Emergency Medicine Deck 2

Question 1

Tx for anticholinesterase or organophosphate poisoning?

Answer 1

atropine (supresses PNS), pralidozime (reactivates cholinesterase)

Question 2

Tx for poisoning with antimuscarinic or anticholinergic agents?

Answer 2

physostigmine (reversible cholinesterase inhibitor)

Question 3

Tx for acetominophen OD?

Answer 3

Tx if >7.5 ingested

give charcoal if within 4h of OD
NAC

Question 4

How to treat acute heavy metal poisoning?

Answer 4

succimer, dimercaprol, or penicillamine

Question 5

How to treat beta-blocker OD?

Answer 5

glucagon

Question 6

How to tx barbiturate or benzo OD?

Answer 6

Barbituates: charcoal, dialysis, supportive care

Benzos: Flumenazil (if acute or accidental ingestion), intubation, supportive care
do not use Flumenazil in a situation of chronic benzo abuse; can cause withdrawal seizures and death

Question 7

Tx for cyanide poisoning?

Answer 7

hydroxycobalamin, amyl nitrate, sodium nitrite

Nitrites induce methemoglobinemia, which binds cyanate

Question 8

Tx for digitalis poisoning?

Answer 8

Anti-digitalis Fab (antibody) in patients with sx

Don’t treat ion imbalances until after initial treatment, since it will restore Na+/K+ pump

Question 9

Tx for heparin or warfarin overdose?

Answer 9

Heparin: protamine sulfate, injected

Warfarin: FFP immediately, Vitamin K over the long-run

Question 10

Tx for iron overdose?

Answer 10

deferoxamine

Question 11

Tx for opioid overdose?

Answer 11

Naloxone
If patient is found unconscious and clinical suspicion suggests opioids, its standard procedure to tx empirically with naloxone

Question 12

Tx for methanol or ethylene glycol (antifreeze) overdose?

Answer 12

Fomepizole, dialysis, Ca+ gluconate

Question 13

Tx for tPA or streptokinase OD?

Answer 13

aminocaproic acid

Question 14

Which drugs induce P-450 enzymes?

Answer 14

BARBara Steals Phen-phen and Refuses Greasy Carbs

Barbiturates
St. John's wort
Phenytoin
Rifampin
Griseofulvin
Carbamazepine

Question 15

Which drugs inhibit P-450 enzymes?

Answer 15

SICKFACES.COM
Sodium valproate
Isoniazid (Abx for TB)
Cimetidine
Ketoconazole (anti-fungal)
Fluconazole
Alcohol (chronic use)
Ciprofloxacin
Erythromycin
Sulfonamides
Chloramphenicol (synthetic strep to break clots)
Omeprazole
Metronidazole
\++++Grapefruit

Question 16

Which drug classes are metabolized by p-450 enzymes?

Answer 16

sedatives (benzos, barbiturates)
cardiac drugs (metoprolol, propranolol, nifedipine, warfarin, quinidine)
anticonvulsants (phenytoin, carbamazepine)

Question 17

Which drugs create gynecomastia?

Answer 17

Some Drugs Create Awesome Knockers

Spironolactone
Digitalis
Cimetidine
chronic Alcohol use
Ketoconazole

Question 18

Which drugs confer risk of Stevens-Johnson syndrome>

Answer 18

Lamotrigine
Sulfonamides
Penicillins

Question 19

Which drugs can cause drug-induced SLE?

Answer 19

chlorpromazine, hydralazine, INH, methyldopa, penicillamide, procainamide, quinidine

Question 20

Which troponin is specific for heart muscle?

Answer 20

I and T: specific to heart muscle
C: found in skeletal muscle and heart muscle
Elevated troponin I and T confirm MI.

CK itself is not specific, and normal CK doesn’t rule out MI (CK-MB specific to heart muscle)

Question 21

Your patient is actively having an MI. What do you give him while you wait for the bus?

Answer 21

Chewable aspirin is the most important thing- increases survival probability because its a thrombolytic. 325 mg.

