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Peds Boards > Emergency/Toxicology > Flashcards

Emergency/Toxicology Flashcards

1
Q

What is miosis?

A

Small pupils

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2
Q

What drugs can cause miosis?

A 
"CCOOPPS looks for small pupils."
Clonidine
Cholinergics
Opioids
Organophosphates
Pilocarpine
Phencyclidine
Sedatives
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3
Q

What is mydriasis?

A

Large pupils

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4
Q

What drugs can cause mydriasis?

A

“Think of how big your eyes got when you realized the benefit of AAA Savings.”
Antihistamines
Antidepressants
Anticholinergics (Atropine)
Sympathicomimetics (amphetamine, cocaine, phencyclidine)

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5
Q

What drugs can cause diaphoresis?

A 
"Sweaty skin needs SOAP."
Sympathicomimetics
Organophosphates
Aspirin
Phencyclidine (PCP)
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6
Q

What drugs cause nystagmus?

A 
"Your PAAL should not give you nystagmus, but she does."
PCP
Alcohol
Anticonvulsants
Lithium
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7
Q

Which ingestions can charcoal be used for?

A 
"Charcoal uses TAATA trucks to ship out the toxins from the body."
Tricyclic antidepressants 
Aspirin
Acetaminophen 
Theophylline 
Anticholingergics
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8
Q

What are the symptoms of amphetamine use?

A 
HYPERTENSION
EUPHORIA
Agitation
Arrhythmias
Psychosis
Seizures
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9
Q

What are the symptoms of cocaine use?

A 
AGGRESSION
VIOLENCE
EUPHORIA
Overconfidence
Hypertension (tx w/ nitoprusside)

May give diazepam

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10
Q

What are the symptoms of Phencyclidine (PCP) use?

A 
Vertical or horizontal nystagmus
Ataxia
Muscle rigidity
Rhabdomyolysis 
Paranoia
Agitation
Hypertension
Violence
Hallucinations (auditory or visual)
Pupils may be big or small

Tx: cooling blanket, haloperidol

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11
Q

What are the symptoms of opioid use?

A 
Respiratory depression
Miosis
Euphoria
Indifference to pain
Hypotension
Hypothermia
Urinary/stool retention 
Pulmonary edema
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12
Q

Is binge drinking a predictor for future alcoholism?

A

No

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13
Q

Which alcohol does not cause a positive anion gap?

A

Isopropyl alcohol

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14
Q

What is the most common substance of abuse among adolescents?

A

Alcohol

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15
Q

What is the most common illicit substance of abuse in adolescents?

A

Marijuana

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16
Q

What are the symptoms of Ethylene glycol ingestion?

A
  • Antifreeze
  • Tachycardia
  • Hypertension
  • Cardiorespiratory failure from acidosis and hypocalcemia (calcium oxalate crystals in the urine)
  • Tx: ethanol, fomepizole, HD
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17
Q

What are the symptoms of methanol ingestion?

A
  • Windshield washer fluid
  • Visual complaints (snowstorm appearance)
  • Abdominal pain
  • Tx: ethanol, fomepizole, HD
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18
Q

Which alcohol result in a positive ethanol reading on toxicology screens?

A

Isopropyl alcohol

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19
Q

What are the findings of isopropyl alcohol ingestion?

A
  • Found in mouthwash and rubbing alcohol
  • CNS depressant
  • Fruity odor from breath
  • Ketones present
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20
Q

How long is drug testing positive for marijuana use?

A
  • One time use: 1 week
  • Frequent use: 2 weeks
  • Daily use: 1 month
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21
Q

When do you obtain and acetaminophen level after ingestion?

A

4 hours post ingestion

22
Q

At what dose do you give NAC without waiting for an acetaminophen level?

A

140 mg/kg

23
Q

What is the time cut off for giving NAC after acetaminophen ingestion?

A

8 hours

24
Q

Name the cholinergic drugs.

A

Bethanochol
Organophosphates (pilocarpine)
Neostigmine

25
Q

What are the effects of cholinergic drugs?

A 
DUMBELLS
Diarrhea
Urination
Miosis
Bronchospasm, bradycardia
Emesis
Lacrimation
Lethargy
Salivation
  • Includes organophosphates = ⬆️ organ activity (except for ❤️ - bradycardia)
26
Q

What is the treatment for cholinergics?

A

Atropine

Pralidoxime

27
Q

What medications have anti-cholinergic effects?

A 
Diphenhydramine
Atropine
Pralidoxime
Tricyclic acids
Jimson weed
28
Q

What are the symptoms of anti-cholinergics?

A

“Hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a Hatter while the bowel and bladder lose their tone, and the heart runs alone.”

Fever
Blurred vision
Dry mouth/eyes
Hyperthermia
Psychosis
Decreased bowel sounds
Urinary retention
Tachycardia
29
Q

What are the symptoms of TCA toxicity?

