All Cards Flashcards
Hangman vs Jefferson fracture
Jefferson - C1 burst fracture, usually from axial loading (like a diving injury)
Hangman - posterior C2 fracture, usually from hyperextension
symptoms and management of hydrofluoric acid burns?
used in glass etching, metal cleaning, and electronics manufacturing
hypocalcemia, hypomag, and hyperkalemia
treat with topical, intra-arterial, IV calcium gluconate
mild vs moderate vs severe hypothermia
definitions and treatment
mild 32-35: active external warming
moderate 28-32: +active core (bladder, gastric lavage)
severe < 28: ECMO, pleural lavage
treatment of shivering
BDZs
atropine dose
0.02mg/kg (minimum dose of 0.1mg)
What’s a normal ankle-brachial index?
> 0.9
disorder with mousy/musty odor
PKU
fishy odor
trimethylaminuria
sweaty feet smell
isovaleric acidemia
SIRS criteria
Core temp < 36 or >38.5
tachycardia or bradycardia
tachypnea
leukocytosis, lymphopenia, or 10%+ bandemia
Septic shock definition
sepsis + SIRS + continued cardiovascular dysfxn after 40ml/kg fluids
refractory septic shock definitions
fluid refractory: after 60ml/kg fluidscatecholamine refractory: after 10 mcg/kg/min of dopa, epi, or norepi
severe sepsis definition
when associated with:
ARDS
cardiovascular dysfxn
dysfxn of 2 or more organ systems
what is hydrogen sulfide
mustard gas
causes superficial skin burns, eye irritation, and resp tract irritation
What are the classifications of neutropenia
severe < 500
moderate 500-1000
mild 1000-1500
What is the discriminatory zone with HCG?
transvaginal US- 1,500 mIU/mL
transabdominal US- 6,000 mIU/mL
symptoms of carbemazepine toxicity
can cause resp compromise, altered mental status, vomiting, drowsiness, slurred speech, nystagmus, hallucinations, hypotension, coma, dystonic reactions, seizures has some anticholinergic properties false positive for TCAs on UDS
expected compensation for acute resp acidosis
increase in serum bicarb 0.1 meq for each 1 mmHg PCO2
expected compensation for acute metabolic acidosis
decrease in PCO2 1.2 mmHgfor each 1 meq of bicarb
expected compensation for acute resp alkalosis
decrease in serum bicarb 0.2 meq for each 1mmHg PCO2
expected compensation for acute metabolic alkalosis
increase in PCO2 0.6 mmHg for each 1meq of bicarb
how frequently can you repeat epi in anaphylaxis?
3-4 times every 5-15 minutes
what is the pathophys of staph scalded skin syndrome?
hematogenous spread of epidermolytic or exfoliative toxin; children are more affected that adults due to inefficient renal clearance
most common nerve injury in supracondylar fracture
median nerve
most common artery injury in supracondylar fracture
brachial artery
treatment of DUB
combo pills or progestin only pill taper
sites for IO access
proximal tibia distal tibia distal femur proximal humerus sternum in adults
MUDPILES
methanol/metabolic defects uremia DKA, alcoholic ketoacidosis, starvation paraldehyde iron and INH lactic acidosis ethylene glycol salicylates * also CO, cyanid, hydrogen sulfide, metformin, phenformin, sulfur, theophyllin, and toulene!
normal CSF opening pressure
< 20 cm H2O
LR +
= (positive test/presence of disease) / (positive test/absence of disease)
= sensitivity / (1 - specificity)
LR -
= (negative test/presence of disease) / (negative test/absence of disease)
= (1 - sensitivity) / specificity
How do you use LRs?
You have to convert the pretest probability to odds
This is pretest probability / (1 - pretest probability)
Then you multiply by the LR
Finally, you convert the odds BACK to the probability!
What are clinically significant LRs?
