Miscellaneous

Question 1

Mx for Organophosphate poisoning

Answer 1

Remove clothes and decontaminate skin. Atropine for muscarininc symptoms, pralidoxine for nicotinic symptoms. Other general mx and symptomatic treatment

Question 2

Exceptional heat stroke vs heat exhaustion

Answer 2

EHS is >40°C and has CNS signs. HE < 40°C and has no CNS signs

Question 3

Mx of Exhaustion heat stroke

Answer 3

Rapid cooling: ice water immersion
preferred; can consider high-flow cold
water dousing, ice-wet towel rotation,
evaporative cooling

• Fluid resuscitation, electrolyte
correction
• Management of end-organ
complications
No role for antipyretic therapy

Question 4

Beta blocker OD

Answer 4

Low temp, low glucose, low HR and blood pressure. No pupil changes.

Question 5

Management of BB overdose

Answer 5

Airway stuff, GI decontamination, IV fluids, IV atropine, IV glucagon

Question 6

Drowning general ventilation rules

Answer 6

Start with high flow O2, then step up is NIPPV. The next step is intubation. If the patient is unconscious then must intubate since the patient cannot protect to the airway from aspiration.

Question 7

Antimuscarinc toxidrome causing drugs

Answer 7

Antihistamines
• Diphenhydramine, cyproheptadine

Psychotropics
• 1st generation: chlorpromazine, haloperidol
• 2nd generation: clozapine
•Tricyclic antidepressants: amitriptyline, clomipramine

Antiparkinson
• Benztropine, trihexyphenidyl

Antimuscarinic
• Ipratropium (bronchodilator)
• Oxybutynin, darifenacin (overactive bladder)
• Dicyclomine, hyoscyamine (antispasmodics)
• Scopolamine (antiemetic)
Mydriatics
• Atropine, cyclopentolate
Plant-based
• Muscarinic mushroom species
• Jimsonweed
•Nightshade species

Question 8

Bites/stings that cause urticaria, Tx

Answer 8

No tx

Question 9

Bites/stings that cause a large local reaction, Tx

Answer 9

Oral antiH with or without CS

Question 10

Systemic reaction from bites or stings, Tx

Answer 10

Epinephrine

Question 11

Excersize induced hypotension details, how to DDX heat stroke. Tx?

Answer 11

Sudden relaxation of muscles, drop in preload and thus CO. No LOC or AMS like heat stroke, and Temp only minor elevation here. Trenedlenurg and oral fluids

Question 12

Mx overview for dangerous substance ingestion (pre Hosp, ED, inpatient)

Answer 12

Prehospital
• Decontamination (eg, remove contaminated clothing, brush off visible chemical, irrigate
exposed skin)
• Do not induce vomiting or give charcoal

Emergency department
• Confirm decontamination; chest & abdominal x-rays
• Endotracheal intubation for significant oropharyngeal injury
• Consider gastric lavage if nasogastric tube is placed

Inpatient
• Endoscopy within 12-24 hr if hemodynamically stable & without respiratory distress or
perforation
• Serial x-rays to rule out perforation
• Tube feedings & surgical intervention for severe injury
• Serlal X-rays to rule out perforation
• Tube feedings & surgical intervention for severe injury

Question 13

Pathogens seen in CGD patients

Answer 13

Staphylococcus aureus, Serratia marcescens, Burkholderia cepacia, Nocardia species, and Aspergillus species