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Final Exam Flashcards

1
Q

Do not treat ___________ children with STI prophylaxis. However, _____ prophylaxis should be considered.

A

prepubertal

HIV

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2
Q

Prophylactic treatment of STIs for adolescents

A

Ceftriaxone PLUS
Azithromycin PLUS
Metronidazole OR
Tinidazole

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3
Q

Diagnostic of sexual abuse: ________, _________, _________, _________

A

Gonorrhea
Syphilis
HIV
Chlamydia

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4
Q

High suspicion of sexual abuse: ________, _______ _______

A

Trichomonas

Genital herpes

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5
Q

Suspicious of sexual abuse: _________ ________

A

Anogenital warts

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6
Q

Inconclusive of sexual abuse: ________ _________

A

Bacterial vaginosis

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7
Q

When a pediatric patient is well appearing:

A

5 vital signs

S, O, A, P

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8
Q

When a pediatric patient is sick appearing (5 things):

A
  1. Oxygen (assist ventilation if needed)
  2. Pulse ox
  3. Cardiorespiratory monitor
  4. IV access
  5. CXR/EKG
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9
Q

Normal blood pressure is maintained up over _____% of a child’s circulating volume is lost. Therefore hypotension is a late finding in ______

A

30%

Shock

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10
Q

Signs of shock/poor tissue perfusion in a pediatric patient (3):

A
  1. Cool or mottled skin
  2. Tachycardia
  3. AMS
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11
Q

Fluid resuscitation for the pediatric patient in shock

A

20 ml/kg boluses NS or LR until signs of improved perfusion and resolution of tachycardia

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12
Q

Fluid resuscitation for the pediatric patient in shock due to hemorrhage

A

2 boluses of NS/LR 20 ml/kg

After, PRBC 10 ml/kg

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13
Q

Treatment if signs of increased ICP with herniation in pediatric patient

A
  1. Elevate HOB 30 degree
  2. Hypertonic saline (3%)
  3. Mannitol
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14
Q

Seatbelt sign

A

High probability of abdominal injury; CT of abdomen warranted

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15
Q

Pain before vomiting in children is typical of ____________

A

Appendicitis

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16
Q

Abnormal rotation of mesentery during embryonic development

A

Intestinal malrotation

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17
Q

Management/treatment of intestinal malrotation

A
  1. IV fluid resuscitation
  2. NG tube w/ intermittent suction
  3. Call your surgeon
  4. Upper GI series
  5. Laparotomy
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18
Q

Preferred imaging and classic image of intussusception

A

Ultrasound

Coiled spring or bullseye

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19
Q

Management of intussusception

A
  1. ABCs, resuscitate with IVF
  2. NGT if frequent vomiting
  3. IV abx if concern for perforation
  4. Notify surgery early, abdominal x rays to exclude perforation with free air
  5. Air enema reduction
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20
Q

Contraindications to air enema for intussusception

A
  1. > 3 days
  2. Signs of peritonitis
  3. Evidence of free air on plain X Ray
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21
Q

A WBC count of less than _______ and an absolute neutrophil count of less than _______ makes appendicitis much less likely

A

9,000

7,000

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22
Q

Management for appendicitis

A
  1. IV Fluids
  2. IV pain meds and antiemetics
  3. IV ABX (ancef or zosyn if concern for perforation)
  4. Call surgeon
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23
Q

Classic presentation of sudden unilateral lower abdominal pain, nausea and vomiting with a palpable mass

A

Ovarian Torsion

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24
Q

In ovarian torsion, the ______ side is more commonly affected than the _______ side

