Med Emerg Management Flashcards
NARCOTIC TOXIDROME Drug Examples (7)
Morphine Codeine Heroin Methadone Fentanyl Oxycodone ASA
NARCOTIC TOXIDROME S/S (8)
Hypoventilation Respiratory arrest Constricted pupils Bradycardia Hypotension Track marks Drowsy/Stupor Coma
SYMPATHOMIMETIC Drug Examples (7)
Pseudoephedrine Amphetamine Meth Cocaine Caffeine Nasal decongestants Bath salts
SYMPATHOMIMETIC S/S (9)
HTN Diaphoresis Tachycardia Tachypnea Dilated pupils Agitation Seizure Hyperthermia Paranoia
SEDATIVE HYPNOTIC Drug Examples (6)
Phenobarbital Diazepam Versed Lorazepam Propofol Ethanol
SEDATIVE HYPNOTIC S/S (9)
Hypoventilation Respiratory arrest/depression Drowsy Uninhibited Ataxia Slurred Speech Confusion Progressive CNS depression Hypotension
CHOLINERGIC Drug Examples (3)
Organophosphates
Sarin
V agent
CHOLINERGIC S/S- DUMBELS
Diarrhea Urination Miosis (constricted pupils)/Muscle Weakness Bradycardia/Bronchospasm Emesis Lacrimation Seizures/Salivation/Seating
Respiratory depression
ANTICHOLINERGIC Drug Examples (6)
Atropine Antihistamines Benadryl Tricyclic AntiDepressants AntiPsychotics Jimson weed
ANTICHOLINERGIC S/S (9)
Agitation Dry mucous membranes Flushed Hyperthermia Tachycardia Dilated pupils Blurred vision Mild hallucinations Delerium
Cranial Nerve 1
Olfactory- Smell
Cranial Nerve 2
Optic- Vision
Cranial Nerve 3
Oculomotor- Movement of Eye/Pupil
Cranial Nerve 4
Trochlear- Movement of eye
Cranial Nerve 5
Trigeminal- Chewing/Px/Temp/Touch of face and mouth
Cranial Nerve 6
Abducens- movement of eye
Cranial Nerve 7
Facial- tears/salivation/taste/movement of face
Cranial Nerve 8
Auditory- hearing and balance
Cranial Nerve 9
Glossopharyngeal- swallow, taste, sensation of pharynx and mouth
Cranial Nerve 10
Vagus- sensation and movement of pharynx/larynx/thorax/GI
Cranial Nerve 11
Accessory- Movement of head/shoulders
Cranial Nerve 12
Hypoglossal- movement of tongue
Cushings Triad
Decreased HR
Decreased Respiratory rate
Widened pulse pressures (systolic)
Hallmarks of Increased ICP (5)
Cushing triad Decorticate/decerebate posturing Biot/Apneustic/Cheyne Stokes Respirations Unresponsive Dilated Pupils
Standard Neuro Tx Plan
Scene Safety ABC's Check blood glucose Consider stroke eval Assess for ICP Check for drug use Assess for seizures Evaluate temp Provide support for family
Tx Plan for Pt with increased ICP
Ensure BP of 110-120 Give fluids as needed Elevate head by 30 degrees if no trauma Support ventilation Maintain EtCO2 high 20's and low 30's Clear Airway
Do not aggressively suction–>vagus nerve stimulation increases ICP
If bradycardia due to increased ICP, no atropine or TCP is indicated
Prompt txp
DO NOT use solutions with dextrose
Normal Cerebral perfusion pressure
70-90
Hemorrhagic stroke S/S
Severe HA- worst ever
difficult to arouse
s/s increased ICP
cannot speak
Normal ICP
1-20
CPP Equation
CPP= MAP-ICP
A-EIOUTIPS (2)
Alcohol- 02, glucose, temp, thiamine
Acidosis- bicarb
AE-IOUTIPS (3)
Epilepsy- 02, versed
Endocrine- supportive
Electrolytes- EKG, ABC’s
AEI-OUTIPS
Insulin- dextrose, glucagon
AEIO-UTIPS
Opiates- narcan, ABCs
Other drugs
AEIOU-TIPS
Uremia (kidney failure)- 02, glucose, temp
AEIOUT-IPS
Trauma- c spine, adequate BP
Temperature- cool or warm pt
AEIOUTI-PS
Infection- ensure adequate BP
AEIOUTIP-S
Poisoning- care based on agent
Psychogenic causes- 02, glucose, temp, restraints
AEIOUTIPS-
Shock- ABC’s and adequate circulation/vasopressors
Stroke- 02, glucose, temp, ABC’s
Syncope- ABC’s, EKG, trauma if fell
Space occupying lesion- tx seizure or stroke
Subarachnoid hemorrhage- tx seizure or stroke
ALOC Medical Rapid Onset
Insulin Stroke Epilepsy ETOH OD
ALOC Medical Gradual Onset
Acidosis Uremia Psychosis Infection OD
