropathy, paralytic ileus

204

Tremor (6-12 hrs)
Tachycardia, HTN, agitation, seizure (48hrs)
Hallucinations

Alcohol withdrawal

205

Severe autonomic instability leading to tachycardia, HTN, delirium and possibly death within 2-7 d

DT

206

Tx Etoh withdrawal

BDZ
Haloperidol hallucinations
Thiamine, folate, multivitamin

207

Anxiety, seizures, delirium, tremor, tachycardia, HTN

barbs withdrawal

208

Tx barb withdrawal

BDZ

209

Rebound anxiety, seizures, tremor, insomnia

BDZ withdrawal

210

Tx BDZ withdrawal

BDZ taper

211

Depression, hyperphagia, hypersomnolence

Cocaine/amphetamine withdrawal

212

Tx cocaine or amphetamine withdrawal

Supportive
Avoid pure beta blockers which can lead to unopposed alpha activity = HTN

213

Anxiety, insomnia, flu like Sx, piloerection, fever, rhinorrhea, lacrimation, yawning, nausea, stomach cramps, diarrhea, mydriasis

Opiod withdrawal

214

Tx opiod withdrawal

Antiemetics
MM relaxers
NSAID
Clonidine, buprenorphine, or metadone if severe to mod Sx

215

Vit def: night blindness and dry skin, Bitot spots (debris on conjunctiva)

Vit A

216

Vit def: beriberi (polyneuritis, dilated CMP, high output CHF, edema), Wernicke Korsakoff

VIt B1 thiamine

Wet beriberi: high output cardiac failure
dry beriberi: peripheral neuropathy

217

Vit def: Angular stomatitis, chelitis, corneal vascularization, dermatitis

Vit B2 riboflavin

218

Vit def: Pellagra- diarrhea, dermatitis, dementia

Vit B3 niacin

219

Vit def: Dermatitis, enteritis, alopecia, adrenal insuff

Vit B5 pantothenate

220

Vit def: Convulsions, hyperirritability, microcytic anemia, seborrheic dermatitis, stomatitis, cheilosis; required w/ INH

Vit B6 pyridoxine

221

Vit def: Macrocytic megaloblastic anemia, neuro Sx (optic neuropathy, subacute combined degneration, paresthesias), glossitis

Vit B12 cobalmin

222

Vit def: Scurvy, poor wound healing, hyperkeratotic hair follicles, bone pain (2/2 periosteal hemorrhages)

Vit C

223

Vit def: Rickets in kids, osteomalacia in adults, hypocalcemic tetany

Vit D

224

IVit def: increased RBC fragility, anemia

Vit E

225

Neonatal hemorrhage, Inc PT and aPTT, Vit def: normal BT

VIt K

226

Vit def: Dermatitis, enteritis; can be caused by ingestion of raw eggs or antibiotic use

Biotin

227

Vit def: MOST COMMON VIT DEF, sprue, macrocytic megaloblastic anemia without neuro

Folate

228

Vit def: Weakness, mm cramps, exacerbation hypocalcemic tetany, CNS hyperirritability lead ing to tremors, choreoarthertoid movement

Magnesium

229

Vit def: Keshan disease -CMP

Selenium

230

"4th degree burn"

electrical burns - may injure bone, mm, other internal structures
May have cardiac (vfib) or neuro Sx (seizure, loss of vision)

231

When inpatient for burns

2nd degree over >10% body
3rd degree >2% body
2nd or 3rd-face, gentile, hands, major flexion creases

232

When to intubate 3rd and 2nd degree burns

>25% BSA or face

233

Risk factors mortality in burns

>60 yrs
>40% BSA
Inhalation
more factors - more risk = 0.3% (0 risk), 3% (1), 33%(2), 90%(3)

234

Salt water vs fresh water drowning

Fresh: hypotonic fluid absorbed into vasculature = DECREASED electrolyte conc and RBC lysis
Salt: hypertonic fluid creates osmotic gradient draws fluid from pulm capillaries into alveoli and causes PULMONARY EDEMA and INCREASED electrolyte conc

235

Most common location aspirated items that pass beyond trachea

Right main stem bronchus = greater vertical orientation

236

Hypothermia
Temperature?
Risks
EKG

<95/35
old, intoxication
EKG: J waves (end of QRS complex), Vtach or Vfib

237

Brown recluse bite
Complication
Tx

Possible ulceration and necrosis = ileus, CV collapse, hemolytic anemia, DIC, rhabdo
TX: wound care, dapsone to prevent tissue necrosis

