Oral Baords Flashcards
(157 cards)
1
Q
WBI
A
Indicated in Iron Over dose (case showed at 5 hours post ingestion)
especially if see in the stomach on X ray
500 ml/hr in kids
2 L/hr for adults of Polyethelyene gylycol
NO activated charcaol for iron
2
Q
Iron OD
A
Deforaxmine (if greater than 350, shock, acidosis, seizure)
EKG (rule out TCA)
WBI (NGT needed)
IV/fluids
ASA/Tylenol
HD in very rare cases
3
Q
Maint fludis in kids
A
can be D51/4 NS
4
Q
IPH critical actions - AMS
A
If you see Brady and HTN
Airway
IVF
POCG
Coags
Reverse coags - Vit K/FFP or PCC
Head CT
NSGY
NICU
5
Q
AMS important actions
A
ABG after a tube
Narcan, thiamine, dextrose (if hypoG)
if arrives intubated- check tube
6
Q
Penetrating chest trauma crtical actions
A
Needle or tube throacostomy
upright cxr
pain
full seocndary survey
surgical consult
IVF (ok to givve in trauma and hypotension?)
7
Q
Slam dunk cholecystitis- what else to add on?
A
MI for older patients
Pelvic exam for Fitz Hugh Curtis and sexual hisotry
Add Vanc And Zosyn (need full braod coverage)
signs of gangeene is emergent surgery
8
Q
feb neo always get a
A
Glucose
5/ml/kg D10
4ml/kg D25
9
Q
feb neo, still lethargic when you get to physcial exam…
A
Intubate- decreases metabolic demands
If you are this sick of a feb neo, an LP can wait if it delays stabilization
10
Q
vent settings ne
A
10 ml/kg
rate 30
100% fio2
11
Q
feb neo meds
A
tylenol rectal
Cefotaxime and amicillin
up to 80 ml/kg! our 4 boluses
techincal ICU consult
Discussion with family!
12
Q
Nec Fasc, Do you get CT or no?
A
No, tell the ocnsultant it would delay care and they need to come in
they will give clue on speed of infection
remeber to add clinda! V/C/C
Gen surg consult
c Can get cardiac enzymes in old chronic disease person
AVOID pressors if you can! reduces blood flow
consider hyeprbarics
Vitals signs were normal!
ANY AMS needs glucose
13
Q
HyperK actions
A
Ca
Insulin D 50
Albuterol
Sodium Bicarb
Lasix
KAyexolate
Stat lytes
Treat Patient before K is BACK!
COnsider nephrology consult for Dialysis with renal fialure
14
Q
Acute angle glaucoma
A
Phys Exam: EOM, Pupils, SLIT LAMP!, VA!!!, peripheral vision, IOP, stain, appearance, palpation
Brimonidine
Timolol
Pilocaprine
acetazolimide
mannitol
steroids
optho
15
Q
Stranglated bowel
A
If your think it is incarcerated dont reduce
NGT placement! be prepared to say how its done
AbdXray!
16
Q
ASA overdose
A
Dont forget:
1. ABG Resp Alkalosis, then met acidosis
2. Lactate
3. ICU Consult/toxicologist
4. Repeat ASA levels in 2 hours
5. Continue to mintor vitals
6.Poison control
7. MOnitor K, dont want hypoK
Start bicarb drip if over 20
HD over 100 or organ failure
Activated CHARCOAL if right after ingestion
17
Q
Peds speccifics for Abdominal pain
A
Uright CXR, AXR, Obsturctive series, US
1 IV access “largest bore possible”
Dont worry about exams, if there is bloody poo need to do rectla and GU
for abd pain: ranitidine IV, Steroids IV(HSP) (i was htinking tylenol and fentanyl?)
after a bolus start at a rate (nook says half maint at 1/2 NS?)
