Emergency/Toxicology Flashcards
(51 cards)
1
Q
What is miosis?
A
Small pupils
2
Q
What drugs can cause miosis?
A
"CCOOPPS looks for small pupils." Clonidine Cholinergics Opioids Organophosphates Pilocarpine Phencyclidine Sedatives
3
Q
What is mydriasis?
A
Large pupils
4
Q
What drugs can cause mydriasis?
A
“Think of how big your eyes got when you realized the benefit of AAA Savings.”
Antihistamines
Antidepressants
Anticholinergics (Atropine)
Sympathicomimetics (amphetamine, cocaine, phencyclidine)
5
Q
What drugs can cause diaphoresis?
A
"Sweaty skin needs SOAP." Sympathicomimetics Organophosphates Aspirin Phencyclidine (PCP)
6
Q
What drugs cause nystagmus?
A
"Your PAAL should not give you nystagmus, but she does." PCP Alcohol Anticonvulsants Lithium
7
Q
Which ingestions can charcoal be used for?
A
"Charcoal uses TAATA trucks to ship out the toxins from the body." Tricyclic antidepressants Aspirin Acetaminophen Theophylline Anticholingergics
8
Q
What are the symptoms of amphetamine use?
A
HYPERTENSION EUPHORIA Agitation Arrhythmias Psychosis Seizures
9
Q
What are the symptoms of cocaine use?
A
AGGRESSION VIOLENCE EUPHORIA Overconfidence Hypertension (tx w/ nitoprusside)
May give diazepam
10
Q
What are the symptoms of Phencyclidine (PCP) use?
A
Vertical or horizontal nystagmus Ataxia Muscle rigidity Rhabdomyolysis Paranoia Agitation Hypertension Violence Hallucinations (auditory or visual) Pupils may be big or small
Tx: cooling blanket, haloperidol
11
Q
What are the symptoms of opioid use?
A
Respiratory depression Miosis Euphoria Indifference to pain Hypotension Hypothermia Urinary/stool retention Pulmonary edema
12
Q
Is binge drinking a predictor for future alcoholism?
A
No
13
Q
Which alcohol does not cause a positive anion gap?
A
Isopropyl alcohol
14
Q
What is the most common substance of abuse among adolescents?
A
Alcohol
15
Q
What is the most common illicit substance of abuse in adolescents?
A
Marijuana
16
Q
What are the symptoms of Ethylene glycol ingestion?
A
- Antifreeze
- Tachycardia
- Hypertension
- Cardiorespiratory failure from acidosis and hypocalcemia (calcium oxalate crystals in the urine)
- Tx: ethanol, fomepizole, HD
17
Q
What are the symptoms of methanol ingestion?
A
- Windshield washer fluid
- Visual complaints (snowstorm appearance)
- Abdominal pain
- Tx: ethanol, fomepizole, HD
18
Q
Which alcohol result in a positive ethanol reading on toxicology screens?
A
Isopropyl alcohol
19
Q
What are the findings of isopropyl alcohol ingestion?
A
- Found in mouthwash and rubbing alcohol
- CNS depressant
- Fruity odor from breath
- Ketones present
20
Q
How long is drug testing positive for marijuana use?
A
- One time use: 1 week
- Frequent use: 2 weeks
- Daily use: 1 month
21
Q
When do you obtain and acetaminophen level after ingestion?
A
4 hours post ingestion
22
Q
At what dose do you give NAC without waiting for an acetaminophen level?
A
140 mg/kg
23
Q
What is the time cut off for giving NAC after acetaminophen ingestion?
A
8 hours
24
Q
Name the cholinergic drugs.
A
Bethanochol
Organophosphates (pilocarpine)
Neostigmine
25
What are the effects of cholinergic drugs?
```
DUMBELLS
Diarrhea
Urination
Miosis
Bronchospasm, bradycardia
Emesis
Lacrimation
Lethargy
Salivation
```
- Includes organophosphates = ⬆️ organ activity (except for ❤️ - bradycardia)
26
What is the treatment for cholinergics?
Atropine
| Pralidoxime
27
What medications have anti-cholinergic effects?
```
Diphenhydramine
Atropine
Pralidoxime
Tricyclic acids
Jimson weed
```
28
What are the symptoms of anti-cholinergics?
"Hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a Hatter while the bowel and bladder lose their tone, and the heart runs alone."
```
Fever
Blurred vision
Dry mouth/eyes
Hyperthermia
Psychosis
Decreased bowel sounds
Urinary retention
Tachycardia
```
29
What are the symptoms of TCA toxicity?
