Emergency Medicine Flashcards
CRP given at a rate of
100compressions/min
after 30 compressions ..2 ventilations
5 cm depth
is transcutaneous pacing used for asystole
no
is atropine recommended for asystole?
no,epinephrine is used
diff bw difibrillation and cardioversion
nonsynchronised(shock given at any phase)
synchronised(at QRScomplex)..if at T wave:VF
hypothermia protocol
done post resusitationto reduce neurologic injury
narrow complex tachycardia is always atrial in origin(QRS complex<0.12 sec)
true
but wide complex can be atrial or ventricular in origin
miosis seen in
clonidine barbiturates opiates cholinergics pontinr stroke
mydriasis seen in
antichol
sympathomimmetics
dry skin
antichol
wet skin
cholinergics
sympathomimmetics
diff via pupil
blisters
barbiturates
CO
ipecac
induce vominting
useful within 1-2 hour
disad
- delay antidote use
- not to be given to child
lavage useful within
first hr of ingestion
forced diuresis is helpful in
alkaline diuresis hepls in eliminating
salicylates and phenobarbital
any toxin related seizure should be treated with
BZD only
whole bowel irrigation done with
ethylene glycol
charcoal used when
patient arrives >1-2 hrs after ingestion
charcoal doesnt bind to
PHAILS pesticide heavy metals acid.alklai.alcohol lithium solvents
substances requiring hemodialysis
I STUMBLE
isopropanol salicylates uremia methanol barbiturates lithium ethylene glycol
best initial test for toxicology screen
urine immunoassay
confirmatory test for tocicology screen
gas chromatography/mass spectrometry
NAC has to be given within
8 hrs:most efficacous
if late ..still give
tt of acetaminophen toxicity
do not do gastric emptying
charcoal
NAC
time and dose both are req to dtermine toxicity
yes
toxic dose of acetaminophen
toxic :7-10 gm
lethal :12-15 gm
alcoholics and liver ds :4gm/day
osmolar gap
gap=measured- calculated
normal=0-10
cal=2(Na)+ BUN/2.8 + glucose/18 + etOH/5
causes of osmolar gap
isopropyl methanol ethylene glycol glycerol mannitol
metabolic acodoisis with anion gap shown by which alcohols
all MA
only meth and isopropyl show anoin gap
which vitamin given in methanol toxicity
folate
which vitamin given in ethylene glycol toxicity
thiamine
pyridoxine
route of methanol toxicity
ingestion
inhalation
skin
CO poisoning cam be confused with
hypoglycemia
flu during winter time
pO2 in CO poisoning
normal because it is the pressure as gas form
not bound to Hb
what does routine pulse oximetry show in CO poisoning?
normal
so CO pulse oximetry should be used(initial diagnostic test)
can naloxone be given in opiate toxicity
yes
withdrawal is uncomfortable but not fatal
why the use of flumenezil is controversial in BDZ toxicitu
- in chronic users may ppt withdrawal and seizures.
2. if used for medical condition may exaberate condition
hallucinogen intoxication tt
BZD
hallucinogens
marijuana mescaline LSD peyote psilocyben phencyclidine(PCP/angel dust)
diagnosis of lead poisoning
blood lead levels
<10 ug /dL acceptable
microcytic anemia and abdominal pain
which heavy metal poisoning?
Pb
Tt of lead poisoning
EDTA
dimercaprol(BAL)
pencillamine
succimer(ORAL)
potential precipitants of lithium toxicity
diuretics
ACEi
NSAIDS
cause of hyperventilation in aspirin
- central stimulation
2. compensatory mech to Metabolic acidosis
what is the ph in aspirin toxicity
variable
special feature of aspirin tox
tinnitus
toxicity of TCAs is due to
anticholinergic
Na channel blocking affect
ECG changes in TCA toxicity
widening of QRS complex
any sign of cardiac toxicity in TCAs should lead to imediate use of
bicarbonate
cardioprotective
not for excretion purposes
features of WE and KP in alcoholism
WE
confusion
ataxia
nystagamus
KP
amnesia
confabulations
mainstay of diagnosis of head injury
CT scan(plain …not contrast , no skull Xray )
cervical spine xray
diagnosis of concussion
history of loss of conciousness
and negative CT findings
why is slight htn maintained during head injury?
SBP=110-160
so than CPP is normal since ICP has risen which can decrease CPP leading to ischemia
it should not be much high so as to cause bleeding
if initial CT is normal..still SAH is suspected then?
lumber puncture
diagnostic for SAH
xanthochromia needs how much time to form
4 to 6 hrs
its presense is indicative of SAH
RBCs in CSF can be due to traumatic needle entry also
xanthochromia needs how much time to form
4 to 6 hrs
its presense is indicative of SAH
RBCs in CSF can be due to traumatic needle entry also
parkland formula
4 × kg × burnt percentage
give half in first 8 hrs
next half in next 16 hrs
osborne wave /J wave
characteristic of hypothermia
elevation of J point
sensitivity of blood cells to radiations
lympho>neutro………>RBC (least)
hypothermia is one of the few times in which a patuent can be resuscitated from pulselessness beyond the usual 10 minutes of efforts
yes
org in cat bite
pasteurella multocida mainly
dog bites org
pasteurella
eikenella
hemolytic streptococci
staph aureus
capnocytophaga canimorsus(high risk of sepsis in asplenic patients)
eikenella corrodens found in which bite
human
prophlactic antibiotics in bites
human
monkey
cat
ALWAYS
dogs AS PER INDICATIONS bite on face, genitals, hand immunocomp asplenic
