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1. Pediatrics > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

[EM/Toxicology]

Categories of drug for ‘excited’ (agitation, hypertension, tachycardia, hyperventilation, hyperthermia, mydriasis) (3)

A
  1. Anticholinergics (antihistamin, TCA, atropine)
  2. Sympathomimetics (pseudoephedrine, cocaine, amphetamine)
  3. Hallucinogens (LSD, Psilocybin)
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2
Q

[EM/Toxicology]

Categories of drugs for ‘depressed’ (obtundation, hypotension, bradycardia, hypoventilation, hypothermia, miosis) (4)

A
  1. Cholinergics (organophosphate, insecticides)
  2. Sympatholytics (clondine)
  3. Opiates (oxycodone)
  4. Sedative-hyponitcs (BZ, barbiturates)
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3
Q

[EM/Toxicology]

Anticholinergic toxidrome (7)

A

Dry, flushed skin
Hyperthermia
Mydriasis
Agitation, delirium, hallucinations
Urinary retention, decreased bowel sounds
Tachycardia, hypertension

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4
Q

[EM/Toxicology]

Cholinergic toxidrome (7)
D
U
M
B
E
L
S

A

Diarrhea
Urination
Miosis
Bronchorrhea, bronchospasm, bradycardia
Emesis
Lacrimation
Salivation

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5
Q

[EM/Toxicology]

Which toxidrome?

Muscle weakness, fasciculation, paralysis
Respiratory depression, lethargy, seizures, coma
Bradycardia

After Insecticides (organophosphate/carbamate) ingestion

A

Nicotinic toxidrome

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6
Q

[EM/Toxicology]

Which toxidrome?

CNS depression
Miosis
Respiratory depression/apnea
Bradycardia, hypotension

A

Opioid toxidrome

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7
Q

[EM/Toxicology]

Which toxidrome (class)?

Agitation, tremors, hallucinations, seizures
Tachycardia, hypertension
Mydriasis

Ingestion of
Pseudoephedrine
Psychostimulants, cocaine, amphetamines

A

Sympathomimetic toxidrome

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8
Q

[EM/Toxicology]

Which agent?

Sympathomimetic toxidrome (agitation, tachycardia, mydriasis)
With vertical nystagmus, miosis

A

PCP (Phencyclidine)

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9
Q

[EM/Toxicology]

Examples of anticholinergics (5)

A
  1. Antihistamin
  2. Neuroleptics (chorpromazine, quetiapine)
  3. Tricyclinc antidepressants
  4. Atropine
  5. Antispasmodics (hyoscyamine)
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10
Q

[EM/Toxicology]

Examples of sympathomimetics (5)

A
  1. Ephedrine
  2. Dextromethorphan
  3. Cocaine
  4. Amphetamine/methamphetamine
  5. MDMA (ecstasy)
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11
Q

[EM/Toxicology]

Examples of hallucinogens (3)

A
  1. LSD
  2. PCP
  3. Mescaline, psilocybin
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12
Q

[EM/Toxicology]

Examples of cholinergics

A

Insecticides (organophosphate, carbamate)

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13
Q

[EM/Toxicology]

Examples of sympatholytics (1)

A

Clonidine

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14
Q

[EM/Toxicology/Sadatives]

Examples of sedative-hypnotics (2)

A

Benzodiazepines
Barbiturates

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15
Q

[EM/Toxicology/AAP]

Acetaminophen minimal toxic dose is
___ mg/kg in < 12 years old
___ g in adults

A

150 mg/kg in < 12 years old
7.5 g in adolescent/adults

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16
Q

[EM/Toxicology/AAP]

Symptoms of acetaminophen toxicity

Stage 1 (0-24 hours): ___
Stage 2 (1-3 days): ___
Stage 3 (3-4 days): ___
Stage 4 (4-14 days): ___

A

Stage 1 (0-24 hours): nausea/vomiting, normal LFT
Stage 2 (1-3 days): RUQ pain, Increased LFT, PT/INR
Stage 3 (3-4 days): fulminant hepatic failure, coagulopathy
Stage 4 (4-14 days): recovery or death

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17
Q

[EM/Toxicology/AAP]

Treatment of acetaminophen toxicity

If less than 1 hour: ___
If toxicity is possible: ___

A

If less than 1 hour: activated charcoal
If toxicity is possible: NAC (N-acetylcysteine)

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18
Q

[EM/Toxicology]

Which ingestion?
Treatment?

