Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Step 3 > Emergency and Toxicology > Flashcards

Emergency and Toxicology Flashcards

1
Q

What is the next step in management for a pt who presents to ED with acute change in mental status and decreased RR of unclear etiology?

A

Administer:
Naloxone
Thiamine
Dextrose

(Remember, ALWAYS give Thiamine BEFORE Dextrose)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When should Gastric emptying be used in a pt with acute mental status changes subsequent to possible drug overdose?

A

ONLY within the FIRST HOUR of the overdose!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When should Ipecac be used in possible overdose situations?

A

Never in children
Never when there is altered mental status (pt will aspirate)

Don’t Use it!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When can Intubation and lavage be used in possible overdose?

A

Only within the first 1-2 hours following overdose after a trial of Naloxone,Thiamine, and dextrose have failed to correct symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is an absolute contraindication to Gastric Emptying for overdose/Intoxication?

A

When acids/alkalis (caustic substances) ingested

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When should Charcoal be given to a pt with possible intoxication/overdose?

A

When it is unclear what to do–>charcoal is a safe option
It can be given at anytime to any such pt
It has no negative effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the steps in management for a pt who presents with an Overdose?

A

1) Antidote (known toxin) or Naloxone,Thiamine, Dextrose
2) Toxicology Screen
3) Charcoal
4) Labs: CBC, Chemistry, Urinalysis
5) Order Psychiatric Consultation (if suicide attempt)
6) Oxygen (anyone w/ dyspnea and /or CO poisoning)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the antidote for ACETAMINOPHEN intoxication?

A

N-acetyl Cysteine (NAC)

Note: Always GIVE FIRST, then get levels if unknown amount

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the antidote for ASPIRIN intoxication?

A

Bicarbonate (alkalinize urine, aspirin will be excreted)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the antidote for BENZODIAZEPINE intoxication?

A

Let pt sleep.

DO NOT GIVE Flumazenil (can induce withdrawal –> seizure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the antidote for CARBON MONOXIDE intoxication?

A

100% Oxygen (Hyperbaric if needed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the antidote for DIGOXIN intoxication?

A

Digoxin-binding Ab’s (DigiFAB/Digibind)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the antidote for ETHYLENE GLYCOL intoxication?

A

Fomepazole or Ethanol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the antidote for METHANOL intoxication?

A

Fomepazole or Ethanol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the antidote for METHEMAGLOBINEMIA?

A

Methylene Blue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the antidote for NEUROLEPTIC MALIGNANT SYNDROME?

A

Bromocriptine or Dantrolene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the antidote for OPIATES intoxication?

A

Naloxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the antidote for ORGANOPHOSPHATE intoxication?

A

Atropine and Pralidoxime (cannot give atropine alone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the antidote for TRICYCLIC ANTIDEPRESSANT (TCA) intoxication?

A

Bicarbonate (cardioprotective) (prevents QT prolongation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the presentation of a pt with Acetaminophen intoxication?

A

Nausea/Vomiting within first 24 hrs; then it resolves

Hepatic Failure at 48-72 hrs post intoxication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When should NAC be given to a pt with Acetominophen overdose?

A

Best within first 24 hrs, but give to any pt with acetominophen overdose of a toxic amount

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What can be given with NAC to treat Acetaminophen toxicity?

A

Charcoal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

If pt with acetaminophen toxicity is vomiting, what should be used as an antidote?

A

IV NAC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the order of treatment/workup for a pt presenting in ED with Acetaminophen ingestion?

A

1)Give NAC (if vomiting–> use IV) THEN…

2)If ingested amount unknown,
-order Acetaminophen bld level (to determine if there
will be toxicity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What amount of Acetaminophen are considered toxic and fatal?