18
Q
Snake Bite
A
Not serious:
ABC
Assess Wound
ID the snake (crotalid rattlesnakes and cotton mouthsvs Elapid- corals and cobras)
Crotalid:cytolytic- edema, hemorrhage, necrosis, close to and far away
Elapid:neurotoxic- diplopia, ptosis, resp issues, paresthesias- delayed
Check for compartment syndrome (surgery)
DIC, hemolysis, thrombcoytpoenia
Anitvenin for either bite
TETANUS
No suction, no tourniquet (but maybe consitrciotn band with elastic bandage)
Dry bites need 12 hours obsveration in hopsital - physical exam is normal, labs nromal
19
Q
Right eye vision loss, blood and edema on fudnoscopic exam, Pupil doesnt conrict to light, consticts in opp eye
A
CRVO
DC home with optho follow up
Ch 16 for review
Loss of vision = loss of light to the brian= no pupil constirciotn, but when in othe other eye, light to brain= consitrction
20
Q
peds dosing
A
Code epi 0.01 mg/kg epi
Atropine 0.02 mg/kg
Electrciity 1J >2J/kg
adenosine 0.1 mg/kg
morphine:
<6 months - .05 mg/kg IV
>6 month- .1 mg/kg IV
if over 50 kg then you are getting into adult dosing
21
Q
Peds vent/Peds intubation
A
22
Q
peds stuff
A
broelow tape
23
Q
cyanide OD anitdote
A
Hydroxycobalamine
24
Q
TCA OD anitdote
A
Sodium bicarb
25
Iron OD anitodte
Defroxaimine
26
HF Acid
Calcium gluconate
27
INH OD antidote
Pyridoxine
28
Ethylene glycol OD
Foempizole, pyridoxine, Thiamine
29
Methanol OD antodote
Fomepizole, Folate
30
RSI things I forget
quick neuro check ith pupils
C spine immbolizaion
OG and foley post sedation
31
what do you do with wounds?
irrigate + tdap
32
PALS!
Tube- verify placement
Oxygen- 8-10 breath per minute
CPR thumb enciricling hand at 100/min
22-24 guage IV x 2 or IO
20 cc/kg warmed fluids + rewarming if cold
epi 0.01 mg/kg q 3 min
H&Ts
SIDS- PALS
Assess for abuses
support for family
autopsy w/ blood and urine smapl
33
POst torsades peds antiarrythmic drip ?
lidocaine drip
34
ORtho stuff
Make them NWB status
Make sure to get bilateral films for comparison
Phys exam bilaterally
Lateral views as well
35
GU exam always in
Abdominal pain patient
36
testicualr pain always get
G/c Swab, UA think infeciotn /epipdudmitis
37
38
Bradycardia
Atropine 0.5 mg ip to 3 mg
Place pads on the patient- pace even if sinus
Consider an Epi drip
Cards consult
Glucagon drip for BB OD 10 mg IV
39
Asthma
Things I forgot:
SC .25 mg terbutaline, .3 mg Epi
Bipap
Emiric ABx is recommended against!
Magnesium
Need to say ipratroprium
BIOMES
Tube:
Ams, exhaustion, hypoxia, arrest
40
SJS
Didn’t say steroids
Derm and optho consultations
Stop the offending agent
Can give ppx Abx
(some evidence but not full on IVIG or steroids)
41
Laceration
Repair it, tend to it!
42
SDF
FSG
HIstory of fall
Non CT
Labs
pain
NSGY
ICU
43
Perianal abscess
Pain
Rule out fistulas
ID
Post drainage education: sitz bath, stool softener, frequent dressing changes
follow up
no abx if no systemtic or or overlying cellulitis
44
Ectopic pregnancy
IV
Blood type and corss match
Rhogam
hcg
pelvic exam
pelvic us
pain
OBGYN
DONT FORGET TO DO A FAST
O NEG= RHOGAM
45
Alcohol intoxication
FSG
non con head
LAc repair
!!! ANion gap, Osmol gap
toxic alcohols
dont forget about ASA/Tylenol OD
Still give thiamine, folate D5 for AKA
46
DKA + UTI
FSG
Fluids (this says NS then 1/2 NS
insulin drip
replete potassium (even if nromal)
EKG
ICU
Abx
47
STEMI
EKG
GET a right sided EKG (or posterior)
IV access and fluid bolus if right sided (dont give nitro)
ASA
Avoid nitro
cards consult
activate cath lab
remember you may need to do thrombolysis!
fluids up to 1-2L and then pressors
48
Ovarian torsion
Preggo test
pelvic exam
pelvic US
OBGYN
analgesia
CT is not definitive
49
Opiate OD
FSG
Naloxone admin
EKG
CXR
Reassess
ALSO: tox consult
admit or observe for long time
Get co ingestion labs!!!
still get a work up
50
Travelers diarrhea
Social hisotry
OP
fecal leukocytes
Giadria anitgen
C diff toxic
Fecal stool sample
rehydrate, replete Lytes! even if it potassium 3.2!!!!!!!!!!!!
