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Clinical Disciplines- Emergency Medicine > Exam 3 - Study guide (MC) > Flashcards

Exam 3 - Study guide (MC) Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Opiate toxidrome antidote

A

Naloxone (Narcan)

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2
Q

Valproate antidote (2)

A

Charcoal

L-carnitine

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3
Q

Methanol antidotes (3)

A

Fomepizole
Etoh
HD

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4
Q

Visine antidote

A

Atropine

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5
Q

Camphor antidotes (2)

A

Charcoal

Benzos

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6
Q

Cocaine antidote

A

Benzos

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7
Q

Iron poisoning tx (4)

A

Gastric lavage
Whole bowel irrigation
MOM
Deferoxamine

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8
Q

Cyanide toxicity tx (5)

A 
100% O2
Amyl nitrite
Sodium nitrite 
Sodium thiosulfate 
Hydroxocobalamin
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9
Q

Digoxin antidote? How often should you check levels? What should you avoid?

A
  • Digibind
  • Check level at least 6 hrs after last dose
  • Avoid Ca –> increased arrhythmias (“stone heart”)
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10
Q

CCB antidotes (4)

A

CaCl
Glucagon
Epi
Insulin

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11
Q

Acetaminophen antidote? At what time is it no longer beneficial? What are side effects of the antidote?

A

N-acetylcystine

  • No benefit if > 8hrs
  • N/V/D
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12
Q

Barbiturates antidotes (3)

A

Glucose
Narcan
Charcoal

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13
Q

Lithium antidote

A

Benzos for seizures

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14
Q

Isopropanol tx (2)

A

IVF

Ventilation

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15
Q

Ethylene glycol tx

A

Similar to methanol:
Fomepizole
Etoh
HD

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16
Q

Bath salts antidotes (4)

A

Cooling
IVF
Bicarb
Benzos

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17
Q

Amphetamines antidotes (3)

A

Benzos
Haldol
Cooling

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18
Q

MDMA (ecstacy) antidote

A

Benzos

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19
Q

Phenycyclidine (PCP) antidote

A

Benzos

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20
Q

Hydrofluoric acid antidote

A

Ca gluconate

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21
Q

Dystonic reactions antidotes (2)

A

Benadryl

Benzos

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22
Q

TCAs antidotes (2 categories)

A

For hypotension: fluids, bicarb, alpha agonists

For seizures: benzos, barbituates

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23
Q

TCAs + ________ = DEATH

A

Procainamide

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24
Q

BB antidote

A

Glucagon

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25
Q

What increases osmolar gap?

A

ME DIE

  • Methanol
  • Ethylene glycol
  • Diuretics
  • Isopropyl alcohol
  • Etoh
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26
Q

What causes 1/4 of all trauma related deaths?

A

Blunt trauma

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27
Q

When should you provide ventilatory support to a trauma pt? (6)

A
  • Upper airway obstruction
  • Flail chest
  • Multiple injuries
  • Comatose
  • Elderly
  • O2 < 50% on RA or < 80% on >40% O2
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28
Q

How do you dx sternal fx?

A

Serial EKGs q 8hrs for 24-36hrs

Echo

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29
Q

How do you tx scapular fx?

A

Sling
Ice
Analgesics
Early ROM

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30
Q

When does a scapular fx require surgery?

A

If it involves glenoid &/or coracoid

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31
Q

When is mechanical ventilation required for flail chest?

A
  • Shock
  • 3+ injuries
  • Head injury
  • Prior pulm disease
  • 8+ rib fractures
  • > 65yo
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32
Q

What occurs during pulmonary contusion?

A

Direct injury w/ no laceration –> hemorrhage & edema –> interstitial & intra-alveolar fluid collection

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33
Q

How do you dx pulmonary contusion?

A

pulmonary opacity within 6hrs of blunt trauma

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34
Q

How do you tx pulmonary contusion?

A

Ventilation

Pain & chest physiotherapy

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35
Q

When is mechanical ventilation for pulmonary contusion required?

A

When 1/4 lung volume involved or pre-existing pulmonary disease
*May need to have uninjured lung down!

