Master the Boards Step 3 Flashcards
When can gastric emptying be used in the setting of toxic ingestion
Only in the first 1 hr after ingestion. Rarely the right answer, because you can rarely guarantee that it has been 1 hr or less.
-50% of pills can be removed in this time
**NEVER use w/ caustic ingestion
When is intubation and lavage used in the setting of toxic ingestion
Rarely
In first 1-2 hrs post ingestion, if patient does not respond to naloxone, thiamine, and dextrose and substance is not caustic
What is the antidote for acetaminophen toxicity
N-acetylcysteine
Also give charcoal
What is the antidote for aspirin toxicity
Bicarbonate to alkalinize the urine
What is the antidote for carbon monoxide toxicity
100% oxygen, hyperbaric if needed
What is the antidote for digoxin toxicity
digoxin binding antibodies
What is the antidote for ethylene glycol toxicity
Fomepizole or ethanol
What is the antidote for methanol toxicity
Fomepizole or ethanol
What is the antidote for Methemoglobinemia
methylene blue
What is the antidote for neuroleptic malignant syndrome
Bromocriptine or dantrolene
What is the antidote for opiates
Naloxone
What is the antidote for Organophosphate toxicity
atropine, pralidoxime
What is given in triclycic antidepressant (TCA) toxicity
Bicarbonate to protect the heart
What is the general presentation of acetaminophen toxicity
First 24 hr: nausea and vomiting
48-72 hrs: hepatic failure
with history of ingestion
When to give N-acetylcysteine for acetaminophen toxicity
Within first 24 hrs, after 24 hrs there is no specific treatment for toxicity
What are the findings associated with aspirin (salicylate) toxicity
-HYPERVENTILATION
-ARDS
-tinnitus
-AG Metabolic acidosis
-Respiratory alkalosis
-Renal insufficiency
-Elevated PT
-Altered mental status
-Fever
What diagnositic tests should be ordered in suspected aspirin (salicylate) toxicity
-CBC
-Chem panel
-ABG
-PT/PTT/INR
-Salicylate (ASA) level
What is the initial treatment for aspirin toxicity
-D5W + 3 amps Bicarbonate to alkalinize the urine & increase excretion
-Charcoal to block absorption (1st hr only)
-Dialysis in severe cases
Alkalinization of the urine with Bicarbonate faciliates excretion of which toxins
ASA (salicylates)
TCAs (tricyclic antidrepressants)
Phenobarbital
Chlorpropamide
What is the acute managment for benzodiazepine overdose
Monitor and test for co-ingestion with ASA, acetaminphen, and ETOH
Toxic effect often self-resolves
What is the most common cause of death associated with fires
Carbon monoxide poisoning (60% of deaths in first 24 hrs)
What are the symptoms of carbon monoxide poisoning
-SOB
-lightheadedness/Headaches
-Disorientation
-metabolic acidosis in severe cases from tissue hypoxia
What is the best initial test for diagnosing pulmonary hypertension
Echocardiography (noninvasive)
Cough, coryza, conjunctivitis, and Koplik spots are most commonly associated with ________
Measles
Of the MMR infections, _____ can cause orchitis and subsequent infertility
Mumps
Of the MMR infections, _______ is most commonly associated with parotitis
Mumps
What is the mechanism of SGLT2 inhibitors
Blocking renal uptake of glucose resulting in urinary excretion of glucose
Sulfonylureas are associated with weight ______ (gain/loss)
Gain
How many oz of formula does a baby need to take to not need vitamin D supplementation
34 oz or 1 liter of formula probably has 400 IU of vitamin D. Anything less and baby needs supplementation. *all babies in Alaska need supplementation (800 IU daily total goal)
Should be started within first 2 months of life
