Treatment for malignant hyperthermia
Hyperventilation, oxygen, dantrolene
What predicts risk for future deterioration in near drowning events
Hx of apnea and cpr in the field
Neurological signs (seizure or disorientation) or respiratory failure from aspiration
Arterial desaturation and or tachypnea
What is the key to prognosis in a near drown event
Duration of asphyxia
If a pt requires less than 10 mins of cpr there is a good chance they will survive with no neurological impairment
Factors that worsen prognosis in near drowning
Submersion > 25 mins
Apnea or coma at admission
Initial arterial pH of < 7
Initial tx for caediogenic shock
Dobutamine
Tx with presented with acute heart failure
Furosemide
What findings are consistent with brain death
Absense of vertebral and carotid artery blood flow
Must make sure there are no other disorders which obscure neurological functioning
Formula for calculating ET tube size
Age divided by 4 plus 4
If an intubation pt experiences deterioration what should you consider
Displacement of ET tube
Obstruction
Pneumothorax
Equipment failure
What medications can be given by ET tube
Lidocaine
Atropine
Narcan
Epi
What medication can you give for bradycardia
Atropine
When are antibiotics for bites indicated
When dogs, cats, humans When on hands, feet, face Dirty wound Crush injuries Cartilage involvement Immunocompromised
Antibiotic for bite wounds
Augmentin
If penicillin allergic clinda plus Bactrim
How does brown recluse spider bite present
Target lesion consisting of a red circle surrounding a white ring that appears within hours
Bite becomes necrotic
Tx of brown recluse spider bite
Self limited
How does black widow spider bite present
Puncture wound barely noticed
Systemic symptoms within 8 hrs - muscle aches and HTN
Tx of black widow bite
Local wound care and pain control
Benzodiazepine in severe muscle spasms
In severe cases may use anti venom
Verify tetanus
Initial management of venamous snake bite
ABCs and then immobilize the limb and let it hang at the patients side
When is a head CT indicated
Prolongues LOC Protracted vomiting Progressing headache Retrograde amnesia Lethargy
Poor prognostic signs for a pt in coma
Cerebral bleeding
Brain edema
Coma lasting longer than 6 hrs
Low Glasgow score (less than 8 severe)
Fractures due to abuse
Bucket handle fractures Corner fractures Spiral fractures in infants Rib fractures Multiple skull fractures Spinous process fractures Scapular fractures Sternum fractures
What could Peri-orbital ecchymoses be a sign of
Neuroblastoma
Female athlete triad
Menstrual irregularity
Eating disorder
Low bone mass
What is the half life for 5 cycles
After 1 - 50% of the drug remains After 2 - 25% of the drug remains After 3- 12.5% of the drug remains After 4 - 6.25% of the drug remains After 5- 3.125% of the drug remains
After 5 half lives 97% of the drug would have been cleared from the body
What is steady state
When the drug is administered at a steady interval and the Amt in equals the amt out
A drug will reach 97% of steady state after 5 half lives
Which medications should you not have with dairy
Tetracycline, doxycycline, ciprofloxacin
What happens when an antacid is administered with iron
Antacid binds iron and prevents its absorption
Which medications should be taken with fatty foods
Isotretinoin and griseofulvin
Erythromycin, ciprofloxacin, cimetidine and omeprazole have inhibitory effects on hepatic enzymatic systems how does this impact other drugs
Reduces theophylline, codeine, beta blocker, antidepressants, corticosteroids, warfarin and metronidazole metabolism resulting in increased bioavailability and toxicity
Which drugs inhibit renal metabolism of digoxin resulting in elevated levels
Quinidine and amiodarone
What are dose related side effects of furosemide
Ototoxicity and renal toxicity
Mechanism of action of furosemide
Blocks absorption of Na and Cl results in wasting of calcium, potassium and hydrogen chloride
Mechanism of action of acetazolamide
Carbonic anhydrase inhibitor
In proximal tubule presents reuptake of bicarb and causes metabolic acidosis with alkaline urine
What happens with potassium with spironolactone
Potassium sparring
What is required for monitoring during conscious sedation
Pals certified member to monitor
Pulse ox, Bp and vitals q5min
Bag mask and oxygen should be immediately available
Reversal agents like naloxone (opiates) and flumazenil (benzos) should be available
Define moderate sedation
Pt retains ability to respond normally to verbal commands and cardio respiratory function are unaffected
Define deep sedation
Responds to repeated or painful stimuli. Partial or complete loss of protective airway reflexes
Define minimal sedation
Relief of apprehension with minimal effect on perception and sensorium
Parkland formula for first 24 hr fluid replacement
4 x wt (kg) x %TBSA