LR + > 10
LR - < 0.1
Amanita phalloides ingestion
white mushroom that can kill. classically:
stage I: 6-24hrs of no sxs
II: V/D 12-24hrs
III: seeming recovery
IV: 2-4d later with liver and renal failure
loss of contralateral pain and temperature
loss of ipsilateral motor
Brown Sequard syndrome
hemisection of the spinal cord
loss of motor and pain sensation
preserved temp and proprioception
Anterior cord syndrome
disruption of the anterior spinal artery
upper extremities affected more than lower extremities
central cord syndrome
Posterior cord syndrome
loss of proprioception and pain sensation
loss of proprioception and pain sensation
posterior cord syndrome
ectasy/MDMA intoxication
hyponatremia, concentrated urine, altered mental statusmay see serotonin syndrome
lab abnormality in hereditary angioedema
low C4
reasons to use VariZig
only for post-exposure ppx, but NOT once there is varicella infection
lab abnormalities in strep glomerulonephritis
low C3, nml C4. if levels are normal, consider something else
non-ketotic hypoglycemia with metabolic acidosis should make you think of…
fatty acid oxidation disorder
classic lab findings in fatty acid oxidation disorder
non-ketotic hypoglycemia
anion gap formula
AG = Na - Cl - HCO3
calculated osmolarity
= 2 x Na + glucose/18 + BUN/2.8
Multi-casualty vs mass casualty event
multi-casualty = 5+ victims
mass casualty = strains the existing EMS system
What can different levels of responders do: first responders? EMT-B? EMT-I? EMT-P?
1st responders: airway clearance, control blood loss, AED, CPR
EMT-B: assessment, spinal immobilization, BVM, defibrillation
EMT-I: pacing, cardioversion, IO, EKG, needle thoracostomy, advanced airway management
EMT-P: arrhythmias, advanced airway management, intubation, cricothyrotomy, meds, fluids
Best pressors for shock that is:
- cold
- warm
- normal BP
- epi
- norepi
- dopa
CXR findings (measurements) for RPA
prevertebral soft tissue swelling >7mm at C2 or 14mm at C6
Lab findings concerning for a pulmonary EXUDATE
WBC >10K glucose < 50% of serum protein > 50% of serum amylase > 200 LDH > 60% of serum pH < 7.0 (v. suggestive of empyema)
EKG findings in pericarditis
widespread ST elevation
PR depression
ST elevation in limb and precordial leads with concave elevations
Location for ____ nerve block at wrist:
1) ulnar
2) median
3) radial
1) ulnar - proximal ventral crease at ulnar styloid
2) median - medial tendon of flexor carpi radialis
3) radial - dorsal crease @ radial styloid
pressure readings associated with compartment syndrome
> 30 mmHg
Components of the pediatric trauma score
- size
- airway
- consciousness
- SBP
- fractures
- cutaneous
ranges from -6 to 12
lower the score, the higher the chance of mortality
How do you determine size for:
- ET tube
- ET tube depth of insertion
- NG tube size
- chest tube size
- ET tube = age/4 + 4
- ET tube depth of insertion = ETT x 3
- NG tube size = ETT x2
- chest tube size = ETT x 4
low plasma alanine levels are associated with what IEM?
ketotic hypoglycemia
what are treatments for hyperammonemia?
IV arginine
sodium benzoate
phenylacetate
hemodialysis
what disease is associated with +reducing substances in the urine, cloudy cornea, and HSM?
galactosemia
What is the BP treatment for pheochromocytoma?
phenotalamine 2nd line is CCBs
NO beta-blockers!!!
Patient with a PAINFUL Horner’s syndrome should make you think of…
carotid artery dissection
treatment for HOCM emergency?
B-blockers and CCBs
what is the treatment for lichen sclerosis?
topical steroids
treatment of prolapsed urethra
topical estrogen
treatment for tet spells
morphine (decreases pulmonary venous return, relaxes the infundibulum)
phenylephrine (increases SVR)
sodium bicarb (reduces acidosis)
beta-blockers (relaxes infundibular spasm, decreases inotropic effect)
treatment of HOCM?
what should you avoid?
beta-blockers
CCBs
avoid - diuretics and digoxin
Criteria for Acute Rheumatic Fever
JONES (major) PEACE (minor) Joints - arthritis O - heart - pancarditis Nodules (subcutaneous Eythema marginatum Sydenham chorea
PR prolonged ESR elevated Arthralgias (rather than arthritis) CRP/WBC elevated Elevated temp >39C (previous rheumatic fever too)
*Polyarthritis is the most frequently found major criteria
*Dx if 2 major or 1 major + 2 minor
Tx: PCN
med to rapidly inhibit release of thyroid hormone in pediatrics
potassium iodide (PTU is contraindicated in kids; methimazole doesn’t work acutely)
Symptoms of autonomic dysfxn syndrome
tachycardia, tachypnea, diffuse diaphoresis, hyperthermia, hypertension, mydriasis, and dystonia
Treatment of autonomic dysfxn/sympathetic storm
bromocriptine, dantrolene, benzodiazepines, clonidine, and narcotics
What are the components of Cushing’s triad?
