Med Emerg Management

Question 1

NARCOTIC TOXIDROME Drug Examples (7)

Answer 1

Morphine
Codeine
Heroin
Methadone
Fentanyl
Oxycodone
ASA

Question 2

NARCOTIC TOXIDROME S/S (8)

Answer 2

Hypoventilation
Respiratory arrest
Constricted pupils
Bradycardia
Hypotension
Track marks
Drowsy/Stupor
Coma

Question 3

SYMPATHOMIMETIC Drug Examples (7)

Answer 3

Pseudoephedrine
Amphetamine
Meth
Cocaine
Caffeine
Nasal decongestants
Bath salts

Question 4

SYMPATHOMIMETIC S/S (9)

Answer 4

HTN
Diaphoresis
Tachycardia
Tachypnea
Dilated pupils
Agitation
Seizure
Hyperthermia
Paranoia

Question 5

SEDATIVE HYPNOTIC Drug Examples (6)

Answer 5

Phenobarbital
Diazepam
Versed
Lorazepam
Propofol
Ethanol

Question 6

SEDATIVE HYPNOTIC S/S (9)

Answer 6

Hypoventilation 
Respiratory arrest/depression
Drowsy
Uninhibited
Ataxia
Slurred Speech
Confusion
Progressive CNS depression
Hypotension

Question 7

CHOLINERGIC Drug Examples (3)

Answer 7

Organophosphates
Sarin
V agent

Question 8

CHOLINERGIC S/S- DUMBELS

Answer 8

Diarrhea
Urination
Miosis (constricted pupils)/Muscle Weakness
Bradycardia/Bronchospasm
Emesis
Lacrimation
Seizures/Salivation/Seating

Respiratory depression

Question 9

ANTICHOLINERGIC Drug Examples (6)

Answer 9

Atropine
Antihistamines
Benadryl
Tricyclic AntiDepressants
AntiPsychotics 
Jimson weed

Question 10

ANTICHOLINERGIC S/S (9)

Answer 10

Agitation
Dry mucous membranes
Flushed
Hyperthermia
Tachycardia
Dilated pupils
Blurred vision
Mild hallucinations
Delerium

Question 11

Cranial Nerve 1

Answer 11

Olfactory- Smell

Question 12

Cranial Nerve 2

Answer 12

Optic- Vision

Question 13

Cranial Nerve 3

Answer 13

Oculomotor- Movement of Eye/Pupil

Question 14

Cranial Nerve 4

Answer 14

Trochlear- Movement of eye

Question 15

Cranial Nerve 5

Answer 15

Trigeminal- Chewing/Px/Temp/Touch of face and mouth

Question 16

Cranial Nerve 6

Answer 16

Abducens- movement of eye

Question 17

Cranial Nerve 7

Answer 17

Facial- tears/salivation/taste/movement of face

Question 18

Cranial Nerve 8

Answer 18

Auditory- hearing and balance

Question 19

Cranial Nerve 9

Answer 19

Glossopharyngeal- swallow, taste, sensation of pharynx and mouth

Question 20

Cranial Nerve 10

Answer 20

Vagus- sensation and movement of pharynx/larynx/thorax/GI

Question 21

Cranial Nerve 11

Answer 21

Accessory- Movement of head/shoulders

Question 22

Cranial Nerve 12

Answer 22

Hypoglossal- movement of tongue

Question 23

Cushings Triad

Answer 23

Decreased HR
Decreased Respiratory rate
Widened pulse pressures (systolic)

Question 24

Hallmarks of Increased ICP (5)

Answer 24

Cushing triad
Decorticate/decerebate posturing
Biot/Apneustic/Cheyne Stokes Respirations
Unresponsive
Dilated Pupils

Question 25

Standard Neuro Tx Plan

Answer 25

``` Scene Safety ABC's Check blood glucose Consider stroke eval Assess for ICP Check for drug use Assess for seizures Evaluate temp Provide support for family ```

Question 26

Tx Plan for Pt with increased ICP

Answer 26

