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Flashcards in Final Exam Deck (229):
1

Do not treat ___________ children with STI prophylaxis. However, _____ prophylaxis should be considered.

prepubertal
HIV

2

Prophylactic treatment of STIs for adolescents

Ceftriaxone PLUS
Azithromycin PLUS
Metronidazole OR
Tinidazole

3

Diagnostic of sexual abuse: ________, _________, _________, _________

Gonorrhea
Syphilis
HIV
Chlamydia

4

High suspicion of sexual abuse: ________, _______ _______

Trichomonas
Genital herpes

5

Suspicious of sexual abuse: _________ ________

Anogenital warts

6

Inconclusive of sexual abuse: ________ _________

Bacterial vaginosis

7

When a pediatric patient is well appearing:

5 vital signs
S, O, A, P

8

When a pediatric patient is sick appearing (5 things):

1. Oxygen (assist ventilation if needed)
2. Pulse ox
3. Cardiorespiratory monitor
4. IV access
5. CXR/EKG

9

Normal blood pressure is maintained up over _____% of a child's circulating volume is lost. Therefore hypotension is a late finding in ______

30%
Shock

10

Signs of shock/poor tissue perfusion in a pediatric patient (3):

1. Cool or mottled skin
2. Tachycardia
3. AMS

11

Fluid resuscitation for the pediatric patient in shock

20 ml/kg boluses NS or LR until signs of improved perfusion and resolution of tachycardia

12

Fluid resuscitation for the pediatric patient in shock due to hemorrhage

2 boluses of NS/LR 20 ml/kg
After, PRBC 10 ml/kg

13

Treatment if signs of increased ICP with herniation in pediatric patient

1. Elevate HOB 30 degree
2. Hypertonic saline (3%)
3. Mannitol

14

Seatbelt sign

High probability of abdominal injury; CT of abdomen warranted

15

Pain before vomiting in children is typical of ____________

Appendicitis

16

Abnormal rotation of mesentery during embryonic development

Intestinal malrotation

17

Management/treatment of intestinal malrotation

1. IV fluid resuscitation
2. NG tube w/ intermittent suction
3. Call your surgeon
4. Upper GI series
5. Laparotomy

18

Preferred imaging and classic image of intussusception

Ultrasound
Coiled spring or bullseye

19

Management of intussusception

1. ABCs, resuscitate with IVF
2. NGT if frequent vomiting
3. IV abx if concern for perforation
4. Notify surgery early, abdominal x rays to exclude perforation with free air
5. Air enema reduction

20

Contraindications to air enema for intussusception

1. > 3 days
2. Signs of peritonitis
3. Evidence of free air on plain X Ray

21

A WBC count of less than _______ and an absolute neutrophil count of less than _______ makes appendicitis much less likely

9,000
7,000

22

Management for appendicitis

1. IV Fluids
2. IV pain meds and antiemetics
3. IV ABX (ancef or zosyn if concern for perforation)
4. Call surgeon

23

Classic presentation of sudden unilateral lower abdominal pain, nausea and vomiting with a palpable mass

Ovarian Torsion

24

In ovarian torsion, the ______ side is more commonly affected than the _______ side

Right
Left

25

Management of ovarian torsion

1. Pain control
2. IV Fluids
3. US with doppler
4. Emergent operative intervention

26

What to do when patient is having a seizure:

1. Assess ABCs
2. Place patient on his/her side
3. O2, pulse ox, IV access, bedside glucose
4. If longer than 3 minutes: lorazepam, diazepam, midazolam

27

PMH details to watch for in pediatric seizures

1. Neurosurgical procedures (shunt for hydrocephalus)
2. Prematurity or developmental delays
3. History of meningitis, CNS infections
4. Hx of head trauma
5. Hypercoagulable state (sickle cell)
6. Immunosuppression
7. TB exposures/access to INH
8. Formula mixing

28

Signs of increased ICP in pediatric patients

1. Bulging fontanelle
2. Papilledema

29

2 important questions to always ask after a pediatric seizure:

1. Vaccination status (DTP/MMR)
2. Recent ABX (can be masking signs/symptoms of meningitis)

30

Lumbar puncture is an option in a post-seizure child that is:

1. Deficient in immunizations OR
2. Pretreated with ABX

31

Lumbar puncture is clearly indicated in a post-seizure child that has:

1. Status epilepticus
AND
2. Fever

32

____% of children will experience recurrent febrile seizures

33

33

Preferred imaging modalities for children in epilepsy evaluation

EEG
MRI

34

2 tests that should be ordered right away for a child in suspected DKA

1. Accucheck
2. Urinalysis

35

Definition of DKA

Hyperglycemia > 200 mg/dL
AND
Venous pH < 7.30
OR
Bicarbonate < 15 mmol/L

36

Physical exam findings of a child in DKA

1. Kussmaul respirations
2. Tachycardia
3. Dehydration (sunken eyes, dry mucous membranes)
4. Delayed capillary refill
5. Abdominal tenderness

37

Electrolyte imbalances in kids with DKA

Hyponatremia
Hypokalemia

38

The 4 I's of DKA

1. Insulin lack
2. Indiscretion
3. Infection
4. Impregnation

39

Management of pediatric DKA

1. ABCs, cardiac monitor, vital signs, accucheck
2. IV access
3. BMP, VBG, +/- CBC, +/- EKG
4. Accucheck every hour
5. VBG every 1-2 hours
6. BMP every 4 hours
7. Neurological checks every hour

40

Treatment of DKA: Step 1

NS/LR bolus 20 ml/kg over 1 hour
Next: LR at 2x MIVF rate

41

Treatment of DKA: Step 2

Insulin infusion -.05-0.1 U/kg/hr
No insulin bolus in children
Switch to D5NS when glucose is < 300 mg/dL

42

Treatment of DKA: Step 3

Next 4-6 hours, NS with 40 mEq/L K+
After, switch to 0.45% saline with electrolytes

43

Most serious complication of DKA and its treatment

Cerebral Edema
Treatment:
1. Reduce rate of IVF
2. Mannitol 0.5-1 g/kg over 20 minutes
3. Hypertonic saline (3%)
4. Consider intubation

44

In the event of spinal cord injury, ___________ should be given if within ____ hours

High dose steroids
8 hours

45

Most commonly injured organ in blunt trauma

Spleen

46

Second most commonly injured organ in blunt trauma

Liver

47

Glasgow Scale for mild TBI

13-15

48

Glasgow Scale for moderate TBI

9-12

49

Glasgow Scale for severe TBI

8 or less

50

Canadian CT Head Rules for mild TBI

1. GCS score < 15 at 2 hours after injury
2. Suspected open or depressed skull fracture
3. Any sign of basal skull fracture
4. Vomiting > 2 episodes
5. Age > 65 y/o

Medium Risk
6. Amnesia before impact > 30 minutes
7. Dangerous mechanism

51

Cushing's Reflex

Triad of intracranial hypertension
Systolic BP increase
Bradycardia
Irregular respirations

52

Fastidious gram-negative rod. Can cause bacteremia and fatal sepsis after animal bites, especially in asplenic patients, chronic alcohol abusers or those with underlying hepatic disease

Capnocytophaga canimorsus

53

Organism responsible for cat scratch disease

Bartonella henselae

54

Diagnostic testing for animal bites

Blood cultures prior to abx
X Rays AP and lateral (if deep or markedly infected wounds)

55

Criteria for closure of dog bite wound

1. Clinically uninfected
2. Less than 12 hours old (24 hours on the face)
3. NOT located on the hand or foot

56

Kanavel sign

Flexor Tenosynovitis
1. Finger held in slight flexion
2. Fusiform swelling
3. Tenderness along the flexor tendon sheath
4. Pain with passive extension of the digit

57

Treatment of flexor tenosynovitis (infectious)

Surgical drainage
Consult hand surgeon

58

Rabies postexposure prophylaxis

1. Wound cleansing (soap/water or povidone/iodine solution)
2. RIG infiltrated around wounds
3. Vaccine - IM in deltoid area
Days 0, 3, 7, and 14

59

All ______ bites require antibiotic prophylaxis

Human

60

Bacteria commonly found in human bites

Streptococci, staph aureus, eikenella, fusobacterium, peptostreptococcus, prevotella, and porphyromonas species