A 
10g = Toxic
15g = Fatal

These will be lower for those with underlying liver disease or alcohol abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the physiologic effects of Apirin toxicity? (10)

A

Respiratory Alkalosis (Brainstem-increased resp drive)

ARDS (Direct Lung Toxicity)

High Anion Gap Metabolic Acidosis (Inhibition of Kreb Cycle Enzymes, Uncouples Ox Phos, increased catabolic activity–> generating acidic byproducts)

Elevated PT (Inhibition of Vit-K dep Clotting Factors 2,7,9,10 c/s)

Renal Insufficiency (Direct tubule toxicity)

Fever (increased O2 utilization/increased Glc demand–> glycogenolysis and other catabolic processes)

Tinnitus (Direct CNS toxicity, early sign)

Altered mental status (confusion, seizure, coma d/t direct CNS toxicity, electrolyte losses, decreased O2 and glc availibility)

Dehydration (increased urinary, GI, and insensible fluid losses)

Nausea/Vomiiting (Direct CNS/GI toxicity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What should be ordered in the workup of Aspirin (Salicylate) toxicity?

A 
CBC
Chemistry panel
ABG
PT/PTT/INR
Salicylate (ASA) Level
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the order of treatment for Aspirin (Salicylate) overdose?

A

Bicarbonate (3 amps) w/ D5Water (glucose in needed)
Charcoal(block GI absorption)
Dialysis (if severe)

(Note: Alkalinization of Urine aids in excretion of ASA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is an early and specific sign of Aspirin toxicity?

A

Tinnitus (direct CNS toxicity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the most common cause of death from fires?

A

Carbon Monoxide (CO) Poisoning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the mechanism of CO poisoning?

A

CO has very high affinity for Hb–> does not allow max O2 carrying capacity
AND…
When 1 molecule of CO binds Hb–>increased the affinity of other binding sites for O2–> decreased O2 delivery to tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the features associated with a pt with CO poisoning? (5)

A 
Fatigue
Headache/Lightheadedness
Dyspnea/SOB
Disorientation
Metabolic Acidosis (severe cases, d/t tissue hypoxia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Under what conditions/history should CO poisoning be suspected?(3)

A

Pt involved in Fire
Indoor Grilling
Home-bound (from snowstorm) w/wood-burning stove; symptomatic relief when outside of home

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the workup/treatment for CO poisoning?

A

Call ambulance if in field
If at hospital–> immediately give
-100% oxygen (esp to all in fires until CO levels known)
-Check CO levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the most common presentation for Digoxin Toxicity?

A

GI disturbances (N/V, abdominal pain, diarrhea)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Besides GI symptoms, what are other findings associated with Digoxin toxicity? (5)

A

Vision changes (blurry/Yellow Halos)

Arrythmia (Heart Block, Paroxysmal Atrial Tachycardia w/ block, PR prolongation, or any other abnormal rhythm)

Encephalopathy

Hyperkalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What metabolic abnormality can precipitate Digoxin toxicity?

A

Hypokalemia (facilitates Digoxin binding to N/K ATPase)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the treatment for Digoxin Toxicity?

A

Severe Cases : DigiFAB/Digibind (Digoxin-binding Ab’s)
Always check EKG, Electrolytes (K+),
{Note: severe cases are those involving CNS/cardiac abnormalities]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the common features seen in both Ethylene Glycol and Methanol poisoning?

A

Ingestion/Intoxication

High Anion Gap Metabolic Acidosis

40
Q

What are specific findings associated with Ethylene Glycol Poisoning?

A

Renal Insufficiency (Tubule toxicity)
Sones (oxalic Acid + calcium)
Hypocalcemia (oxalic acid is a metabolite of EG–>Ca binding–> decreased calcium)

41
Q

What are specific findings associated with Methanol poisoning?

A 
Visual disturbances --> Blindness
Retinal Hyperemia (d/t Formic acid formation)
42
Q

What is the treatment for both Ethylene Glycol and Methanol Poisoning? (2)

A

Ethanol or Fomepizole

Dialysis (to remove the alcohols before they are metabolized; metabolites are toxic)

43
Q

What are some typical exam findings associated with METHEMOGLOBINEMIA?

A 
Cyanosis
SOB
Dizziness
Headache
Confusion
Seizure
44
Q

What is the underlying mechanism for Methemoglominemia toxicity?

A

Hb is locked into a Ferric (Fe3+) state-does not facilitate O2 binding, but when it does, it does not unload it efficiently

45
Q

What is the workup for Methemoglobinemia?

