Emergency Med Flashcards
Gram stain of strep pneumonia
Gram positive diplococci
atropine use
Severe Bradycardia
MOI: Inhibits vagal response (stops PNS so SNS takes over with epi/norepi naturally)
Black Widow bite characteristics
two fang marks
Systemic reaction= Latrodectism: Muscle spasm, tachycardia, N/V
tx: antivenom (can cause serum sickness, III hypersensitivity)
Brown Recluse bite characteristics
Midwest and central US
local NECROTIC lesion
systemic reaction= Loxoscelism: hemolysis
tx corticosteroids, hydration, analgesics
Coral snake features
red on black, venom lack
red on yellow, kill a fellow
if bite: neurologic sx, tremors, diplopia, fixed pupils
Tx. antivenin (No ice, tourniquet, suction, etc.)
Lyme disease features
Borrelia burgdorfi deer tick spread flu like sx, fever, weakness, joint pain Characteristic rash: erythema migrans, "bulls eye" rash tx. doxy
ITP
Usually after viral illness in kids
autoimmune disease
labs with thrombocytopenia, prolonged bleeding time, normal PT/PTT
Tx with prednisone if platelets
Drugs that cause secondary ITP
Sulfonamides, Thiazides, Cimetidine (H2 blocker), Heparin (HIT)
TTP diagnostic pentad
Hemolytic anemia (schistiocytes, elevated bili)
Low platelets
Fever
Neurologic manifestation (HA, confusion, seizure)
Renal manifestation (hematuria, proteinuria, increased BUN/Cr)
HUS
more renal less neuro than TTP
precipitated by a diarrhea illness, especially E Coli
Supplements needed for sickle cell patients
Folic acid (at 1 year age) and PCN V (at 2 months)
Cushing reflex (triad) of head trauma (increased ICP)
progressive hypertension
bradycardia
decreases respiratory rate
Diffuse axonal injury
deceleration methods transmit sheering forces diffusely
MOI of shaken baby syndrome
Subdural vs epidural hematomia imaging
SDH: crescent shaped that crosses suture margins
EDH: lens shaped that does not cross sutures
Treatment of cluster HA
100% oxygen
1st line medication for actively seizing patient
Lorazapam (Ativan)
give thiamine before glucose if alcoholic
Peripheral vertigo
Causes: BPPV, vestibular neuritis, herpes zoster, meniere’s, labyrinthitis, acoustic neuroma, OM
S/Sx: N/V, HORIZONTAL nystagmus, tinnitus, vision changes
Central vertigo
Causes: Migraine, brainstem ischemia, CVA
S/Sx: Gait disturbance, Vertical nystagmus, NO tinnitus, no vision changes
Myasthenic Crisis
severe enough bulbar weakness to produce dysphagia and aspiration that may lead to respiratory failure.
Patient has generalized weakness.
Tx intubation and IVIG
***Where do 90% of nose bleeds arise?
Keisselbach’s plexus
Peritonsillar abscess
Severe pain, “hot potato voice”, drooling, dysphagia, uvular deviates away
CT of neck
OR for I&D
start IV abx pcn, augmentin or clindamycin
Ludwig’s angina
Hx of recent dental procedure or poor dental hygeine
cellulitis of sub lingual area
pain, swelling, trismus, dysphagia, “bull’s neck”
Painless unilateral vision loss, suspect…
CRAO
PE: pallor of optic disc, cherry red fovea (macula), boxcar segmentation of retinal veins
Painless vision loss with a curtain across visual field suspect…
Retinal detachment
IOP is normal or low, pupil exam unremarkable
retina appears gray with white folds
Cremasteric reflex and Phren’s sign absent in…
Testicular torsion (present’s with high riding teste, swelling, tenderness)
Epididymitis
tender posterior and lateral to testes
positive phren’s sign (elevate testicle and pain relieved)
etiology: 35 prsotatitis (Doxy)
Blue dot sign seen in
torsion of appendicieal testes (7-14)
Paraphimosis
Foreskin is retracted behind glans and cannot be returned to normal position
Can be from foley that didn’t have foreskin replaced after
White cell casts seen in
Pyelonephritis (tx IV ceftriaxone, PO FQ)
Imaging if suspect nephrolithiasis
NON contrast CT
Opiod/Narcotic Intoxication overdose (heroin, oxy, morphine)
CNS depression
miosis
respiratory depression
Treat with Narcan
Activated charcoal does not bind
Potassium
Alcohol
Iron
Lithium (PAIL)
Anticholinergic antidote
Physostigmine
***Benzo antidote
Flumazenil
Methanol/Polyethylene glycol antidote
Alcohol, because it has a higher binding affinity
Acetominophen toxicity
toxic dose is >140 mg/kg
Treat with acetylcystine (mucomist)
Best level is 4 hours after ingestion
Stimulants (Cocaine/amphetamine) overdose
dilated pupils, hypertension, euphoria
treat with Benzos
DO NOT GIVE BB (unopposed alpha)
***Cyanide toxicity
bitter almonds
**Arsenic toxicity
Garlic odor breath
Menengitis Triad
Fever, nuchal rigidity, mental status changes
(also petichial rash
LP of bacterial meningitis
(DO NOT perform if papilledema) WBC: 1000-10,000 Neuts: >80% Glucose: Low Protein: High Gram Stain: + (TREAT with Rocephin)
LP of Fungal Meningitis
WBC:
LP of viral meningitis
WBC:
Impetigo causative agent
Strep (Rarely staph)
small vesicles with honey colored crusts
Botulism characteristics
Cranial neuropathy with descending weakness
Gram positive, rod-shaped spore-forming anaerobe
absence of fever
Leading cause of death in children under 5
Drowning
Difference between heat exhaustion and heat stroke
Heat exhaustion has normal mental status and heat stroke does not Heat stroke= core temp above 105 F( 40.5 C), Heat exhaustion is
neuroleptic malignant syndrome treatment
SE of anti psychotic drugs
See intense rigidity, hyperthermia and mental status changes
Treat with DANTROLENE
Difference between primary and secondary adrenal insufficiency
Primary= addison’s from autoimmune destruction or dysfunction of renal cortex (hyperpigmentation, low aldosterone, hyponatremia, hyperkalemia, decreased BP)
Secondary=stimulation of adrenal cortex by ACTH from exogenous steroids or pituitary tumor
Adrenal crisis
life threatening
presents with flank/abdominal pain hypotension that is resistant to catecholamine and IV fluid administration
need to replace missing cortisol with IV glucocorticoids
seen in elderly with chronic disease or post operation
Pheochromocytoma
tumor of neural crest cells which release catecholamines
cause EPISODIC palpitations, sweating, syncope and hypertension
Tumor of renal medulla
Myxedema coma
presents in elderly with hypothyroidism, hypothermia and confusion
EKG with sinus brady, and possible QT prolongation
Treat with levothyroxine and glucocorticoids
Pericardial Tamponade EKG
low voltage sinus tachy, PR depression, electrical alternans, height of QRS changes
