Emergency Care Flashcards
Which type of snake bites do you have to worry about?
Pit vipers - triangle shaped head, elliptical eyes, pit between each eye and nostril
How do you treat snake bites?
Initially, immobilize body part and keep it above the level of the heart. Then can give antivenom if its a viper
Brown recluse bite
bite is painless, but pain at site 2-8 hours later, hemorrhagic blister with large ulceration. No antivenon
Black widow spider bite
Neurotoxic, muscle cramps, abdominal pain, chest tightness, hypertension, Supportive care with pain meds and benzos, antivenim for severe cases
first degree burns
superficial, red, blanches with pressure, dry minor swelling and pain, resolve in 5-7 days
Second-degree burns
partial thickness - red, wet, very painful often with blisters or blebs. The tissue underneath is stillw ell perfused, may take 2-5 weeks to heal
third-degree burns
dry leathery, waxy, no pain, require grafting
How to measure burn surface for >14yo
Rule of 9s, palm rule for
When do you need IVFs for burns?
When >15% BSA
Which toxic substances cross the placenta easily?
lead, mercury (enhanced by placenta), insecticides
For which substances is activated charcoal a poor choice?
alcohol, lithium, cyanide, heavy metals
When should coins be removed?
When they have not passed through the stomach within 24 hours, even if the child is asymptomatic. All coins in the proximal esophagus should be removed. If in the mid - lower esophagus can observe for 12-24 hours
Which coins do you worry about if swallowed
pennies made before 1982 because they have zinc in them which is corrosive to the esophagus - patient needs endoscopy quickly
What is the most important predictor of outcome regarding acetaminophen toxicity?
the 4 hour post ingestion level - if >150 = moderate hepatotox, if >300 = severe toxicity
What is management of tylenol ingestion?
1) activated charcoal 2) 4 hour level and plot on nomogram, 3.) If within 8 hours of ingestion give NAC
For what amount of acetaminophen should NAC be given empirically without waiting for a level?
> 150mg/kg
When do transaminases rise in tylenol toxicity?
3-4 days out
Management of salicylate toxicity
activated charcoal, salicylate level, sodium bicarb to alkalinize the urine
depressed mentation, constricted pupils, profuse sweating, tearing, abdominal pain, wheezing and respiratory distress
organophosphate toxicity
anasarca, asymmetric pupils, agitated and violent
PCP ingestion
What is the MOA of organophosphates?
Inhibits acetylcholinesterase therefore the effect is due to AcH overload - both muscurinic (pulmonary - bronchospasm and increased secretions - can give atropine) and nicotinic effects ( salivation, sweating, urination, diarrhea, emesis, miotic pupils,and cns depression - can give pralidoxime.)
When is the hyperbaric chamber indicated for CO toxicity?
pregnancy, acidosis, signs of cardic involvement, signs of neurologic involvement
How do cyanide poisoned patients present?
Similar to CO toxicity, but do not improve with 100% oxygen. Any smoke exposure can cause CN toxicity
treatment of cyanide toxicity
hydroxocobalamin, sodium thiosulfate or nitrate used previously