A

ABG- Normal PaO2 w/ Chocolate-brown blood

Methemoglobin Level

46
Q

What is the treatment for Methemoglominemia?

A 
100% oxygen
Methylene Blue (to restore reduce Hb to normal Ferrous(2+) state)
47
Q

What medications can be associated with Methemoglobinemia?

A

Nitrates
Anesthetics (-caine’s)
Dapsone
Other Oxidants

48
Q

What condition should be susprected in a pt who is Cyanotic but has a normal PaO2?

A

Methemoglobinemia

49
Q

What are features common of all heat/overheating disorders?

A

Rhabdomyolysis

+/-Confusion, Seizure, Arrhythmia

50
Q

What tests are involved in the workup of Neuroleptic Malignant Syndrome (NMS)?

A

No specific tests but should check:

  • CPK, K+ (can be high)
  • Physical Exam: muscle rigirdity
51
Q

What history finding will be present in all cases of NMS?

A

Ingestion of Antipsychotic (neuroleptic) medications (ex: Phenothiazines)

52
Q

What is the treatment for NMS?

A

Dopamine Agonists:
-Bromocriptine
-Carbergoline
Dantrolene (muscle relaxant)

53
Q

What is a common component of pt history associated with Malignant Hyperthermia?

A

Anesthesia use (inhaled, ex halothane)

54
Q

What is the treatment for Malignant Hyperthermia?

A

Dantrolene

55
Q

What features of history are usually present in a pt that should be suspected of Heat Stroke?

A

High Ambient Temp and Dehydration/Physical Exertion

56
Q

What are some typical findings associated with Heat Stroke?

A 
Dry skin
Fever
Altered Mental Status 
   -Confusion
   -Seizures
Hyperkalemia
Arrhythmias

(same with NMS and MH)

57
Q

What is the treatment for Heat Stroke?

A

Physical Removal of Heat from pt Body:

  • Ice bath/pack
  • Spraying pt with water and fanning in AC’d room

[Note: never inject iced saline–> can cause cardiac arrest]

58
Q

What findings can be associated with heat Exhaustion to help distinguish it from Heat stroke?

A

Excessive Sweating

Nausea/Vomiting

59
Q

What is the treatment for Heat Exhaustion?

A

Normal IV Saline

Remove pt from hot environment to cool one

60
Q

What is the cause of death associated with Opiate intoxication?

A

Respiratory Depression

61
Q

What occupation or exposure should raise suspicion for Organophosphate intoxication?

A

Crop dusters/Insecticide exposure

Nerve-gas exposure

62
Q

What findings are associated with organophosphate intoxication?

A

Whee SLUDGE:

Wheezing
Salivation
Lacrimation
Urination
Defecation/Diaphoresis
GI distress
Emesis
63
Q

What treatment is used for Organophosphate intoxication?

A

1) Wear protective Apparel
2) Remove pt clothing(absorbed through skin)
3) Atropine (anticholinergic)
4) Pralidoxime (most effective–> rescues Achesterase)
5) Wash chemical off pt (absorbed through skin)

64
Q

What are the main causes of death associated with TCA overdose?

A

Seizure

Arrhythmia ( Ventricular-Wide QRS/ Torsade ; Long QT)

65
Q

What is the first step in management for a pt presenting with suspicion of TCA overdose?

A

EKG (check for arrhythmias)

66
Q

What is the next step in management for a pt with a TCA overdose whose EKG shows wide QRS or any arrhythmia?

A

Bicarbonate administration

Transfer to ICU

67
Q

When should Bicarbonate be given to a pt with TCA overdose?

A

Only with EKG confirmed arrythmia!!

(Always check EKG FIRST, then proceed to rest of management)

68
Q

What are some features associated with TCA overdose?

A

Anticholinergic Phenom:

  • Dry mouth/skin
  • Dilated Pupils
  • Constipation
  • Urinary Retention
69
Q

What features are associated with a bite from a Black Widow Spider?

A

Abdominal pain, rigidity w/o tenderness on exam (looks like perforation but no tenderness)
Hypocalcemia

70
Q

What is the treatment for a black wiow spider bite?

A

Antivenin

71
Q

What features are associated with a Brown recluse spider bite?