What is the earliest and most sensitive indicator?
bradycardia, hypertension, irregular respirations
most sensitive/earliest: bradycardia
What are the impt landmarks for IJ venous access?
The medial approach uses the apex of the triangle formed by the sternal and clavicular heads of the SCM.
Best localized with mild hyperextension of the neck.
Location for a distal ulnar nerve block?
just proximal to the ulnar styloid process
Location for a distal median nerve block?
between the palmaris longus and flexor carpi radialis tendons
Nerve block achieved at: between the palmaris longus and flexor carpi radialis tendons
median nerve block
Reasons to refer a patient to a burn center (4)
1) partial thickness depth >10% if 20% BSA > 11 years)
2) full thickness depth > 2% BSA
3) high risk for disability or poor cosmetic outcome (e.g., hands, feet, face, circumferential burns and those overlying joints)
4) associated inhalation injury or trauma
Parkland Formula
4 x BSA x wt (kg) Give half in first 8 hours Give second half in subsequent 16 hours Does NOT account for maintenance fluids Should only include partial and full thickness burns in BSA calculation Only apply if 15% BSA is involved
Max dose of bupivicaine
2mg/kg without epi
3mg/kg with epi
1% lidocaine is how many mg/ml
0.25% bupivicaine is…
10mg/ml
2.5mg/ml
Things that can cause false positive guaiac stools
Horseradish
Turnips
Cherries
Tomatoes
Things that can cause red stool that isn’t bloody
cefdinir/omnicef red food dye licorice blueberries spinach beets bismuth iron preparations
Most common reason for child to have hypoglycemia?What’s low/wrong?
ketotic hypoglycemia
low alanine stores in muscles
Distinction between organic acidemias and urea cycles defects?
OA: elevated ammonia and acidotic
UC: VERY high ammonia (1000s) and usually NOT acidotic; low BUN, nml lactate, encephalopathy
IEM mimic of child abuse with macrocephaly, chronic subdural effusions?
How to diagnose?
glutaric acidemia type I
dx with urine organic acidsdx usually made during crises (intercurrent illnesses) with metabolic acidosis, hyperammonemia and encephalopathy.
Lab that is usually diagnostic for CAH
17-hydroxyprogesterone (17-OHP)
IEM associated with reducing substances in urine?
galactosemia
Management of Kawasaki when acute?
When convalescent?
Acute: IVIG, high dose ASA
Conv: low dose ASA (3-5mg/kg/day)
Management of dry gangrene in scleroderma
tx with systemic or topical nitro; or CCBs
How do you calculate sodium deficit?
Figure out the volume deficitNa/1000 x 0.6 x volume deficit
Labs in RTA type IV
hyperkalemic, hyperchloremic, metabolic acidosis with normal AG
Winter’s Formula
PCO2 = 1.5 x HCO3 + 8 +/- 2
explains what the appropriate CO2 response should be to metabolic acidosis
Symptoms of scorpion sting
local pain, restlessness, hyperactivity, roving eye movements, and respiratory distress. More severe signs include seizures, drooling, wheezing, hyperthermia, cyanosis, GI hemorrhage, respiratory distress and death from shock or respiratory paralysis
Envenomation associated with metallic taste
rattlesnake
systemic symptoms of brown recluse spider bite
fever, chills, malaise, weakness, nausea, vomiting, joint pain, petechial morbilliform rash, intravascular hemolysis, hematuria, and renal failure
what do you need to avoid when treating a patient with ciguatera poisoning?
opioids - may interact with toxin and cause hypotension
order of tissues with resistance to electricity
Bone > fat > tendon > skin > muscle > nerve.
when should you consider active rewarming measures
cardiovascular instability, T < 32ºC, or inadequate response to passive re-warming methods
how do you grade frostbite injuries?
