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Master the Boards > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

gastric lavage useful in….

A

1 hour of ingestion

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2
Q

ALL types of gastric emptying are dangerous in

A
  1. caustic ingestion
  2. altered mental status
  3. acetaminophen overdose
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3
Q

ALWAYS WRONG ANSWER GIT emptying…

A
  1. ipecac
  2. cathartics
  3. diuresis: fluids and diuretics
  4. whole bowel irrigation
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4
Q

ipecac

A

prior to coming to hospital

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5
Q

cathartic agents=

A

sorbitol

does NOT eliminate ingestion without absorption

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6
Q

diuresis=

A

pulmonary edema

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7
Q

only times whole bowel irrigation is correct

A
  1. massive iron ingestion
  2. lithium
  3. swallowing drug filled packets
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8
Q

not clear what cause of OD is, go with..

A

acetaminophen or
aspirin

(since mcc death from OD)

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9
Q

patient with altered mental status and unknown cause order of steps

A
  1. naloxone and dextrose
  2. intubation
  3. gastric lavage
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10
Q

chronic benzo user given flumazenil

A

INSTANT WITHDRAWAL–> seizures

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11
Q

first time benzo use and TCA

A

benzos PROTECT from TCA induced seizures

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12
Q

first time benzo use and TCA and give flumazenil

A

flumazenil removes the protection from seizures by benzzos–> SEIZURES

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13
Q

opiate OD vs benzo OD

A 
opiate= fatal
benzos= non fatal (DO NOT GIVE FLUMAZENIL)
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14
Q

charcoal use

A

ANYONE with pill OD, not dangerous, and not specific

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15
Q

charcoal in comparison

A

BETTER than lavage and ipecac

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16
Q

don’t know what to do in toxicology give….

A

CHARCOAL

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17
Q

what scenario when less acetaminophen is needed to cause toxicity

A

ALCOHOLICS

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18
Q

toxic amount of acetaminophen ingested (8-10grams)

A

N-A-C

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19
Q

OD acetaminophen more than 24hrs ago

A

NO TX

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20
Q

amount of ingestion of acetaminophen is unclear

A

DRUG LEVEL

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21
Q

ok to give both NAC and charcoal

A

YESSS it is

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22
Q

PC aspirin OD

A
  • tinnitus
  • hyperventilation
  • resp alkalosis —> metabolic acidosis
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23
Q

why metabolic acidosis in aspirin OD

A

aspirin messes with ox phos–> anaerobic–> lactic acidosis

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24
Q

blood gases for aspirin OD

A

low O2
low bicarb
HIGH PH

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25
Q

best initial test for someone with TCA ingestion after given antidotes…

A

EKG

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26
Q

what are you looking for on EKG with TCA OD

A

TdP—> WIDENING of QRS

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27
Q

serious consequences of TCA OD

A

seizures

arrhythmia

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28
Q

bicarb use in TCA OD

A

protects from arrhythmias

DOES NOT increase urinary excretion

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29
Q

caustics

A

acids and alkalis (drain cleaner)

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30
Q

caustics cause….

A

mechanical damage to oropharynx, esophagus, stomach–> PERFORATION

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31
Q

reversal with caustics

A
  1. flush out caustics

2. endoscopy: assess degree of damage

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32
Q

steroids with caustics

A

NOOOOOPE– does nOT prevent injury

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33
Q

MCC death in fires

A

CO poisoning

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34
Q

PC CO poisoning

A

SOB
CONFUSION
MI (since LV cannot tell difference between anemia, carboxyhemoglobin, stenosis in CAD)

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35
Q

O2 levels in CO and methHb

A

FALSELY NORMAL WITH OXIMETRY

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36
Q

most accurate test CO poisoning

A

carboxyhaemoglobin level

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37
Q

acid base disturbance in CO poisoning

A

low bicarb
low pH

(metabolic acidosis)

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38
Q

tx of CO poisoning

A

100% oxygen

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39
Q

PC severe CO poisoning

A
  • CNS symptoms
  • cardiac symptoms
  • metabolic acidosis
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40
Q

causes of methhb

A
  • benzocaine/anaesthetics
  • nitrites and NG
  • dapsone
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41
Q

PC methHb

A
  • SOB, cyanosis
  • headache, confusion, seizures
  • met acidosis
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42
Q

tx MethHb

A

methylene blue

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43
Q

blood CO poisoning

A

BRIGHT RED

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44
Q

blood MethHb poisoning

A

BROWN

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45
Q

nerve gas vs organophosphate poisoning

A

NERVE GAS= FASTER

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46
Q

death in nerve gas and organophosphate poisoning

A

RESP ARREST

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47
Q

antidote for nerve gas and organophosphate poisoning

A

atropine

pralidoxime

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48
Q

pralidoxime

A

reactivates AChE

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49
Q

what predisposes to digoxin toxicity?

