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Step 2 CK > EM > Flashcards

EM Flashcards

1
Q

Unidentified pills ingested within 1hr w/ no changing MS, next best step

A

Gastric lavage

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2
Q

When is gastric lavage dangerous

A

Altered MS
Caustic injestion
Acetaminophen OD

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3
Q

How much does gastric lavage remove

A

50% at 1 hr

15% at 2hrs

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4
Q

What is always the wrong answer w/ response to poisoning

A

Ipecac
Cathartics
Forced diuresis
Whole bowel irrigation

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5
Q

Cause of OD is unclear

A

Acetaminophen

Aspirin

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6
Q

MCC death by OD

A

Acetaminophen

Aspirin

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7
Q

Best initial management of OD >1hr w/ Altered MS

A

Naloxone
Dextrose
Thiamine

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8
Q

Is benzo OD fatal

A

No, but acute withdrawal causes seizures

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9
Q

When is charcoal given

A

Anyone w/ pill OD

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10
Q

How much acetaminophen is toxic

A

8-10 grams

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11
Q

How much acetaminophen is fatal

A

12-15 grams

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12
Q

Lab changes in acetaminophen OD

A

Elevated AST, Bili

Abd pain and vomitting

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13
Q

Clearly toxic amount of acetaminophen ingested, next best step

A

NAC

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14
Q

Acetaminophen OD >24hrs, what now

A

Nothing

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15
Q

Can’t tell how much acetaminophen was ingested

A

Get level

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16
Q

Charcoal in acetaminophen OD

A

Give it w/ NAC even if vomitting

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17
Q

Features of Aspirin OD

A

Resp alk → Tinnitus
Metab acid → Hyperventilation
Renal tox and altered MS
Increased anion gap

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18
Q

How does aspirin OD affect lungs

A

ARDS

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19
Q

Rx aspirin OD

A

Alkalinize urine w/ bicarb

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20
Q

ABG in aspirin OD

A

↓ pCO2
↓ HCO3
↑ pH

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21
Q

Fatal consequences of TCA OD

A

Seizures

Arrhythmias

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22
Q

What can prevent seizures in TCA OD

A

Benzos

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23
Q

Best initial test in TCA OD

A

EKG

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24
Q

What is seen on EKG in TCA OD

A

Wide QRS

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25
Q

Main sx in TCA OD

A

Dry mouth
Constipation
Urinary retention

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26
Q

Rx TCA OD

A

Na bicarb

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27
Q

MCC death in fires

A

CO poisoning

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28
Q

Only way to rx caustic ingestion

A

Water in high volumes to flush out

Endoscopy to assess degree of damage

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29
Q

Hx clues for CO poisoning

A

Gas heaters, wood burning stoves

Automobile exhaust

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30
Q

Presentation of CO poisoning

A

Dyspnea, lightheadedness, confusion, seizures

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31
Q

How does CO poisoning kill you

A

MI

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32
Q

ABG picture in CO poisoning

A

May be normal
Lactic acidosis
- Low bicarb
- Low pH

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33
Q

Most accurate test for CO poisoning

A

Carboxyhemoglobin level

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34
Q

Soot around mouth and nose but not inside

A

Don’t intubate

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35
Q

Burns inside mouth

A

Intubate

4mL NS per % body surface affected

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36
Q

Best initial therapy for CO poisoning

A

Give 100% O2

Hyperbaric O2 if severe

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37
Q

What is severe CO poisoning

A

CNS sx
Cardiac sx
Metabolic acidosis

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38
Q

MCC death from burns

A

Infection

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39
Q

What is methemoglobinemia

A

Hb locked in ferric state

Brown, will not carry O2

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40
Q

What can cause methemoglobinemia

A

Benzocaine and other anesthetics
Nitrites and nitroglycerin
Dapsone

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41
Q

Sx methemoglobinemia

A

Dyspnea and cyanosis
HA, confusion, seizures (altered MS)
Metab acid

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42
Q

Most accurate test for methemoglobinemia

A

Methemoglomin level

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43
Q

Best initial therapy for methemoglobinemia

A

100% O2

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44
Q

Most effective therapy for methemoglobinemia

A

Methylene blue

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45
Q

What predisposes digoxin toxicity

A

Hypokalemia

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46
Q

MC presentation of digoxin toxicity

A

GI issues (N/V)

