Just to Know

Question 1

Abx for uncomplicated UTI - 5

Answer 1

Uncomplicated UTI

1. Nitrofurantoin 100mg PO BID x 5 (avoid if suspect early pyelo or CrCl< 30)
2. Bactrim DS PO BID x 3
3. Fosfomycin 3gm x 1 injection
4. Pivmecillinam 400mg PO BID x 3
5. Cipro IR 250mg PO BID x 3 - ONLY USE IF NECESSARY AS RESISTANCE IS DEVELOPING

Bactrim DS = 800mg/160mg and Pivmecillinam is an extended gram - spectrum PCN

Question 2

What are the criteria for SIRS (Systemic Inflammatory Response Syndrome)

Answer 2

SIRS Must have ≥2 of:

SangraPumper (Heart) > 90 bpm

Immune (WBC) external to 4-12K (or > 10% immature bands)

Respiratory rate > 20 (or PaCO2 < 32)

Surrounding Temperature external to 36-38C

SIRS + infection = Sepsis

Screen these pts with POC Lactate as they may only come in with malasie, fatigue or weakness!

Question 3

Empiric Abx for Sepsis -4

Answer 3

Choose one from the Kumar study…

1. CefTriaxone
2. Zosyn
3. Aztreonam
4. Carbapenem

Question 4

What does Septic SHOCK mean?

Answer 4

Pt still has SPB<90 DESPITE IVF OF 30cc/kg x 3 hrs

Question 5

What does SEVERE Sepsis mean? ; List the 7 examples

Answer 5

Sepsis + end-organ dysfunction

System, Liver, Kidney

1. Lactate≥2
2. Systolic<90 (or MAP<70)
3. Bilirubin>2
4. Platelet<100K
5. INR>1.5 (or aPTT>60s = coagulopathy)
6. Cr>2
7. UOP<0.5 cc/kg/hr for > 2 hr

Question 6

S/S of Alcohol Withdrawal -10

these sx PEAK during 2nd day of abstinence and resolve by day 5

Answer 6

PAST NITE

Psychomotor agitation

Anxiety

Seizures

Tremor & DELIRIUM TREMENS

NV

Insomnia & Irritability

Transient Hallcuinations

Excitable autonomics (⬆︎HR, BP)

Question 7

Describe Delirium Tremens-5 ; when does DT onset?

Answer 7

Further progression of Excitable autnomics =

1. ⬆︎ HR
2. ⬆︎ BP
3. Fever
4. Hallucinations
5. Tremulousness –> Death

Onsets 2 days post last EtOH (when withdrawal sx peak)

Question 8

Status Epilepticus Mngmt - 5

Answer 8

1st: ABCs!
2nd: Ativan IV bolus 0.1mg/kg = 4-8 mg (repeat in 5-10 min if needed)
3rd: FosPhenytoin IV 20 units/kg (no faster than 150 mg/min) (Continuous IV Phenytoin –>Purple Glove Syndrome and so is alternative)

4th (if still status): Alternate Diazepam Keppra

5th (if still status): Pentobarb coma

Image showing Cortical Laminar Necrosis s/p Status Epilepticus

Question 9

Mngmt for acute Anaphylaxis - 6

Answer 9

Anaphylaxis makes you DEFORM for sure!

1. Diphenhydramine
2. Epinephrine 0.3mg IM (or IV if unstable VS)
3. Fluids IV
4. O2 nonRebreather
5. Ranitidine
6. Methylprednisolone

Question 10

Cholinergic poisoning clinical presentation - 9

Answer 10

DUMBBELSS

1. Diarrhea
2. Urination
3. Miosis
4. Bronchospasm
5. Bradycardia
6. Excitation of sk muscle and CNS
7. Lacrimation
8. Sweating
9. Salivation

tx = Atropine + Pralidoxime

Question 11

Describe Neuroleptic Malignant Syndrome - 5

Answer 11

RARE SE of Any Dopamine Blocker (Antipsychotics vs. GI meds) that –> FEVER

• [Fever > 40C]
• Encephalopathy (Confusion)
• Vitals unstable (INC HR / RR / BP from autonomic dysfunction)
• Enzymes ⬆︎ (CPK)
• Rigitidy ⬆︎ (Tremor)

Question 12

What are the Ottawa Knee rules

Answer 12

Ottawa Knee rules

Obtain Knee radiographs on anyone who has to WAFFT

1. Weight bearing is negative x ≥ 4 steps immediately after injury AND in ED (limping is ok)
2. Age ≥55
3. Fibular head TTP
4. Flexion of knee 90° is negative
5. TTP to Patella and NO OTHER BONY AREA

If any of these are positive –> Knee Radiographs

Question 13

DDx for Altered Mental Status - 14

Answer 13

Altered Mental Status DDx - 14

AEEEIIOU TiiiPS

1. Alcohol
2. Encephalopathy
3. Electroyte imbalance
4. Endocrine
5. Insulin imbalance
6. Intussuception
7. Overdose (think Opiates)
8. Uremia
9. Trauma
10. infection
11. intracerebral hemorrhage
12. infarction
13. Psych
14. Seizure

Question 14

Name the common dialyzable drugs - 9

Answer 14

Common Dialyzable drugs

Toxic Substances CLIMBED

1. Theophylline/caffeine
2. Salicylates
3. Carbamazepine
4. Lithium
5. INH
6. Methanol
7. Barbituates
8. Ethylene glycol
9. Depakote