Abx Ciprofloxacin 3 days or metronidazole or rifaxmin or bactirm
COnatact CDC
loperamide for loose stools
oral rehdryation
51
TTP
Need pripheral smear
PEtiachia on exam
Interpret labs
steroids!
PLasampheresis
Hematology consult
Admit to icu
haptogllobin, high retic, high idnrieect bili
52
ludwigs angina
airway management- diffcult airway to the bedside
abx
ENT couslt (dont techincially need imaging- trismus is all you need)
Admit
53
Pericardial tamponade trauma
Intubate early! and get stuff to thebedisde when they are still alive (you intubating them shoudlnt kill them)
fluids (Acitvate MTP)
Blood transfusion
Surgical cosnult
THrocotomy- describe procsure
pericardiocentesis- nto sufficicent
extras: ancef, tdap, foley, Bedside US
54
Cat bite hand
Abx- Augmentin or (CLinda + Doxy/cipro)
tdap
follow up wound check
Assess for FB in hand(X ray)
tendon, Neuro, vascula rinjury
assess for rabies risk and contact CDC
irrigate
55
TOA
everything you think of + G/C sent
discuss with PMD if need fo radmission
56
Cavernous venous sinus thrombosis
Early abx
lumbar puncture
MRI
ICU
+++ Neuro
+optho
+steroids
+heaprin (in consultation)
57
Kawaskai Kids
ASA (100mg/kg/day)
IVIG!!! (2g/kg)
Ped rheum
Ped ID
Ped card- Echo , anusyrusm
family
inflammatory markers
rapid strep!
Consider meningitis (LP is appropriate here)
58
SIDS
1. PALS
2. Assess for signs of trauma and abuse
3. Resuscitate and ensure temperature is normal before ending code
4. Support for family
Case 55! start there
59
Septic arthritis
pain
arthocentesis
abx after fluid reuslts
x ray
60
Tx of rmsf in preggos and kids
Doxy!
only other agent that works is chloramphenicol (nly in anaphylaxis for tetras)
61
Acute chest syndrome
o2
ivf
pain
cxr
abx
EXCHANGE transfusion
MICU
62
Meningitis
Abx before LP
LP
Isolation admission to ICU
Public health concerns! (discuss with close ones for ppx and rpeort to dept of health/cdc
63
pericarditis
EKG
exam
ECHO!
NSAIDS
admit
64
Hypolgycemia sulfonurea
IV
FSG
D50
oral feeding or octreotide
admit
65
High altitude cerebal edema
Dexamethasone
rapid decent
oxygen
(possible hyperbarics)
66
Digoxin toxicity
EKG
Atropine or pacr pads
dig fab
Treat hyperK
CCU
the dig EKG looks like laternans
levels over 5.5 and looks funky
66
CHF exacerbation
NItro drip if HTN
lasix
aspirin
ccu
67
aortic coarctation
Oxygen and intubate
IV access, ekg,cxr
recognize cardiomegaly
cards ocnsult
prostalgnic administration!!! to KEEEEEP it open. Indomethacin closes it
68
Status Epilepticus
FSG
IV access
IV benzos Start with 4 then give another 4!
I do keppra but then phenytoin load too
Neuro for EEG
Head CT
a bunch of labs and tox labs
69
Intuss in a kid
NS bolus 20 cc/kg
complete physical
barium enema!
peds surg consult
70
HIV PJP pneuminia
dont forgrt reps isolation
71
SVT
talk about adenosine wiht patient
6 then 12 mg with 3 way stop cock
defib at the bedside
repeat EKG
72
Neuogenic shock from c spine injury
IV access and fluid bolus
c spine precautions
ct c spine
nsgy
tube
pressors
dont forget you can start a central line in cricitally ill patients
73
Tpa blood pressure stroke
general stroke bp
185/110
210/130!!! I dont do this!