``` Ensure BP of 110-120 Give fluids as needed Elevate head by 30 degrees if no trauma Support ventilation Maintain EtCO2 high 20's and low 30's Clear Airway ``` Do not aggressively suction-->vagus nerve stimulation increases ICP If bradycardia due to increased ICP, no atropine or TCP is indicated Prompt txp DO NOT use solutions with dextrose

Question 27

Normal Cerebral perfusion pressure

Answer 27

70-90

Question 28

Hemorrhagic stroke S/S

Answer 28

Severe HA- worst ever difficult to arouse s/s increased ICP cannot speak

Question 29

Normal ICP

Answer 29

1-20

Question 30

CPP Equation

Answer 30

CPP= MAP-ICP

Question 31

A-EIOUTIPS (2)

Answer 31

Alcohol- 02, glucose, temp, thiamine | Acidosis- bicarb

Question 32

AE-IOUTIPS (3)

Answer 32

Epilepsy- 02, versed Endocrine- supportive Electrolytes- EKG, ABC's

Question 33

AEI-OUTIPS

Answer 33

Insulin- dextrose, glucagon

Question 34

AEIO-UTIPS

Answer 34

Opiates- narcan, ABCs | Other drugs

Question 35

AEIOU-TIPS

Answer 35

Uremia (kidney failure)- 02, glucose, temp

Question 36

AEIOUT-IPS

Answer 36

Trauma- c spine, adequate BP | Temperature- cool or warm pt

Question 37

AEIOUTI-PS

Answer 37

Infection- ensure adequate BP

Question 38

AEIOUTIP-S

Answer 38

Poisoning- care based on agent | Psychogenic causes- 02, glucose, temp, restraints

Question 39

AEIOUTIPS-

Answer 39

Shock- ABC's and adequate circulation/vasopressors Stroke- 02, glucose, temp, ABC's Syncope- ABC's, EKG, trauma if fell Space occupying lesion- tx seizure or stroke Subarachnoid hemorrhage- tx seizure or stroke

Question 40

ALOC Medical Rapid Onset

Answer 40

``` Insulin Stroke Epilepsy ETOH OD ```

Question 41

ALOC Medical Gradual Onset

Answer 41

``` Acidosis Uremia Psychosis Infection OD ```

Question 42

ALOC Trauma

Answer 42

Head injury | Hypotension

Question 43

Seizure types

Answer 43

Tonic clonic Pseudoseizures Absence seizures Partial seizures- either shaking of one limb, or subtle changes in LOC

Question 44

Seizure tx

Answer 44

``` ABC's Protect from injury If still seizing, give Versed/Ativan Check blood glucose Give 02- consider NPA and high flow 02 ```

Question 45

Cardiac causes of Syncope (10)

Answer 45

``` Bradycardia Sick Sinus SVT Pacemaker malfunction TdP Transient Asystole Transient VF VT MI Medication problem ```

Question 46

NonCardiac Causes of Syncope (5)

Answer 46

``` Dehydration Hypoglycemia Vasovagal PE Other medications ```

Question 47

Syncope tx

Answer 47

``` ABC's Sit/Lay down if needed Orthostatics Drugs/ETOH EKG Blood glucose check ``` Consider fluids or vasopressor

Question 48

Migraine tx

Answer 48

Consider px management | Zofran 4mg

Question 49

Dystonia tx

Answer 49

Benadryl 25-50mg

Question 50

Encephalitis s/s (8)

Answer 50

``` Fever HA N/V Malaise ALOC Stiff neck Photophobia Seizure ```

Question 51

Meningitis S/S

Answer 51

Runny nose Cough Malaise ``` HA Fever Neck rigidity Chills Photophobia N/V Seizure ALOC Inc ICP ``` Kernig sign-px with hips flexed and straightening knee Brudzinski sign- px when neck flexed to chest while lying down

Question 52

Polio Tx

Answer 52

Watch Airway and Breathing

Question 53

Brain Abscess consideration

Answer 53

watch for seizures

Question 54

S/S Hemorrhagic Stroke

Answer 54

``` decreased HR Cheyne Stokes breathing HTN Unequal pupils posturing ```

Question 55

Target EtCO2 for Stroke Pt

Answer 55

30-35

Question 56

Multiple Sclerosis

Answer 56

Autoimmune disorder--> body attacks myelin sheath surrounding the axons of neurons. Causes scarring and decreased neural function.