A

Right

Left

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25
Management of ovarian torsion
1. Pain control 2. IV Fluids 3. US with doppler 4. Emergent operative intervention
26
What to do when patient is having a seizure:
1. Assess ABCs 2. Place patient on his/her side 3. O2, pulse ox, IV access, bedside glucose 4. If longer than 3 minutes: lorazepam, diazepam, midazolam
27
PMH details to watch for in pediatric seizures
1. Neurosurgical procedures (shunt for hydrocephalus) 2. Prematurity or developmental delays 3. History of meningitis, CNS infections 4. Hx of head trauma 5. Hypercoagulable state (sickle cell) 6. Immunosuppression 7. TB exposures/access to INH 8. Formula mixing
28
Signs of increased ICP in pediatric patients
1. Bulging fontanelle | 2. Papilledema
29
2 important questions to always ask after a pediatric seizure:
1. Vaccination status (DTP/MMR) | 2. Recent ABX (can be masking signs/symptoms of meningitis)
30
Lumbar puncture is an option in a post-seizure child that is:
1. Deficient in immunizations OR | 2. Pretreated with ABX
31
Lumbar puncture is clearly indicated in a post-seizure child that has:
1. Status epilepticus AND 2. Fever
32
____% of children will experience recurrent febrile seizures
33
33
Preferred imaging modalities for children in epilepsy evaluation
EEG | MRI
34
2 tests that should be ordered right away for a child in suspected DKA
1. Accucheck | 2. Urinalysis
35
Definition of DKA
``` Hyperglycemia > 200 mg/dL AND Venous pH < 7.30 OR Bicarbonate < 15 mmol/L ```
36
Physical exam findings of a child in DKA
1. Kussmaul respirations 2. Tachycardia 3. Dehydration (sunken eyes, dry mucous membranes) 4. Delayed capillary refill 5. Abdominal tenderness
37
Electrolyte imbalances in kids with DKA
Hyponatremia | Hypokalemia
38
The 4 I's of DKA
1. Insulin lack 2. Indiscretion 3. Infection 4. Impregnation
39
Management of pediatric DKA
1. ABCs, cardiac monitor, vital signs, accucheck 2. IV access 3. BMP, VBG, +/- CBC, +/- EKG 4. Accucheck every hour 5. VBG every 1-2 hours 6. BMP every 4 hours 7. Neurological checks every hour
40
Treatment of DKA: Step 1
NS/LR bolus 20 ml/kg over 1 hour | Next: LR at 2x MIVF rate
41
Treatment of DKA: Step 2
Insulin infusion -.05-0.1 U/kg/hr No insulin bolus in children Switch to D5NS when glucose is < 300 mg/dL
42
Treatment of DKA: Step 3
Next 4-6 hours, NS with 40 mEq/L K+ | After, switch to 0.45% saline with electrolytes
43
Most serious complication of DKA and its treatment
``` Cerebral Edema Treatment: 1. Reduce rate of IVF 2. Mannitol 0.5-1 g/kg over 20 minutes 3. Hypertonic saline (3%) 4. Consider intubation ```
44
In the event of spinal cord injury, ___________ should be given if within ____ hours
High dose steroids | 8 hours
45
Most commonly injured organ in blunt trauma
Spleen
46
Second most commonly injured organ in blunt trauma
Liver
47
Glasgow Scale for mild TBI
13-15
48
Glasgow Scale for moderate TBI
9-12
49
Glasgow Scale for severe TBI
8 or less
50
Canadian CT Head Rules for mild TBI
1. GCS score < 15 at 2 hours after injury 2. Suspected open or depressed skull fracture 3. Any sign of basal skull fracture 4. Vomiting > 2 episodes 5. Age > 65 y/o Medium Risk 6. Amnesia before impact > 30 minutes 7. Dangerous mechanism
51
Cushing's Reflex
Triad of intracranial hypertension Systolic BP increase Bradycardia Irregular respirations
52
Fastidious gram-negative rod. Can cause bacteremia and fatal sepsis after animal bites, especially in asplenic patients, chronic alcohol abusers or those with underlying hepatic disease
Capnocytophaga canimorsus
53
Organism responsible for cat scratch disease
Bartonella henselae
54
Diagnostic testing for animal bites
Blood cultures prior to abx | X Rays AP and lateral (if deep or markedly infected wounds)
55
Criteria for closure of dog bite wound