238

When to not use charcoal

Metals
Alcohols

239

Antidote CCB
Sx

Glucagon, insulin, dextrose (like Beta blockers)
Sx: bradycardia, hypotension

240

Antidote cocaine
Sx

Support
Sx: tachycardia, agitation

241

Antidote isopropyl alcohol
Sx

Ethanol, fomepizole, dialysis
Sx: decreased consciousness, N, abd pain

242

Antidote sulfonylureas
Sx

Octreotide, dextrose
Sx: hypoglycemia

243

Antidote organophosphates
Sx

Atropine, pralidoxime, support
Sx: DUMBBELSS
Diarrhea, urination, miosis, bronchospasm, bradycardia, excitation of skeletal mm, lacrimation, sweating, salivation
CAN ABSORB THROUGH SKIN- REMOVE CLOTHING

244

Cardiac arrest lasting longer than ? = brain death

10 minutes

245

Low retroperitoneal bleeding - tx

Angiography and emoblization if blunt
Lap if penetrating

246

12 Ps neuro exam

Paired ocular movement
Papilledema
Patellar and other reflexes
Paralysis
Paresthesias
Pee (incontinence)
Pressure (blood and intracranial)
Psych (mental status)
Ptosis
Pulse rate
Pupils
Pyramidal signs

247

Sites of significant (1500 mL) blood loss not found on PE

Injury scene
Pleural cavity- See with OCR
Intra-Abd- CT or US
Pelvic-CT
Thighs- X-ray

248

Swan Ganz catheter
Where inserted, where sits, what measures

Inserted: left subclvian, right internal jugular
Sits: RA and pulm A
Measures: PCWP = LA P, may measure CO, mixed venous O2 sat, systemic vascular resistance

249

When to use whole blood

Severe blood loss- rarely used

250

When to use PRBCS

Low HCT 2/2 blood loss or anemia

251

When to use autologous blood?
What is it?

Elective surgery or chemo
Blood donated by pt, frozen until needed

252

When to use FFP?

Warfarin OD
Clotting factor def
DIC
TTP

253

When to use cryoprecipitate?
What is it?

Smaller volume than FFP, preferable to FFP in cases where large transfusion V warranted
-Clotting factor and vWF rich precipitate collected during thawing of FFP

254

When to use platelets

Thrombocytopenia not due to rapid platelet destruction

255

When to use clotting factors

Specfic deficience - hemophilia

256

Vasopressor anaphylactic shock

Epi

257

Vasopressor shcok (Renal sparing)

DA

258

Vasopressor CHG

Dobutamine

259

Anticholinergic crisis

Blind as a bat- eye mm not focus
Hot as a hare
Mad as a hatter
Dry as a bone
Red as a beet
Dilated pupils and increased HR
(Anti muscarinic and Anti nicotinic meds)

260

Causes disulfiram like reaction

Metronidazole
Cephalosporins

261

Aspiration pneumo cause alcoholics

Klebsiella

262

Alcoholic: how to not precipitate wernicke

Thiamine before glucose- b1 used in glc metabolism

263

Currant jelly sputum

Klebsiella

264

Wernicke vs korsakoff

AWernicke: acute encephalopatyh - opthalmoplegia, nystagmus, ataxia, or confusion

Korsakoff: chronic psychosis - anterograde amnesia, confabulation, irreversible

265

Area of brain affected by Korsakoff

Mamillary bodies and thalamic nuclei

266

Vit def causes wernicke and korsakoff

Thiamine/ B1

267

Mineral def: microcytic anemia, koilonychia (spoon shaped fingernails)

Iron

268

Mineral def: goiter, cretinism, hypothyroidism

Iodine

269

Mineral def: dental caries

Fluorine

270

Mineral def: Hypogeusia (dec taste), rash, slow wound healing

Zinc

271

Mineral def: menkes disease - Xlinked, kinky hair, mental retardation

Copper

272

Mineral def: CMP and mm pain

Selenium

273

Mineral def: impaired glc tolerance

Chromium

274

Vit toxicity: pseudotumor cerebri, bone thickening, teratogen

Vit A

275

Vit toxicity: hypercalcemia, N/V, renal toxicity

Vit D

276

Vit toxicity: Necrotizing enterocolitis in infants

Vit E

277

Vit toxicity: hemolysis -->kernicterus

Vit K

278

Vit toxicity: peripheral neuropathy

Vit b6

279

Mineral toxicity: hemochromatosis

Iron

280

Mineral toxicity: Myxedema

Iodine

281

Mineral toxicity: flurosis with mottling of teeth and bone exostoses

Fluorine

282

Mineral toxicity: Wilson

Copper

283

Mineral toxicity: Loss of hair and nails

Selenium

284

Mineral toxicity: miners ore causes "madness"

Manganese

285

Conditions associated with pernicious anemia
What is pernicious anemia

What: antiparietal cell Ab destroy ability to secrete IF

DM I, vitiligo, hypothyroidism
Removal of ileum, IBD

286

Tapeworm causes B12 def

Diphyllobothrium latum