74
Pevic fx and hypotensive
IV
blood
trauma
FAST
cxr-pelvis x ray
reduce pelvis
consult IR
74
thyrotoxicosis
Ct and LP for possible meningitis!?
serum tox labs?!
Propranol. PTU or methimazole, Iodine (steroids)
Abx for possible meningiits
75
Start on pg 364
76
Headache, elevated Cr plus high BP
HTN emergency
IV antihyerensives]pain control (25 % reduction in MAP)
LP to rule out SAH
ct head
admit to tele
77
Hypothermia perals for rewarming
get partient naked, look for trauma and wet clothes off
blankets, bair, humidified an dwarm air, warm IVF
+ Foley and NGT with warmed fluids
avoid big movements that could give an arrythmia, under 30 celcius is severe and leads to fixed pupils, v fib etc.
If unstable and cold= coded or v fib then do the thoacic and peritolnela lavage or dialsysis!!
Abx can be given in drownings
78
What to do after intubation
CXR
OGT
Foley
Set the vent
get a gas and ent tidal capnopgraphy to confirm
Sedation
79
potassium 3.3, diarrhea, bloody diarrhea, good vitals
IVF
still give potassium
abx
talk about diet and edcuation on diarrhea
80
PJP PNA in HIV
Steroids (if pa02 less than 70 on ABG)
Cftx plus azithro
add bactrim
consider TB tx
81
NAT 3 yr old abd pain
pain (morphine)
CT abd for serious injury
inconsisitn story recongition
surgery conuslt (splenic lac)
optho conuslt (rule out retinal hemorgahes)
Social work
talk with family
full skeletal survery
tell the authorities
82
5 yo old, abd pain, cola urine, bloody diarrhea
HUS
get smear for schistocytes
Abx may make this worse!
DONT give anti motility agents
watch out for hyperK
EKG (lytes)
not necesssary to give platelts usually but type an cross
1. IVF
2. family
3. admit
4. peds heme and nephology consult
5. supportive care
6. if very severe think plasma exchange
83
2 yo sudden resp distress
FB in airway
Oxygen, BVM if necessary
Prepare for intubation but dotn intubate
think about abdominal thrusts (if over a year)
INs and exp x ray for FB
ENT consult
talk with family
84
what is needed to jet venitlate a kid
14 g needle
3 cc synrige
7.0 Ett adapter
BVM
84
tylenol overdose
1. timing of ingestion
2. 150 mg/kg of NAC
3. get tlyneol leveland oco ignestion (anf ABG)
4. EKG
5. suicide precations
psych
poison control
Urine tox
85
STEMI
ASA, Oxygen, morphine and or nitro (avoid in right side)
HEparin drip +/- tal with cards about ticagrelor
cardiac cath lab
86
sepsis in old lady
IVF (30 cc kg)
lactate
cbc
Bcx ucx
cxr
look for sourcres includes skin, decubitus ulcers, UA (plevic exam?)
Early abx in these patients
87
You are dead on for hyperthermia - here are other things you dont think of
once they go down 3ish degrees celisum start to pull back to not overshoot
benzos treat shivering
tachydsyrhtimias respond to cooling, dont cardiovert just yet
DONT give tylenol -disrupts hypothalamus
only 500 cc bolus (to a L) then 250 cc/hr! DONT give a ton of fluids
LAbs to check: TSH, CK, myoglobin, tox screen
LP!
Abx for sure
FOley to guide urine out put
88
ESRD hypotenion
Pericardial tamponade
pulsus paroxus(10 drop inBp with insipriation)
electiral alternans!
89
always think US when hypotenion
grab Your FAST and be done with it
90
Tension PTX
Needle to tube (clinical)
CXR to conifrm tube, Ancef, Tdap
EFAST
pain
surgery consult
CT
fulls econdary survbery
give fluids and blood
91
Ct scan abd with....
Can do PO, IV and rectal contrasgt!
92
diverticulitis
pelvic exam
admit (if fever or vitals signs or pain)
Abx
surgry consult
93
Stable V tach
Amio 150 x 2 then a drip of 1 mg/min
synch cardiovert for unstable at 100 J bipahsic
cards and admit ccu
93
Eclampsia
IV labetalol
4 g mag over 15 mins
still give lorazepam
CT head!!!