A
  • Anticholinergic symptoms
  • Anion gap acidosis
  • Wide QRS complex
  • QT prolongation
  • Tx: sodium bicarbonate
  • Meds end with: -pine, -mine, -line (except doxepin)
30
Q

What are the symptoms of salicylate toxicity?

A
  • Drugs: aspirin, oil of wintergreen
  • Primary anion gap metabolic acidosis
  • Cerebral edema, pulmonary edema, electrolyte disturbances, cardiovascular collapse
  • Decreases gastric motility
  • Tx: gastric lavage, charcoal, hydration, bicarbonate, hemodialysis
31
Q

How is iron overdose managed?

A
  • Sxs: capillary leak, hypertension, anion gap acidosis, hematemesis, scarring of pylorus
  • Tx: chelation with deferoxamine
    • Give if level is >500 mg/dL
    • Makes urine pink
    • Continue until urine is not pink
32
Q

What are the stages of iron overdose?

A

IR❤️N

I = indigestion (GI): nausea, vomiting, abdominal pain, hematemesis
R = recovery (latent)
❤️ = cardiovascular collapse, liver damage
N = (delayed) narrowing of pylorus or other parts of GI track, obstruction from strictures
33
Q

When is chelation therapy for lead poisoning indicated?

A
  • Level > 45

- EDTA, dimercaptol, d-penicillamine

34
Q

What medications can cause dystonic reactions?

A

Clonidine
Phenothiazine
Metoclopramide
Promethazine

Tx with diphenhydramine

35
Q

What are the symptoms of and treatment for digoxin toxicity?

A
  • GI symptoms, weakness, arrhythmias
  • There is an increased chance of toxicity with low K+, low Mg, poor renal fxn, hypoxia
  • Tx: charcoal, digibind, correct K+ and Mg
36
Q

What are the symptoms of and treatment for theophylline toxicity?

A
  • Levels > 20: N/V, ⬇️BP, ⬆️Ca, ⬇️K+, metabolic acidosis, seizures
  • Tx: charcoal, beta-blockers for arrhythmias (if BP ok), benzos for seizures
  • Decreases GI motility
37
Q

When do you treat carbon monoxide poisoning with 100% oxygen?

A
  • Carboxyhemoglobin level > 25%
  • Pt has GI sxs
  • Pt has neurological sxs
38
Q

How do you treat cyanide poisoning?

A

Sodium thiosulfate

Nitrate

39
Q

What is the clinical presentation of and treatment for methemoglobinemia?

A
  • Due to an enzyme deficiency
  • Reduced O2 carrying capacity
  • Blue/cyanotic skin
  • Chocolate colored blood
  • Tx: methylene blue, oxygen, remove offending agent
40
Q

What animals transmit the rabies virus?

A

BCDFRSW

Bats
Cats
Dogs
Foxes
Raccoons
Skunks
Woodchucks
41
Q

What is the management for possible rabies exposure?

A

Wound care + HRIG + 4 vaccine doses

42
Q

What is the BSA for burn estimation?

A 
Arms: 9%
Legs: 18%
Front trunk: 18%
Back trunk: 18%
Head:
     Adult: 9%
     Baby: 18%
43
Q

What is the treatment for 1st° burns?

A
  • Red, painful skin

- Soap, cool water, analgesics

44
Q

What is the treatment for second-degree burns?

A
  • Partial thickness
  • Blisters, erythematous skin that blanches with pressure
  • Painful
  • Do not rupture blisters
  • Once blisters rupture, treat with debridement, topical anabiotics, non-adherent dressing
45
Q

What is the treatment for third-degree burns?

A
  • Full thickness
  • White, dry, leathery skin
  • Painless
  • Burn center referral
46
Q

What is the Parkland formula and when is it used?

A
  • To replace fluids for burns on > 15% of body

(4ml/kg) x (% body burned) + maintenance

Give half over first 8 hours after burn

47
Q

What indicates a good prognosis after a near drowning?

A

Good pulse on EMS arrival
OR
Required <10 minutes CPR

48
Q

What criteria are needed for a patient to be discharge from the ED after a near drowning?

A

Does not need hospitalization if:

  • In water for <60 seconds
  • No LOC
  • No CPR required
49
Q

What indicates a poor prognosis after a near drowning?

A
  • Cold on EMS arrival (< 90°F)
  • CPR needed for >10 minutes
  • > 25 minutes under water
  • Apnea
  • Coma
  • pH < 7.1
50
Q

How do you determine the appropriate ET tube size?

A

Uncuffed: (Age/4) + 4 in.
Cuffed: (Age/4) + 3 in.

Babies:
<1.5 kg: 2.5 mm
<2.5 kg: 3.0 mm
> 2.5 kg: 3.5 mm

51
Q

What medications can be given via ETT?

A 
NAVEL
Naloxone
Atropine
Valium
Epinephrine
Lidocaine

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