61

Treatment for human bites

Amoxicillin clavulanate (Augmentin) and Moxifloxacin
Cellulitis 10-14 days
3 weeks for tenosynovitis
4 weeks for septic arthritis
6 weeks for osteomyelitis

62

Medications for insect bite rxns

1. Epinephrine (DOC)
2. Antihistamines (H1 blocker - diphenhydramine; H2 blocker - Ranitidine)
3. Corticosteroids (methylprednisolone)

63

Diagnostic testing for snake bites

1. CBC, electrolytes, creatinine, blood urea nitrogen
2. Serum creatinine kinase - indicative of rhabdo
3. PT and PTT/INR, fibrinogen, UA (rhabdo), EKG

64

_______ prophylaxis should be given for all snake bites

Tetanus

65

Dosing for CroFab

Not weight-based
Initial dose is 4-6 vials
After 1 hour, determine is initial control has been reached. If yes, 2 vials every 6 hours for 18 hours
If no, repeat initial dosing of 4-6 vials

66

Complications of snake bites

Coagulopathy
Compartment Syndrome

67

Indications for intubation in post-drowned patients

1. Inability to protect airway
2. PaO2 < 60 mmHg or O2 saturation < 90% on high-flow O2
3. PaCO2 > 50 mmHg

68

Water-borne pathogens that commonly cause pneumonia in post-drowning survivors

Pseudomonas
Proteus
Pseudallescheria boydii (fungus)

69

Pseudallescheria boydii

Fungus found in contaminated water such as floods

70

How does cold diuresis work in a post-drowning survivor?

1. Pt is hypothermic, so blood is shunted to the core
2. Central volume receptors sense fluid overload
3. ADH is decreased
4. Diuresis and hypovolemia occur
5. Body goes into hypotension and shock

71

Symptoms of heat exhaustion

Moist and clammy skin, dilated pupils, normal or subnormal body temperature

72

Symptoms of heat stroke

Dry hot skin, constricted pupils, very high body temperature (>104)

73

Vital signs of a pt undergoing heat stroke

Elevated core body temp
Tachycardia
Tachypnea
Widened pulse pressure
Hypotension

74

Physical exam signs of a patient undergoing heat stroke

Flushing
Crackles
Excessive bleeding
Altered mentation
Slurred speech

75

Management of heat stroke patient

1. ABCs
2. Rapid cooling
3. Intubation often necessary
4. Fluid resuscitation for hypotension

76

Cooling methods for heat stroke patients

Evaporative cooling methods are best (moistened skin with fans across patient)
Immersion in ice water is rapid and effective in young patients with exertional heat stroke

77

Rules for collecting urine culture via bladder catheterization in a child

All males < 6 mo and all uncircumcised males < 12 mo
All females < 24 mo and older female children if symptoms of UTI

78

Fever workup in the toxic child (labs)

Rapid testing for viruses
CBC (looking for bandemia)
Blood cultures, CXR, obtain stool for WBCs and guaiac if diarrhea is present
Lumbar puncture

79

4 types of shock

1. Cardiogenic
2. Obstructive
3. Distributive
4. Hypovolemic

80

Clinical manifestations of shock

Hypotension
Tachycardia
Oliguria
Mental status changes
Cool, clammy, cyanotic, mottled skin
Metabolic acidosis

81

Shock patients may need as much as ______ L of fluid for resuscitation

4-6

82

Inadequate blood volume to maintain supply of oxygen and nutrients to tissue

Hypovolemic

83

Hypotension unresponsive to fluid resuscitation, metabolic acidosis, encephalopathy, oliguria and coagulation disorders

Distributive or Septic Shock

84

Clinical signs of septic shock

Hyperthermia or hypothermia
Tachycardia
Wide pulse pressure
Low blood pressure (SBP < 90)
Mental status changes

85

Treatment of septic shock

2 large bore IVs - NS bolus 1-2 L wide open
Supplemental oxygen
Empiric antibiotics: Zosyn and ceftriaxone OR imipenem

86

Treatment for hypotension if no response after 2-3 L IVF

Start a vasopressor (norepinephrine, dopamine)

