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Emergency Medicine > AMS & Toxicology > Flashcards

AMS & Toxicology Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Not fully alert

drifts to sleep

limited awareness

loses train of thought

A

Lethargic/somnolent

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2
Q

difficult to aroused

confused when aroused

stimulation required to elicit minimal cooperation

A

obtunded

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3
Q

doesn’t rouse spontaneously

vigorous stimulation for very little response

moan or mumble when aroused

A

stuporous/semicomatose

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4
Q

unarousable unresponsiveness…

A

coma

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5
Q

minimum GCS even if dead…

A

3

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6
Q

GCS scoring…

A

Eye: 1-4

Motor: 1-6

Verbal: 1-5

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7
Q

What posturing?

flexion w. adduction of arms and extension of legs

(flexor posturing)

A

decorticate

COR - hands over heart

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8
Q

This type of posturing a/w corticospinal lesion (cortex to upper midbrain)

A

decorticate

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9
Q

What posturing?

extension, adduction, internal rotaion of arms and leg extension

(extensor posturing)

A

Decerebrate

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10
Q

Decerebrate posturing is associated with damage where?

A

brainstem (pons, upper medulla)

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11
Q

Which is worse, decorticate or decerebrate?

A

decerebrate

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12
Q

Dementia (or Major Neurocognitive Disorder) has significant cognitive impairment in 1 of 6 domaines…

A

learning/memory

language

executive function

complex attention

perceptual motor function

social cognition

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13
Q

A fluctuating disturbance in attention and awareness and cognition developing over a short period of time…

A

delerium

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14
Q

are focal or lateralized neuro findings characteristic of delerium?

A

no

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15
Q

MOVE STUPID describes what etiology of AMS

A

metabolic
oxygen
vascular
endocrine

seizure
trauma
uremia
psych
infx
drugs
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16
Q

initial lab workup for AMS

A 
lytes
Cr
Glucose
Ca
CBC
UA
Urine Preg
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17
Q

What diagnostic for AMS?

CAD hx or age > 50

A

ECG

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18
Q

What diagnostic for AMS?

resp sxs
fever

A

CXR

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19
Q

What diagnostic for AMS?

focal neuro exams

hx of trauma

A

Head CT

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20
Q

What diagnostic for AMS?

hypoxic

suspected metabolic acidosis

A

ABGs

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21
Q

3 tx options that pose little harm in tx of AMS

A

thaimine
dextrose
naloxone

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22
Q

Physical restraints should be used when with AMS?

A

last resort

23
Q

What 3 things can lessen disruptive behavior in AMS?

A

frequent reassurance, touch, verbal orientation

24
Q

Haloperidol should be reserved for…

A

potential harm to patient, providers, family

25
Q

BZs as a tx for undifferentiated AMS?

A

no

26
Q

are cholinesterase inhibitors effective in tx of delerium?

A

no

27
Q

When can BZs be considered for AMS?

A

withdrawal

sympathomimetic/anticholinergic poisoning

28
Q

delirium may take _____ to resolve

A

weeks to months

29
Q

4 important questions for toxicology hx?

A

which toxin?
how much?
when?
precipitating event?

30
Q

Cholinergic like organophosphates cause physiologic ______

A

depression

31
Q

The below are examples of what kind of decon?

  • Forced diuresis
  • Urine ion trapping
  • Hemodialysis
  • Exchange transfusion
A

enhanced elimination

32
Q

Amitriptyline antidote

A

sodium bicarb

33
Q

anticholinergic antidote

A

physostigmine

34
Q

beta blocker antidote

A

glucagon

35
Q

cyanide antidote

A

hydroxocobalamin/nitrates

36
Q

hydrofluoric acid antidote

A

calcium

37
Q

iron antidote

A

desferrioxamine

38
Q

methanol/ethylene glycol antidote

A

ethanol

39
Q

methemoglobin antidote

A

methyline blue

40
Q

organophosphates/anticholinesterase antidote

A

atropine, 2-PAM

41
Q

salicylate antidote

A

urine alkalization, dialysis

42
Q

sulfonylurea antidote

A

octreotide

43
Q

Urine or serum tests?

  • Opioids
  • Benzos
  • Cocaine
  • THC
  • Barbiturates
  • Amphetamines/methamphetamines
  • TCAs
  • Buprenorphine
A

urine

44
Q

urine or serum tests?

  • Acetaminophen
  • Salicylate
  • Carboxyhemoglobin
  • Digoxin
  • Lithium
  • Iron, lead, mercury
  • Ethylene glycol
  • Antiepileptic drugs
A

Serum

45
Q

4 labs for all poisonings and patients w. AMS

A

preg
glucose
acetaminophen/salicylate testing

46
Q

Cholinergic toxidrome sxs:

SLUDGE and Killer BBBs

A 
Salivation
Lacrimation
Urination
Defecation
GI distress
Emesis

Bradycardia, Bronchorrhea. Bronchospasm

47
Q

Cholinergic toxidrome tx…

A

agressive decon

atropine + 2 PAM

48
Q

Anticholinergic toxidrome drugs (2)

A

antihistamines

jimson weed

49
Q

Earliest and most reliable sign of anticholinergic toxidrome…

A

tachycardia

50
Q

Tx of anticholinergic poisoning…

A

BZs for agitation

Activated charcoal if recent

Physostigmine

51
Q

What toxidrome?

  • Hyperthermia
  • Tachycardia/dysrhythmia
  • HTN
  • Diaphoresis
  • Agitation, hallucinations, paranoia
  • Dilated pupils
  • Seizures (
A

sympathomimetic

52
Q

How can you tell sympathomimetic vs anticholinergic?

A

anticholinergic = dry skin, hypoactive BS

Sympathomimetic = diaphoresis, hyperactive BS

53
Q

Which toxidrome?

  • Hypothermia
  • Vitals usually relatively normal
  • Bradypnea/apnea
  • CNS depression, coma
  • Hyporeflexia
  • VARIABLE pupils
A

sedative hypnotic

54
Q

Tx for sedative hypnotics…

A

time +/- flumazenil

Emergency Medicine (12 decks)

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