Question 57

Multiple Sclerosis S/S

Answer 57

Muscle weakness Speech changes depression light touch causing px

Question 58

Guillan Barre Tx

Answer 58

Largely supportive--> may need to be aggressive with intubation, ventilation, and fluid infusion

Question 59

ALS

Answer 59

attacks motor neurons causing death and thereby muscle atrophy 

Question 60

ALS (Lou Gehrigs) Tx

Answer 60

May need aggressive airway intervention

Question 61

Graves Disease

Answer 61

Hyperthyroidism | Risk of thyroid storm

Question 62

Thyroid storm s/s

Answer 62

``` extreme high fever diaphoresis tachycardia N/V agitated delerium seizures unconscious hypoglycemia ```

Question 63

Thyroid storm tx

Answer 63

``` tx hypoglycemia if needed may require very high benzo amounts aggressive fluids if normo-hypotensive beta blocker medication if tachycardic active cooling ```

Question 64

Hypothyroidism/Myxedema coma

Answer 64

Occurs when ALOC, and hypothermic

Question 65

Myxedema coma tx

Answer 65

maintain 02 maintain temp/passive rewarming intubation if no gag reflex or inadequate breathing monitor ECG and blood glucose

Question 66

Adrenal insufficiency s/s

Answer 66

``` ALOC hypotension weakness weakness N/V diarrhea ```

Question 67

Adrenal insufficiency tx

Answer 67

aggressive fluid management treat hypoglycemia if present treat hyperkalemia if present

Question 68

Cushings s/s

Answer 68

``` weakness fatigue depression mood swings buffalo hump facial hair moon face ```

Question 69

Cushing tx

Answer 69

treat symptoms | treat hypoglycemia if present

Question 70

Congenital adrenal hyperplasia

Answer 70

inadequate production of cortisol and aldosterone

Question 71

Extreme episode in Type I Diabetes

Answer 71

Diabetic ketoacidosis

Question 72

Extreme episode in Type II Diabetes

Answer 72

Hyperosmolar Hyperglycemic State --> or Hyperosmolar hyperglycemic nonketotic coma, hyperosmolar nonketotic coma

Question 73

Hypoglycemia tx

Answer 73

25g-50g D50 and flush | 250mL D10 soln

Question 74

Hyperglycemia tx

Answer 74

at least 1L NS in first 30mins evaluate lung sounds watch cardiac function watch for hyperkalemia---> calcium chloride 1g

Question 75

Anaphylaxis tx

Answer 75

``` remove offending agent cardiac monitoring 0.3mg 1:1000 epi IM at least 1 large bore IV fluid run wide open benadryl 25-50mg solumedrol 125mg ``` consider albuterol neb if wheezing, or epi neb 3mg 1:000 if pt's on beta blocker, consider glucagon IVP q 5mins may need epi infusion ---> 1mg 1:1000 epi in 1L NS and run mix at 0.1mcg/kg/min or push dose epi ---> 0.1mg in 0.9mL NS

Question 76

Systemic Lupus Erythematosus

Answer 76

multisystem autoimmune disorder effecting whole body common in women in child bearing age with joint pain, fever, rash

Question 77

Pneumonia S/S

Answer 77

Fever Chills productive cough- colored chest px

Question 78

Hepatitis S/S

Answer 78

jaundice low grade fever malaise grey feces

Question 79

Lyme S/S

Answer 79

bulls eye mark fever chills muscle and joint px

Question 80

Rabies S/S

Answer 80

``` flu like symptoms numb bite seizures hyperactive delerium bizarre behavior ```

Question 81

Anticholinergic Phrase

Answer 81

``` Blind as a bat- dilated pupils Red as a beet- vasodilation/flushed Hot as a hare- hyperthermia Dry as a bone- dry skin Mad as a hatter- hallucinations/agitated ```

Question 82

CO poisoning S/S

Answer 82

