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
What dose of iron is toxic?
> 40mg/kg of elemental iron. IF level of Iron is >500, need chelation
What can iron toxicity cause?
phase 1 : vague GI symptoms, pain, vomiting, phase 2: deceptive improvement 6-24 hours phase 3: metabolic acidosis, coagulopathy, CV collapse phase 4: GI strictures
Management of iron toxicity
Levels at 4 hours. If serum iron > 350, WBC > 15 or glc > 150 this is significant and need chelation. Should do KUB,
which substances decrease lead absorption.
Calcium, iron, and vitamin C reduce lead absorption, therefore diets rich in these nutrients should be encouraged for patients at risk for lead toxicity
Management of causic ingestions?
symptomatic - EGD immediately, asymptomatic, ok to observe for 6 hours
What kind of household substances are caustic?
toilet bowl cleaners, laundry detergents, stain and mildew removers, floor cleaners, oven cleaners, rust removers, phenol-based disinfectants, swimming pool products, and batteries
Most commonly reported form of abuse
neglect
the most commonly reported manifestation of physical abuse
soft tissue injury
The most commonly reported cause of death due to physical abuse
head injury
Which type of fractures are concerning for abuse?
posterior rib fractures, metaphyseal chip fractures, spiral fractures of the long bones (especially if too young to ambulate)
When does a soft callus of bone form?
7-14 days
oil of wintergreen
is ASA
Which systems dose salicylate toxicity affect?
CNS - tinnitus, vertigo, agitation, confusion, coma, Resp - tachypnea, respiratory alkalosis, ARDS, GI - abdominal pain, nausea, vomiting
What is Reye syndrome?
hepatitis and encephalitis associated with ingestion of large doses of ASA in the setting of a recent viral illness
What are the cardiac effects are TCAs
hypo or hypertension, tachycardia including VT, widened QRS, prolonged QT, rightward axis. *A tall R wave in avR is specific
When do you treat with sodium bicarb in TCA overdose?
When have ECG abnormalities. Titrate dose to QRS widening
symptoms of an anticholinergic syndrome
dry skin, low UOP, flushing, mydriasis, agitation, sz, hyperthermia
What is akathisia?
a subjective feeling of restlessness and impulse to move. Associated with antipsychotics
What is acute dystonic reaction and how do you treat?
wry (twisted) neck, protruding tongue or deviated gaze. Side effect of antipsychotics. Treat with benztropine or diphenhydramine.
Ibuprofen toxicity
If >400mg/kg can cause seizures and coma
What does cherry red skin suggest?
CO toxicity
How do patients with cyanide toxicity present?
Interferes with oxygen utilization by the mitochondria. Pts have histotry of smoke inhalation, shock and profound lactic acidosis. Or exposed to nitroprusside. A venous blood gas has high PaO2 suggests oxygen is not being extracted by tissues
Management of hydrocarbon exposure
Get CXR, may be normal and still need to be observed in ED. Need to externally decontaminate
treatment of methanol ingestion
sodium bicarb, fomepizole, folate enhances metabolism of formic acid, hemodialysis if severe
Management of organophosphate toxicity
decontaminate (can’t only use latex gloves and mask (need full protective clothing)), give activated charcoal. Atropine, pralidoxime. Symptoms persist for weeks without treatment.
What are the effects of foxglove, lily of the valley, oleander?
digitalis effect
What are the effects of jimson weed, deadly nightshade?
atropine effects (anticholinergic)
What are the effects of pear and apple seeds, peach pit, bitter almond?
cyanide like
What are the effects of pilodendron and dieffenbachia?
oral pain
What are the effects of poinsettia, mistletoe, holly
mild GI upset
Which substances are particularly important to decontaminate topically?
corrosives and organophosphates
Amanita mushroom has what effect?
anticholinergic
Which alcohol causes gastritis?
isopropyl
Which alcohol causes pancreatitis?
methanol
vertical nystagmus, hallucinations, psychosis
PCP
Altered perception, seeing smells and hearing colors, tachycardia, dilated pupils
LSD
Antidote for CCB ingestion
calcium chloride
What age is skeletal survey the most helpful for?
<3yo
For which ingestion is it important to avoid epinephrine?
Hydrocarbon ingestion as can induce ventricular fibrillation