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47
Q

Other sx of digoxin tox

A 
Hyperkalemia
Confusion
Visual disturbance
Rhythm disturbance
Gynecomastia (rare)
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48
Q

What else causes hyperkalemia

A

ACEIs, ARBs, BBs, Spironolactone

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49
Q

Most accurate test for digoxin toxicity

A

Digoxin levels

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50
Q

Best initial test for digoxin tox

A

K level and EKG

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51
Q

EKG finding in dig tox

A

Downsloping ST

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52
Q

Most common arrhythmia in dig tox

A

Atrial tachy w/ variable AV block

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53
Q

Rx Dig tox

A

Control K

Digoxin Ab

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54
Q

Strongest indication for digoxin Ab

A

CNS and cardiac involvement

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55
Q

Presentation of organophosphate/nerve gas poisoning

A 
Salivation
Lacrimation
Polyuria
Diarrhea
Bronchospasm (resp arrest if severe)
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56
Q

Rx organophosphate/nerve gas poisoning

A

Atropine immediately

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57
Q

Presentation of Pb poisoning

A 
Abd pain
ATN
Sideroblastic anemia
Wrist drop
Memory loss, confusion
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58
Q

Best initial test for Pb poisoning

A

Increased free erythrocyte protoporphyrin

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59
Q

Most accurate test for Pb poisoning

A

Lead level

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60
Q

Most accurate test for sideroblastic anemia

A

Prussian blue stain

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61
Q

Rx Pb poisoning

A

Succimer (oral)

EDTA, Dimercaprol (IV)

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62
Q

Sx in Mercury poisoning

A

Oral - CNS

Inhaled - Lung fibrosis

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63
Q

Specific CNS sx in mercury poisoning

A

Nervous, jittery, twitchy, hallucinatory

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64
Q

Can lung damage in mercury poisoning be reversed

A

No

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65
Q

Rx Mercury poisoning

A

Dimercaprol, Succimer

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66
Q

Effects of methanol and ethylene glycol poisoning

A

Intoxication
Metabolic acidosis
Increased anion gap

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67
Q

Rx methanol and ethylene glycol poisoning

A

Fomepizole

Dialysis

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68
Q

Source of methanol poisoning

A

Wood alcohol
Cleaning solutions
Paint thinner

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69
Q

Source of ethylene glycol poisoning

A

Antifreeze

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70
Q

Metabolite in methanol poisoning

A

Formic acid/ Formaldehyde

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71
Q

Metabolite in ethylene glycol poisoning

A

Oxalic acid/ Oxalate

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72
Q

Presentation of methanol poisoning

A

Ocular toxicity

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73
Q

Presentation of ethylene glycol poisoning

A

Renal toxicity

74
Q

Initial diagnositic abnormality in methanol poisoning

A

Retinal inflammation

75
Q

Initial diagnositic abnormality in ethylene glycol poisoning

A

Hypocalcemia

Enveloped shaped crystals in urine

76
Q

Calculation of serum osmolality

A

2xNa + BUN/2.8 + Glc/18

77
Q

MC injury from snake bite

A

Local injury

78
Q

What damages local tissue in snake bites

A

Proteases and lipses

79
Q

How does snake hemolytic toxin kill you

A

Hemolysis and DIC

80
Q

How does snake neurotoxin kill you

A

Resp paralysis

81
Q

Ineffective snake bite remedies

A

Tourniquets
Ice
Incision and suction

82
Q

Effective snake bite remedies

A

Pressure
Immobilization
Antivenom

83
Q

Presentation of black widow bite

A

Abd pain

Muscle pain

84
Q

Presentation of brown recluse bite

A

Local skin necrosis
Bullae
Blebs

85
Q

Lab tests in black widow bite

A

Hypocalcemia

86
Q

Lab tests in brown recluse bite

A

None

87
Q

Rx black widow bite

A

Calcium

Antivenom

88
Q

Rx brown recluse bite

A

Debridement
Steroids
Dapsone

89
Q

Management of dog, cat, human bites

A

Amoxicillin/Clavulanate

Tetanus vaccine booster if >5yrs since last

90
Q

Organisms in dog/cat bites

A

Pasteurella multocida

91
Q

Organisms in human bites

A

Eikenella corrodens

92
Q

What’s worse dog/cat bites or human

A

Human

93
Q

When is rabies vaccine given

A

Animal has altered MS

Attack was unprovoked by stray that cannot be observed

94
Q

Management of any head trauma causing altered MS or LOC

A

Head CT first

95
Q

Best initial test in head trauma

A

Head CT without contrast to look for blood

96
Q

Difference between concussion and contusion

A

Normal CT in concussion

Ecchymoses in contusion

97
Q

Can you differentiate between subdural/epidural hematomas and concussion without a CT