1st degree- numbness and erythema with no tissue loss
2nd - superficial blistering, with clear to milky fluid, surrounded by edema and erythema
3rd - deeper blisters with blood containing fluid (leave blisters alone)
4th - affects muscle and bone.
in hypothermia, resuscitate to at least what temperature
The patient should be resuscitated until a body temperature of 32 – 34ºC
Symptoms of lithium toxicity
coarse tremor, ataxia, dysarthria, vomiting, diarrhea, cardiovascular changes and renal dysfunction. Later signs: impaired consciousness, muscle fasciculations, myoclonus, seizures, coma and death.
Best med for an agitated (possibly delirious) child?
haldol NOT BDZs (could loosen inhibitions or worsen delirium)
What are the different levels of sedation?
Minimal - respond normally to verbal commands and not asleep.
Moderate - does not need repeated painful stimulation to be aroused and should not require intervention to maintain a patent airway.
Deep sedation - patient cannot be easily aroused but respond purposefully after repeated verbal or painful stimulation; ability to independently maintain ventilatory function may be impaired.
General anesthesia is not arousable, even by painful stimulation.
What are the ASA classifications?
I - normal, healthy patient
II - mild systemic illness without functional limitation
III - severe systemic disease with definite functional limitation
IV - severe systemic disease that is a constant threat to life
V - moribund patient who is not expected to survive without the procedure
Epi dose for bradycardia in neonatal resuscitation
0.01 mg/kg of 1:10,000
How do you differentiate between main types of neonatal conjunctivitis?
Gonococcal - 3-5 days after birth.
Chlamydial - 5- 14 days after birth.
Negative gram stain (obligate intracellular parasite) Non-gonococcal, non-chlamydial bacterial - after the first 2 weeks of life.
Chemical (due to silver nitrate prophylaxis) - first day of life and resolves in 2-4 days.
Symptoms of morning glory intoxication?
mydriasis, hyper or hypothermia, perspiration, bronchorrhea and increased salivation
What’s the difference between:
boutonniere deformity
swan neck deformity
hammer/mallet finger
boutonniere - flexed PIP, extended DIP
swan neck - extended PIP, flexed DIP
hammer - flexed DIP due to rupture of extensor digitorum tendon
Fruity odor, ingestion with no acidosis, but +osmolar gap?
isopropyl alcohol (odor is from acetone metabolic byproduct)
How often do physically restrained patients need their restraints renewed according to JACHO?
< 9 years - every hour
9-17 years - every 2 hours
adults - every 4 hours.
Patients must be evaluated, face-to-face, by the physician ordering the restraints within 1 hour of placing the order.
Findings in cardiac tamponade
Beck’s triad: hypotension, muffled heart sounds, and distended neck veins
Low QRS voltages in all leads
Electrical alternans in precordial leads
What is the dose for naloxone?
0.1mg/kg
x-ray findings in RPA
> 7mm at C2
>14mm at C6
EKG findings in pericarditis
An ECG will demonstrate changes of epicardial inflammation with widespread ST elevation, PR depression, ST elevation in limb and precordial leads. The elevations are concave.
treatment of malignant hyperthermia
dantrolene
Treatment of labial adhesions?
Treatment of urethral prolapse?
Treatment of lichen sclerosis?
1st line: topical estrogen cream; 2nd line: topical steroids
topical estrogen
topical steroids
medical treatment of phimosis
topical steroids
epi dosing for anaphylaxis
1: 1000 epi
0. 01 mg/kg
0. 01 ml/kg
epi dosing for codes
1: 10,000
0. 01 mg/kg
0. 1 ml/kg
management of frenulum lacerations
expectant - do not suture as they heal spontaneously
With regards to hemothorax, what amount of bloody output should trigger operative management?
Immediate return of 1500mL or 10-15ml/kg
>200ml/hr or 2-4ml/kg/hr of bloody drainage
Immediate treatment of commotio cordis?
defibrillation
What qualifies for a positive DPL?
free aspiration of gross blood, gastrointestinal contents, vegetable fibers or bile through the lavage catheter upon entering the abdominal cavity
presence of ≥100,000 RBC/mm3
≥500 WBC/mm3
bacteria on Gram stain of the lavage fluid.
Malaria mimic seen in New England?
Transmission?
How do you diagnose it?
Treatment?