1. Clinically uninfected 2. Less than 12 hours old (24 hours on the face) 3. NOT located on the hand or foot
56
Kanavel sign
Flexor Tenosynovitis 1. Finger held in slight flexion 2. Fusiform swelling 3. Tenderness along the flexor tendon sheath 4. Pain with passive extension of the digit
57
Treatment of flexor tenosynovitis (infectious)
Surgical drainage | Consult hand surgeon
58
Rabies postexposure prophylaxis
1. Wound cleansing (soap/water or povidone/iodine solution) 2. RIG infiltrated around wounds 3. Vaccine - IM in deltoid area Days 0, 3, 7, and 14
59
All ______ bites require antibiotic prophylaxis
Human
60
Bacteria commonly found in human bites
Streptococci, staph aureus, eikenella, fusobacterium, peptostreptococcus, prevotella, and porphyromonas species
61
Treatment for human bites
``` Amoxicillin clavulanate (Augmentin) and Moxifloxacin Cellulitis 10-14 days 3 weeks for tenosynovitis 4 weeks for septic arthritis 6 weeks for osteomyelitis ```
62
Medications for insect bite rxns
1. Epinephrine (DOC) 2. Antihistamines (H1 blocker - diphenhydramine; H2 blocker - Ranitidine) 3. Corticosteroids (methylprednisolone)
63
Diagnostic testing for snake bites
1. CBC, electrolytes, creatinine, blood urea nitrogen 2. Serum creatinine kinase - indicative of rhabdo 3. PT and PTT/INR, fibrinogen, UA (rhabdo), EKG
64
_______ prophylaxis should be given for all snake bites
Tetanus
65
Dosing for CroFab
Not weight-based Initial dose is 4-6 vials After 1 hour, determine is initial control has been reached. If yes, 2 vials every 6 hours for 18 hours If no, repeat initial dosing of 4-6 vials
66
Complications of snake bites
Coagulopathy | Compartment Syndrome
67
Indications for intubation in post-drowned patients
1. Inability to protect airway 2. PaO2 < 60 mmHg or O2 saturation < 90% on high-flow O2 3. PaCO2 > 50 mmHg
68
Water-borne pathogens that commonly cause pneumonia in post-drowning survivors
``` Pseudomonas Proteus Pseudallescheria boydii (fungus) ```
69
Pseudallescheria boydii
Fungus found in contaminated water such as floods
70
How does cold diuresis work in a post-drowning survivor?
1. Pt is hypothermic, so blood is shunted to the core 2. Central volume receptors sense fluid overload 3. ADH is decreased 4. Diuresis and hypovolemia occur 5. Body goes into hypotension and shock
71
Symptoms of heat exhaustion
Moist and clammy skin, dilated pupils, normal or subnormal body temperature
72
Symptoms of heat stroke
Dry hot skin, constricted pupils, very high body temperature (>104)
73
Vital signs of a pt undergoing heat stroke
``` Elevated core body temp Tachycardia Tachypnea Widened pulse pressure Hypotension ```
74
Physical exam signs of a patient undergoing heat stroke
``` Flushing Crackles Excessive bleeding Altered mentation Slurred speech ```
75
Management of heat stroke patient
1. ABCs 2. Rapid cooling 3. Intubation often necessary 4. Fluid resuscitation for hypotension
76
Cooling methods for heat stroke patients
Evaporative cooling methods are best (moistened skin with fans across patient) Immersion in ice water is rapid and effective in young patients with exertional heat stroke
77
Rules for collecting urine culture via bladder catheterization in a child
All males < 6 mo and all uncircumcised males < 12 mo | All females < 24 mo and older female children if symptoms of UTI
78
Fever workup in the toxic child (labs)
Rapid testing for viruses CBC (looking for bandemia) Blood cultures, CXR, obtain stool for WBCs and guaiac if diarrhea is present Lumbar puncture
79
4 types of shock
1. Cardiogenic 2. Obstructive 3. Distributive 4. Hypovolemic
80
Clinical manifestations of shock
``` Hypotension Tachycardia Oliguria Mental status changes Cool, clammy, cyanotic, mottled skin Metabolic acidosis ```
81
Shock patients may need as much as ______ L of fluid for resuscitation
4-6
82
