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Kaplan > Emergency > Flashcards

Emergency Flashcards

1
Q

what is most common overdose ingestion in the US?

A

tylenol

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2
Q

what is most common cause of acute liver failure?

A

tylenol

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3
Q

minimum toxic dose of tylenol

A

150mg/kg; hepatotoxicity at 250mg/kg

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4
Q

Presentation tylenol OD in first 24 hours

A

often asymptomatic or nausea/vomiting/dehydration

-LFTs start to elevate

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5
Q

Management Tylenol OD

A
  • unspecified dose: level initial and at 4 hours with CMP
  • activated charcoal in first 4 hours
  • NAC per protocol within 24 hours of ingestion; prevents hepatotoxicity if first 8 hours
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6
Q

Classic Lab changes in salicylate poisoning

A
  • anion gap metabolic acidosis
  • respiratory stimulation causes respiratory alkalosis and alkauria
  • -so will see acidosis with respriatory alkalosis
  • hypokalemia
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7
Q

First 12 hours Salycilate poison

A
  • tinnitus
  • hyperthermia and CNS change
  • hyperventilation
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8
Q

Management of Salycilate

A
  • can add ferric chloride to UA
  • ABG, CMP, UA
  • salicylate blood: initial, ever 2 hours until peak then every 4 to 6 until resolution
  • peak usually 4 to 6 hours
  • activated charcol
  • whole bowel irrigation if enteric coated
  • can consider alkalinizatino of blood and urine with bicarb
  • HD if severe (>100 at 6 hours)
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9
Q

What is antifreeze?

A

ethylene glycol

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10
Q

Presentation ethylene glycol ingestion

A
  • increase in glyoxilc acid and oxalic acid which are toxic and combine with Calcium–>hypocalemia, calcium oxalate crystals
  • first 12 hours: they seem drunk and with metabolic acidosis
  • 12 to 24 ours: tetany, muscle pain, arrhythmia 2/2 hypocalcemia
  • beoynd heart failure, renal failure, cerebral edema, seizures
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11
Q

Management Ethylene glycol

A
  • can screen by mixing fluorescein and urine
  • estimate levels by osmol gap (NOT serum levels)
  • charcol doesn’t work
  • alklainize with na bicarb
  • fomepizole!!! (inhibit aldehyde dehydrogenase)
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12
Q

What is the most frequent toxic exposure in the US

A

carbon monixde

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13
Q

Who is most at risk from CO poisoning?

A

very young, fetuses (fetal hgb binds tighter), very old, chronically ill
-note if intentional then higher mortality

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14
Q

Pathophys CO poisonining

A

-shift dissociation curve to the left (hgb can’t carry oxygen); interrupts cellular respiration, makes free radicals, increases inflmmatory response, DIC, vasolidation, myocardial depression

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15
Q

Pulse ox in CO poisoning

A

normal because carboxy-Hgb read same; spectrophotometer can tell difference

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16
Q

Most common long term complication of CO poisoning

A

neuro and neuropsych sequelae

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17
Q

Management CO poisoning

A
  • ABG for acid base status (PaO2 will be normal)
  • do spectrophotometer
  • asymtpomatic with < 10% go home
  • mild symtpoms: 100% O2 x 4 hours; follow up 24 to 48 hours and a month for delayed neuro findings
  • 100% oxygen!
  • do not correct acidosis
  • CMP, CK, UA, CBC, CXR with pulm, coags, trops, ECG
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18
Q

Most common morbidity 2/2 organophosphate?

A

respiratory failure

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19
Q

Pathophys organophosphate

A
  • inactivates cholinesterase so accumulate Ach resulting in nicotinic and muscarinic effects
  • -nicotinic: skeletal depolarization and fasciculations
  • -muscarinic: smooth muslce contractions, cardiac conduction delay
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20
Q

Presentation Organophosphate

A

SLUDE: salivation, lacrimation, urination, defecation, GI, emesis

  • -conduction issues
  • -HTN
  • -wheezing, pulmonary edema, respiratory muscle weakness
  • -CNS: AMS!!!!!!!! seizures
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21
Q

Tx organophosphate

A
  • can measur eRBC cholinesterase level if want to document exposure
  • ATROPINE for muscarinic effects
  • Pralidoxime for nicotinic receptors (first 18 hours or else may be irreversible)
  • benzos for seizures
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22
Q

Complications of Hydrocarbons

A
  • resp: hypoxia, ARDS
  • CV: arrhythmias, myocardial damage, coronary vasospasm
  • neuro: AMS, peripheral neuropathy
  • heme: hemolysis, bone marrow toxicity
  • hepatic and renal failure
  • RTA
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23
Q

Management of Hydrocarbon Exposure

A
  • CXR: initially normal and must get at 6 hours
  • symptomatic must admit and observe
  • no charcoal, no inducing emesis
  • gastric lavage if CHAMPS (camphor, halogenated hydro, aromatic hydro, heave metal hydro, pesticide contatining hydro)
24
Q

