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Flashcards in Get your EM here Deck (26):
1

suicidal kid after OD refusing treatment

any SI cannot refuse rx

if needed can intubate and put OG tube down w/ activated charcoal
(forcing them to drink may --> aspiration)

2

Telling jimpson weed (anticholinergic) apart from cocaine (sympathomimetic) OD

both= big pupil + delirium

cocaine= sweaty

j weed= dry

3

Anticholinergic toxidrome

Hot as a hare: increased body temperature
Blind as a bat: mydriasis (dilated pupils)
Dry as a bone: dry mouth, dry eyes, decreased sweat
Red as a beet: flushed face
Mad as a hatter: delirium

4

Belladonna is

deadly night shade- Anticholinergic

5

Charcoal does not bind ______ in ODs

metals (such as iron)
alcohols
hydrocarbons

Whole bowel irrigation is used in cases where charcoal is not effective, with certain sustained release products, and in cases of illicit drug packet ingestions (body packers)

6

Indicator of severe toxicity with TCA OD

QRS prolonged

7

Acute salicylate overdose characteristically causes a? acid base

metabolic acidosis mixed with a respiratory alkalosis.

8

The lethal dose of APAP is ___________

150mg/kg
the antidote is N-acetylcysteine (Mucomyst)
and
repeated doses of activated charcoal

9

An acetaminophen level drawn at _________ can be plotted on the Rumack-Matthew nomogram to guide therapy based on the potential for hepatic toxcicity

hours 4-20

10

Unlike the Rumak nomogram of acetaminophen, the ___________ is associated with aspirin ingestions

Done nomogram

11

The hallmark signs and symptoms of clonidine toxicity include:

hypotension, bradycardia, mental status change, respiratory depression, and miosis. The presentation very closely mimics opioid toxicity.

12

Amitriptyline has anticholinergic activity that will cause a sinus tachycardia. Additional EKG findings with TCA toxicity include?

interval prolongation and terminal 40 ms right axis deviation.

13

_________ binds directly to free iron and thus is the antidote for iron toxicity.

Deferoxamine

often causes the patient’s urine to turn color (vin rosé urine).

14

_________ is the antidote for isoniazid toxicity

Pyridoxine

15

Severe lead toxicity can commonly result in which of the following clinical symptoms
A. Stocking glove peripheral neuropathy
B. Constipation
C. Dermatitis
D. Memory loss

D. Memory loss

16

A 27 year old woman is brought into the emergency department by her roommate 30 minutes after ingesting a bottle of aspirin in a suicide attempt. Which of the following acid-base disorders is most likely to be present in this patient?

Respiratory alkalosis due to stimulation of the respiratory center and increased CO2 production

A primary metabolic acidosis typically develops as well.

17

For which of the following cases (all of which are characterized by an ingestion history known with certainty) is gastric lavage most likely indicated?

-Adult patient, nortriptyline ingestion (50 mg/tab x 100 tablets, 45 minutes PTA)
-Adult patient, ibuprofen ingestion (800 mg/tab x 5 tabs, 20 minutes prior to arrival (PTA) in the ED
-Adult patient, kerosene ingestion (8 oz, 20 minutes PTA)
-Adult patient, metoprolol ingestion (100 mg/tab x 100 tablets, 6 hours PTA)

nortriptyline ingestion - Gastric lavage (GL) is generally not effective if performed more than a few hours (exact time ranges depend on clinical circumstances) after ingestion. Due to risks of lavage (aspiration, gastric/esophageal perforation), trivial ingestions are not an indication for GL. Due to the risk of aspiration with hydrocarbons and further injury with caustic ingestions, GL is contraindicated for hydrocarbon and caustic ingestions.

18

Sympathomimetics and anticholinergics such as Jimson Weed can be differentiated by the presence of ___________ although both can cause delirium and mydriasis

sweating

19

Some toxins _______________do not bind to charcoal.

heavy metals such as lithium, lead, and
iron

20

Due to the risk of aspiration with hydrocarbons and further injury with caustic ingestions, _________ is contraindicated for hydrocarbon and caustic ingestions.

Gastric lavage

21

charcoal is contraindicated in patients with

-unprotected airways- risk of aspiration
-caustic ingestions as the black color of the charcoal interferes with the EGD eval

22

_____________ are common precipitants of lithium toxicity in the patient chronically taking lithium

Dehydration, over-diuresis, and drug-drug interaction (particularly NSAIDs)

rx: Hemodialysis

23

__________ are the treatment mainstay for cocaine toxicity.

Benzodiazepines

24

The hallmark signs and symptoms of clonidine toxicity include:

hypotension, bradycardia, mental status change, respiratory depression, and miosis. The presentation very closely mimics opioid toxicity.

25

_______ can serve as an antidote for beta blocker, calcium channel blocker, or insulin overdoses.

glucagon

26

Severe lead toxicity can commonly result in which of the following clinical symptoms
-Dermatitis
-Stocking glove peripheral neuropathy
-Memory loss
-Constipation

-Memory loss

Lead toxicity affects a variety of systems. The central nervous system effects are many and range from encephalopathy and seizure to sleep disturbance and memory deficits. The peripheral nervous system can also be involved, with paresthesias and wrist drop being common. Colicky abdominal pain is often present. While dermatitis is not common in lead poisoning, you can see bluish lead lines on the gingiva.