Inadequate blood volume to maintain supply of oxygen and nutrients to tissue
Hypovolemic
83
Hypotension unresponsive to fluid resuscitation, metabolic acidosis, encephalopathy, oliguria and coagulation disorders
Distributive or Septic Shock
84
Clinical signs of septic shock
``` Hyperthermia or hypothermia Tachycardia Wide pulse pressure Low blood pressure (SBP < 90) Mental status changes ```
85
Treatment of septic shock
2 large bore IVs - NS bolus 1-2 L wide open Supplemental oxygen Empiric antibiotics: Zosyn and ceftriaxone OR imipenem
86
Treatment for hypotension if no response after 2-3 L IVF
Start a vasopressor (norepinephrine, dopamine)
87
Anaphylactic Shock Treatment
1. ABCs 2. IV, cardiac monitor, pulse ox 3. IVFs, oxygen 4. Epinephrine 5. Second line: corticosteroids, H1/H2 blockers
88
Epi pen dosage
0.3 mg IM of 1:1000 in the thigh | Repeat every 5-10 minutes as needed
89
Occurs after acute spinal cord injury, results in hypotension and bradycardia
Neurogenic shock
90
Neurogenic Shock Treatment
1. ABCs (c-spine precautions) 2. Fluid resuscitation - keep MAP at 85-90 mmHg for first 7 days. If crystalloid is insufficient, use vasopressors 3. For bradycardia, atropine or pacemaker 4. Methylprednisolone - high dose therapy for 23 hours, must be started within 8 hours
91
Treatment for cardiogenic shock due to MI
``` Aspirin Beta blocker Morphine Heparin IV fluids if no pulmonary edema If pulmonary edema: dopamine, dobutamine ```
92
Tx for tension pneumothorax
Needle decompression, chest tube
93
Beck's Triad
Cardiac Tamponade Hypotension Muffled heart sounds JVD
94
Treatment for cardiac tamponade
Pericardiocentesis
95
Imaging for cardiac tamponade
CXR, ECHO
96
Treatment for pulmonary embolism
Heparin, consider thrombolytics
97
Signs of pulmonary embolism
Tachypnea, tachycardia, hypoxia
98
Drug intoxication associated with tachypnea and hyperpnea
Salicylates
99
Drug intoxication associated with large pupils
Anticholinergic or sympathomimetic
100
Drug intoxication associated with small pupils
Cholinergic or opioids (pinpoint)
101
Drug intoxication associated with physiologic stimulation (everything is up)
Sympathomimetics Anticholinergics Stimulants Hallucinogens
102
Drug intoxication associated with physiologic depression
Cholinergic, opioids, sedatives-hypnotics
103
Coma cocktail
Oxygen Thiamine Dextrose Naloxone
104
Toxic dose of acetaminophen
150 mg/kg
105
First NAC dose for APAP overdose
150 mg/kg | If given within 8 hours, hepatotoxicity is uncommon and death is rare
106
Maintenance NAC dose for APAP overdose
50 mg/kg over 4 hours
107
Toxic dose of aspirin (salicylates)
150 mg/kg
108
Lethal dose of aspirin (salicylates)
480 mg/kg
109
Stimulates respiratory drive causing hyperventilation, but limits ATP production, causing metabolic acidosis
Aspirin | Salicylates
110
Treatment for salicylate overdose
No antidote Empiric dextrose, activated charcoal, urinary alkalinization Possible hemodialysis
111
Presents with N/V, tinnitus, diaphoresis, confusion, deafness, tachypnea, vertigo, respiratory alkalosis
Salicylate overdose
112
Fruity breath, ketosis without acidosis, osmolar gap
Alcohol overdose (isopropanol)
113
Causes permanent retinal injury, blindness parkinsonian syndrome
Methanol
114
Treatment for methanol/ethylene glycol overdose
``` Supportive, bicarb for acidosis Benzos for seizures Folic acid, thiamine, magnesium Ca gluconate to correct hypocalcemia Fomepizole 15 mg/kg 10% ethanol in 5% DW IV Hemodialysis ```
115
May cause urine to fluoresce
Ethylene Glycol (Antifreeze)
116
Examples of amphetamines
Ephedrine, bath salts, Ritalin (ADHD treatment)
117
Amphetamine OD Tx
Charcoal Benzos External cooling Monitoring for cerebral edema
118
Opioid Toxicity Tx
Naloxone 0.4-2 mg IV/IM/SC
119
Most common cause of abdominal pain requiring surgery
Acute appendicitis
120