OB GYN
UA!!!!
look for bradydysrhthamis, hypreflexia, respirotory
140/90 BP
94
ACLS Stuff!
When do you give amio after what shock? 3 (300 then 150). Give epi after 2nd shock.
End tidal cprnhprahy monitoring!
95
When to give acitvated charcoal
quickly after tylenol or TCA OD
MUST intubate tho! for apsiration
96
TCA OD
Sodium bicarb drip
EKG and then repat EKG after bicarb
CO-ingestion
FLuids boluses > Noorepi if needed
stabiliz first then think charocaol
97
Liver transplant Fever
1. V/Z/Fluc
2. PAra to ruel out SBP
3. talk with transplant team
4. cultuters before abx
5. admit isolation
Other: think possible TB, liver abscess, cholangiits - need imaging CT/US or REJECTION
98
unstable trauma
PAN scan
EFAST
blood
okay to give quick liter
Logroll ith c spine immobilization for full exam
CXR, pelvic x ray - still labs
adovacate or ex lap if big spleni lac or something
99
20 day old, fussy, bloody poop
Nectorziing entoerolciites
Spetic baby work up + Abd upright and possible abd US
V/C/clinda
peds surgery
fludi boluses
100
farmer, cough, wide mediastinum
POssible tube
Levofloxacin + Vanc (NO CFTX!)
Cipro to ALL healthcare workers
CDC
admit siolation
101
anaphylaxis kid
airway if needed
o2
EPI 0.01 mg/kg/dose up to x 3
LOTS of fluid- assume hypotenin
adjunct meds
obs for 6 hours! at least or admit and if dc avoid trigger and give epipen
102
simple febrile sziure
still give antipyretics
good HP to rule out serious illness (get a workup still!)
counsel paretns
103
cocaine chesg tpain
EKG-O2-
Benzos and nitrates
trop
cxr
obs admit
104
SBO
You can still give abx here
105
Guillan BArre
FSG, neuro exam (sensory intact, weak) DDx
Neurolgy cosnult
LP
intubate and get a NIF to recofnize it
PLasma excahnge or IVIG
ICU
106
PALS adenosine doses
0.1 mg/kg
1J then 2 J sync
sinus tach Infants <220, chilren under 180- find and treat cause
107
PALS VT Greater than .08 or 80
May attempt adneoinse Then 1J then 2 J sync
Amio 5 mg/kg
108
PALS bradycardia
BAsically all supprtive with oxygenation and ventialtion and if there ARE signs of poor perfusion, AMS, shock & HR <60 then:
1. CPR
2. Atropine .02 mg/kg
2. epi .01 mg/kg
Think hyothermia, hypoxia, OD
109
PALS arrest
no breath but a pulse= rescue breathes q 5 seconds- acitvate EMS and check pulses
no pulse, no breath:
1. CPR
- 30:2 singles
-15:2 doubles
used AED as soon as it arrives to go down:
wide or narrow
tachy vs brady
Shockable vs non shockable
110
All the Hs and Ts
Hypo/er K
Hypo/er G
Acidosis
Hypoxia
Hypovolemia
Hypo/er thermia
Toxins
Thrombosis - PE, STEMI
Tension PTX
Tamponade
Trauma?
111
PJP PNA to-dos
Add on resp isolation
consider TB tx
112
Isonizad toxicity
B6
Airway (if you need to)
POC glucose
Serum tox workup!
Non con of the head
neuro consult
ID consult?
charcoal if immediately
Sodium bicarb if there is lactic acidosis
113
92 yo M eder neglect with stage 3 decub
1. report for elder abuse
2. social work consult
3. IV hydartion / po nourhishment
4. Check for rhabdo
5. EKG
6. Work up sepsis and infection
SKIN CARE/WOUND CARE!
