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STEP 3 > Emergency Medicine/ Toxicology > Flashcards

Emergency Medicine/ Toxicology Flashcards

1
Q

What should be done initially on CCS if a pt presents to the ER with acute change in mental status of unclear etiology?

A

Give naloxone, thiamine, dextrose and oxygen and saline while checking toxicology screen

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2
Q

When is gastric emptying useful?

A

First hour of overdose

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3
Q

What is the best initial step in management of a pt presenting to the ER with acute change in mental status of unclear etiology?

A

Administer nalxone, dextrose, and thiamine

Correct for opioid overdose, hypoglycemia, and alcoholic issue

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4
Q

What six things should be done simultaneously for an overdose case on the CCS?

A
  1. specific antidote (or dextrose, thiamine and naloxone)
  2. toxicology screen
  3. charcoal
  4. CBC, chemistry, urinalysis
  5. psychiatric consult (if suicide attempt)
  6. oxygen (for possible carbon monoxide)
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5
Q

What is the specific antidote for acetaminophen overdose?

A

N-acetyl cysteine (prevents liver toxicity in first 24 hours)

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6
Q

What is the specific antidote for aspirin overdose?

A

bicarbonate (to alkalinize urine)

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7
Q

What should be avoided in benzodiazepines overdose?

A

flumazenil (will precipitate benzo withdrawal and seizures)

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8
Q

What is the specific antidote for carbon monoxide poisoning?

A

100% oxygen (hyperbaric in some cases)

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9
Q

What is the specific antidote for digoxin overdose/ poisoning?

A

digoxin-binding antibodies (digiband)

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10
Q

What is the specific antidote for ethylene glycol overdose?

A

fomepizole or ethanol (along with dialysis)

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11
Q

What is the specific antidote for methanol overdose?

A

fomepizole or ethanol (along with dialysis)

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12
Q

What is the specific antidote for methemoglobinemia?

A

methylene blue (with 100% oxygen)

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13
Q

What is the specific antidote for neuroleptic malignant syndrome?

A

bromocriptine or dantrolene

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14
Q

What is the specific antidote for opiates overdose?

A

naloxone

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15
Q

What is the specific antidote for organophosphate overdose?

A

atropine and/or pralidoxime

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16
Q

What is the specific antidote for tricyclic antidepressants overdose?

A

bicarbonate (protects the heart)

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17
Q

What two diseases/ disorders lowers the amount of acetaminophen needed for toxicity and fatality in overdose?

A
  1. liver disease

2. alcohol abuse

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18
Q

What are the symptoms of acetaminophen overdose in the first 24 hours and between 48-72 hours after ingestion?

A

24 hours: nausea and vomiting

48-72 hours: hepatic failure

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19
Q

What is the lowest acetaminophen level in a normal pt in which it is toxic to the patient?

A

10 grams

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20
Q

What is the lowest acetaminophen level in a normal pt in which it is a fatal to the patient?

A

15 grams

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21
Q

What is the next best step in management of a pt presenting with acetaminophen ingestion however the amount of ingestion is equivocal?

A

obtain acetaminophen level

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22
Q

An overdose pt presenting with hyperventilation, respiratory alkalosis followed by metabolic acidosis with elevated anion gap, renal insufficiency, elevated prothrombin time (PT), confusion, fever and tinnitus most likely overdosed on ….

A

aspirin (salicylate)

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23
Q

What five things should be done on CCS in a case of aspirin overdose?

A
  1. CBC
  2. chemistry panel
  3. arterial blood gas (ABG)
  4. coagulation study (PT, PTT, INR)
  5. salicylate (ASA) level
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24
Q

What is the treatment for aspirin overdose?

A
  1. alkalinize urine (increase excretion)
  2. charcoal (block absorption)
  3. dialysis (if severe)
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25
Q

What is used to to alkalinize the urine in overdose cases (salicylates, TCAs, phenobarbital, chlorpropamide)?