A

HYPOkalaemia (since less K bound to ATPase= more digoxin can bind)

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50
Q

most common PC digoxin toxicity

A

nausea

vomiting

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51
Q

other complications from digoxin toxicity

A
  • HYPERkalaemia
  • yellow halls around objects
  • ARRHYTHMIA ANY KIND
  • NEURO–confusion
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52
Q

when to give digi-bind

A

cardiac and cns INVOLVEMENT

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53
Q

EKG findings of digoxin toxicity

A

downsloping of the ST segment

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54
Q

don’t forget the renal complication of lead poisoning….

A

ATN

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55
Q

most accurate test for lead poisoning

A

lead level

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56
Q

best initial test for lead poisoning

A

FEP increased

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57
Q

most accurate test for sideroblastic anaemia

A

prussian blue stain

58
Q

tx of lead poisoning

A
  • succimer
  • dimercaprol
  • EDTA
59
Q

PC mercury poisoning

A
  • nervous
  • jittery
  • twitchy
  • hallucinatory
60
Q

2 big complications from mercury poisoning

A
  • irreversible lung fibrosis

- neuro problems

61
Q

tx of mercury poisoning

A
  • succimer

- dimercaprol

62
Q

wood alcohol, cleaning solutions, paint thinner….

63
Q

toxic metabolite of methanol

A

formic acid/formaldehyde

64
Q

toxic metabolite of ethylene glycol

A

oxalic acid/oxalate

65
Q

osmolar gap increased by

A
  • methanol
  • ethylene glycol
  • ETHANOL=ALCOHOL
66
Q

best initial tx for methanol and ethylene glycol toxicity

A

fomepizole (inhibits alcohol dehydrogenase)

67
Q

most effective tx for methanol and ethylene glycol toxicity

68
Q

most common injury from snake bites

A

local wound

69
Q

when snake bites get into bloodstream, death by:

A
  • hemolysis
  • DIC
  • resp arrest
70
Q

dangerous/ ineffective tx snake bite

A
  • tourniquet
  • ice
  • incision and mouth suction
71
Q

beneficial tx snake bite

A
  • pressure
  • immbolization (decrease movement of venom)
  • antivenin
72
Q

black widow bite PC

A

abdo pain and muscle pain

73
Q

lab tests for black widow bite

A

HYPOcalcemia

74
Q

tx of black widow bite

A

calcium

antivenin

75
Q

brown recluse bite PC

A

local skin necrosis
bullae
blebs

76
Q

lab tests for brown recluse bite

77
Q

tx brown recluse bite

A

debridement
steroids
dapsone

78
Q

human bites

A

MORE DAMAGING

Eikenella corrodens

79
Q

LOC …. what next?

A

CT!!!!!!

no matter how minor the trauma is

80
Q

normal CT and LOC=

A

concussion

81
Q

ecchymoses CT (blood mixed in parenchyma) and LOC=

82
Q

lucid interval found in….

A

BOTH BOTH BOTH BOTH

epidural and subdural haematomas

83
Q

concussion tx

A

HOME– check for development of lucid

84
Q

contusion tx

A

HOSPITAL– check for development of lucid

85
Q

LARGE subdural or epidural haematoma

A
  1. intubation and hyperventilation (bridge to surgery)
  2. mannitol
  3. drainage
86
Q

moa hyperventilation in RICP

A

hyperventilation= decrease CO2= vasoconstriction brain blood vessels= decrease blood volume= BIG decrease ICP

87
Q

what prophylaxis when hx of

  • head trauma
  • burns
  • endotracheal intubation
  • coagulopathy with rest failure
A

PPI’s, to prevent curling stress ulcers

88
Q

steroids with intracranial bleeding?

