em 2 Flashcards
reasons to do ct before lp
immunocompromised h/o seizure w/in 1 week abnormal level of consciousness h/o cns diseae (mass, lesion, stroke, focal infxn) Papilledema focal neurological deficit possible focal infxn
difference between encephalitis and meningitis
encephalitis has altered brain function and neurological findings (i.e. personality changes, paralysis, hallucinations, altered smell, problems w/ speech)
treatment of encephalitis
acyclovir 10mg/kg empiric tx for hsv
what must you do on any hot swollen joint
arthrocentesis
how to send joint fluid analysis
culture + sensitivity + r/o gonorhea
what do you do if suspect gonoorrhea
do cervical, urethral, and rectal cultures (do this cause joint fluid usually doesn’t show gonorrhea
tx of gram negative bactrameia
gentamycin + cefepime (antipseudomonal cephalosporin) +/- vanco
tx for gram positive bactraemia
empiric tx- vanco
mssa-pcn, naficillin, vanco,
mrsa-vanco
work up should include echo to check for infective endocarditis
3 reasons what make soft tissue infxn an emergency
infxn around face or hand
cellulitis in presence of pvd or diabetes
local infxn in presence of hiv or leukemia
malaria sxs
uncomplicated fever, malaise, myalgia, arthralgia, and HA
complicated-fever, anemia, splenomegaly, alterned consciousness, ards, etc…
abx for wound botulism
pcn g or metronidazole
where is small pox rash most prominent
face and extremities (palms and soles)
what causes mediastinal widening
inhalation anthrax
cutaneous anthrax tx
cipro and doxy
cipro can’t exceed 1 gram daily in children
gastric lavage indications
suspected serious ingestoins when emesis has failed
pts are lethargic or otherwise uncooperative
when gag reflex is markedly depressed
when pts have ingested rapidly acting convulsants (can’t induce emesis in these)
what must the toxin be for hemodialsis
relatively water soluble and not highly protein bound indicated for MELS methanol etylene glycol lithium salicylate
what is the benefit of hemoperfusion over hemodialsis
drug or toxin is in direct contact with absorbent material
hemoperfusion
small volume of distribution and slow rate of intrinsic clearance usuful for tri pep td tricyclic antidepresant paraquat ethchlorvynol phenobarbital theophyline digitoxin
cocaine overdoses
euphoria, excitement, restlessness, toxic psychosis, seizures, hypertension, tachycardia, hyperthermia, and possible MI
tca overdose
Delerium, blurred vision, mydriasis, hallucinations, coma, dry mucous membranes, inhibition of sweating, hyperthermia, tachycardia
when to use phystigme for overdose
cns problems
when to never use phystigme
tricyclic overdose, asthma, or mechanical bowel or bladder obstruction
best way to monitor chelation therapy for arsenic intoxication
24 hour urine arsenic level
acute arsenic ingestion
gi lavage and charcal and dimercaperaol
chronic use is pencil amine
Chelation therapy is of no value in the acute exposure to arsine gas
tx for carbon monoxide poisoning
100% fi02 for 4 hour
if hyperkalemia in dig toxicity >7
glucose + insulin thearpy
organophosphate
DUMBELS –Diarrhea, Urination, Miosis, Bronchospasms, Excitation, Lacrimation, Salivation
main things that differentiate thyroid storm from hyperthyroid
fever and cns dysfunctoin (agitation, stupor, confusion, delirium, coma, seizure) in storm
what do 1st and 2nd gen antipsychotics do
lower seizure threshold
never give hypotonic solution in
increase ice
trauma
burns
liver disease
when not to use lactated ringer
kidney failure liver disease (can't metabolize lactate)
when are packed rbc always indicated
hgb <6
indications for platelets
<50,000