A

No

98
Q

Which hematoma types have a lucid interval

A

Epidural

Subdural

99
Q

Rx concussion

A

Nothing, wait 24hrs before returning to sports

Observe at home for changes in MS

100
Q

Rx contusion

A

Nothing

101
Q

Rx Subdural/epidural hematoma

A

Small - nothing

Large - Intubation, hyperventilation, mannitol, drainage

102
Q

What is the benefit of hyperventilation in hematoma management

A

Decreases pCO2
Constricts vessels thereby decreasing pressure
Bridge to surgery

103
Q

Definition of large intracranial hemorrhage

A

Compression
Herniation
Worsening MS or focal findings

104
Q

Who gets PPX for stress ulcers

A

Head trauma
Burns
Intubated
Coagulopathy

105
Q

Best initial therapy for anyone trapped in a fire

A

100% O2 for smoke inhalation and CO poisoning

106
Q

Second most common cause of death from burns

A

Airway burn

107
Q

When to intubate a pt caught in a fire

A

Stridor
Hoarseness
Wheezing
Burns inside mouth or nasopharynx

108
Q

2nd MCC of death if no airway burn

A

Fluid loss

109
Q

Burn fluid replaced with

A

Ringer lactate (NS if it’s not there)

110
Q

Body percentages in burns

A 
Head - 9
Arms - 9 each
Legs - 18 each
Chest/back - 18 each
Hand - 1 each
111
Q

How much fluid is given to burn pts

A

4mL%bodykg

Biggest number in answer choices

112
Q

Routinely given to burn pts

A

Topical abx for infection PPx

113
Q

Risk factors for heat disorders

A

Exhaustion - Hot outside temperature, Exertion
Heatstroke - Hot outside temperature, Exertion
NMS - Antipsychotics
Malignant hyperthermia - Anesthetics

114
Q

Difference between heat exhaustion and other heat disorders

A

Heat exhaustion has normal body temp, CPK, K

115
Q

Rx heat exhaustion

A

Oral fluids and electrolytes

116
Q

Rx heat stroke

A

IV fluids

Evaporation

117
Q

Rx NMS

A

Dantrolene or DA agonists

Bromocriptine, cabergoline

118
Q

Rx malignant hyperthermia

A

Dantrolene

119
Q

When to suspect hypothermia

A

Intoxicated person with low body temp

120
Q

MCC death in hypothermia

A

Cardiac arrhythmia

121
Q

Best initial step in hypothermia

A

EKG

122
Q

EKG in hypothermia

A

Elevation at J point

123
Q

Management of drowning

A

Manage airway and administer positive pressure ventilation

124
Q

What happens in salt water drowning

A

Acts like CHF with wet heavy lungs

125
Q

What happens in fresh water drowning

A

Causes hemolysis

126
Q

First step in potential cardiac arrest patient

A

Make sure they’re unresponsive

Call 911, activate EMS

127
Q

Next step after confirming cardiac arrest pt is unresponsive and EMS activated

A

Open airway
Rescue breaths
Check pulse and give compressions

128
Q

When is precordial thump the answer

A

Very recent onset (

129
Q

Cause of sudden loss of pulse

A

Asystole
V-fib
V-tach
Pulseless electrical activity (PEA)

