Emergency Medicine Flashcards
When do you use gastric lavage for ingestion?
Within the first hour or 2 of ingestion
Do not use if altered mental status or caustic ingestion
What amount of acetaminophen is generally toxic?
> 8-10 grams
Fatal if 12-15 grams
What treatment do you use if a clear toxic amount of acetaminophen has been ingested?
NAC
What do you do if acetaminophen ingestion was > 24 hours ago?
NOTHING
What do you do if the amount of acetaminophen ingested is unclear?
Draw a level
Can you use charcoal with NAC?
YES
Presentation and Tx of ASA Overdose
Tinnitus
ARDS
Inc prothrombin time
Hyperventilation –> respiratory alkalosis
Renal toxicity, AMS
Inc anion gap metabolic acidosis (anaerobic glucose metabolism –> lactose)
Tx = alkaline urine; give bicarb
Blood Gas Values in ASA Overdose
Low PCO2 (hyperventilation)
Low Bicarb (metabolic acidosis)
PH = about 7.45
Carbon Monoxide Poisoning v. Methemoglobinemia
Both - similar presentation to anemia because dec oxygen to tissues; normal pO2
CO - binds to oxygen so not delivered, 100% oxygen or hyperbaric oxygen if severe (CNS sx, cardiac sx, metabolic acidosis)
Methe - HgB in ferric state that will not carry oxygen, start with 1–% oxygen, most effective is methylene blue
Relationship between digoxin and potassium
Hypokalemia –> digoxin toxicity because more binding sites open for digoxin not bound by K+
Dig toxicity then results in HYPERkalemia because Na-K ATPase is blocked
Osmolar Gap
2 (Na) + BUN/2.8 + glucose/18
Measured - calculated = gap
Snake Bites (complications and effective treatments)
Local tissue damage via proteases and lipases in venom
Neuro toxin - respiratory paralysis, ptosis, dysphagia, diplopia
Hemolytic toxin - hemolysis and DIC
Tx = pressure to wound, anti-venin, immobilization to decrease movement of the venom
DO NOT USE ice, tourniquet, incision/suction
Black Widow v. Brown Recluse Spider Bites
Black - ab pain, muscle pain, hypocalcemia (give Ca)
Brown - local skin necrosis, bullae, blebs (debridement, steroids, dapsone)
When should you intubate in burn injuries?
Stridor
Hoarseness
Wheezing
Burns inside nasopharynx or mouth
Burn Fluid Replacement Calculation
4 mL x %SA x kg
What abx do you use for burns?
TOPICAL silver sulfadiazine
EKG Finding in Hypothermia
J point elevation
Heat Exhaustion v. Heat Stroke
Exhaustion = normal body temp and normal labs, oral fluids
Stroke = elevated body temp, elevated K+ and CPK, IV fluids and evaporation
High Altitude Pulmonary Edema
Dx = 2 sx and 2 signs
Sx - dyspnea, cough, weakness, chest tightness
Signs - crackles, wheezing, cyanosis, tachypnea, tachycardia
Tx = oxygen, rapid descent, steroids, nifedipine, sildenafil
Like pulmonary edema with normal EF
Unlikely under 5000 ft elevation
How do you treat jellyfish stings?
Hot water to inactivate toxin
Vinegar to prevent toxin release
Remove nematocysts
Topical steroids and anti-histamines for symptomatic relief
Mercury v Lead Poisoning
Lead - ab pain, ATN, sideroblastic anemia, wrist drop, memory loss/confusion
Tx = succimer, EDTA/dimercaprol (IV)
Mercury = nervous/twitch/hallucinations and lung fibrosis if inhaled
Tx = succimer or dimercaprol for neuro toxicity; CANNOT reverse lung fibrosis
4 Causes of Pulselessness (how do you treat each?)
1 - asystole (CPR and epi)
2 - V fib (CPR, UNSYNC defibrillation and epi)
3 - V tach (treatment based on HD status - hypotension/confusion/CHF)
- if pulseless UNSYCN just like VF
- if unstable SYNC cardiovert first then amio, lidocaine, procainamide
- if stable do amio, lidocaine, procainamide first then SYNC cardiovert if needed
4 - PEA aka normal EKG no pulse (oxygen, fluids, glucose, chest tube, etc)
Causes of PEA (11)
H’s
- hypovolemia
- hypo/hyperkalemia
- hypoxia
- hypothermia
- hypoglycemia
- H+ (acidosis)
T’s
- tension pneumo
- thrombosis (AKA PE or coronary)
- tamponade
- trauma
- toxins
CHADSVASC (when is it used?)
C - CHF or cardiomyopathy H - HTN A - age (>75) - 2 points D - DM S - stroke or TIA - 2 points V - vascular disease A - age 65-74 - 1 point S - sex (female)
Use if someone has a fib and trying to decide if they need anti-coagulation (use if 2 or more, not needed if 0 or 1)