87

Anaphylactic Shock Treatment

1. ABCs
2. IV, cardiac monitor, pulse ox
3. IVFs, oxygen
4. Epinephrine
5. Second line: corticosteroids, H1/H2 blockers

88

Epi pen dosage

0.3 mg IM of 1:1000 in the thigh
Repeat every 5-10 minutes as needed

89

Occurs after acute spinal cord injury, results in hypotension and bradycardia

Neurogenic shock

90

Neurogenic Shock Treatment

1. ABCs (c-spine precautions)
2. Fluid resuscitation - keep MAP at 85-90 mmHg for first 7 days. If crystalloid is insufficient, use vasopressors
3. For bradycardia, atropine or pacemaker
4. Methylprednisolone - high dose therapy for 23 hours, must be started within 8 hours

91

Treatment for cardiogenic shock due to MI

Aspirin
Beta blocker
Morphine
Heparin
IV fluids if no pulmonary edema
If pulmonary edema: dopamine, dobutamine

92

Tx for tension pneumothorax

Needle decompression, chest tube

93

Beck's Triad

Cardiac Tamponade
Hypotension
Muffled heart sounds
JVD

94

Treatment for cardiac tamponade

Pericardiocentesis

95

Imaging for cardiac tamponade

CXR, ECHO

96

Treatment for pulmonary embolism

Heparin, consider thrombolytics

97

Signs of pulmonary embolism

Tachypnea, tachycardia, hypoxia

98

Drug intoxication associated with tachypnea and hyperpnea

Salicylates

99

Drug intoxication associated with large pupils

Anticholinergic or sympathomimetic

100

Drug intoxication associated with small pupils

Cholinergic or opioids (pinpoint)

101

Drug intoxication associated with physiologic stimulation (everything is up)

Sympathomimetics
Anticholinergics
Stimulants
Hallucinogens

102

Drug intoxication associated with physiologic depression

Cholinergic, opioids, sedatives-hypnotics

103

Coma cocktail

Oxygen
Thiamine
Dextrose
Naloxone

104

Toxic dose of acetaminophen

150 mg/kg

105

First NAC dose for APAP overdose

150 mg/kg
If given within 8 hours, hepatotoxicity is uncommon and death is rare

106

Maintenance NAC dose for APAP overdose

50 mg/kg over 4 hours

107

Toxic dose of aspirin (salicylates)

150 mg/kg

108

Lethal dose of aspirin (salicylates)

480 mg/kg

109

Stimulates respiratory drive causing hyperventilation, but limits ATP production, causing metabolic acidosis

Aspirin
Salicylates

110

Treatment for salicylate overdose

No antidote
Empiric dextrose, activated charcoal, urinary alkalinization
Possible hemodialysis

111

Presents with N/V, tinnitus, diaphoresis, confusion, deafness, tachypnea, vertigo, respiratory alkalosis

Salicylate overdose

112

Fruity breath, ketosis without acidosis, osmolar gap

Alcohol overdose (isopropanol)

113

Causes permanent retinal injury, blindness parkinsonian syndrome

Methanol

114

Treatment for methanol/ethylene glycol overdose

Supportive, bicarb for acidosis
Benzos for seizures
Folic acid, thiamine, magnesium
Ca gluconate to correct hypocalcemia
Fomepizole 15 mg/kg
10% ethanol in 5% DW IV
Hemodialysis

115

May cause urine to fluoresce

Ethylene Glycol (Antifreeze)

116

Examples of amphetamines

Ephedrine, bath salts, Ritalin (ADHD treatment)

117

Amphetamine OD Tx

Charcoal
Benzos
External cooling
Monitoring for cerebral edema

118

Opioid Toxicity Tx

Naloxone 0.4-2 mg IV/IM/SC

119

Most common cause of abdominal pain requiring surgery

Acute appendicitis

120

Most common cause of abdominal pain requiring surgery in the elderly patient

Cholecystitis

121

Periumbilical migrating to the RLQ with N/V after onset of pain, anorexia

Appendicitis

122

Preferred imaging for appendicitis

CT scan

123

Preferred imaging for biliary tract disease

Ultrasound

124

Preferred imaging for biliary tract disease

Abdominal X Ray
CT Scan with IV

125

Preferred lab for pancreatitis

Lipase (increased speed and accuracy over amylase)