check for sexual abuse as well
114
Acute gout
1. arhtorcentesis
2. Pain (colchincine/NSADIS)
3. COunsleing on alcohol reduction
X rays
uric acid
lab work up
115
Carotid artery dissection
1. CT non cons
2. CT angio (they are separate) or MRA
3. Neurology consult? (vascular)
4. Heparin (aspirin)
5. pain
remmeber this can gice you anisocoria! (anhidorisis would be horner syndrome)
116
Sigmoid volvus, OLDY
1. pain
2. Xray obsutrtive sereies
3. NG tube
5. Gastroenterolgy and surgery consult
Abx
Sigmoidocsy and rectal tube for decompression
117
LVAD
1. Infection (or hypovolemia)- pressors needed
2. Bleeding (On history)
3. Thrombosis (tea colored urine)
4. Failure (hypervolemia)
5. Tamponade
6. Arrythmia, VT/VF (cardioveriosn vs shock)
A. Doppler BP for MAP (or art line
B. Bedside Echo
c. CXR
CC. EKG
D. Exam (volume status, leads, hum, pump/battery failure)
E> VAD Team consult
F> labs (COags, trop, BNP, hemolysis)
G. Heparin? for pump thrombosis or possible ECMO!!
118
Sepssis w/ DIC actions
Book says Trsnfuse platelets to 50k (but only if need surgery or bleed risk), otherwise 10k transfusion threshold
Give Cryporecitpate for fibrinogen <100, if >100 and coagulopathic then FFP (especially if INR is sky high)- basically if they are supe r low then transfuse
Repeat labs and lactate!
119
Cool the patient or no?
PERFORM A NEURO EXAM POST CODE! IF THEY SHOW SIGNS OF BRAIN INJURY START IT
Definitely say normothothermia!
SDome evidence to suggest 36degrees after a code with evidence of some brain injury (ice pack and cooling blankets) with rectal probe or Foley catheter probe
Complications:
Shivering= meperideine
Electrolyte problems
120
Post arrest care
NEURO EXAM! Reflexes, painful stimuli,posturing
Airway: ETCO2, CXR, vent (confirm of already)
FSG
CENTRAL LINE
ART LINE
OG/FOley
Core temp monitoring
GI Ppx
Sedation
If you think it is a stem I- aspirin, possible heparin, Cards CONUSLT AND push for going to the cath lab
121
DVT TRX
Rivaroxaban 15 mg BID - follow up in several days wit PCP for lab and symptom monitoring
Pain management
122
Superior vena cava syndrome
1. LAsix!
2. Elevate head of bed’
3. Surg Onc, IR, VAscular for resection and stent placement of veins and biopsy
Possible steriods,
123
tox HF acid
1. Get Ca
2. Get Mg
3. IV calcium glucvonate or topical calcium gel 5%
4. Copious irrigation
5. If no improvement then intraarticular calcium gluconate with art line
6. EKG dyshrthymia
7. Analgesia
8.Burn or fox consult
124
BEER potomonia cerebral edema
1. NGT
2. HypoNa to 113, AMS, 100 cc 3% HTN saline
3. Serum/urine osm (hypoosmolar,hyponatremia)
4. Slow Sodium correction (avoid central pontine) 2-3 quickly then 0.5/hr after that not going over 10 in 24 hrs
125
Hypercalcemia SSCL
1. Fluids bonus then 200 cc/hr
‘2. Zolendronic acid 4 mg over 15 min
3. Calcitonin 4 IU
4. Replete other lytes
5. Get iCal
Look for short QT
Possible kidney stones- get CT. STONEs, bones, moans AMS, groans PUD
126
Cushing syndrome
1. Labs
2. Random cortisol
3. Follow up endocrine- high risk HTN, dm2, bone disease
Causes: adrenal tumor (coortisol), Lung or Pituitary mass (ACTH tumor), or too much steroids
127
Aplastic crisis
CBC
Transfusion prbcs
Cxr
Pain control
Admit-heme consult
ABX!