Babesiosis
Ixodes tick
dx with thick and thin smears (like malaria); may see the Maltese cross
atovaquone + azithromycin OR clinda + quinine
Cutaneous ulcer OR purulent conjunctivitis with preauricular lymph nodes should make you think of this disease:
tularemia
Bloody diarrhea infectious agent associated with vaginitis?
Shigella
Bloody diarrhea infectious agent associated with bandemia on CBC?
Shigella
treatment of Shigella dysentery?
5d of azithro; can also do bactrim, 3rd gen cephalosporin, fluoroquinolones
infectious diarrhea agent to treat with antibiotics?
Shigella
tx for tularemia
streptomycin, gentamicin, doxycycline, cipro
responsible organism in Lemierre’s disease?
treatment?
Fusobactermium necrophorum
unasyn
Pt with fever, PNA, endocarditis, flu-like symptoms.
Dx?
Tx?
Q-fever (Coxiella burnetti, rickettsial organism)
tx with doxy, fluoroquinolone
Treatment for cat scratch dz
Can usually observe, but if abx desired, try azithromycin to reduce duration of lymphadenopathy
Can also try rifampin, bactrim, and cipro
formula for NNT
NNT = 1/ARR ARR = absolute risk reduction
type I error
rejecting the null hypothesis when it’s actually correct
false positive study
alpha
type II error
failure to reject the null hypothesis appropriately
false negative study
beta
failure to reject the null hypothesis appropriately
type II error
rejecting the null hypothesis when it’s actually correct
type I error
What 3 factors do you need to look at to determine the appropriate type of statistical test to perform?
- is the distribution parametric or not?
- is your data continuous, nominal/ordinal, or categorical?
- are your tested populations dependent or independent?
Sensitivity =
TP / TP+FN
Specificity =
TN / TN+FP
Power
1 - beta
beta = type II error rate
PPV =
TP / TP+FP
NPV =
TN / TN+FN
Incidence vs Prevalence
Incidence = RATE of new diseases over a period of time Prevalence = number of existing disease cases at a specific POINT in time
What do you need to calculate the sample size for a study?
- the effect size
- the type I error rate
- the type II error rate
what is the reciprocal of the rate difference?
the NNT
What is the other name for the Mann-Whitney U test?
Wilcoxon rank-sum test
What is another name for the Wilcoxon rank-sum test?
Mann-Whitney U test
What is the t-test?
statistical test for parametric, continuous data that is independent
what is the paired t-test?
statistical test for parametric, continuous data that is paired
what is the ANOVA?
statistical test for parametric, continuous data with 3 or more independent groups
what is the wilcoxon signed-rank sum test?
statistical test for non-parametric, continuous data that is paired
non-parametric corollary to paired t-test
what is the wilcoxon ranked-sum test?
statistical test for non-parametric, continuous data that is independentnonparametric corollary to t-testalso called the mann-whitney u test
what is the kruskal-wallis?
statistical test for non-parametric, continuous data with 3 or more independent groupsnonparametric corollary to ANOVA
what is the Chi-square test?
statistical test for parametric, categorical data with independent groups
what is the Fisher’s exact test?
statistical test for parametric, categorical data with independent groups if there are <5 measurements/group
what is logistic regression?
statistical test to predict the relationship between a DICHOTOMOUS outcome vs a set of variables while controlling for other variables in the analysis
what is Bonferroni’s correction
a method to correct for multiple repeated testing on the same data set
what is Kolmogorov-Smirnov?
test to determine if data is parametric or not
what is Shaprio-Wilk?
test to determine if the data is parametric or not
formula for odds ratio
(AxD)/(BxC) in standard 2x2 table
what’s the difference between odds ratio and relative risk?
relative risk is used when patients are followed over time.
odds ratio is used when patients already have the outcome and you look back retrospectively at an exposure of interest
In treating hypothermia, at what temperature should you initiate resuscitation meds and defibrillation attempts?