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36
Q

What is the clinical presentation of a basilar skull fx? (3)

A
  • Raccoon eyes
  • Battle sign
  • Hemotympanum
37
Q

What is the clinical presentation of transtentorial/uncal herniation?

A
  • Oculomotor n compression –> ipsilateral dilated pupil

- Cerebral peduncle compression –> contralateral hemiparesis

38
Q

What are warning signs of an orbital blow-out fx? (3)

A
  • Infraorbital numbness
  • Enophthalmos
  • limited upward gaze w/ diplopia
39
Q

How do you tx orbital blow-out fx?

A

Augmentin

Tetanus prophylaxis

40
Q

What do you see w/ splenic rupture?

A

Kher’s sign (L shoulder pain)

41
Q

What is the MC blunt trauma of the abd? What is the MC penetrating?

A 
Blunt = splenic
Penetrating = liver
42
Q

How do you dx renal injuries?

A

CT
IVP
Angiography

43
Q

What causes renal injuries?

A

Direct impact or decelerating force

44
Q

How is the pancreas injured? How do you dx?

A

Compression against spine

CT
*Amylase & DPL are NOT reliable

45
Q

How do you dx bladder injuries?

A

Cystogram

CT w/ contrast

46
Q

What are S/S of pneumomediastinum?

A
  • Hamman’s crunch

- SubQ emphysema in neck

47
Q

What are S/S of cardiac tamponade? What is the triad?

A
  • Becks triad: JVD, muffled heart sounds, hypotension
  • Pulsus paradox (10-15 drop in SBP during inspiration)
  • Kussmaul sign (increase in JVD & pressure during inspiration)
  • Electrical alternans
48
Q

How do you tx cardiac tamponade?

A

Pericardiocentesis via paraxyphoid approach w/ 18 gauge & 20cc syringe, directed toward L scapular tip

49
Q

What are characteristics of an aortic rupture? What is seen on CXR?

A
  • Most commonly involves aortic isthmus
  • Retrosternal or interscapular pain (worse w/ increased BP)
  • CXR: mediastinal widening (MC), deviation of esophagus (most accurate sign), L pleural effusion, blurred aortic knob
50
Q

What imaging do you use to dx aortic rupture?

A

TEE
CT
Aortography

51
Q

How do you tx aortic rupture?

A

Avoid valsalva/vomiting
Maintain SBP <120
Surgery

52
Q

What is most associated w/ myocardial contusion? What is the main cause?

A

Sternum fx

MVC

53
Q

What indicated increased ICP? What is the triad?

A

Cushings triad: HTN, depressed respiratory, brady

54
Q

How do you tx salicylate overdose? (5)

A
  • Gastric lavage if within 1hr
  • Charcol
  • Normal saline
  • NaHCO3
  • HD (if ESRD, CNS toxicity, serum>100, worsening, failure to alkalinize)
55
Q

How do you tx barbiturate overdose? (4)

A

Glucose
Narcan
Charcoal
Urinary alkalinization

56
Q

What are sx of acetaminophen overdose? (3)

A
  • Centrolobular necrosis
  • Vomiting (esp children)
  • Renal failure
57
Q

What are the phases of acetaminophen overdose?

A

0-24 hrs = N/V, pallor, diaphoresis, malaise

24-48 hrs = RUQ pain, increased LFTs

72-96 hrs = LFTs peak, coagulopathy, encephalopathy

4-14 days = recover or die

58
Q

What is the serotonin syndrome triad?

A

Myoclonus
MS changes
Shivering

59
Q

What are other sx of sertonin syndrome?

A 
"A2D2H2T" 
Agitation, ataxia
Diarrhea, diaphoresis
Hyperreflexia, hyperthermia
Tremor
60
Q

Antifreeze toxicity - what does the urine fluorescence reveal?

A

Ca oxalate crystals

61
Q

Digoxin overdose - what is seen on EKG?

A

Atach w/ AV block

62
Q

What is the triad seen w/ hypoglycemia?

A

Whipple’s triad

  • Diaphoresis
  • Nausea
  • AMS
63
Q

Iron toxicity - what is seen on labs?

A

Basophilic stippling & “vin rose” urine

64
Q

What is the clinical presentation of dystonic rxns?