Tinitus
GI: Nasuea/vomiting
Respiratory: tachypnea, respiratory alkalosis
Metabolic: anion gap acidosis,
CNS: agitation, coma

A

Salicylate ingestion

  • Treatment:
    Alkalinization with sodium bicarbonate
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19
Q

[EM/Toxicology]

Which class drug ingestion and treatment?

Bradycardia, hypotension, ventricular dysrhythmias
Hypoglycemia

A

Antihypertensives (b-blocker)
(If HYPERglycemia, CCB)

Treatment:
Glucagon
Vasopressor

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20
Q

[EM/Toxicology]

Which class drug ingestion and treatment?

Bradycardia, hypotension, ventricular dysrhythmias
Hyperglycemia

A

Calcium channel blocker
(HYPOglycemia: b-blocker)

Treatment:
Calcium gluconate

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21
Q

[EM/Toxicology]

Which class drug ingestion?

CNS and respiratory depression, pinpoint pupils, bradycardia
Hypothermia
Anticholinergic effects; dry mouth, constipation

A

Clonidine (Symphatolytics)
(Opiate: no hypothermia/anticholinergic effects)

22
Q

[EM/Toxicology/Iron]

5 phases of iron ingestion?

A
  1. GI phase (30 min to 6 hours): nausea/vomiting, diarrhea
  2. Relative stability phase (6 hours to 1 day): asymptomatic
  3. Systemic toxicity phase (1-3 days): hypovolemic shock, anion gap metabolic acidosis
  4. Hepatic toxicity (within 2 days)
  5. GI/pyloric scarring (2-6 weeks): bowel obstruction
23
Q

[EM/Toxicology/Iron]

Treatment for iron toxicity?

A

Deferoxamine (if iron level > 500 µg/dL)

24
Q

[EM/Toxicology]

Which drug ingestion?
Treatment?

Convulsions, coma,
Cardiac dysrhythmias: QRS prolongation
Acidosis

A

TCA (triCyClic Antidepressants)