Most common cause of abdominal pain requiring surgery in the elderly patient
Cholecystitis
121
Periumbilical migrating to the RLQ with N/V after onset of pain, anorexia
Appendicitis
122
Preferred imaging for appendicitis
CT scan
123
Preferred imaging for biliary tract disease
Ultrasound
124
Preferred imaging for biliary tract disease
Abdominal X Ray | CT Scan with IV
125
Preferred lab for pancreatitis
Lipase (increased speed and accuracy over amylase)
126
Preferred imaging for pancreatitis
CT Scan
127
Treatment for pancreatitis
Symptom control Bowel rest Admit vs obs vs D/C
128
Preferred imaging of diverticulitis
CT Scan
129
Treatment for diverticulitis
Uncomplicated: ABX and D/C | Septic, co-morbid conditions, abscess, perforation: consult for admission and IV ABX
130
Main causes of ulcer disease
Helicobacter pylori and NSAIDs
131
Treatment for ulcer disease if no concern for perforation
Treatment of symptoms | GI cocktail: PPI, H2 blocker
132
Preferred imaging for ulcer disease (hemorrhage)
Acute abdominal X Ray
133
Management of ulcer disease with hemorrhage
1. Type and cross screen 2. Fluid resuscitation 3. IV PPI bolus and drip 4. NG tube 5. Consultation for admission 6. Broad spectrum antibiotics if concern for perforation
134
Inadequate fixation of testis to tunica vaginalis
Testicular torsion
135
Bell Clapper deformity
Testicular torsion
136
Testicular torsion most commonly occurs after ______________ or ______________
Vigorous activity or | Trauma
137
In testicular torsion, will see a negative __________ reflex and a negative __________ sign on physical exam
Cremasteric Reflex | Prehn's Sign
138
Risk factors for ovarian torsion
Pregnancy Ovulation Ovarian cysts, tumors or masses
139
Preferred imaging for ovarian torsion
Color flow doppler transvaginal ultrasonography
140
Signs and symptoms of ectopic pregnancy
Severe pain, delayed or missed menses, syncope, signs of shock
141
Diagnostics for ectopic pregnancy
Quantitative B-hCG | Pelvic ultrasonography
142
Common diagnoses for dyspnea and wheezing
Asthma COPD Anaphylaxis
143
Common diagnoses for dyspnea and fever
Pneumonia | Pulmonary embolism
144
Common diagnoses for dyspnea and cough
Pneumonia COPD/Asthma Pulmonary embolism Heart failure
145
Common diagnoses for dyspnea and leg edema
Heart failure Pulmonary embolism Acute coronary syndrome
146
Common diagnoses for dyspnea and tachycardia
Pulmonary embolism Tachyarrhythmias Pneumonia Heart failure
147
Common diagnoses for dyspnea and chest pain
Acute coronary syndrome Pulmonary embolism Pneumonia Trauma
148
Treatment for COPD
Supplemental oxygen (90-92%) Bronchodilators Antibiotics Steroids
149
Treatment for asthma (in the ED setting)
1. Supplemental oxygen 2. B2 agonists (albuterol) 3. Anticholinergics (Atrovent) 4. Corticosteroids (within 1 hr of arrival - Prednisone, Solumedrol, Decadron) 5. Magnesium (shown in help in severe asthma)
150
Discharge for asthma patients (home orders)
``` Steroids for at least 5 days All need B2 agonists Pts with mod to severe should measure daily peak flows All patients need close follow up All patients need education about asthma Smoking cessation counseling ```
151
Signs/Symptoms of HF
Respiratory distress, cool/diaphoretic skin, weight gain, peripheral edema Elevated JVD, S3, HTN, rales
152
Treatment of CHF
NTG by sublingual or IV | Lasix-Diuresis starts in 15-20 minutes
153
Primary spontaneous pneumothorax that is < ____% and does not cause respiratory or cardiac symptoms can be safely observed w/o treatment if chest X Rays done at ___ and ____ hours show no progression
20% | 6 and 48 hours
154
Presenting symptoms of a pulmonary embolism
``` Syncope Abdominal pain Fever Cough Dyspnea Wheezing ```
155
Physical exam findings of a pulmonary embolism
``` Tachypnea Rales Accentuated 2nd heart sounds Tachycardia Fever Potentially S3 or S4 ```
156