Nitroglycerin second-most important thing. 0.3-0.6 chewable tablets every 5m up to 3x.

Question 22

AED placement for adults vs children?

Answer 22

Adults: one pad on the right side between nipple and collarbone. One pad on the left side of the chest below the nipple and toward the midaxillary line.

Children: one in the middle of the chest, one in the middle of the back

Question 23

What is a common and dangerous complication of MI?

Answer 23

Ventricular tachycardia

Question 24

What is most important to ask a possible victim of domestic violence?

Answer 24

If there are children in the home and if they are ever witnesses or victims of the violence. You will need to alert child services.

Question 25

Which O2 delivery system is most appropriate for a breathing patient and delivers 40% O2 at 6L/min?

Answer 25

Simple face mask

Bag-valve mask in non-breathing patients; 90% O2 at 10-15 L/min

Resuscitation mask is 50% and 6L/min
Partial rebreather is 60-80% and 10-15L/min; high rate
Non-rebreather mask, 10, 90%; best way to get O2 to a pat without intubating**
Venturi: used in hospitals; 40% at 4-15L/m

Question 26

What is the immediate treatment and imaging for AAA?

Answer 26

Abdominal CT then non-selective beta-blockers like propranolol

Question 27

How to treat a patient in DKA?

Answer 27

Dx: urine ketones

Give rapid infusion of 0.9% saline to rehydrate (patient loses glucose in urine, takes water with it, gets very dehydrated).
Use 24g needle for the IV, give continuous regular insulin.
Cerebral edema is the worst case side effect from DKA then rapid rehydration in children.

Question 28

A 14mo child is choking on a toy. What do you do?

Answer 28

If they are conscious and breathing, encourage them to cough. If they cannot cough or breathe, do the Heimlich maneuver. If this does not work, call 911. If CPR is needed, ratio is 30:2, one hand on their chest.

For children <12mo, you would support their head and deliver back blows. Use two fingers on their chest.

Question 29

How do you adapt your CPR when someone has a suspected head/neck injury?

Answer 29

30 compressions, jaw thrust, 2 breaths.

If no head/neck injury, use head tilt/chin lift instead.

It is not legal to stop delivering care if the individual dies, You must continue until someone more qualified than you reaches the scene and declares the patient dead or takes over the situation.

Question 30

You find a woman lying on the ground in your office building. What is your first step?

Answer 30

1. Survey the scene
2. Trap squeeze (to see if she’s conscious)
3. Call 911 if no
4. CPR if indicated
5. If she is breathing, secondary survey (check for broken bones, watch her face)

Question 31

Epi dosing for a child?

Answer 31

0.01mg/kg 1:1000 IM every 15m

Adult dosing- 0.3-0.6mg 1:1000 IM every 15m

If they need fluids, choose an isotonic solution like lactated ringers

Question 32

You accidentally hit a cyclist and he breaks his tibia. What do you while you wait for the bus? He then has a seizure. What do you do?

Answer 32

Apply firm pressure with sterile gauze. If you don’t have that, use feminine hygiene products like pads, if available. Don’t elevate the leg as that can cause more problems.
He should get Vancomycin (to prevent staph infection) and tDAP if he isn’t vaccinated. Worse SE is compartment syndrome, fat embolism possible but rare.

If he has a seizure, remove any objects from the area around him, wait till the seizure is done, then assess ABCs. Do NOT roll him on his side or hold his head- can damage his C-spine

Question 33

How will a broken femoral neck present?

Answer 33

Shortened, externally rotated leg. Loss of pulse is the most dangerous sign (loss of sensation next dangerous).

Most important SE is DVT. Compartment syndrome is not common in fractures in this location.

Question 34

What is the proper order of treatment of fractured bones?

Answer 34

Spine, skull, pelvis, thigh, rib cage

Question 35

Which body fluids require universal precaution?

Answer 35

Blood, CSF, synovial fluid, semen, vaginal secretions, pleural fluid, pericardial fluid, peritonial fluid, amniotic fluid, and another other fluid tainted w blood