Retic count >3 means bone marrow is trying
128
Rhabdo with Heat exhaustion
1. Cool with ice packs
2. Fluids
3. EKG
4. Cardiac history
5. Renal for possible dialysis’
5. ICU
READ ALL LAB VALUES! You have. Missed diagnses by skimming
129
Migraine
Prochloperazine 10 mg
Benadryl
Sumatriptan 6 mg IM
Neuro exam
Possible neuro imagine
130
Acute ischemic stroke posterior
1. BP goals < 220/120
2. Neuro consult, NSGY (edema,herniating risk), IR for clot retrieval
3. Stroke protocols, MRI/MRA (if neg then….
4. Aspirin!!!!
5. Zofran
6. Detailed neuro exam, Establsihing onset of time
131
Myasthenia Gravis
1. Baseline labs, CT head
2. Neuro consult
3. Tox works up, TSH
4. Ice pack test for improvement of ptosis (no tension test anymore)
5. Pyridostigmine +/- steroids, plasma exchange, IVIG(If organophospahsetes then praldoxime and atropine)
NIF for reps depression
Try to avoid paralytics
132
Ethylene glycol
1. Low calcium! Correct
2. EKG, prolonged QT
3. Fomepizole
4. GAP GAP! Anion and osmolarity gap
5. B6 b1 Foempizole
6. HD!!!!
EKG
Sodium bicarbonate for serve acidosis
TRY NOT TO INTUBATE FOR KUSSMUAL ACIDOSIS!
133
All toxic alcohols have an anion gap, and osmolarity gap- which one doesn’t?
No osmolarity gap in isopropyl alcohol (ketones)- supportive care!
134
30-60 day feb kid
CFTX
Amp for listeria
Vanc possibly
possibly acylovir
>60 days is vanc cefepime
134
feb neo abx
AMp and gent
ask for risk of HSV!
YOU CAN GIVE VANC IF NEEDED!
135
Post arrest care- first 4 things to do
1. Ensure airway, vent settings (normo oxixxa, morno carbia yada yada)
2. Ensure BP doesnt need support
3. EKG/Unstable cardio= Possible cath lab
4. Neuro exam
- if bad neuro exam cool to 32-36 for 24 hours, avoid fever, foley monitirnig
- Head CT
- NEuro, EEG monitoring
136
Next step post arrest care after firt 4?
OG, FOley, CXR
Sedation if needed
Temp monitoring
Art line
Central line
FSG
GI PPX
137
Tox- No acidosis, but ketosis
Isopropyl alcohol- supportive care
138
tox-Acidosis, osmol gap, eyes
Methanol, folate
139
tox, acidosis, osmol gap, Kidneys, cacium disurption
ethlyene glycol, b1, b6 foemipzile
140
tox Dry as a bone, red as beet, blind as bat, mad as hatter, hottter than a hare=
Anticholinergic/muscarinic toxicity
GIve pyhsostigmine
141
tox Slaivating, vomiting, diarrhea, lacrimating, bronchrrhea, miosis
Organophopsate posioning
GIve atropine and praldixoime and decomtaminate
142
tox BB/CCB OD Rx
C FAG PIL
Fluids
Calcium
Atropine
Gulcagon
Insuline and D50
Pressors-epi
Lipid emulsion
WBI if ER formulation
143
tox, dig toxciity
1. K managemaget
2. Dig FAb
3. Charcaol maybe
HD is not inidicated and nor is Ca
144
tox-Baby botulism
weak and consitpated
Human derived Immunoglobulin therpay
If adult- equine heptavalent
CDC
145
Tox CO posioning
High flow oxygen
Co-ox and levels
Poisslbe Hyperbarics (25%, 15% preggo, LOC, Acidosis <7.25!!, end organ damage)
Talk about post neuropyschiatric disorders
Need EKG, cardaic biomarkers etc
146
Cynaide
Hydorxycobalamin
Big acidosis on labs
147
Fever Non infectious DDX
Need phys exam, hx and lab clues:
EXtnernally cool all of them!
SSS (from RX)- Cyprohepatidine, benzos
NMS- supportive, benzos, dantorlene
Thyrod Storm
Malignant hyperthermia - DANTROLENE
External
ASA OD, Anticholinergics OD
Drugs- COcaine, Meth BENZOS
148
tox lithium
FLuids
WBI if recent
HD
149
Tox metthgb
CHoclate blood, i think stuck at 85%
from nitrites
Give emthlyene blue
150
tox sulfonureS
Octreotide
glucose drip
151
TCA OD
1. Sodium Bicarb
2. Benzos if seizure
3. Charcoal if quick
NO physotigmine, no flumazeil
152
what is parkland paofrmula
KG X TBSA X4
half over the next 8 hours
