E-med rosh Qs Flashcards
Amitriptyline (TCA) overdose
“anti-cholinergic sx”
tachy
dry mouth
dilated eyes
warm, flushed skin
EKG abnormalities seen with TCA (Amitriptyine) overdose
Widened QRS and prolonged QTc
More serious consequences of TCA overdose
seizures (tx w Diazepam)
QRS >100 and dysrhythm (tx w Sodium Bicarb)
Bilateral interfacetal dislocation
unstable neck dislocation
from Hyperflexion
Severe neurologic sequelae common
Tx of B-blocker overdose
Fluids
Glucagon
Calcium
Vasopressor, Insulin
B-blocker OD
Propranolol
Hypotension, bradycardic, heart block
Hypoglycemic
Tx of B-blocker Toxicity
Glucagon
High dose insulin
Lead poisoning may present as
GI sx
Microcytic Anemia w Basophilic stippling
Tx to Lead poisoning
Succimer
it SUCCS to eat LEAD
HA, joint pain, constipation
“lead lines” on X Ray at metaphyses
Hypochromic, “basophilic stippling”
Tx: Succimer
Lead poisoning
Trauma to eye often results in
Hyphema
blood in anterior chamber
Emergent Ophtho consult
Sx of Hyphema
after trauma
Decreased vision, photophobia, pain, absence of red reflex
Tx of Hyphema
eye protection, limited activity, head elevation of 30-45 degrees
Iron tabs often have “candy like” appearance so may be OD’d by kids
Tx is: Deferoxamine
Tx of Tylenol toxicity
N-acetylcyestine (NAC)
NAC is tx for
Tylenol (acetaminophen) toxicity
Signs of Tylenol OD`
N/v at first
Then, Metabolic acidosis, liver/kidney failure, coag defects, coma, death
Abdominal X Ray of kid shows radiopaque particles in stomach
Iron
Anticholinergic OD
flushed, hot skin
decreased/absent bowel sounds
urinary retention
seizures
TCA OVERDOSE
Tx of TCA overdose
Diazepam or Lorazepam for seizures
Sodium bicarb to combat the Na channel blockade
Dose of Epi for airway compromise
0.3-0.5 mg
Atlanto-occipital dislocation
“Internal decapitation”
YIKES
Manage airway, make sure HemoD stable, Rigid C collar
Def tx: Halo placement
Sx of Atlanto Occipital dislocation
High speed MVA is often the mechanism
Cruciate paralysis of Upper extremities, sparing lower
Cat bite treatment
Augmentin
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
