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3rd Year (Step 2) > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

Organophosphate poisoning

– Presentation?

A

Salivation, Lacrimation, Polyuria, Diarrhea, Bronchospasm, Bronchorrhea, & respiratory arrest (if severe enough)
– causes massive increase in the level of ACh by inhibiting its metabolism

(Organophosphates = insecticides. Nerve gas has same effects & is more rapid)

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2
Q

Organophosphate poisoning

– Treatment?

A

Atropine = 1st step (blocks effects of ACh that’s already increased in the body)

Pralidoxime reactivates acetylcholinesterase, however does not work as instantaneously as Atropine.

Should also remove clothes & wash patient since organophosphates/nerve gas can be absorbed through the skin.

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3
Q

Gastric Lavage – when is it useful?

A

Useful w/in 1st hour of ingestion

    • removes 50% of pills at 1 hour
    • removes 15% of pills at 2 hours

Dangerous to use in AMS (aspiration) or caustic ingestion (burns esophagus & oropharynx)

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4
Q

Charcoal – when is it useful?

A

Charcoal is benign & should be given to anyone w/ a pill overdose.
Can remove substances even after being absorbed.
Repeated doses lower blood levels of toxins faster.

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5
Q

Amount of Acetaminophen for toxicity? Lethality?

A

Toxicity = 8-10 grams

Fatality > 12-15 grams

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6
Q

Acetaminophen toxicity – treatment?

A

N-acetylcysteine (if >8g ingested)

    • if overdose was >24 hours ago, NO therapy
    • if amount unclear, get a drug level
    • Can give charcoal along w/ N-acetylcysteine
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7
Q

Aspirin overdose – presentation?

A
    • Tinnitus & Hyperventilation
    • Respiratory alkalosis progressing to metabolic acidosis (from lactate)
    • Renal toxicity & AMS
    • Increased anion gap

(causes ARDS & raises PT. Also interferes w/ oxidative phosphorylation & results in anaerobic glucose metabolism, producing lactate)

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8
Q

Aspirin overdose – treatment?

A

Alkalinizing the urine, which increases the rate of aspirin excretion.
ex = Bicarbonate

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9
Q

Aspirin overdose – Blood gas results?

A

Respiratory alkalosis w/ a low pCO2 & metabolic acidosis w/ decreased Bicarbonate.

pH = alkalotic
pCO2 = low  (normal is ~40)
Bicarb = low  (normal is ~24)
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10
Q

Anti-depressants that might cause seizures?

A

Tricyclic antidepressants
(can be prevented by benzodiazepines)

– TCA toxicity is rapidly detected on EKG as widening of QRS complex

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11
Q

TCA toxicity – EKG changes?

A

Early changes = widening of QRS complex.

Then, prolongs the QT until Torsade develops.

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12
Q

TCA toxicity – presentation?

A

– Anticholinergic effects: Dry mouth, constipation, urinary retention.

– Seizures & Arrythmia (wide QRS, prolonged QT, eventually Torsades)

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13
Q

TCA toxicity – treatment?

A

Sodium Bicarbonate. Bicarbonate will protect the heart, it does not increase TCA excretion as it does for Aspirin.

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14
Q

Caustic ingestion of acids/alkali – treatment?

A

Flush out the caustics w/ water in high volumes.

Endoscopy is performed to assess degree of damage.

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15
Q

CO poisoning – blood gas results?

A

Lactic acidosis

Normal pO2.
Low pH, pCO2, & Bicarbonate.

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16
Q

CO poisoning – treatment?

A

100% oxygen

If severe, give Hyperbaric Oxygen.

Severe = CNS symptoms, Cardiac symptoms, or Metabolic acidosis

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17
Q

Methemoglobinemia – pathophysiology?

A

Hemoglobin is oxidized & locked in Ferric state, meaning it is brown & does not carry Oxygen.

Occurs as reaction to drugs:

    • Benzocaine & other anesthetics
    • Nitrites & Nitroglycerin
    • Dapsone

Methemoglobinemia – Hg will not pick up O2.
CO poisoning – Hg will not release O2 to tissues.

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18
Q

Methemoglobinemia – presentation?

A
    • Dyspnea & Cyanosis
    • Headache, confusion, seizures
    • Metabolic acidosis

(same as CO poisoning)

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19
Q

Methemoglobinemia – tests?

A

Best initial = Blood gas

Most accurate = Methemoglobin level

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20
Q

Methemoglobinemia – treatment?

A

Best initial = 100% oxygen

Most effective = Methylene Blue
decreases half-life of methemoglobin

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21
Q

Most likely Dx?

Cyanosis + normal pO2

A

Methemoglobinemia

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22
Q

Digoxin toxicity – what electrolyte abnormality predisposes to this?

A

Hypokalemia, because K+ & Digoxin compete for binding at same site on sodium/potassium-ATPase.
When less K+ is bound, more Digoxin is bound.

23
Q

Digoxin toxicity – presentation?

A

Most commonly = GI problems such as nausea, vomiting, & abdominal pain.
Other Sx:
– Hyperkalemia from inhibition of Na/K-ATPase
– Confusion
– Visual disturbance such as yellow halos around objects
– Arrhythmia (can cause any type)

24
Q

Digoxin toxicity – tests?

A

Best initial = Potassium level & EKG

Most accurate = Digoxin level

(EKG will show downsloping of ST segment in all leads. Atrial tachycardia w/ variable AV block is the most common digoxin toxic arrhythmia)

25
Q

Digoxin toxicity – EKG & cardiac problems?