``` N/V Confusion HA Weakness Cherry red face **usually unsurvivable at this point ``` **check blood sugar to be sure not hypoglycemic

Question 83

Cyanide poisoning S/S

Answer 83

Lethargy weakness breathing will be rapid-->to slow-->arrest bitter almond smell

Question 84

Cyanide poisoning tx

Answer 84

Use of antidote Benzos for seizures **rapid transport

Question 85

Esophageal Varices S/S

Answer 85

copious hematemesis | due to portal HTN from EtOH

Question 86

Esophageal Varices Tx

Answer 86

02 Saline lock Fluid if hypotensive **Zofran usually doesn't work

Question 87

Mallory Weiss Tx

Answer 87

``` Bleeding less severe than varices Common from protracted vomiting O2 IV access Fluids for dehydration Zofran to limit vomiting ```

Question 88

Appendicitis S/S

Answer 88

Fever N/V LRQ px rebound tenderness

Question 89

Appendicitis Tx

Answer 89

Position of comfort IV Fluids if shock present

Question 90

Cholecystitis S/S

Answer 90

jaundice px after eating fatty meal N/V RUQ px

Question 91

Cholecystitis Tx

Answer 91

morphine makes px worse- tightens sphincter

Question 92

Diverticulitis S/S

Answer 92

``` n/v Fever malaise LLQ px **easy to turn septic **be prepared for lots of fluids ```

Question 93

RAAS

Answer 93

renin (kidney) converts angiotensinogen (liver)--> angiotensin I which is converted by ACE in lungs to angtiotensin II angtiotensin II promotes release of aldosterone in adrenals--->promotes water retention to increase BP

Question 94

Dialysis emergencies

Answer 94

Air Embolism Disequilibrium syndrome HypoK/HyperK Hypotension/Shock

Question 95

Disequilibrium syndrome

Answer 95

Acute haemodialysis is associated with this syndrome due to the reduction of plasma solute level over a limited time. Plasma becomes hypotonic compared to brain cells and water shifts from the plasma into the brain tissue Systemic and neurological symptoms are associated with disequilibrium syndrome. Early signs include nausea, headache, vomiting, and restlessness. More serious symptoms can result in seizures and coma.

Question 96

Heat Stroke Tx

Answer 96

Cool aggressively Fluids Cardiac montior IV

Question 97

Heat exhaustion Tx

Answer 97

``` Cool Cardiac monitor IV Fluids 1L over 1 hour Zofran is N/V ```

Question 98

Mild Hypothermia

Answer 98

95-90 degrees

Question 99

Mild Hypothermia tx

Answer 99

``` remove wet clothes warm warmed fluids cardiac monitor treat hypoglycemia if present **check!! manage seizures IV ```

Question 100

Moderate Hypothermia

Answer 100

90-82.4 degrees

Question 101

Moderate Hypothermia Tx

Answer 101

``` remove wet clothes warm warm fluids/IV cardiac monitor check hypoglycemia watch for bradycardic rhythms ```

Question 102

Severe Hypothermia

Answer 102

82.3 and under

Question 103

Severe hypothermia Tx

Answer 103

``` remove wet clothes warm warm fluids and IV cardiac monitor expect V Tach and no pulse CPR until warm and dead ```

Question 104

Cold water drowning temps

Answer 104

under 68 degrees

Question 105

Drowning tx

Answer 105

``` watch for pulmonary edema EtCO2 SpO2 EKG Albuterol for wheezing be prepared to intubate ```

Question 106

Snake bite- pit viper and coral snake

Answer 106

pit viper- immobilize extremity and rapid txp coral snake- constricting band to slow spread. be prepared to aggressively manage airway

Question 107

Spider bite tx

Answer 107

benzos for px and paralysis | narcotics for px

Question 108

Scorpion tx

Answer 108

``` ABCs intubate if necessary treat cardiac dysrhythmias constricting band to slow lymph return to heart rapid tx ```

Question 109

DT S/S

Answer 109

``` high BP shakes chills irregular HR hallucinations sweating ```