A

D5W with 3 amps of bicarbonate

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26
Q

On CCS, what three levels should always be checked in an overdose patient?

A
  1. aspirin (salicylate)
  2. acetominophen
  3. alcohol

(high frequency of co-ingestion)

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27
Q

A pt presents to the ER with fatigue, headache, shortness of breath, lightheadedness, and disorientation after a fire or being snowed in and using a wood-burning stove, and feels better when shoveling snow outside most likely suffers from…

A

Carbon Monoxide Poisoning

cant release oxygen to tissue

28
Q

What is the best initial step in management for a patient being rescued from a fire?

A

call ambulance and give 100% oxygen (until obtain carbon monoxide level)

29
Q

A pt presents with nausea, vomiting, diarrhea, seeing yellow halos around objects, blurred vision, arrhythmia, hyperkalemia and encephalopathy most likely suffers from…

A

Digoxin Toxicity

tx: digoxin binding antibodies if severe –> CNS and cardiac abnormalities

30
Q

A pt presents with intoxication, metabolic acidosis with increased anion gap, renal insufficiency, hypocalcemia, and kidney stones most likely suffers from…

A

Ethylene Glycol intoxication

tx: ethanol/ fomepizole and dialysis

31
Q

A pt presents with intoxication, metabolic acidosis with increased anion gap, visual disturbances and retinal hyperemia most likely suffers from …

A

Methanol intoxication

tx: ethanol/ fomepizole and dialysis

32
Q

A pt presents cyanotic with shortness of breath, dizziness, headache, confusion, seizures, normal pO2, chocolate brown colored blood, and a history of nitrate/ anesthetic/ dapsone/ med ending in “caine”/ nitroglycerin use most likely suffers from ..

A

Methemoglobinemia

hemoglobin locked in oxidized state so cant pick up oxygen

33
Q

What are the two diagnostic tests for methemoglobinemia?

A
  1. normal pO2 on arterial blood gas with chocolate brownish blood
  2. methemoglobin level
34
Q

A pt presenting with elevated CPK levels, hyperkalemia, muscle rigidity, hyperthermia, CNS dysfunction (confusions, seizures), arrhythmia, a history of anti-psychotic medication use and possibly rhabdomyolysis most likely suffers from…

A

Neuroleptic Malignant Syndrome

tx: dopamine agonists –> cabergoline/ bromocriptine/ dantrolene

35
Q

A pt presenting with elevated CPK levels, hyperkalemia, muscle rigidity, hyperthermia, CNS dysfunction (seizures, confusion), a history of anesthetic use, and possibly rhabdomyolysis most likely suffers from…

A

Malignant Hyperthermia

tx: dantrolene

36
Q

A pt presents with hyperthermia, excessive sweating, nausea, vomiting, and possibly hyperkalemia and rhabdomyolysis after physically exerting themselves in the summer time most likely suffers from …

A

Heat Exhaustion

37
Q

What is the treatment for heat exhaustion?

A
  1. normal saline IV (at room temp)

2. removal of pt from hot environment

38
Q

A pt presents with hyperthermia, dry skin, confusion, seizures, hyperkalemia, arrhythmia, and possibly rhabdomyolysis after physically exerting themselves in the summer time most likely suffers from …

A

Heat Stroke

39
Q

What is the treatment for heat stroke?

A
  1. removal from heat

2. spraying pt with water/ fanning pt in air conditioned room/ applying ice baths/packs

40
Q

What causes death in opiate toxicity?

A

respiratory depression

41
Q

A crop duster/ pt involved in nerve gas attack presents with salivation, lacrimation, urination, diarrhea and wheezing from bronchospasm most likely suffers from …

A

Organophosphate poisoning

inhibits Acetylcholinesterase so increases ACh activity

42
Q

What is the best initial treatment for organophosphate poisoning?

A
  1. Atropine

2. and remove clothes and was the rest of pt off

43
Q

What is the most effective treatment for organophosphate poisoning?