126

Preferred imaging for pancreatitis

CT Scan

127

Treatment for pancreatitis

Symptom control
Bowel rest
Admit vs obs vs D/C

128

Preferred imaging of diverticulitis

CT Scan

129

Treatment for diverticulitis

Uncomplicated: ABX and D/C
Septic, co-morbid conditions, abscess, perforation: consult for admission and IV ABX

130

Main causes of ulcer disease

Helicobacter pylori and NSAIDs

131

Treatment for ulcer disease if no concern for perforation

Treatment of symptoms
GI cocktail: PPI, H2 blocker

132

Preferred imaging for ulcer disease (hemorrhage)

Acute abdominal X Ray

133

Management of ulcer disease with hemorrhage

1. Type and cross screen
2. Fluid resuscitation
3. IV PPI bolus and drip
4. NG tube
5. Consultation for admission
6. Broad spectrum antibiotics if concern for perforation

134

Inadequate fixation of testis to tunica vaginalis

Testicular torsion

135

Bell Clapper deformity

Testicular torsion

136

Testicular torsion most commonly occurs after ______________ or ______________

Vigorous activity or
Trauma

137

In testicular torsion, will see a negative __________ reflex and a negative __________ sign on physical exam

Cremasteric Reflex
Prehn's Sign

138

Risk factors for ovarian torsion

Pregnancy
Ovulation
Ovarian cysts, tumors or masses

139

Preferred imaging for ovarian torsion

Color flow doppler transvaginal ultrasonography

140

Signs and symptoms of ectopic pregnancy

Severe pain, delayed or missed menses, syncope, signs of shock

141

Diagnostics for ectopic pregnancy

Quantitative B-hCG
Pelvic ultrasonography

142

Common diagnoses for dyspnea and wheezing

Asthma
COPD
Anaphylaxis

143

Common diagnoses for dyspnea and fever

Pneumonia
Pulmonary embolism

144

Common diagnoses for dyspnea and cough

Pneumonia
COPD/Asthma
Pulmonary embolism
Heart failure

145

Common diagnoses for dyspnea and leg edema

Heart failure
Pulmonary embolism
Acute coronary syndrome

146

Common diagnoses for dyspnea and tachycardia

Pulmonary embolism
Tachyarrhythmias
Pneumonia
Heart failure

147

Common diagnoses for dyspnea and chest pain

Acute coronary syndrome
Pulmonary embolism
Pneumonia
Trauma

148

Treatment for COPD

Supplemental oxygen (90-92%)
Bronchodilators
Antibiotics
Steroids

149

Treatment for asthma (in the ED setting)

1. Supplemental oxygen
2. B2 agonists (albuterol)
3. Anticholinergics (Atrovent)
4. Corticosteroids (within 1 hr of arrival - Prednisone, Solumedrol, Decadron)
5. Magnesium (shown in help in severe asthma)

150

Discharge for asthma patients (home orders)

Steroids for at least 5 days
All need B2 agonists
Pts with mod to severe should measure daily peak flows
All patients need close follow up
All patients need education about asthma
Smoking cessation counseling

151

Signs/Symptoms of HF

Respiratory distress, cool/diaphoretic skin, weight gain, peripheral edema
Elevated JVD, S3, HTN, rales

152

Treatment of CHF

NTG by sublingual or IV
Lasix-Diuresis starts in 15-20 minutes

153

Primary spontaneous pneumothorax that is < ____% and does not cause respiratory or cardiac symptoms can be safely observed w/o treatment if chest X Rays done at ___ and ____ hours show no progression

20%
6 and 48 hours

154

Presenting symptoms of a pulmonary embolism

Syncope
Abdominal pain
Fever
Cough
Dyspnea
Wheezing

155

Physical exam findings of a pulmonary embolism

Tachypnea
Rales
Accentuated 2nd heart sounds
Tachycardia
Fever
Potentially S3 or S4

156

Common ECG findings with pulmonary embolism

Tachycardia
Atrial arrhythmias
New RBBB
Interior Q and/or T wave inversion
S1Q3T3

157

Hampton's Hump on CXR

Pulmonary embolism

158

Treatment for hemodynamically stable with pulmonary embolism

LMWH
Apixaban, dabigatran, rivaroxaban, edoxaban
Warfarin

159

Where are osborne or notched J waves seen?