A

Local Necrosis
Bullae
Eschar

72
Q

What is the treatment for a Brown recluse spider bite?

A

Wound Debridement

Steroids/Dapsone may be useful in some cases

73
Q

What is the most common cause of death from fires?

A

CO poisoning

74
Q

What are the three initial steps in management for a burn victim?

A

1) Give 100% Oxygen and check CO levels
2) Check Airway-determine if intubation needed
3) Give Fluids

75
Q

What are the indications for intubating a burn pt?

A

Hoarsness
Wheezing
Stridor
Burns within nose or mouth

76
Q

When should fluid administration follow Oxygen administration in s burn pt?

A

Only AFTER airway is assessed and no intubation indicated

77
Q

What are the guidelines for fluid adminstration in a burn pt?

A

Lactated Ringers or Normal Saline:

(4mL ) x (%w/2nd or 3rd degree burn) x (wt in kgs)

78
Q

What is the most common cause of death in HypOthermic pts?

A

Arrhythmias

79
Q

What is the first step in management for a pt presenting with Hypothermia?

A

EKG

80
Q

What EKG finding is specific for Hypothermia?

A

J-waves of Osbourne (look like ST elevation)

81
Q

Who is most likelt to present with hypothermia?

A

Alcoholic who fell asleep outside in winter

82
Q

What is the typical physical exam/history finding for a pt with Acute Angle Closure Glaucoma

A

Sudden onset Eye pain with Redness, Hard on Palpation
Fixed Midpoint pupil
Hazy Cornea

83
Q

What are the best initial steps in management/treatment for a pt with Acute Angle Closure Glaucoma?

A

1) Tonometry Exam then

2) Give Pilocarpine Drops (to constrict pupil-Ach agonist)

84
Q

In addition to the best initial treatment, what other medications are used to treat/manage acute angle closure glaucoma?

A

Mannitol (osmotic diuresis)
Acetzolamide (decrease Aqueous humor production)
Prostaglandin Analog (Latanaprost, Travaprost
B-Blocker (Timolol)
Apha Agonist (Apraclonidine)

85
Q

What is the most common complaint associated with Retinal detachment?

A

Sudden loss of vision “like curtain coming down over eye”

86
Q

What is the best initial steps in managing Retinal Detachment?

A

Dilated Eye/Retinal Exam

Order Ophthalmology Consultation

87
Q

What are the treatment options for Retinal Detachment?

A

1) Tilt pt Head Bk
2) Reattach retina via
- Surgery
- Cryotherapy
- Expansile Gas Injection

3)If these fail, place band around eye–>bring retinal close to sclera

88
Q

What are 4 common conditions associated with Red Eye?

A

Glaucoma (Acute Angle Closure)
Conjunctivitis
Uveitis
Corneal Abrasion

89
Q

What is the next step in management for a pt presenting with BILATERAL watery, non purulent ocular discharge, redness, and itching?

A

Dx based on clinical presentation

-Viral conjunctivitis or Allergic conjunctivitis

90
Q

What is the next step in management for a pt presenting with UNILATERAL purulent ocular discharge with redness and lid crusting and stuck together?

A

Dx based on clinical presetnation: Bacterial Conjunctivitis

91
Q

What is the treatment for conjunctivitis?

A

Bacterial: topical Antibiotics, Warm Compresses

92
Q

What is the most likely diagnosis when a pt presents with PHOTOPHOBIA, eye pain w/o discharge, redness, floaters, +/- blurry vision?

A

Uveitis

93
Q

What is the next step in dx’ing Uveitis?

A

SLit lamp Exam

94
Q

What treatment if given for Uveitis?

A

Steroids (anti-inflammatory)

95
Q

What is the most likely dx in a pt presenting with red watery eye and a h/o eye trauma, esp from contact lenses, or foreign body getting into eye?

A

Corneal Abrasion

96
Q

What is the next step in management for a pt presenting with a possible corneal abrasion?

A

Eye exam using Fluoroscein Stain

97
Q

What is the treatment for corneal abrasion?

A

No specific therapy

Do not patch abrasions d/t contacts

Step 3 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions