EM & Radiology Flashcards by Stephanie Hawks

What test would you order to r/o cranial hemorrhage?

Noncontrast head CT

How well did you know this?

Not at all

Perfectly

What test would you order to assess AV malformations or metastatic cranial tumors?

head CT with contrast

How well did you know this?

Not at all

Perfectly

When is an abdominal pelvic CT most useful?

to look at retroperitoneal structures

How well did you know this?

Not at all

Perfectly

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.

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

When can you give charcoal?

always. it will never hurt anyone.

How well did you know this?

Not at all

Perfectly

Whats the antidote: Acetaminophen

N-acetylcysteine

How well did you know this?

Not at all

Perfectly

Whats the antidote: ASA

Bicarb to alkalinize the urine and help with clearance

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Whats the antidote: CO

100% oxygen *someone comes in after fire? give them 100% oxygen

How well did you know this?

Not at all

Perfectly

Whats the antidote: Digoxin

Digoxin-Abs

How well did you know this?

Not at all

Perfectly

Whats the antidote: Methanol

Fomepizole or Ethanol (same as EG)

How well did you know this?

Not at all

Perfectly

Whats the antidote: Methemoglobinemia

100% O2 and Methylene blue (look for hx of anethetics or nitrate use!)

How well did you know this?

Not at all

Perfectly

Whats the antidote: Neuroleptic Malignant Syndrome

Bromocriptine & Dantrolene

How well did you know this?

Not at all

Perfectly

Whats the antidote: Opiates

Naloxone

How well did you know this?

Not at all

Perfectly

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?

1. Charcoal = block further absorption 2. Alkalize the urine = increase excretion 3. 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)