Hypothermia

160

P waves change shape; <100 beats/min

Wandering pacemaker

161

P waves change shape; >100 beats/min

Multifocal atrial tachycardia

162

Arrhythmia most commonly associated with COPD

Multifocal atrial tachycardia

163

Rapid series of smooth sine waves from a single rapid-firing ventricular focus

Ventricular flutter

164

Large diphasic P with tall initial component

Right atrial hypertrophy

165

Large diphasic P with wide terminal component

Left atrial hypertrophy

166

Large R wave in V1 gets progressively smaller from V2-V3-V4

Right ventricular hypertrophy

167

Large S wave V1 + large R wave in V5 is > 35 mm

Left ventricular hypertrophy

168

Pathologic Q waves indicate:

Necrosis

169

T wave inversion indicates:

Ischemia

170

Treatment for supraventricular tachycardia

Vagal maneuvers
Adenosine 6 mg
Adenosine 12 mg
Defib

171

Treatment for atrial flutter

Diltiazem (CCB)

172

A premature atrial contraction will have a:

Narrow QRS complex

173

A premature ventricular contraction with have a:

Wide QRS complex

174

Treatment for monomorphic ventricular tachycardia without a pulse, and stable with a pulse

W/o pulse: 200 J biphasic shock
W/ pulse and stable: amiodarone

175

Treatment for ACS in ED

1. ASA and oxygen
2. NTG
3. Morphine
4. Heparin
5. B Blockers
6. Statins

176

RRSIDEAD

Resuscitation
Risk Assessment
Supportive Care
Investigations
Decontamination
Enhanced elimination
Antidotes
Disposition

177

5 basic toxidromes

1. Sympathomimetic
2. Opiate
3. Anticholinergic
4. Cholinergic
5. Sedative hypnotics

178

Examples of sympathomimetics

Cocaine, methamphetamine, ecstasy, ADHD meds, ephedrine, caffeine

179

Lethal dose of caffeine

150 mg/kg

180

Sympathomimetic toxidrome

Hyperthermia, diaphoresis, mydriasis, agitation, tachycardia, combativeness, hypertension

181

Caffeine OD Symptoms

Tremor, restlessness, N/V, tachycardia, agitation

182

Caffeine withdrawal symptoms

HA, yawning, drowsiness, nausea, rhinorrhea, lethargy, irritability, nervousness, depression, decreased motivation

183

Death from cocaine OD usually due to

Ventricular arrhythmia
Status epilepticus
Intracranial hemorrhage
Hyperthermia
Rhabdomyolysis
Renal failure
Coagulopathy

184

Benzoylecgonine, the metabolite of cocaine, is usually present for ______ days

2-10

185

Imaging for cocaine OD

CT of head if suspected hemorrhage
Abdominal x Ray if packing suspected

186

With MDMA, the electrolyte abnormality likely to show on a BMP is:

Hyponatremia

187

Opioid Toxidrome symptoms

Miosis
Respiratory depression (<12 breaths per minute)
CNS depression (coma)

188

Treatment for opioid OD

Ventilation - bag valve mask
Naloxone - IV onset 2 min

189

Anticholinergic Toxidrome (7)

Hot as Hades - Fever
Blind as a bat - mydriasis
Full as a tick - urinary retention
Dry as a bone - anhidrosis
Mad as a hatter - delirium
Red as a beet - flushing
Fast as a hare - tachycardia

190

Examples of anticholinergics

Atropine, Pralidoxime
Antihistamines (Benadryl)
Antipsychotics/neuroleptics (Haldol)
Antidepressants (TCA, amitriptyline)
Several plant species

191

Treatment for anticholinergic toxidrome

Supportive care
Benzos for agitation
Physostigmine (cholinesterase inhibitor)

192

Differentiation between sympathomimetics and anticholinergics

Sym: agitation, diaphoresis, bowel sounds
Anti: dry skin/mucus membranes, flushing, urinary retention, bowel sounds absent

193

Cholinergic Toxidrome (DUMBBBELS)

Diarrhea
Urinary incontinence
Miosis
Bradycardia
Bronchorrhea
Bronchospasm
Emesis
Lacrimation
Sweating, salivation

194

This toxidrome gives off a garlic or hydrocarbon odor

Cholinergic (pesticides, etc.)