A

do NOT benefit, just DECREASE EDEMA around mass lesions

89
Q

second most common cause of death from burns

A

only if there has been airway injury– INSIDE nasopharynx or mouth

90
Q

second mcc death in burns is

A

hypovolaemia

91
Q

volume fluid replacement in burns

A

RINGER LACTATE

or normal saline

92
Q

calculation for fluid replacement

A

4ml x % BSA burned x weight (kg)

93
Q

patchy burns

A

each hand width= 1% BSA

94
Q

mcc death from burn immediately

A

lung injugry

95
Q

mc death from burns few days later

96
Q

prophylactic antibiotics for burns

A

TOPICAL not iv

97
Q

hypothermia seen in

A

INTOXICATED PATIENTS

98
Q

mcc death in hypothermia

A

CARDIAC ARRHYTHMIA

99
Q

ECG finding in hypothermia

A

ELEVATED J WAVE= osborn wave

100
Q

tx for drowning

A

airway

POSITIVE pressure ventilation

101
Q

salt water drowning

102
Q

fresh water drowning

A

HAEMOLYSIS

103
Q

wrong answers for drowning

A

steroids

antibiotics

104
Q

precordial thump the answer when…

105
Q

sudden loss of pulselessness

A
  • VF
  • VT
  • PEA
  • asystole
106
Q

tx for all forms of pulselessness

107
Q

unsynchronized cv=

A

defib

  • VF
  • VT pulseless
108
Q

tx pulse VT

A

amiodarone

109
Q

tx VF

A
  1. defib
  2. epinephrine or vasopressin
  3. amiodarone> lidocaine
110
Q

order of mgmt for vf

A

SHOCK-cpr-drug-SHOCK-cpr-drug-SHOCK-cpr-drug

111
Q

intracardiac mgmt is…

A

ALWAYS THE WRONG ANSWER

112
Q

PEA

A
  • normal ECG- electrical

- NO PULSE-motor contraction

113
Q

tx of PEA/ asystole

A
  • CPR

- epinephrine or vasopressin

114
Q

causes of PEA

A
  • tamponade
  • tension pneumothorx
  • hypovolaemia, hypoglycemia
  • massive PE
  • hypoxia, hypothermia, met acidosis
  • POTASSIUM increase or decrease
115
Q

afib vs. aflutter

A

SAME MGMT
irregular rhythm- afib
regular rhythm- aflutter

116
Q

tx afib/aflutter unstable or less than 48hours

A

synchronized cardioversion

117
Q

tx stable more than 48hrs/chronic a fib

A

rate-bb and cab
rhythm-amiodarone
anticoag- CHADS2V

118
Q

what % of people with a fib will revert to fibrillation

119
Q

rhyme for a fib treatment

A

slow the rate and anticoagulate

120
Q

does rate control convert the patient into sinus rhymth?

121
Q

without warfarin, how many embolic strokes would there be per year

A

6/100 patients

122
Q

anticoagulation for afib

A

less than or equal to 1 chad: aspirin
greater than or equal to 2: warfarin first
UNLESS there is already a clot in atrium, in which case give heparin

123
Q

diseased/cardiomyopathic heart and a fib

A

atria are shot from the excess dilation/stretching of conduction pathways, atria have to work harder to contribute to CO (from 10% to 30-50%), and will eventually fail–> ACUTE PULMONARY EDEMA

124
Q

major bleeding from warfarin

A

intracranial hemorrhage

requiring transfusion

125
Q

tx SVT

A
  1. vagal

2. adenosine

126
Q

WPW gets worse after

A
  • CCB
  • BB
  • Digoxin

since all work on the AV node

127
Q

acute tx WPW

A
  1. procainamide or amiodarone
128
Q

long term tx WPW

A

radio frequency catheter ablation

129
Q

most accurate test for WPW

A

electrophysiology studies–since give exact location of where the anatomic defect is

130
Q

MAT on EKG

A

3 different morpholopgies of P waves

131
Q

MAT associated with

A

lung disease, thus treat lung disease treat the MAT

132
Q

tx of MAT same as a fib except…

A

NO BETA BLOCKERS–since lung disease

133
Q

isoproterenol

A

NEVER THE RIGHT ANSWER

134
Q

sinus bradycardia symptomatic

A
  • atorpine= best initial

- pacemaker= most effective

135
Q

sinus bradycardia asymptomatic and first degree AV block

136
Q

second degree AV block mobitz I=

A

= wenckebach block

NORMAL AGING

137
Q

tx of second degree block mobitz I

A

NO TX if asymptomatic

138
Q

mobitz II tx

A

PACEMAKER for BOTH asympt and sympt

139
Q

patient experiences VTac after MI 72hrs, what is best next step

A

angiography for angioplasty or bypass– BECAUSE ischema is causing the arrhythmia, tx ischemia, tx the arrhythmia

140
Q

above patient who experiences VTac after MI 72hrs, how to determine recurrence?

A

ECHO– because can tell what the LV function is like

141
Q

if cause is known for Vtach…

142
Q

unknown source of ventricular arrhythmia, what next

A

EP studies

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