Flashcards in Emergency Medicine Deck 2 Deck (35)
Tx for anticholinesterase or organophosphate poisoning?
atropine (supresses PNS), pralidozime (reactivates cholinesterase)
Tx for poisoning with antimuscarinic or anticholinergic agents?
physostigmine (reversible cholinesterase inhibitor)
Tx for acetominophen OD?
Tx if >7.5 ingested
give charcoal if within 4h of OD
How to treat acute heavy metal poisoning?
succimer, dimercaprol, or penicillamine
How to treat beta-blocker OD?
How to tx barbiturate or benzo OD?
Barbituates: charcoal, dialysis, supportive care
Benzos: Flumenazil (if acute or accidental ingestion), intubation, supportive care
do **not** use Flumenazil in a situation of chronic benzo abuse; can cause withdrawal seizures and death
Tx for cyanide poisoning?
hydroxycobalamin, amyl nitrate, sodium nitrite
Nitrites induce methemoglobinemia, which binds cyanate
Tx for digitalis poisoning?
Anti-digitalis Fab (antibody) in patients with sx
Don't treat ion imbalances until after initial treatment, since it will restore Na+/K+ pump
Tx for heparin or warfarin overdose?
Heparin: protamine sulfate, injected
Warfarin: FFP immediately, Vitamin K over the long-run
Tx for iron overdose?
Tx for opioid overdose?
If patient is found unconscious and clinical suspicion suggests opioids, its standard procedure to tx empirically with naloxone
Tx for methanol or ethylene glycol (antifreeze) overdose?
Fomepizole, dialysis, Ca+ gluconate
Tx for tPA or streptokinase OD?
Which drugs induce P-450 enzymes?
BARBara Steals Phen-phen and Refuses Greasy Carbs
St. John's wort
Which drugs inhibit P-450 enzymes?
Isoniazid (Abx for TB)
Alcohol (chronic use)
Chloramphenicol (synthetic strep to break clots)
Which drug classes are metabolized by p-450 enzymes?
sedatives (benzos, barbiturates)
cardiac drugs (metoprolol, propranolol, nifedipine, warfarin, quinidine)
anticonvulsants (phenytoin, carbamazepine)
Which drugs create gynecomastia?
Some Drugs Create Awesome Knockers
chronic Alcohol use
Which drugs confer risk of Stevens-Johnson syndrome>
Which drugs can cause drug-induced SLE?
chlorpromazine, hydralazine, INH, methyldopa, penicillamide, procainamide, quinidine
Which troponin is specific for heart muscle?
I and T: specific to heart muscle
C: found in skeletal muscle and heart muscle
Elevated troponin I and T confirm MI.
CK itself is not specific, and normal CK doesn't rule out MI (CK-MB specific to heart muscle)
Your patient is actively having an MI. What do you give him while you wait for the bus?
Chewable aspirin is the most important thing- increases survival probability because its a thrombolytic. 325 mg.
Nitroglycerin second-most important thing. 0.3-0.6 chewable tablets every 5m up to 3x.
AED placement for adults vs children?
Adults: one pad on the right side between nipple and collarbone. One pad on the left side of the chest below the nipple and toward the midaxillary line.
Children: one in the middle of the chest, one in the middle of the back
What is a common and dangerous complication of MI?
What is most important to ask a possible victim of domestic violence?
If there are children in the home and if they are ever witnesses or victims of the violence. You will need to alert child services.
Which O2 delivery system is most appropriate for a breathing patient and delivers 40% O2 at 6L/min?
Simple face mask
Bag-valve mask in non-breathing patients; 90% O2 at 10-15 L/min
Resuscitation mask is 50% and 6L/min
Partial rebreather is 60-80% and 10-15L/min; high rate
Non-rebreather mask, 10, 90%; best way to get O2 to a pat without intubating**
Venturi: used in hospitals; 40% at 4-15L/m
What is the immediate treatment and imaging for AAA?
Abdominal CT then non-selective beta-blockers like propranolol
How to treat a patient in DKA?
Dx: urine ketones
Give rapid infusion of 0.9% saline to rehydrate (patient loses glucose in urine, takes water with it, gets very dehydrated).
Use 24g needle for the IV, give continuous regular insulin.
Cerebral edema is the worst case side effect from DKA then rapid rehydration in children.
A 14mo child is choking on a toy. What do you do?
If they are conscious and breathing, encourage them to cough. If they cannot cough or breathe, do the Heimlich maneuver. If this does not work, call 911. If CPR is needed, ratio is 30:2, one hand on their chest.
For children <12mo, you would support their head and deliver back blows. Use two fingers on their chest.
How do you adapt your CPR when someone has a suspected head/neck injury?
30 compressions, jaw thrust, 2 breaths.
If no head/neck injury, use head tilt/chin lift instead.
It is not legal to stop delivering care if the individual dies, You must continue until someone more qualified than you reaches the scene and declares the patient dead or takes over the situation.