- Anticholinergic symptoms
- Anion gap acidosis
- Wide QRS complex
- QT prolongation
- Tx: sodium bicarbonate
- Meds end with: -pine, -mine, -line (except doxepin)
30
What are the symptoms of salicylate toxicity?
- Drugs: aspirin, oil of wintergreen
- Primary anion gap metabolic acidosis
- Cerebral edema, pulmonary edema, electrolyte disturbances, cardiovascular collapse
- Decreases gastric motility
- Tx: gastric lavage, charcoal, hydration, bicarbonate, hemodialysis
31
How is iron overdose managed?
- Sxs: capillary leak, hypertension, anion gap acidosis, hematemesis, scarring of pylorus
- Tx: chelation with deferoxamine
- Give if level is >500 mg/dL
- Makes urine pink
- Continue until urine is not pink
32
What are the stages of iron overdose?
IR❤️N
```
I = indigestion (GI): nausea, vomiting, abdominal pain, hematemesis
R = recovery (latent)
❤️ = cardiovascular collapse, liver damage
N = (delayed) narrowing of pylorus or other parts of GI track, obstruction from strictures
```
33
When is chelation therapy for lead poisoning indicated?
- Level > 45
| - EDTA, dimercaptol, d-penicillamine
34
What medications can cause dystonic reactions?
Clonidine
Phenothiazine
Metoclopramide
Promethazine
Tx with diphenhydramine
35
What are the symptoms of and treatment for digoxin toxicity?
- GI symptoms, weakness, arrhythmias
- There is an increased chance of toxicity with low K+, low Mg, poor renal fxn, hypoxia
- Tx: charcoal, digibind, correct K+ and Mg
36
What are the symptoms of and treatment for theophylline toxicity?
- Levels > 20: N/V, ⬇️BP, ⬆️Ca, ⬇️K+, metabolic acidosis, seizures
- Tx: charcoal, beta-blockers for arrhythmias (if BP ok), benzos for seizures
- Decreases GI motility
37
When do you treat carbon monoxide poisoning with 100% oxygen?
- Carboxyhemoglobin level > 25%
- Pt has GI sxs
- Pt has neurological sxs
38
How do you treat cyanide poisoning?
Sodium thiosulfate
| Nitrate
39
What is the clinical presentation of and treatment for methemoglobinemia?
- Due to an enzyme deficiency
- Reduced O2 carrying capacity
- Blue/cyanotic skin
- Chocolate colored blood
- Tx: methylene blue, oxygen, remove offending agent
40
What animals transmit the rabies virus?
BCDFRSW
```
Bats
Cats
Dogs
Foxes
Raccoons
Skunks
Woodchucks
```
41
What is the management for possible rabies exposure?
Wound care + HRIG + 4 vaccine doses
42
What is the BSA for burn estimation?
```
Arms: 9%
Legs: 18%
Front trunk: 18%
Back trunk: 18%
Head:
Adult: 9%
Baby: 18%
```
43
What is the treatment for 1st° burns?
- Red, painful skin
| - Soap, cool water, analgesics
44
What is the treatment for second-degree burns?
- Partial thickness
- Blisters, erythematous skin that blanches with pressure
- Painful
- Do not rupture blisters
- Once blisters rupture, treat with debridement, topical anabiotics, non-adherent dressing
45
What is the treatment for third-degree burns?
- Full thickness
- White, dry, leathery skin
- Painless
- Burn center referral
46
What is the Parkland formula and when is it used?
- To replace fluids for burns on > 15% of body
(4ml/kg) x (% body burned) + maintenance
Give half over first 8 hours after burn
47
What indicates a good prognosis after a near drowning?
Good pulse on EMS arrival
OR
Required <10 minutes CPR
48
What criteria are needed for a patient to be discharge from the ED after a near drowning?
Does not need hospitalization if:
- In water for <60 seconds
- No LOC
- No CPR required
49
What indicates a poor prognosis after a near drowning?
- Cold on EMS arrival (< 90°F)
- CPR needed for >10 minutes
- >25 minutes under water
- Apnea
- Coma
- pH < 7.1
50
How do you determine the appropriate ET tube size?
Uncuffed: (Age/4) + 4 in.
Cuffed: (Age/4) + 3 in.
Babies:
<1.5 kg: 2.5 mm
<2.5 kg: 3.0 mm
> 2.5 kg: 3.5 mm
51
What medications can be given via ETT?
```
NAVEL
Naloxone
Atropine
Valium
Epinephrine
Lidocaine
```
