Oral Board Review Management

Question 1

Iron overdose

Answer 1

• Large bore IV line and cardiopulm monitor w/ cont O2 sat
• EKG (r/o TCA overdose) and FS gluc
• Labs: CBC, CMP, preg, coags, BAL, ASA and acetaminophen levels, UDS, ABG, LA, iron level
• IVF bolus if hypotensive (aggressive hydration)
• Reglan or Zofran for nausea/vomiting
• CXR and AXR - sometimes visible on imaging
• Place NG tube for whole bowel irrigation for large ingestion using polyethylene glycol (200-500ml/h children, 2L/h adults )
• Deferoximine (serum iron > 350 μg/dL in symptomatic patient or >500 μg/dL, shock, coma/seizure, acidosis) 5mg/kg/hr IV infusion
• Call poison control
• If intentional OD, place on elopement precautions, one to one obs, Baker act, consult psych
• Admit

Question 2

Pyloric stenosis

Answer 2

• Large bore IV line and cardiopulm monitor w/ cont O2 sat
• NPO, FS gluc
• Labs: CBC, CMP/LFTs, ABG, LA
• IVF bolus at 20cc/kg x2, then D5 1/4 NS at maintenance rate
• AXR, Abdominal US
• NG tube for decompression
• Consult peds gen surg for pylorotomy
• Admit to peds

Question 3

AMS - ICH on coumadin

Answer 3

• Large bore IV line and cardiopulm monitor w/ cont O2 sat
• FS gluc and EKG
• Intubate early if low GCS
• Labs: CBC, CMP/LFTs, Coags, ASA and acetaminophen level, ammonia level, Trop, UA, UDS
• CT brain, CXR for tube confirmation
• Vitamin K, FFP or PCC for anticoagulation reversal
• Neuro surg consult and ICU consult
• Admit ICU

Question 4

Penetrating chest trauma/ pneumothorax

Answer 4

• Large bore IV line and cardiopulm monitor w/ cont O2 sat
• Needle thoracostomy if tension pnxth
  -Tube thoracostomy
• Labs: CBC, CMP, Coags, BAL, UDS (if intox)
• Supplemental O2 NRB vs Intubate early if low GCS
• FAST exam
• Look for other injuries
• Analgesia (morphine), Abx (ancef), Td
• Trauma Surg
• Admit to trauma surg

Question 5

Acute cholecystitis

Answer 5

• Large bore IV line and cardiopulm monitor w/ cont O2 sat
• Labs: CBC, CMP, Lipase, Coags, T&S, Preg
• RUQ US
• Analgesia (morphine), Antipyretic (Tylenol), Antibiotics (Zosyn = piperacillin/Tazobactam) coverage against G+ and G- aerobic and anerobic bacteria
• Consult gen surg and admit

Question 6

Neonatal sepsis

Answer 6

• IV line/IO and cardiopulm monitor w/ cont O2 sat
• FS Gluc
• Rectal Tylenol
• IVF bolus 20 cc/kg x 2
• Labs: CBC, CMP/LFTs, LA, Coags, UA and Cx, Blood Cx, CSF
• LP when stable
• Intubate early if lethargic (Vent settings: [ ])
• Empiric abx IV Cefotaxime and IV ampicillin
• Consult PICU and admit to PICU

Question 7

Chest pain -Boerhaave’s syndrome

Answer 7

• IV line/IO and cardiopulm monitor w/ cont O2 sat
• EKG
  -CXR, Chest CT
• Labs: CBC, CMP, Trop, Dimer, Coags
• Antibiotics (Zosyn = piperacillin/Tazobactam)
• Consult GI and CT surg
• Admit

Question 8

Back pain - epidural abscess