Common ECG findings with pulmonary embolism
``` Tachycardia Atrial arrhythmias New RBBB Interior Q and/or T wave inversion S1Q3T3 ```
157
Hampton's Hump on CXR
Pulmonary embolism
158
Treatment for hemodynamically stable with pulmonary embolism
LMWH Apixaban, dabigatran, rivaroxaban, edoxaban Warfarin
159
Where are osborne or notched J waves seen?
Hypothermia
160
P waves change shape; <100 beats/min
Wandering pacemaker
161
P waves change shape; >100 beats/min
Multifocal atrial tachycardia
162
Arrhythmia most commonly associated with COPD
Multifocal atrial tachycardia
163
Rapid series of smooth sine waves from a single rapid-firing ventricular focus
Ventricular flutter
164
Large diphasic P with tall initial component
Right atrial hypertrophy
165
Large diphasic P with wide terminal component
Left atrial hypertrophy
166
Large R wave in V1 gets progressively smaller from V2-V3-V4
Right ventricular hypertrophy
167
Large S wave V1 + large R wave in V5 is > 35 mm
Left ventricular hypertrophy
168
Pathologic Q waves indicate:
Necrosis
169
T wave inversion indicates:
Ischemia
170
Treatment for supraventricular tachycardia
Vagal maneuvers Adenosine 6 mg Adenosine 12 mg Defib
171
Treatment for atrial flutter
Diltiazem (CCB)
172
A premature atrial contraction will have a:
Narrow QRS complex
173
A premature ventricular contraction with have a:
Wide QRS complex
174
Treatment for monomorphic ventricular tachycardia without a pulse, and stable with a pulse
W/o pulse: 200 J biphasic shock | W/ pulse and stable: amiodarone
175
Treatment for ACS in ED
1. ASA and oxygen 2. NTG 3. Morphine 4. Heparin 5. B Blockers 6. Statins
176
RRSIDEAD
``` Resuscitation Risk Assessment Supportive Care Investigations Decontamination Enhanced elimination Antidotes Disposition ```
177
5 basic toxidromes
1. Sympathomimetic 2. Opiate 3. Anticholinergic 4. Cholinergic 5. Sedative hypnotics
178
Examples of sympathomimetics
Cocaine, methamphetamine, ecstasy, ADHD meds, ephedrine, caffeine
179
Lethal dose of caffeine
150 mg/kg
180
Sympathomimetic toxidrome
Hyperthermia, diaphoresis, mydriasis, agitation, tachycardia, combativeness, hypertension
181
Caffeine OD Symptoms
Tremor, restlessness, N/V, tachycardia, agitation
182
Caffeine withdrawal symptoms
HA, yawning, drowsiness, nausea, rhinorrhea, lethargy, irritability, nervousness, depression, decreased motivation
183
Death from cocaine OD usually due to
``` Ventricular arrhythmia Status epilepticus Intracranial hemorrhage Hyperthermia Rhabdomyolysis Renal failure Coagulopathy ```
184
Benzoylecgonine, the metabolite of cocaine, is usually present for ______ days
2-10
185
Imaging for cocaine OD
CT of head if suspected hemorrhage | Abdominal x Ray if packing suspected
186
With MDMA, the electrolyte abnormality likely to show on a BMP is:
Hyponatremia
187
Opioid Toxidrome symptoms
``` Miosis Respiratory depression (<12 breaths per minute) CNS depression (coma) ```
188
Treatment for opioid OD
Ventilation - bag valve mask | Naloxone - IV onset 2 min
189
Anticholinergic Toxidrome (7)
``` Hot as Hades - Fever Blind as a bat - mydriasis Full as a tick - urinary retention Dry as a bone - anhidrosis Mad as a hatter - delirium Red as a beet - flushing Fast as a hare - tachycardia ```
190
Examples of anticholinergics
``` Atropine, Pralidoxime Antihistamines (Benadryl) Antipsychotics/neuroleptics (Haldol) Antidepressants (TCA, amitriptyline) Several plant species ```
191
Treatment for anticholinergic toxidrome
Supportive care Benzos for agitation Physostigmine (cholinesterase inhibitor)
192
Differentiation between sympathomimetics and anticholinergics
Sym: agitation, diaphoresis, bowel sounds Anti: dry skin/mucus membranes, flushing, urinary retention, bowel sounds absent
193
Cholinergic Toxidrome (DUMBBBELS)
``` Diarrhea Urinary incontinence Miosis Bradycardia Bronchorrhea Bronchospasm Emesis Lacrimation Sweating, salivation ```