Most common cause of iron overdose

A

children less than 6 who take a bunch of pediatric MVNs

–worst if < 3 years old

25
Q

Pathophys of Iron OD

A
  • mitochondrial disurption
  • GI corrosion, hepatocellular injury
  • anion gap metabolic acidosis
  • coagulopathy
26
Q

Presentation first 6 hours after iron OD

A

hemorrhagic vomiting, diarrhea, and abdominal pain; may lead to shock

27
Q

Presenation 6 to 12 hours after iron OD

A

if mild may recover; but if moderate+ temporary recovery as iron distributes through body followed by lethargy, tachy, and tachypnea

28
Q

Presentation 12 to 24 hours after iron OD

A 
metabolic acidosis
coagulopathy
shock
arrhythmias
CNS
29
Q

When does hepatic injury happen in iron OD

A

2 to 3 days

30
Q

When does scarring of the GI tract occur after iron OD

A

2 to 6 weeks

31
Q

Labs Iron OD

A
  • serum levels 2 hours after

- abdominal XR

32
Q

Tx Iron OD

A
  • whole bowel irrigation

- deferoxamine

33
Q

Tx TCA OD

A
  • first hour can gastric lavage
  • activated charcoal
  • ECG (at least 6 to 8 hours if asymptomatic)
  • alkalinize
34
Q

Clinical Presentation TCA OD

A
  • first anticholinergic: dry skin, mydriasis, urinarty retension, decreased GI motiligy, myoclonic twitching
  • followed by CNS
  • vasodilation with hypotension, heart block
35
Q

3 different pharm effects of cough syrups

A

-antihistamine: anticholingergic
-cathetolamines
0serotnergic

36
Q

Management Cough Syrup Ingestion

A
  • charcoal best in 1 hour
  • dystonia: if 2/2 antihistmain use diazepam; if no antihistamin benadryl
  • seizure: lorazepam
  • serotonins syndrome: cyproheptaidine
37
Q

Most common cause of pediatric death period

A

unintentional injury

38
Q

most common unintential injury overall

A

MVA

39
Q

most common unintentional dath less than 1

A

suffocation

40
Q

most common unintentional death 1 to 4

A

drowning

41
Q

most common unintentional death 5+

A

MVA

42
Q

pathophys saltwater drowning

A
  • inactivation of surfactant leads to ARDS
  • fluid shifts cause hypernatremia and hemoconcentration
  • DI
43
Q

pathophys of freshwater drwoning

A

-washout of surfactant causing ARDS
-hyponatremia and hemodilution
0intravascular hyperkalemia, hemoglobinuria, renal tubular damage
-SIADH

44
Q

Drowning when to actively re-warm

A

if temp is < 32 C

45
Q

Most common pathogens dog bites

A
  • staph aureus

- pasteurella

46
Q

Tx Dog Bite

A
  • Augmentin (azithro if allergic)
  • must consider tetanus and rabies
  • do not suture if > 24 hours or infected; face must be within 6 hours
  • delay closure of hand wounds
  • cultures if > 8 hours, infection, severe, or immunocompromised
47
Q

Tx Cat bite

A
  • must get anerobic and aerobic cultures
  • augmentin
  • suture if less than 24 hours (6 for face); delay closure for hands
  • tetanus and rabies
48
Q

Tx Human Bite

A
  • augmentin
  • aerobic and anaerobic cultures in all
  • consier hepatitis B
49
Q

most common pathogen human bite

A

-anerobe

50
Q

Do you ice or tourniquet poisonous snake bite?

A

no becaue increase risk of ischemia; just immobilize

51
Q

Side Effects of Antivenin

A
  • anaphylaxis

- delayed hypersensitivity (serum sickness; 5 to 21 days later)

52
Q

When to give antivenin

A
  • rattlesnakes
  • best within 4 hours; not effective after 12
  • coral snakes have neurotoxin so give as soon as possible
53
Q

Symtpoms of black widow bite

A
  • within 1 hour dull cramping pain; includes chest and abdomen (boardlike)
  • hypertension and agitation
  • resolves within 24 to 48 hours
54
Q

Management Black Widow Bite

A

-opiates and benzos

0antivenin if severe with autonomic instabililty (acetycholine and norepi is released)

55
Q

Symptoms of brown recluse

A
  • characterized by local necrosis due to hyaluronidase and sphinomyelinase
  • -hemorrhagic blister
  • -can cause hemolysis
56
Q

Management Brown Recluse

A
  • typically just symptomatic

- admit for significant pain; increased risk of hemoglobinuria

57
Q

Management of Scorpion Bite

A
  • if severe antivenin
  • ice and anlgesics
  • -autoimmune dysfunction can happen in 1 hour with salivation, blurred vision, hypotension, nystagmus, and muscle twitching

Kaplan (8 decks)

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