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Step 2 > EM > Flashcards

EM Flashcards

1
Q

Ingestion </= 2 hours

A

Gastric lavage
50%-1 hour
15%- 2 hours

Never try to induce vomiting, it takes 15-20 minutes to work and delays antidote

Contraindicated:
Altered mental status- aspiration
Caustic agent-burns

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2
Q

Ipecac for overdose

A

Do not use

Takes 15-20 min to induce vomiting

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3
Q

Cathartics (sorbitol, Mg sulfate/citrate) for overdose

A

Always WRONG

speeding up GI transit time does not eliminate ingestion

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4
Q

Forced diuresis for overdose

A

WRONG

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5
Q

Whole bowel irrigations for overdose

A

Place NGT-administer GOLYTELY

Only for: massive iron ingestion, lithium, swallowing drug filled packet

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6
Q

Opiate overdose

A

Naloxone
Overdose is fatal
Withdrawal is not

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7
Q 
Slurred speech
Unsteady gait 
Drowsiness 
Normal pupil size 
Mild decrease in respirations
A

Benzo overdose - not fatal

Do not give flumazenil- seizures

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8
Q

Charcoal in overdose

A

Benign and should be used in all patients with pill overdose

Decreases toxin level even once drug is absorbed

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9
Q

Acetaminophen overdose

A

Clear toxic dose (>8mg)- N-acetylcysteine

Unclear dose: Activated charcoal, obtain a acetaminophen level at 4 hours, repeat level at 2 hours, based on two data points determine necessity of n-acetylcysteine within 8 hours of ingestion

24 hours after ingestion- no therapy

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10
Q

Tinnitus hyperventilation
Respiratory alkalosis progression to anion metabolic acidosis
Renal toxicity
Altered mental status

A

Aspirin toxicity

Alkalize urine to increase rate of aspirin excretion

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11
Q

TCA toxicity

A

Fatality from: seizures and prolonged QT causing arrhythmias

Anticholinergic effects: dry mouth, constipation, urinary retention (do not need to treat because not fatal)

Tx: sodium bicarbonate- protects the heart against arrhythmias, does not improve urinary excretion

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12
Q

Carbon monoxide poisoning

A 
Carboxyhemoglobin- same as being super anemic 
Dyspnea 
Light headed 
Confusion 
Seizures 
MI 
Lactic acidosis

Dx: carboxyhemoglobin level, normal PaO2, but lactic acidosis
Tx: 100% O2, if severe hyperbaric chamber

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13
Q

Methemoglobinemia

A

Hemoglobin oxidized in ferric state
Will not carry oxygen- brown
Caused by: benzocaine, nitrites, nitroglycerin, and dapsone

Dyspnea
Cyanosis 
Confusion 
Seizures
Lactic acidosis

Dx: methemoglobin level, normal PaO2, but lactic acidosis
Tx: 100% O2 and methylene blue

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14
Q

Organophosphate/Never gas poisoning

A 
Acetyhcholinesterase inhibitors 
Salvation 
Lacrimation 
Polyuria 
Diarrhea 
Bronchospasm, bronchorrhea, respiratory distress

Tx:
Atropine
Remove clothing
Pralidoxime (reactive acetylcholinesterase, takes a while to work)

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15
Q

Digoxin toxicity

A

Hypokalemia predisposes

GI problems: N/V, anorexia, abdominal pain
Hyperkalemia
Confusion
Visual disturbances
Rhythm disturbances- any arrhythmia is possible, atrial tachycardia with AV block most common

Dx: Digoxin leve
Tx: Control potassium, Digoxin specific antibody

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16
Q

Lead poisoning

A 
Abdominal pain 
ATN 
Sideroblastic anemia 
Peripheral neuropathies-wrist drop 
CNS- memory loss confusion

Accurate- Lead level
Initial- increased free erythrocyte protoporphyrin

Tx:
Mild 5-44: no treatment
Mod 45-60: succimer
Severe >70: EDTA and dimercaprol

17
Q

Mercury poisoning

A

Inhaled- pulmonary fiborosis
Ingested- nervous, jittery, twitchy, hallucinations

No therapy to reverse fibrosis
Dimercaprol and succimer- reverse neuro signs and prevent fibrosis

18
Q

Bradycardia
AV black
Hypotension
Diffuse wheezing

A

Beta-blocker toxicity

Tx:

  1. Atropine and IVF
  2. Glucagon
19
Q

Methanol toxicity

A

Wood alcohol, cleaning solution, paint thinner ingestion

Accumulate: formic acid/formaldehyde
Presentation: occular toxicity- retinal inflammation

Anion gap metabolic acidosis
Osmolar gap

Tx: fomepizole (prevent conversion) and dialysis (remove substance)

20
Q

Ethylene glycol toxicity

A

Antifreeze

Accumulate: Oxalic acid/oxalate

Presentation: renal toxicity with hypocalcemia, enveloped shaped oxalate crystals in urine

Tx: fomepizole (prevent conversion) and dialysis (remove substance)

Step 2 (12 decks)

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