Flashcards in Exam 3 - Study guide (MC) Deck (89):
Opiate toxidrome antidote
Valproate antidote (2)
Methanol antidotes (3)
Camphor antidotes (2)
Iron poisoning tx (4)
Whole bowel irrigation
Cyanide toxicity tx (5)
Digoxin antidote? How often should you check levels? What should you avoid?
- Check level at least 6 hrs after last dose
- Avoid Ca --> increased arrhythmias ("stone heart")
CCB antidotes (4)
Acetaminophen antidote? At what time is it no longer beneficial? What are side effects of the antidote?
*No benefit if > 8hrs
Barbiturates antidotes (3)
Benzos for seizures
Isopropanol tx (2)
Ethylene glycol tx
Similar to methanol:
Bath salts antidotes (4)
Amphetamines antidotes (3)
MDMA (ecstacy) antidote
Phenycyclidine (PCP) antidote
Hydrofluoric acid antidote
Dystonic reactions antidotes (2)
TCAs antidotes (2 categories)
For hypotension: fluids, bicarb, alpha agonists
For seizures: benzos, barbituates
TCAs + ________ = DEATH
What increases osmolar gap?
- Ethylene glycol
- Isopropyl alcohol
What causes 1/4 of all trauma related deaths?
When should you provide ventilatory support to a trauma pt? (6)
- Upper airway obstruction
- Flail chest
- Multiple injuries
- O2 < 50% on RA or < 80% on >40% O2
How do you dx sternal fx?
Serial EKGs q 8hrs for 24-36hrs
How do you tx scapular fx?
When does a scapular fx require surgery?
If it involves glenoid &/or coracoid
When is mechanical ventilation required for flail chest?
- 3+ injuries
- Head injury
- Prior pulm disease
- 8+ rib fractures
- > 65yo
What occurs during pulmonary contusion?
Direct injury w/ no laceration --> hemorrhage & edema --> interstitial & intra-alveolar fluid collection
How do you dx pulmonary contusion?
pulmonary opacity within 6hrs of blunt trauma
How do you tx pulmonary contusion?
Pain & chest physiotherapy
When is mechanical ventilation for pulmonary contusion required?
When 1/4 lung volume involved or pre-existing pulmonary disease
*May need to have uninjured lung down!
What is the clinical presentation of a basilar skull fx? (3)
- Raccoon eyes
- Battle sign
What is the clinical presentation of transtentorial/uncal herniation?
- Oculomotor n compression --> ipsilateral dilated pupil
- Cerebral peduncle compression --> contralateral hemiparesis
What are warning signs of an orbital blow-out fx? (3)
- Infraorbital numbness
- limited upward gaze w/ diplopia
How do you tx orbital blow-out fx?
What do you see w/ splenic rupture?
Kher's sign (L shoulder pain)
What is the MC blunt trauma of the abd? What is the MC penetrating?
Blunt = splenic
Penetrating = liver
How do you dx renal injuries?
What causes renal injuries?
Direct impact or decelerating force
How is the pancreas injured? How do you dx?
Compression against spine
*Amylase & DPL are NOT reliable
How do you dx bladder injuries?
CT w/ contrast
What are S/S of pneumomediastinum?
- Hamman's crunch
- SubQ emphysema in neck
What are S/S of cardiac tamponade? What is the triad?
- Becks triad: JVD, muffled heart sounds, hypotension
- Pulsus paradox (10-15 drop in SBP during inspiration)
- Kussmaul sign (increase in JVD & pressure during inspiration)
- Electrical alternans
How do you tx cardiac tamponade?
Pericardiocentesis via paraxyphoid approach w/ 18 gauge & 20cc syringe, directed toward L scapular tip
What are characteristics of an aortic rupture? What is seen on CXR?
- Most commonly involves aortic isthmus
- Retrosternal or interscapular pain (worse w/ increased BP)
- CXR: mediastinal widening (MC), deviation of esophagus (most accurate sign), L pleural effusion, blurred aortic knob
What imaging do you use to dx aortic rupture?
How do you tx aortic rupture?
Maintain SBP <120
What is most associated w/ myocardial contusion? What is the main cause?
What indicated increased ICP? What is the triad?
Cushings triad: HTN, depressed respiratory, brady
How do you tx salicylate overdose? (5)
- Gastric lavage if within 1hr
- Normal saline
- HD (if ESRD, CNS toxicity, serum>100, worsening, failure to alkalinize)
How do you tx barbiturate overdose? (4)
What are sx of acetaminophen overdose? (3)
- Centrolobular necrosis
- Vomiting (esp children)
- Renal failure
What are the phases of acetaminophen overdose?
0-24 hrs = N/V, pallor, diaphoresis, malaise
24-48 hrs = RUQ pain, increased LFTs
72-96 hrs = LFTs peak, coagulopathy, encephalopathy
4-14 days = recover or die
What is the serotonin syndrome triad?
What are other sx of sertonin syndrome?
Antifreeze toxicity - what does the urine fluorescence reveal?
Ca oxalate crystals
Digoxin overdose - what is seen on EKG?
Atach w/ AV block
What is the triad seen w/ hypoglycemia?
Iron toxicity - what is seen on labs?
Basophilic stippling & "vin rose" urine
What is the clinical presentation of dystonic rxns?
- Sudden onset abnormal posturing of head, neck, jaw
- Contractures of lips, tongue, face, throat
- Trismus, torticollis, tongue protrusions
- Laryngeal, pharyngeal spasms
- Fear, axiety
- Oculogyric crisis (unable to move eyes in vertical plane, double vision)
How do you tx dystonic rxns?
- Benadryl 3-4 days to prevent recurrence
What are RFs for dystonic rxns?
What is the clinical presentation of diverticulitis? (3)
Abrupt onset LLQ pain
Leukocytosis w/ left shift
How do you tx diverticulitis?
If severe --> add vanco
If abscess --> drain
How do you tx mesenteric ischemia?
How do you tx H. pylori?
H2 blockers or PPI
How do you tx urolithiasis?
<5mm = no tx (will pass)
- If infection --> abx, drain, admit
How do you tx pancreatitis?
"Place bowel at rest"
How do you tx frostbite?
Wrap in dry gauze
How do you tx heat stroke? (4)
- Ice packs
- Evaporative cooling*
How do you tx jellyfish sting? (3)
Anesthetics (topical or oral)
How do you tx hymenoptera stings?
Epi (IM or auto-injector)
How do you tx black widow spider bite? (4)
How do you tx scabies?
Lindane (also used for lice)
Oral antipruritic agents
How do you tx snake bites?
Elevate, constriction bands
How do you tx scorpion sting?
How do you tx thermal burns?
Debride, steril dressings
What is the MC active enzyme of the brown recluse spider?
What is the triad of heat stroke?
What is the MCC of pancreatitis? (3)
What is the clinical presentation of epididymitis?
- Gradual, bilateral pain
- Phren's sign (relief w/ scrotal elevation)
- Worse w/ standing
What is the clinical presentation of testicular torsion?
- Bell clapper deformity
- Sudden, unilateral pain
- Absent cremaster reflex
- Vomiting common
- Neonates, 12-15yo
What are sx of a barbiturate overdose?
What are characteristics & dx tests for appendicitis?
- Periumbilical, RLQ pain
- Fever, N/V, anorexia
- Rovsings sign: pain in RLQ w/ palpation of LLQ
- Iliopsoas sign: pt supine, R knee extender & flex right hip
- Obturator sign: pt supine, flex R knee to 90˚, internally/externally rotates hip
- Alvarado score (10 pts total)