EM & Radiology Flashcards
What test would you order to r/o cranial hemorrhage?
Noncontrast head CT
What test would you order to assess AV malformations or metastatic cranial tumors?
head CT with contrast
When is an abdominal pelvic CT most useful?
to look at retroperitoneal structures
When is MRI the best test to order?
evaluating: demyelinating diseases, posterior fossa, base of skull, orbit, acoustic neuromas, pituitary tumors, intraparenchymal brain tumors, bone tumors, soft tissue infections, joint spaces, aseptic necrosis of the femoral head, disease of the spinal cord and spinal column.
What patients can not get CT or MRI with contrast?
- Cr >/= 1.5
- those with multiple myeloma
- those on metformin(must d/c before IV contrast and continue 48 post after r/o kidney dmg)
Patient comes in to the ER with AMS. You have no idea wtf is wrong. Whats the first thing you can order to help them knowing nothing?
- Naloxone, Thiamine & dextrose
2. Oxygen & Saline
When can you use Ipecac/induce vomiting? when is there a clear C/I?
withing the first hour of an OD.
C/I with AMS & children
When can you give charcoal?
always. it will never hurt anyone.
Whats the antidote: Acetaminophen
N-acetylcysteine
Whats the antidote: ASA
Bicarb to alkalinize the urine and help with clearance
Whats the antidote: Benzos
NOTHING! do not give anything! let them sleep it off. it will not kill them. giving flumazenil may induce a seizure and is not worth it
Whats the antidote: CO
100% oxygen *someone comes in after fire? give them 100% oxygen
Whats the antidote: Digoxin
Digoxin-Abs
Whats the antidote: Methanol
Fomepizole or Ethanol (same as EG)
Whats the antidote: Methemoglobinemia
100% O2 and Methylene blue (look for hx of anethetics or nitrate use!)
Whats the antidote: Neuroleptic Malignant Syndrome
Bromocriptine & Dantrolene
Whats the antidote: Opiates
Naloxone
Whats the antidote: Organophosphates
- Atropine 2. Pralidoxime
Whats the antidote: TCAs
Bicarbonate to protect the heart
Clinical course of Acetaminophen OD?
First 24hrs: N+V which resolves
48-72hrs: hepatic failure
Treatment for acetaminophen OD?
charcoal & N-acetylcysteine(NAC)
*NAC can only prevent liver tox if given within 24 hrs
Which dose of acetaminophen is toxic? which dose is deadly?
Toxic = 10g Deadly = 15g
What symptom will always be present with ASA OD? Other symptoms?
Hyperventilating = ASA diretly stimulates the brainstem
- Lung toxicity = RDS
- CNS stim = fever, confusion, seizures, coma
- toxic to kidney tubule = renal insufficiency
- blocks VitaK = elevated PT
- RESPIRATORY ALKALOSIS PRECEDES METABOLIC ACIDOSIS
Which dx test should you order if you suspect ASA OD?
CBC, CMP, ABG, PT/INR/PTT, ASA level
What is the tx for ASA OD?
- Charcoal = block further absorption
- Alkalize the urine = increase excretion
- Dialysis in severe cases
Sx of CO poisoning?
SOB, lightheadedness, HA, disorientation, metabolic acidosis(severe cases)
*hx of fire
Tx for CO poisoning?
100% O2
Sx of Digoxin toxicity? tx?
GI Stuff(NV, Diarrhea, Pain), Yellow “halos”, blurred vision, Arrhythmias(PR prolongation), encephalopathy, HYPERkalemia
tx: digoxin-ab’s
Ethylene glycol poisoning vs methanol poisoning treatment?
Ethanol or Fomepizole & dialysis
Methemoglobinemia sx?
Cyanosis, SOB, Dizziness, HA, Confusion, Seizures
**Hx of NITRATE, ANESTHETIC, DAPSONE or other oxidant use
What tests should you run if you suspect methemoglobinemia? what do you expect to see?
ABG = normal pO2 with chocolate blood, methemoglobin level
Heat Stroke VS Heat Exhaustion
sx? tx?
Heat stroke = dry skin, AMS
*treat by spraying with water or ice packs/bath
Heat Exhaustion = excessive sweating, NV
*treat with IV NS and move to cool enviroment
Opiate OD what kills you?
respiratory depression
tx for acute opiate OD? tx for addiction?
OD: Naloxone
Addiction: buprenorphine
wtf is buprenorphine?
partial opioid receptor moderator, used to detox pt or maintain those with chronic use
Organophospate toxicity sx? What are organophosphates?
Organophosphates = inhibitors of acetylcholinesterase
sx: salivation, lacrimation, urination, diarrhea, wheezing from bronchospasm
* look for crop duster or someone exposed to nerve-gas attack
TCA OD?
Dilated pupils, dry mouth, constipation, urinary retention
Black Widow Spider bite sx & tx
Abdominal pain, rigidity, hypocalcemia (patient will look like they have a perforated abdomen but there is NO TENDERNESS)
tx: antivenin
Brown Recluse Spider bite sx & tx?
local necrosis, bullae and dark lesion
tx: debriding the wound
Calculation for shit to give to burn pplz
%of body burnt x 4ml/kg = amount of LR or NS to give.
Whats the most important thing to do for someone suffering from hypothermia?
EKG! = look for “J-waves of Osborn” = ST segment elevation
Acute Altitude Sickness
sx? tx?
headache(like an alcohol hangover), malaise, slurred speech, abnormal coordination, sleep disturbance, acute pulmonary edema
tx: decend! *can be prevented by acclimating to 6k feet and taking acetazolamide or others(dexamethasone, nifedipine, tadalafil)
Retinal Detachment
sx? tx?
sx: “curtain coming down over eye”
tx: tilt head back & reattach retina(surgery, cryotherapy or injecting gas)
Retinal Artery vs Retinal Vein Occlusion
sx? tx?
BOTH: sudden unilateral loss of vision
Retinal Artery Occlusion: dark pale retina with diministed blood flow
tx: none, attempt thrombolytics, nitrogen, ocular massage
Central Retinal Vein Occlusion: light retina with congested blood in the eye
tx: VEFG inhibitors(ranibizumab or bevacizumab)
