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