Emergency med/toxicology Flashcards
AMS
Ccs tip- what to give
Naloxone Dextrose Thiamine Oxygen NS
gastric emptying
The answer is never gastric emptying
50% removed in the first hour
Ipecac
Can never be used in a pt with Ams
Always wrong in children
Charcoal
Just give it. Won’t hurt
If you have a toxicology question just give it if you don’t know what to do
What to order on tox screen menu
Antidote CBC bmp UA Tox screen Charcoal Psych consult Oxygen
Antidotes:
Acetaminophen Aspirin Bzd CO Digoxin Ethylene glycol Methanol Methemoglobemia NMS OpiAtee Organophosphate TCA
N acetyl cysteine Bicarbonate (alkalanize urine) Do not give flumazenil; it may precipitate a seizure 100% oxygen Dig binding antibodies Fomepizole or ethanol Fomepizole or ethanol Methylene blue Bromocriptine, dantrolene Naloxone Atropine, pralidoxime Bicarbonate protects the heart
Acetaminophen overdose
Give NAC and charcoal. NAC is totally benign and prevents liver toxicity. 10 g is toxic
15g is lethal
Lower levels needed in someone with liver disease or alcohol abuse
Inpt: the specific antidote is more important than adet level but do both on ccs
Aspirin overdose
Direct stimulant to the brainstem causing hyperventilation, respiratory alkalosis, which precedes the high AG met acidosis so it’s toxic to the lungs, results in ARDS
ASA overdose feAtures
High AG met acidosis Respiratory alkalosis Renal insufficiency Elevated PT Confusion Fever
Asa overdose
What to order on ccs
CBC BMP Abg PT/inr/ptt ASA level
ASA overdose
Ccs tip
Alkalanize the ûrine with D5W with 3 anmps bicarb
Bzd overdose
It’s not fatal and let the pt sleep
Do not give flumazenil!
What to order on ccs for all overdoses
Aspirin
Acetaminophen
Alcohol level
CO poisoning
Mcc death in fires
CO symptoms
Shortness of breath
Lightheaded and HA
Disoriented
Severe- met acidosis
CO poisoning, look for the phrase
He feels better when he is shoveling snow
CO poisoning treatment
Call the ambulance
Give 100% oxygen
Digoxin overdose symptoms
N/v/d/abs pain is most common
Yellow halos and blurred vision
arrhythmia s
Encephalopathy
Ethylene glycol and methanol feautures
Increased AG met acidosis Renal insufficiency Hypocalcemia Kidney stones Visual disturbance Retinal hyperemia
Methemoglobinia
Very ** important to know
Nitrates ( nitroglycerin)
Anesthetics ( ending in-caine)
Methemoglobinemia blue box
Cyanosis + normAl
po2 ( cause hemoglobin is in an oxidized staTe
Malignant hyperthermia
History of anesthetic use
TCA overdose
Most urgent dtep
EKG : to look for wide QRS. Can also lead to v tach or torsades
Black widow bite symptoms
Abdominal pain but no tenderness
Rigidity
Hypocalcemia.
Treat with antivenin
Brown recluse spider
Bite has local necrosis bullae and dark lesions
Debridd the wound
Burns
Most importantly step
Treatment
MCC death
100% oxygen
Then intubate or give fluids
Any respiratory symptoms then intubate
If need fluids, 4 ml of LR or NS for each percentage for each kg
Mcc death; infection
Hypothermia
Most urgent step
Ekg: J-waves of
Osborn
Acute angle glaucoma
Best initial Thera
And
Treatment
Best initial: pilocarpine drops And Mannitol Acetozolamide Latanopdost, Travoptost ( prostaglandins Timolol Apraclonodine
Retinal detachments
Treatment
Tilt head back
Reattach retina
If they fail(, then band
Red eye conjunctivitis
Viral v bacterial
Bilateral itchyb eyes
Unilateral and eyelids stuck together
Ginko biloba and omega 3 FA
Ginko—> potentiates aspirin
Omega 3 fa—> prolong bleeding time… they also improve mood