  • Treatment:
    Sodium bicarbonate
25
# [EM/Toxicology] Serotonin syndrome vs NMS and its treatment Myoclonus, hyperrefelxia Hypertension, tachycardia Confusion, hallucination
Serotonin syndrome (SSRIs, MAOIs) (Myoclonus is specific to serotonin syndrome) Treatment: Benzodiazepine, cyproheptadine
26
# [EM/Toxicology] Which class of drug ingestion? Bruxism Hyponatremia Hypertension, tachycardia Confusion, hallucination
MDMA (Ecstasy) (Bruxism, hyponatremia is specific to Ecstasy)
27
# [EM/Toxicology] Serotonin syndrome vs NMS Muscle rigidity: torticolis, protruding tongue Autonomic instability Muscle rigidity Hyperthermia Confusion
Neuroleptic malignant syndrome : idiosyncratic drug reaction to antipsychotics or metoclopramide (Muscle rigidity and autonomic instability is NMS, not in serotonin syndrome)
28
# [EM/Toxicology] Methemoglobinemia vs CO poisoning, and its treatment? Low pulse oxymetry Normal PaO2 Chocolate brown blood Signs of amyl nitrites ingestion (poppers)
Methemoglobinemia Treatment: methylene blue
29
# [EM/Toxicology] Methemoglobinemia vs CO poisoning, and its treatment? Flulike symptoms Cherry-red skin Normal pulse oxymetry Normal PaO2
CO poisoning Treatment: high flow oxygen with non-rebreather mask
30
# [EM/Toxicology] Which metal poisoning and its name?
Lead poisoning Burton line: blue line along the gum Basophilic stippling
31
# [EM/Toxicology] Which chemical poisoning? Smoke inhalation Profound lactic acidosis High oxygen in venous gas
Cyanide poisoning
32
# [EM/Toxicology] Which chemical poisoning? Aspiration pneumonitis with ingested Ventricular arrhythmias when inhaled (no metabolic acidosis)
Hydrocarbons: gasoline, lighter fluid, etc
33
# [EM/Toxicology] Ethanol vs methanol vs ethylene glycol and its treatment CNS depression Hypothermia Hypoglycemia High osmolal gap High anion gap metabolic acidosis
Ethanol Treatment: IV fluid, ABCs, supportive care
34
# [EM/Toxicology] Ethanol vs methanol vs ethylene glycol and its treatment Visual disturbance Abdominal pain CNS depression High osmolal gap High anion gap metabolic acidosis without high lactate or ketones
Methanol: windshield washer, fuel additive Treatment: fomepizole Folinic acid
35
# [EM/Toxicology] Ethanol vs methanol vs ethylene glycol and its treatment CNS depression Acute kidney injury leading to renal failure High osmolal gap High anion gap metabolic acidosis without high lactate or ketones
Ethylene glycol: anti-freeze Treatment: Socium bicarbonate Fomepizole Thiamin, pyridoxine
36
# [EM/Toxicology] Which chemical poisoning and its treatment? Cholinergic effects: DUMBLES Nicotinic: twitching, weakness, paralysis
Organophosphate: pesticides Treatment: Atropine Pralidoxime
37
# [EM/Envenomation] Which insect bite and its treatment for systemic? Painless for 2-8 hours Hemorrhagic blister in 1-2 days Necrotic ulceration Some develop systemic symptoms: fever, N/V, myalgias, rash
Brown recluse spider Treatment: If systemic, steroid
38
# [EM/Envenomation] Which insect bite and its treatment? Pain starts within 30-60 minutes Rash with hallow target sign Diaphoresis, muscle cramping, abdominal pain Agitation Hypertension Rhabdomyolysis
Black widow spider Treatment: Supportive care Antivenom is not used due to mortality
39
# [EM/Trauma/Burn] Burn surface area determination, > 14 years old Head and neck: ___ Each upper limb: ___ Thorax and abdomen, front: ___ Thorax and abdomen, back: ___ Perineum: ___ Each lower limb: ___
Head and neck: 9% Each upper limb: 9% Thorax and abdomen, front: 18% Thorax and abdomen, back: 18% Perineum: 1% Each lower limb: 18%
40
# [EM/Trauma/Burn] Burn fluid calculation Parkland formula for 14 years old: ___ ABA criteria for < 14 years old: ___
Parkland formula for 14 years old: _4_ ml/kg x BSA ABA criteria for < 14 years old: _3_ ml/kg x BSA 50% in the first 8 hours and the rest in 16 hours
41
# [EM/Trauma/Bone] Growth plate injuries: Salter-Harris classification Type 1: S___ Type 2: A___ Type 3: L___ Type 4: T___ Type 5: R___
Type 1: Straight across Type 2: Above Type 3: Lower Type 4: Through Type 5: Rammed together
42
# [EM/Trauma/Bone] Name of fracture and its management?
Greenstick fracture: one side of cortex is broken Management: If no deformation, immobilization
43
# [EM/Trauma/Bone] Name of fracture? Its mechanism and management?
Torus (Buckle) fracture Mechanism: falling on outstretched hand Management: immobilization
44
# [EM/Trauma/Bone] Name of fracture? Its mechanism and management?
Spiral fracture Mechanism: Nonambulatory child - child maltreatment Toddler - twist or jump Management: immobilization
45
# [EM/Trauma/Bone] Name of fracture? Its mechanism? Complication if untreated ischemic damage?
Supracondylar fracture Mechanism: falling on outstretched hand High risk for neurovascular complications: brachial artery, median/radial nerve If untreated: Volkmann contractures
46
# [EM/Trauma/Bone] Diagnosis and its mechanism and treatment?
Acromioclavicular sprain Mechanism: direct blow to the shoulder Treatment: Sling immobilizer
47
# [EM/Trauma/Bone] Diagnosis and its mechanism and treatment?
Anterior shoulder dislocation Mechanism: abducted, extended, externally rotated shoulder Treatment: reduction
48
# [EM/Shock] Target systolic BP minimum in shock?
60 mmHg for 1 month old 70 + 2 x age for > 1 month to 10 years old 90 mmHg for > 10 years old
49
# [EM/Toxicology] Which drug reaction and its reaction name, treatment? Intermittent spasmodic contraction Or sustained involuntary contractions of muscles : Torticollis, oculogyric crisis, facial grimacing
Chlorpromazine, Promethazine Dystonic reaction to antipsychotic drugs Treatment: Diphenhydramine IV
50
# [EM/Toxicology] Which chemical toxicity?
Lead poisoning Linear line in the density of the metaphyses
51
# [EM/Envenomation] Cause? From Arizona, New Mexico Local numbness and swelling without significant erythema Severe systemic symptoms - both sympathetic: tachycardia, hyperthermia - parasympathetic: drooling, wheezing - neuromuscular symptoms: restlessness, muscular fasciculations, ataxia, abnormal eye movements
Scorpion sting

1. Pediatrics (22 decks)

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