T > 30C
What are treatments for high altitude pulmonary edema? (4)
descent
acetazolamide
dexamethasone
nifedipine
pressor to use in heat stroke
dobutamine - supports BP and HR while keeping vessels dilated for heat dissipation
radiopaque toxins (5)
-
COINS*
1. chloral hydrate
2. opiate packets
3. iron and Hg, As, Li
4. neuroleptics
5. SR/enteric coated meds
poisonings that activated charcoal won’t work for (3)
ions/metals
acids/bases
alcohols
toxin that smells like rotten eggs
hydrogen sulfide
Morning Glory poisoning symptoms
hallucinations, mydriasis, perspiration, bronchorrhea, salivation, hyper or hypothermia, diarrhea
Treatment to reduce thyroid uptake of radioactive iodine?
Potassium iodine
Fish associated with scombroid poisoning?
tuna, mackerel, bonito, mahi-mahi, bluefish, sardines, anchovies
Fish associated with cigautera poisoning?
barracuda, snapper, grouper, amberjack, moray eels, triggerfish, parrotfish
bidirectional v tach is pathognomic for what toxicity?
digoxin toxicity
what is unique about digoxin toxicity related hyperkalemia?
do NOT give calcium - it can cause a “stone heart” from excessive intracellular calcium and cardiac tetany
what is the treatment for digoxin toxicity?
atropine
digiFab
mag, potassium
consider PHYT, lidocaine
treatment for cesium radiation poisoning
prussian blue
EKG findings in TCA OD
sinus tach, prolonged PR, QRS, and QT intervals
Symptoms of scorpion sting
local pain, restlessness, hyperactivity, roving eye movements, and respiratory distress.
More severe signs include seizures, drooling, wheezing, hyperthermia, cyanosis, GI hemorrhage, respiratory distress and death from shock or respiratory paralysis
envenomation associated with metallic taste
rattlesnake
systemic symptoms of brown recluse spider bite
fever, chills, malaise, weakness, nausea, vomiting, joint pain, petechial morbilliform rash, intravascular hemolysis, hematuria, and renal failure
toxic dose of acetaminophen?
150mg/kg in adults
200-250mg/kg in kids
toxicity of ethelyne glycol vs methanol?
ethylene glycol: metabolized into oxalic acid, will crystals in urine and possible ARF
methanol: metabolized into formic acid, injures the eyes
normal serum osmolality
285-295
treatment of organophosphate poisoning
atropine if wet/killer Bs
pralidoxime for for weakness (works at nicotinic skeletal muscle receptors)
Coral snake vs king snake?
red on black, venom lack;
red on yellow, kill a fellow.
ricin poisoning
inhalational: sudden onset of fever, chest tightness, cough, dyspnea, nausea, and arthralgias, progressing to cyanosis, pulmonary edema and respiratory failure
Tularemia: symptoms and treatment
fever, malaise, pneumoniatx: streptomycin
aerosolized toxin that smells of “newly mown hay”?
symptoms?
phosgene - ocular and nasal irritation, resp symptoms
inhalational anthrax - presentation
initial mild symptoms followed by abrupt onset resp distress, cyanosis, diaphoresis 1-6 days later. may see widened mediastinum on CXR.
inhalational anthrax ppx
cipro or doxy
staph enterotoxin b symptoms
sudden onset of fever, chills, headache, myalgias and nonproductive cough
pneumonic plague symptoms
The initial presentation includes respiratory symptoms, fever, cough and myalgia. The clinical course is rapidly progressive with bloody sputum, dyspnea, cyanosis, circulatory collapse and a bleeding diathesis.
The initial presentation includes respiratory symptoms, fever, cough and myalgia. The clinical course is rapidly progressive with bloody sputum, dyspnea, cyanosis, circulatory collapse and a bleeding diathesis.
pneumonic plague
toxin with sudden onset of fever, chills, headache, myalgias and nonproductive cough
staph enterotoxin b
initial mild symptoms followed by abrupt onset resp distress, cyanosis, diaphoresis 1-6 days later. may see widened mediastinum on CXR.
inhalational anthrax
bitter almond odor is associated with this toxin
cyanide
treatment of plagueppx?
tx: doxy or streptomycinppx: doxycycline
ingestions where multidose activated charcoal may be helpful?
phenobarbital, carbamazepine, theophylline, and dapsone
carbamezepine toxicity
can cause resp compromise, altered mental status, vomiting, drowsiness, slurred speech, nystagmus, hallucinations, hypotension, coma, dystonic reactions, seizures has some anticholinergic properties false positive for TCAs on UDS
symptoms and management of hydrofluoric acid burns?
used in glass etching, metal cleaning, and electronics manufacturinghypocalcemia, hypomag, and hyperkalemiatreat with topical, intra-arterial, IV calcium gluconate
IV Meds to Tx HTN Emergency (4)
- labetalol 0.2-1mg/kg
- nitroprusside gtt
- nicardipine gtt
- fenoldapam
HOCM murmur
systolic murmur that gets louder with valsalva or standing from squatting
DDx of Late Pregnancy Bleeding? (3)
What do you do?