195

Diagnostic tests for cholinesterase OD

Labs for RBC AChE activity

196

Treatment for cholinesterase OD

1. Decontamination (removal of clothing, irrigation, charcoal, gastric lavage)
2. Atropine
3. 2-PAM
4. Diazepam for seizures
5. Supportive care

197

Examples of sedative hypnotics

Alcohol, valium, ambien

198

Holiday Heart Syndrome

Palpitations, near syncope
May have electrolyte abnormalities
Need ECHO

199

Wernicke Encephalopathy

Associated with chronic alcohol abuse
Thiamine deficiency
Treat with high dose IV thiamine, then glucose

200

Four diagnostic criteria for serotonin syndrome

1. Hyperthermia
2. MS changes
3. Autonomic instability
4. Myoclonus, hyperreflexia or rigidity

201

Treatment for serotonin syndrome

1. ABC, supportive care
2. Cyproheptadine
3. Antipyretics, benzos
4. Chlorpromazine

202

Category A Bioterrorism Agents (6)

1. Anthrax
2. Smallpox
3. Pneumonia plague
4. Tularemia
5. Botulism
6. Viral hemorrhagic fevers

203

Bacillus anthracis

Etiologic agent of anthrax

204

Painless skin lesion evolving from papule to a depressed black eschar with local edema

Anthrax (cutaneous exposure)

205

Brief prodrome resembling a viral respiratory illness, followed by development of hypoxia and dyspnea, with mediastinal widening or pleural effusion on CSR

Anthrax (inhaled exposure)

206

Inhalational Anthrax Symptoms

Fever, chills, chest discomfort, SOB, cough, N/V, dizziness, confusion
Can lead to anthrax meningitis

207

Treatment for anthrax poisoning

Ciprofloxacin or levofloxacin or moxifloxacin
PLUS
Clindamycin or linezolid or doxycycline

208

Post exposure prophylaxis for anthrax

Doxycycline and Ciprofloxacin first line

209

Yersinia Pestis

Etiologic agent for the plague

210

4 versions of the plague

1. Bubonic plague
2. Septicemic plague
3. Pneumonic plague
4. Pharyngeal plague

211

First line treatment for pneumonic plague

First line: streptomycin, gentamicin, ciprofloxacin, levofloxacin

212

Variola virus

Etiologic agent of smallpox

213

Common symptoms are diplopia, blurred vision, drooping eyelids, slurred speech, dysphagia, dry mouth and muscle weakness

Botulism

214

Treatment for botulism

1. Skin testing for sensitivity
2. One vial of antitoxin IV

215

Francisella tularensis

Etiologic agent for tularemia

216

5 forms of tularemia

Ulceroglandular
Glandular
Oculoglandular
Oropharyngeal
Pneumonic

217

Tularemia Treatment

Streptomycin
Gentamicin
Doxycycline
Ciprofloxacin

218

Filoviridae family viruses

Etiologic agent for Ebola and Marburg (viral hemorrhagic fever)

219

Treatment of Ebola/Marburg

Supportive care
Vaccine currently in clinical trials

220

Treatment of sick sinus syndrome

Permanent pacemaker

221

Treatment of premature atrial contractions

No specific treatment, treat underlying disorder

222

Treatment of sinus tachycardia

Treat underlying disorder

223

Treatment of ventricular fibrillation

Electrical defibrillation 360 J monophasic or 120-200 biphasic

224

Outcome is best in cardiac arrest

Pulseless ventricular tachycardia

225

Outcome is the 2nd best in cardiac arrest

Ventricular fibrillation

226

Most common mechanism for cardiac arrest with most dismal outcome

PEA and asystole

227

5 H's and 5 T's of cardiac arrest

Hypothermia
Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypo/hyperkalemia
Tension pneumothorax
Tamponade, cardiac
Toxins
Thrombosis, coronary
Thrombosis, pulmonary

228

Atropine First Dose

0.5 mg bolus (repeat every 3-5 minutes)

229

Epinephrine Dosing

0.1-0.5 mcg/kg per minute