130
Q

What is the role of CPR

A

Keep pt alive until cardioversion

131
Q

Best initial management of all forms of pulselessness

A

CPR

132
Q

Therapy for asystole

A

CPR

Epi

133
Q

MCC sudden death

A

V-fib

134
Q

Best initial therapy for V-fib

A

Unsynchronized cardioversion then resume CPR

135
Q

What is unsynchronized cardioversion

A

Defibrillation

136
Q

Which cardioversions do not have to be synchronized

A

V-fib

Pulseless V-tach

137
Q

Complete management of V-fib

A 
Shock
Shock
Epi/vasopressin every 3-5min
Shock
Amiodarone
Shock
138
Q

First choice medication for V-fib

A

Amiodarone

139
Q

Management of pulseless V-tach

A

Same as V-fib

140
Q

Management of stable V-tach

A

Amiodarone then lidocaine then procainamide

Cardiovert if fails

141
Q

Management of unstable V-tach

A

Cardiovert several time then meds

142
Q

Features of V-tach

A

Rate 160-240

QRS all look identical

143
Q

Definition of hemodynamic instability

A

CP
SOB
Hypotension
Confusion

144
Q

What is pulseless electrical activity

A

Heart electrically normal but no motor contraction

Normal EKG, no pulse

145
Q

Causes of PEA

A 
Tamponade
Tension PTX
Hypovolemia, hypoglycemia
Massive PE
Hypoxia, hypothermia, metab acid
K disorders
146
Q

Rx pulseless electrical activity

A

Fluids

Correct underlying cause

147
Q

Sx atrial arrhythmias

A

Palpitations, dizziness, lightheadedness
Exercise intolerance or dyspnea
Embolic stroke

148
Q

Irregularly irregular heartbeat

A

A-fib

149
Q

MC arrhythmia in USA

A

A-fib

150
Q

Difference between flutter and fibrillation

A

Flutter is regular, goes back to sinus or deteriorates to fib

151
Q

Rx unstable atrial arrhythmias

A

Synchronized cardioversion

- Prevents deterioration into v-tach or v-fi

152
Q

Difference in cardioverting chronic vs acute a-fib

A

Chronic needs anticoagulation first

153
Q

What is chronic a-fib

A

Lasting > 2 days

154
Q

Best initial therapy for fib and flutter

A

Control rate with BBs, CCBs, or digoxin

155
Q

Most appropriate next step in fib and flutter after rate control

A

Warfarin, digatraban or rivaroxaban

156
Q

Only CCBs that can block the AV node in atrial arrhythmias

A

Diltiazem

Verapamil

157
Q

What can atrial rhythm problems cause

A

Acute pulmonary edema

158
Q

Pt w/ CHADS 1 or less management

A

Aspirin only

159
Q

CHADS

A 
CHF/Cardiomyopathy
HTN
Age >75
DM
Stroke or TIA (2pts)
160
Q

What does CHADS indicate

A

What to anticoagulate with
1 or less = aspirin
2 or more = warfarin

161
Q

Presentation of SVT

A

Palpitations in a pt who is hemodynamically stable

162
Q

Best initial therapy of SVT

A

Vagal maneuvers
Adenosine
BBs, CCBs, digoxin

163
Q

Cure for SVT

A

Radiofrequency catheter ablation

164
Q

When to consider WPW

A

SVT alternating with V-tach
SVT getting worse after diltiaze, or digoxin
Delta wave on EKG

165
Q

Most accurate test for WPW

A

EP studies

166
Q

Acute therapy for WPW

A

Procainamide or amiodarone only if WPW currently presenting with arrhythmia

167
Q

Chronic therapy for WPW

A

Radiofrequency ablation is curative

168
Q

What is multifocal atrial tachy associated with

A

Chronic lung disease like COPD

169
Q

Rx MAT

A

Treat underlying disease

Treat MAT like A-fib but no BBs

170
Q

Next step in asymptomatic brady

A

EKG - differentiate from pathologic

171
Q

Rx asymptomatic sinus brady

A

None

172
Q

Best initial therapy for symptomatic brady

A

Atropine

173
Q

Most effective therapy for symptomatic brady

A

Pacemaker

174
Q

Management of first degree AV block

A

Same as sinus brady

175
Q

Who gets Mobitz I

A

Sign of normal aging

176
Q

Management of Mobitz I

A

No Rx if asymptomatic

177
Q

Management of Mobitz II

A

Pacemaker, just like type III block

178
Q

MCC death 72hrs surrounding acute MI

A

Ventricular arrhythmia

179
Q

Test for recurrence of ventricular arrhythmia after MI

A

Echo

180
Q

Pt with multiple syncopal episodes has v-tach, EKG shows v-tach, stress test NL, next step

A

Pacemaker

181
Q

Best test for detecting source of ventricular arrhythmia

A

EP studies

Step 2 CK (21 decks)

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