194
This toxidrome gives off a garlic or hydrocarbon odor
Cholinergic (pesticides, etc.)
195
Diagnostic tests for cholinesterase OD
Labs for RBC AChE activity
196
Treatment for cholinesterase OD
1. Decontamination (removal of clothing, irrigation, charcoal, gastric lavage) 2. Atropine 3. 2-PAM 4. Diazepam for seizures 5. Supportive care
197
Examples of sedative hypnotics
Alcohol, valium, ambien
198
Holiday Heart Syndrome
Palpitations, near syncope May have electrolyte abnormalities Need ECHO
199
Wernicke Encephalopathy
Associated with chronic alcohol abuse Thiamine deficiency Treat with high dose IV thiamine, then glucose
200
Four diagnostic criteria for serotonin syndrome
1. Hyperthermia 2. MS changes 3. Autonomic instability 4. Myoclonus, hyperreflexia or rigidity
201
Treatment for serotonin syndrome
1. ABC, supportive care 2. Cyproheptadine 3. Antipyretics, benzos 4. Chlorpromazine
202
Category A Bioterrorism Agents (6)
1. Anthrax 2. Smallpox 3. Pneumonia plague 4. Tularemia 5. Botulism 6. Viral hemorrhagic fevers
203
Bacillus anthracis
Etiologic agent of anthrax
204
Painless skin lesion evolving from papule to a depressed black eschar with local edema
Anthrax (cutaneous exposure)
205
Brief prodrome resembling a viral respiratory illness, followed by development of hypoxia and dyspnea, with mediastinal widening or pleural effusion on CSR
Anthrax (inhaled exposure)
206
Inhalational Anthrax Symptoms
Fever, chills, chest discomfort, SOB, cough, N/V, dizziness, confusion Can lead to anthrax meningitis
207
Treatment for anthrax poisoning
Ciprofloxacin or levofloxacin or moxifloxacin PLUS Clindamycin or linezolid or doxycycline
208
Post exposure prophylaxis for anthrax
Doxycycline and Ciprofloxacin first line
209
Yersinia Pestis
Etiologic agent for the plague
210
4 versions of the plague
1. Bubonic plague 2. Septicemic plague 3. Pneumonic plague 4. Pharyngeal plague
211
First line treatment for pneumonic plague
First line: streptomycin, gentamicin, ciprofloxacin, levofloxacin
212
Variola virus
Etiologic agent of smallpox
213
Common symptoms are diplopia, blurred vision, drooping eyelids, slurred speech, dysphagia, dry mouth and muscle weakness
Botulism
214
Treatment for botulism
1. Skin testing for sensitivity | 2. One vial of antitoxin IV
215
Francisella tularensis
Etiologic agent for tularemia
216
5 forms of tularemia
``` Ulceroglandular Glandular Oculoglandular Oropharyngeal Pneumonic ```
217
Tularemia Treatment
Streptomycin Gentamicin Doxycycline Ciprofloxacin
218
Filoviridae family viruses
Etiologic agent for Ebola and Marburg (viral hemorrhagic fever)
219
Treatment of Ebola/Marburg
Supportive care | Vaccine currently in clinical trials
220
Treatment of sick sinus syndrome
Permanent pacemaker
221
Treatment of premature atrial contractions
No specific treatment, treat underlying disorder
222
Treatment of sinus tachycardia
Treat underlying disorder
223
Treatment of ventricular fibrillation
Electrical defibrillation 360 J monophasic or 120-200 biphasic
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Outcome is best in cardiac arrest
Pulseless ventricular tachycardia
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Outcome is the 2nd best in cardiac arrest
Ventricular fibrillation
226
Most common mechanism for cardiac arrest with most dismal outcome
PEA and asystole
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5 H's and 5 T's of cardiac arrest
``` Hypothermia Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypo/hyperkalemia Tension pneumothorax Tamponade, cardiac Toxins Thrombosis, coronary Thrombosis, pulmonary ```
228
Atropine First Dose
0.5 mg bolus (repeat every 3-5 minutes)
229
Epinephrine Dosing
0.1-0.5 mcg/kg per minute

Emergency Medicine (2 decks)

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