A
  • Sudden onset abnormal posturing of head, neck, jaw
  • Contractures of lips, tongue, face, throat
  • Trismus, torticollis, tongue protrusions
  • Laryngeal, pharyngeal spasms
  • Fear, axiety
  • Oculogyric crisis (unable to move eyes in vertical plane, double vision)
65
Q

How do you tx dystonic rxns?

A
  • Benadryl 3-4 days to prevent recurrence

- Benzos

66
Q

What are RFs for dystonic rxns?

A 
Male 
Young
Cocaine
Hypocalcemia
Neurodegenerative d/o
67
Q

What is the clinical presentation of diverticulitis? (3)

A

Abrupt onset LLQ pain
Fever
Leukocytosis w/ left shift

68
Q

How do you tx diverticulitis?

A 
Levaquin
Flagyl 
Zosyn 
If severe --> add vanco 
If abscess --> drain
69
Q

How do you tx mesenteric ischemia?

A

Heparin

Abx

70
Q

How do you tx H. pylori?

A

H2 blockers or PPI

Surgery

71
Q

How do you tx urolithiasis?

A

<5mm = no tx (will pass)

> 5mm:

  • Toradol
  • Morphine
  • Antiemetics
  • IVF
  • If infection –> abx, drain, admit
72
Q

How do you tx pancreatitis?

A

“Place bowel at rest”

  • NPO
  • Fluids
  • Demerol
  • Antiemetics
73
Q

How do you tx frostbite?

A 
Elevate, splint
Wrap in dry gauze
Debride
Tetanus 
Analgesics
74
Q

How do you tx heat stroke? (4)

A
  • IVF
  • Ice packs
  • Evaporative cooling*
  • Diazepam
75
Q

How do you tx jellyfish sting? (3)

A

Vinegar
Isopropyl alcohol
Anesthetics (topical or oral)

76
Q

How do you tx hymenoptera stings?

A

Antihistamines
Epi (IM or auto-injector)
Steroids
Beta agonists

77
Q

How do you tx black widow spider bite? (4)

A

Narcotics
Benzos
Antivenin
Ca gluconate

78
Q

How do you tx scabies?

A 
Lindane (also used for lice)
Elemite
Calamine lotion
Oral antipruritic agents 
Analgesics
79
Q

How do you tx snake bites?

A

Elevate, constriction bands

Antivenins: “polyvalent”

80
Q

How do you tx scorpion sting?

A

cool compress

anascorp antivenin

81
Q

How do you tx thermal burns?

A 
Tetanus prophylaxis
NG tube
Narcotics
Debride, steril dressings
Ointment
82
Q

What is the MC active enzyme of the brown recluse spider?

A

Sphingomyelinase D

83
Q

What is the triad of heat stroke?

A

Hyperthermia >105
CNS dysfunction
Anhydrosis

84
Q

What is the MCC of pancreatitis? (3)

A

Alcoholism
Cholelithiasis
Hypertriglyeridemia

85
Q

What is the clinical presentation of epididymitis?

A
  • Gradual, bilateral pain
  • Fever
  • Phren’s sign (relief w/ scrotal elevation)
  • Swelling
  • Worse w/ standing
  • 19-35yo
86
Q

What is the clinical presentation of testicular torsion?

A
  • Bell clapper deformity
  • Sudden, unilateral pain
  • Absent cremaster reflex
  • Vomiting common
  • Neonates, 12-15yo
87
Q

What are sx of a barbiturate overdose?

A

CNS depression
Hypothermia, hypoglycemia
Urinary retention
Aspiration pneumo*

88
Q

What are characteristics & dx tests for appendicitis?

A
  • Periumbilical, RLQ pain
  • Fever, N/V, anorexia
  • Rovsings sign: pain in RLQ w/ palpation of LLQ
  • Iliopsoas sign: pt supine, R knee extender & flex right hip
  • Obturator sign: pt supine, flex R knee to 90˚, internally/externally rotates hip
  • Alvarado score (10 pts total)
89
Q

What are S/S of digoxin?

A
  • N/V, weakness
  • Vision changes (yellow halos)
  • Syncope
  • MS changes
  • Hyperkalemia

Clinical Disciplines- Emergency Medicine (3 decks)

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