Emergency Medicine Deck 2 Flashcards
Tx for anticholinesterase or organophosphate poisoning?
atropine (supresses PNS), pralidozime (reactivates cholinesterase)
Tx for poisoning with antimuscarinic or anticholinergic agents?
physostigmine (reversible cholinesterase inhibitor)
Tx for acetominophen OD?
Tx if >7.5 ingested
give charcoal if within 4h of OD
NAC
How to treat acute heavy metal poisoning?
succimer, dimercaprol, or penicillamine
How to treat beta-blocker OD?
glucagon
How to tx barbiturate or benzo OD?
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
Tx for cyanide poisoning?
hydroxycobalamin, amyl nitrate, sodium nitrite
Nitrites induce methemoglobinemia, which binds cyanate
Tx for digitalis poisoning?
Anti-digitalis Fab (antibody) in patients with sx
Don’t treat ion imbalances until after initial treatment, since it will restore Na+/K+ pump
Tx for heparin or warfarin overdose?
Heparin: protamine sulfate, injected
Warfarin: FFP immediately, Vitamin K over the long-run
Tx for iron overdose?
deferoxamine
Tx for opioid overdose?
Naloxone
If patient is found unconscious and clinical suspicion suggests opioids, its standard procedure to tx empirically with naloxone
Tx for methanol or ethylene glycol (antifreeze) overdose?
Fomepizole, dialysis, Ca+ gluconate
Tx for tPA or streptokinase OD?
aminocaproic acid
Which drugs induce P-450 enzymes?
BARBara Steals Phen-phen and Refuses Greasy Carbs
Barbiturates St. John's wort Phenytoin Rifampin Griseofulvin Carbamazepine
Which drugs inhibit P-450 enzymes?
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
Which drug classes are metabolized by p-450 enzymes?
sedatives (benzos, barbiturates)
cardiac drugs (metoprolol, propranolol, nifedipine, warfarin, quinidine)
anticonvulsants (phenytoin, carbamazepine)
Which drugs create gynecomastia?
Some Drugs Create Awesome Knockers
Spironolactone Digitalis Cimetidine chronic Alcohol use Ketoconazole
Which drugs confer risk of Stevens-Johnson syndrome>
Lamotrigine
Sulfonamides
Penicillins
Which drugs can cause drug-induced SLE?
chlorpromazine, hydralazine, INH, methyldopa, penicillamide, procainamide, quinidine
Which troponin is specific for heart muscle?
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)
Your patient is actively having an MI. What do you give him while you wait for the bus?
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.
AED placement for adults vs children?
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
What is a common and dangerous complication of MI?
Ventricular tachycardia
What is most important to ask a possible victim of domestic violence?
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.
Which O2 delivery system is most appropriate for a breathing patient and delivers 40% O2 at 6L/min?
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
What is the immediate treatment and imaging for AAA?
Abdominal CT then non-selective beta-blockers like propranolol
How to treat a patient in DKA?
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.
A 14mo child is choking on a toy. What do you do?
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.
How do you adapt your CPR when someone has a suspected head/neck injury?
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.
You find a woman lying on the ground in your office building. What is your first step?
- Survey the scene
- Trap squeeze (to see if she’s conscious)
- Call 911 if no
- CPR if indicated
- If she is breathing, secondary survey (check for broken bones, watch her face)
Epi dosing for a child?
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
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?
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
How will a broken femoral neck present?
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.
What is the proper order of treatment of fractured bones?
Spine, skull, pelvis, thigh, rib cage
Which body fluids require universal precaution?
Blood, CSF, synovial fluid, semen, vaginal secretions, pleural fluid, pericardial fluid, peritonial fluid, amniotic fluid, and another other fluid tainted w blood