A

EKG will show downsloping of ST segment in all leads.

Atrial tachycardia w/ variable AV block is the most common digoxin toxicity arrhythmia.

26
Q

Digoxin toxicity – treatment?

A

Digoxin-specific antibodies (Digabind) will remove Digoxin rapidly from circulation.

Also control Potassium levels.

27
Q

Lead poisoning – presentation?

A
    • Abdominal pain (lead colic)
    • Anemia (sideroblastic)
    • Renal tubule toxicity (ATN)
    • Peripheral neuropathies (wrist drop)
    • CNS abnormalities such as confusion & memory loss
28
Q

Lead poisoning – tests?

A

Best initial = Increased level of Free erythrocyte protoporphyrin

Most accurate = lead level

29
Q

Sideroblastic anemia – most accurate test?

A

Prussian Blue stain.

This detects increased iron built up in red cell mitochondria.

30
Q

Lead poisoning – treatment?

A

Chelating agents remove lead from the body.

Succimer = oral

EDTA & Dimercaprol (BAL) = parenteral agents

31
Q

Mercury poisoning – presentation?

A

Inhaled = interstitial fibrosis (irreversible)

Ingested = Neurological problems (nervous, jittery, twitchy, & sometimes hallucinatory)

32
Q

Mercury poisoning – treatment?

A

Chelating agents treat ingested mercury poisoning by removing from the blood. This can also prevent progression of lung fibrosis, but cannot reverse damage.

33
Q

Methanol (wood alcohol, cleaning solutions, paint thinner)

– Presentation?

A

Ocular toxicity
– Retinal inflammation

Both methanol & ethylene glycol cause intoxication, metabolic acidosis w/ increased anion gap, & increased osmolar gap.

34
Q

Methanol (wood alcohol, cleaning solutions, paint thinner)

– Treatment?

A

Fomepizole (inhibits alcohol dehydrogenase)
&
Dialysis (removes toxic metabolite)

35
Q

Ethylene glycol (antifreeze) – treatment?

A

Fomepizole (inhibits alcohol dehydrogenase)
&
Dialysis (removes toxic metabolite)

36
Q

Ethylene glycol (antifreeze) – presentation?

A

Renal toxicity
– Hypocalcemia, enveloped-shaped oxalate crystals in urine

Both methanol & ethylene glycol cause intoxication, metabolic acidosis w/ increased anion gap, & increased osmolar gap.

37
Q

Snake bites – beneficial therapy?

A
    • Pressure
    • Immobilization (decreases movement of venom)
    • Antivenin (if available)
38
Q

Black Widow spider bite – Tx?

A

Calcium

Antivenin

39
Q

Brown Recluse spider bite – Tx?

A

Debridement, Steroids, Dapsone

40
Q

Management of Dog, Cat, or Human bites?

A
    • Amoxicillin/Clavulanate

- - Tetanus vaccination booster if >5 years since last injection

41
Q

Organism ass’d w/ Dog & Cat bites?

A

Pasteurella multocida

42
Q

Organism ass’d w/ Human bites?

A

Eikenella corrodens

43
Q

When to give Rabies vaccine in animal bite?

A

Only if:

    • animal has AMS or bizarre behavior
    • attack unprovoked, by a stray dog & the animal cannot be observed or diagnosed
44
Q

What does contrast detect on CT?

A

Contrast detects mass lesions such as cancer & abscess, NOT blood.

45
Q

Large Subdural or Epidural hematoma – management?

A
  1. Intubation & Hyperventilation (decreases pCO2, causing cerebral circulation to constrict & decrease pressure)
  2. Mannitol (osmotic diuretic, decreases intravascular volume & ICP)
  3. Drainage

– can also give PPI before drainage as proph for stress ulcer.

46
Q

When to give PPI as prophylaxis for stress ulcer?

A
    • Head trauma
    • Endotracheal Intubation
    • Burns
    • Coagulopathy (platelets < 50k or INR>1.5) w/ respiratory failure
47
Q

When are steroids beneficial in CNS disturbances?

A

They decrease edema around mass lesions & inflammatory conditions like meningitis.

They do NOT benefit intracranial bleeding.

48
Q

Burns – treatment?

A
  1. 100% oxygen (treats smoke inhalation & CO poisoning)
  2. Intubate if there’s an airway burn (i.e. if p/w stridor, wheezing, hoarseness, burns inside nasopharynx/mouth)
  3. Fluid replacement w/ Ringer Lactate or NS
    (based on BSA burned)
49
Q

Most common cause of death several days to weeks after a burn?

A

Infection

with Staphylococcus

50
Q

Burns – fluid replacement amount?

A

4 mL x (% BSA burned) x weight in kg

Head, arms = 9% BSA each
Legs, Chest, Back = 18% BSA each
Width of hand ~1% BSA

51
Q

Neuroleptic Malignant Syndrome – cause, pres, treatment?

A

Cause = Antipsychotic meds

Pres = Elevated body temp, CPK, & K+

Tx = Dantrolene or Dopamine agonists (Bromocriptine, Cabergoline)

52
Q

Malignant Hyperthermia – cause, pres, treatment?

A

Cause = Anesthetics administered systemically

Pres = Elevated body temp, CPK, & K+

Tx = Dantrolene

53
Q

Drowning – therapy/mgmt?

A

Airway management & Positive-Pressure Ventilation

3rd Year (Step 2) (44 decks)

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