DDx: placenta previa, placental abruption, preterm labor
Actions: get OB STAT and don’t do a pelvic
Management Options for Laryngospasm (5)
- reposition airway
- give sustained BVM pressure/PEEP
- stimulate “laryngospasm notch” (behind the earlobe, the soft area between the skull base, mastoid bone, and mandible)
- sux 0.1-0.2mg/kg
- propofol 0.5-1mg/kg
If you see metabolic acidosis + respiratory alkalosis, you should think of this poisoning
salicylate poisoning
characteristic EKG finding of hypothermia
J-waves/Osborn waves
treatment of adrenal crisis
1-2mg/kg of hydrocortisone
meds to acutely treat thyroid storm (4)
- propanolol
- iodide/lugols
- methimazole
- steroids
Patient comes in with occipital HA associated with ataxia/vertigo, dysarthria with short period of LOC. Symptoms resolve after emesis. What less scary dx should you think of?
basilar artery migraine
zones of the neck
- angle of mandible to base of skull
- cricoid to angle of mandible
- cricoid to clavicles/thoracic inlet
Patient with alkaline serum but aciduria - what is this???
paradoxical aciduria secondary to potassium depletion
Cutaneous ulcer OR purulent conjunctivitis with preauricular lymph nodes should make you think of this disease:
tularemia
toxin that smells like almonds
cyanide
toxin that smells like garlic
arsenic
toxic alcohol resulting in large ketosis
isopropyl alcohol
penile fracture is disruption of what?
tunica albuginea/corpus cavernosa
presentation of CN III palsy
“down and out” eye
b/c parasympathetics ride on CN III, may also see ptosis and mydriasis
When is TIG needed for tetanus wound ppx?
If it’s a dirty wound and the pt has less than 3 doses of tetanus vaccine
What should you ask the laboring mother in the ED before delivery of her baby?
- due date
- number of babies in utero
- meconium stained fluid?
- PNC/STIs
How do you treat tetanus after development of symptoms?
flagyl, wound care, TIG
DDx of non-anion gap metabolic acidosis
Hyperalimentation Acetazolamide RTA Diarrhea Ureteroenteric fistula Pancreaticoduodenal fistula * also spironolactone
ehrlichiosis - presentation and tx
presents like RMFS
get treated the same with doxy!
toxins causing miosis
COPS cholinergics/clonidine opiates phenothiazines sedatives
treatment for anthrax, plague, and tularemia?
cipro or doxy
WMD with non-specific flu like illness without rhinorrhea
anthrax
WMD with significantly tender regional LAD
plague (buboes)
WMD with classic clinical finding of blood-streaked sputum
plague
WMD gram negative coccobacillus
Tularemia
WMD with rapid onset (3-12hrs) fever, HA, chills, myalgias, and cough
Staph enterotoxin B
nerve agents
sarin and venom x (VX)
act as organophosphates
when are you most likely to see the most severe effects of acute radiation syndrome?
~30 days after exposure
what is the first cell line to decrease in response to radiation?
lymphocyte count
good prognosticator for severity of acute radiation syndrome
BLS vs ALS ambulances
BLS: BVM, OP, NP, bulb suction, regular suction, immobilization (backboard and c-spine), splints, bandages, obstetric kits, extrication materials
ALS: defibrillator, EKG, intubation equipment, NG, IV/IO, meds
pt has low calcium, high phos
dx?
primary hypoparathyroidism
pt has low calcium, low phos
dx?
vitamin D deficiency
differentiation between torticollis and rotary subluxation?
torticollis - muscles spasm of SCM OPPOSITE the side the chin points to
rotary subluxation - muscle spasm of SCM on the SAME side the chin points to; seen with trauma, URIs, or spontaneous
Neonatal ETT sizes
2.5 = < 1000g, 3000g, >38wks