A

pralidoxime

44
Q

A pt with a history of depression presents after overdose resulting from a suicide attempt with dilated pupils, dry mouth, constipation, urinary retention, and possibly CNS or cardiac abnormalities most likely suffers from …

A

tricyclic antidepressant poisoning

45
Q

What is the most urgent step in management of a pt with suspected tricyclic antidepressant poisoning?

A

obtain EKG (assess for widening of QRS that can lead to ventricular tachycardia or torsade de pointes)

46
Q

What is the next best step in management of a pt with suspected tricyclic antidepressant poisoning who also has widening of the QRS on EKG?

A

give bicarbonate and transfer to ICU

47
Q

A pt presenting with abdominal pain without tenderness, rigidity, and hypocalcemia with a possible visible bump on the skin most likely suffers from …

A

black widow spider bite

tx: antivenin

48
Q

A pt presenting with local necrosis, bullae formation and dark lesions after an insect bite most likely suffers from …

A

Brown recluse spider bite

tx: debriding wound and possible steroids and dapsone

49
Q

What are the four indications for intubating a pt who was involved in a fire (after giving 100% oxygen for possible carbon monoxide poisoning)?

A
  1. hoarsenss
  2. wheezing
  3. stridor
  4. burns inside nose or mouth

(signs of respiratory injury)

50
Q

What is the next best step in management of a pt involved in a fire after giving 100% oxygen and assessing for need for intubation (and performing intubation if needed)?

A

give 4 ml of lactated ringers/ normal saline for each percentage of body with 2nd or 3rd degree burn per kilogram

(give fluids to rehydrate)

51
Q

What is the most urgent step in management of an alcoholic that is found sleeping outside in the winter time?

A

EKG (assess for J-waves of Osborn –> similar to ST segment elevations signifying hypothermia)

52
Q

A pt presenting with a rock hard, painful red eye, corneal haziness and a fixed midpoint pupil most likely suffers from …

A

Acute angle closure glaucoma

ophthalmologic emergency

53
Q

What is the best initial therapy for acute angle closure glaucoma?

A

pilocarpine drops (constrict pupil) with or without mannitol (osmotic diuretic to open angle)

54
Q

Other than pilocarpine and mannitol, what other medical interventions are used to treat acute angle closure glaucoma? (4)

A
  1. acetazolamide (decrease aqueous humor production)
  2. prostaglandin analogs (latanoprost, travoprost)
  3. beta blockers topically (timolol)
  4. alpha agonists (apraclonidine)
55
Q

A pt presents with sudden loss of vision like a curtain is coming down most likely suffers from …

A

retinal detachment

56
Q

What is the best initial steps in management of a pt with suspected retinal detachment? (2)

A
  1. consult ophthalmology

2. dilated retinal exam

57
Q

What is the treatment for retinal detachment? (3)

A
  1. tilt head back
  2. reattach retina (surgery, cryotherapy or injecting expansile gas into eye)
  3. if 1 and 2 fail, then place band around eye to get retina close to sclera
58
Q

What is the diagnostic test for suspected glaucoma?

A

tonometry

59
Q

A pt presents with bilateral watery discharge from eyes and the eyes are itchy and red most likely suffers from …

A

viral conjunctivitis

60
Q

A pt presents with unilateral purulent discharge from eye, red eye and eyelids stuck together most likely suffers from …

A

Bacterial conjunctivitis

tx: topical antibiotics

61
Q

A pt presenting with a red eye and associated photophobia most likely suffers from …

A

uveitis

62
Q

What is the diagnostic test for suspected uveitis?

A

slit lamp exam

63
Q

What is the treatment for uveitis?

A

steroids

64
Q

A pt presents with a red eye and history of trauma/ contact lens use most likely suffers from …

A

Corneal abrasion

65
Q

What is the diagnostic test for suspected corneal abrasion?

A

fluorescein stain (detects abrasion)

STEP 3 (19 decks)

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