E-med rosh Qs Flashcards by Alora Marshall

Amitriptyline (TCA) overdose

“anti-cholinergic sx”

tachy
dry mouth
dilated eyes
warm, flushed skin

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EKG abnormalities seen with TCA (Amitriptyine) overdose

Widened QRS and prolonged QTc

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More serious consequences of TCA overdose

seizures (tx w Diazepam)

QRS >100 and dysrhythm (tx w Sodium Bicarb)

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Bilateral interfacetal dislocation

unstable neck dislocation

from Hyperflexion

Severe neurologic sequelae common

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Tx of B-blocker overdose

Fluids
Glucagon
Calcium

Vasopressor, Insulin

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B-blocker OD

Propranolol

Hypotension, bradycardic, heart block

Hypoglycemic

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Tx of B-blocker Toxicity

Glucagon

High dose insulin

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Lead poisoning may present as

GI sx

Microcytic Anemia w Basophilic stippling

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Tx to Lead poisoning

Succimer

it SUCCS to eat LEAD

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HA, joint pain, constipation
“lead lines” on X Ray at metaphyses
Hypochromic, “basophilic stippling”

Tx: Succimer

Lead poisoning

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Trauma to eye often results in

Hyphema

blood in anterior chamber

Emergent Ophtho consult

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Sx of Hyphema

after trauma

Decreased vision, photophobia, pain, absence of red reflex

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Tx of Hyphema

eye protection, limited activity, head elevation of 30-45 degrees

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Iron tabs often have “candy like” appearance so may be OD’d by kids

Tx is: Deferoxamine

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Tx of Tylenol toxicity

N-acetylcyestine (NAC)

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NAC is tx for

Tylenol (acetaminophen) toxicity

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Signs of Tylenol OD`

N/v at first

Then, Metabolic acidosis, liver/kidney failure, coag defects, coma, death

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Abdominal X Ray of kid shows radiopaque particles in stomach

Iron

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Anticholinergic OD

flushed, hot skin
decreased/absent bowel sounds
urinary retention
seizures

TCA OVERDOSE

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Tx of TCA overdose

Diazepam or Lorazepam for seizures

Sodium bicarb to combat the Na channel blockade

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Dose of Epi for airway compromise

0.3-0.5 mg

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Atlanto-occipital dislocation

“Internal decapitation”

YIKES

Manage airway, make sure HemoD stable, Rigid C collar

Def tx: Halo placement

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Sx of Atlanto Occipital dislocation

High speed MVA is often the mechanism

Cruciate paralysis of Upper extremities, sparing lower

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Cat bite treatment

Augmentin

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Inspiratory stridor

upper airway obstruction

What will an obstructed lung look like on X Ray in comparison to an Un-obstructed?

Obstructed: darker, bc the air can't exit the lung, making it appear hypodense Un-Obstructed: more white on X Ray, bc the air is exhaled

Stab wound to back Unable to move L leg, and R leg is numb

Brown Sequard syndrome hemisection of spinal cord, often d/t Penetrating injury

Brown Sequard syndrome

Proprioception/Vibratory, motor loss of Same side of injury Pain/temperature loss of opposite side

Phases of Tylenol Toxicity

<24h: n/v 1-3d: elevated ALT/AST, INR, bilirubin, RUQ pain 3-5d: multi organ failure, coma, death 4d-2w: complete resolve of Liver dysfx

N-acetylcysteine is tx of

Tylenol toxicity

Tx of Anatomical Snuffbox (possible Scaphoid fx) if inital X Ray is unremarkable

Place in "Thumb spice" Refer to Ortho Repeat X ray in 2 weeks

Signs of ASA overdose

n/v/d Vertigo, Tinnitus Vitals: tachypnea, tachycardia, Fever

Broselow Tape

Tape to estimate a child's weight based on their height "Red to head" place the red tape towards the child's head, and run the length down rest of body

Defibrillation

for the pulseless patient immediate life threatening V-fib and V-tachy

Cardioversion

to convert an Arrhythmia back to Sinus rhythm

Cardioversion

for Persistent tachyarrhythmias Synchronized on the R wave

Cardioversion strength

50-200 joules

Defibrillation strength

200-360 joules

What is transcutaneous pacing used for?

Temporary stabilization of Sx-atic Bradycardia Most pts tolerate pacing for <15 minutes

3 diff interventions to heart

Transcutaneous pacing Synchronized Cardioversion Defibrillation

Difference b/w Transcutaneous pacing and Synchronized cardioversion

Transc Pac: providing signal to heart when it's own natural isnt working- to control HR /rhythm (bradycardias) Synch Cardioversion: delivering a selected dose of electricity to heart at specific period at the cardiac cycle- R WAVE!!!- to reset the heart's intrinsic firing rate (tachyarrhythmias)

Obturator sign

to test for appendicitis rotate the hip INTERNALLY

Rovsing sign

the REFERRED pain, pressing on LLQ elicits pain in the RLQ

Tx of b-blocker dose

Glucagon and High dose insulin

Farmer poisoning

Cholinergic Organophosphate SLUDGE, or DUMBBELLS

SLUDGE (cholinergic) poisoning

``` salivation lacrimation urination diarrhea GI cramps emesis ```

DUMBBELLS | cholinergic poisoning

``` diarrhea urination miosis (PINPOINT eyes) bradycardia bronchospasm emesis lacrimation lethargy salivation seizure ```

Treatment of farm, organophosphate poisoning

Atropine | 2-PAM

"Hot as a hare, dry as a bone, mad as a hatter" applies to

Anticholinergic poisoning elevated temp, flushing, dry skin and M.M., AMS, dilated eyes

What type of eyes are a/w SLUDGE? organophosphate

Pinpoint eyes, miosis

SLUDGE AND THE KILLER B'S

Bradycardia Bronchorrhea (excessive d/c of watery mucus from the lungs--> wet cough) Bronchospasm

Anterior cord spinal trauma lesion

Complete loss of everything below lesion EXCEPT Vibratory and Proprioception

Most common cause of Anterior Cord Syndrome injury

Flexion injury

Brown Sequard injury

penetrating trauma

Hyperextension injury to spinal cord

Central cord injury Upper>lower extremity sensory and motor loss

Thoracentesis

to remove FLUID from pleural space i.e. in effusion

Thoracostomy

for PNX Thoracostomy with Chest tube placement If chest tube not available, Needle Decompression should be done

Opioid overdose | i.e. Methadone

Resp depression Sedation Pinpoint eyes Prolonged QTC Torsades de pointe may be described as "QRS complex twisting around isoelectric line"

Tx for Cat bite

Augmentin

Tx for Cat bite if pt is PCN allergic

Doxy + Cipro

Antidote for Amitriptyline (TCA) poisoning

Sodium bicarb