ALOC Trauma
Head injury
Hypotension
Seizure types
Tonic clonic
Pseudoseizures
Absence seizures
Partial seizures- either shaking of one limb, or subtle changes in LOC
Seizure tx
ABC's Protect from injury If still seizing, give Versed/Ativan Check blood glucose Give 02- consider NPA and high flow 02
Cardiac causes of Syncope (10)
Bradycardia Sick Sinus SVT Pacemaker malfunction TdP Transient Asystole Transient VF VT MI Medication problem
NonCardiac Causes of Syncope (5)
Dehydration Hypoglycemia Vasovagal PE Other medications
Syncope tx
ABC's Sit/Lay down if needed Orthostatics Drugs/ETOH EKG Blood glucose check
Consider fluids or vasopressor
Migraine tx
Consider px management
Zofran 4mg
Dystonia tx
Benadryl 25-50mg
Encephalitis s/s (8)
Fever HA N/V Malaise ALOC Stiff neck Photophobia Seizure
Meningitis S/S
Runny nose
Cough
Malaise
HA Fever Neck rigidity Chills Photophobia N/V Seizure ALOC Inc ICP
Kernig sign-px with hips flexed and straightening knee
Brudzinski sign- px when neck flexed to chest while lying down
Polio Tx
Watch Airway and Breathing
Brain Abscess consideration
watch for seizures
S/S Hemorrhagic Stroke
decreased HR Cheyne Stokes breathing HTN Unequal pupils posturing
Target EtCO2 for Stroke Pt
30-35
Multiple Sclerosis
Autoimmune disorder–> body attacks myelin sheath surrounding the axons of neurons. Causes scarring and decreased neural function.
Multiple Sclerosis S/S
Muscle weakness
Speech changes
depression
light touch causing px
Guillan Barre Tx
Largely supportive–> may need to be aggressive with intubation, ventilation, and fluid infusion
ALS
attacks motor neurons causing death and thereby muscle atrophy
ALS (Lou Gehrigs) Tx
May need aggressive airway intervention
Graves Disease
Hyperthyroidism
Risk of thyroid storm
Thyroid storm s/s
extreme high fever diaphoresis tachycardia N/V agitated delerium seizures unconscious hypoglycemia
Thyroid storm tx
tx hypoglycemia if needed may require very high benzo amounts aggressive fluids if normo-hypotensive beta blocker medication if tachycardic active cooling
Hypothyroidism/Myxedema coma
Occurs when ALOC, and hypothermic
Myxedema coma tx
maintain 02
maintain temp/passive rewarming
intubation if no gag reflex or inadequate breathing
monitor ECG and blood glucose
Adrenal insufficiency s/s
ALOC hypotension weakness weakness N/V diarrhea
Adrenal insufficiency tx
aggressive fluid management
treat hypoglycemia if present
treat hyperkalemia if present
Cushings s/s
weakness fatigue depression mood swings buffalo hump facial hair moon face
Cushing tx
treat symptoms
treat hypoglycemia if present
Congenital adrenal hyperplasia
inadequate production of cortisol and aldosterone
Extreme episode in Type I Diabetes
Diabetic ketoacidosis
Extreme episode in Type II Diabetes
Hyperosmolar Hyperglycemic State
–> or Hyperosmolar hyperglycemic nonketotic coma, hyperosmolar nonketotic coma
Hypoglycemia tx
25g-50g D50 and flush
250mL D10 soln
Hyperglycemia tx
at least 1L NS in first 30mins
evaluate lung sounds
watch cardiac function
watch for hyperkalemia—> calcium chloride 1g
Anaphylaxis tx
remove offending agent cardiac monitoring 0.3mg 1:1000 epi IM at least 1 large bore IV fluid run wide open benadryl 25-50mg solumedrol 125mg
consider albuterol neb if wheezing, or epi neb 3mg 1:000
if pt’s on beta blocker, consider glucagon IVP q 5mins
may need epi infusion —> 1mg 1:1000 epi in 1L NS and run mix at 0.1mcg/kg/min
or push dose epi —> 0.1mg in 0.9mL NS
Systemic Lupus Erythematosus
multisystem autoimmune disorder effecting whole body
common in women in child bearing age with joint pain, fever, rash
Pneumonia S/S
Fever
Chills
productive cough- colored
chest px
Hepatitis S/S
jaundice
low grade fever
malaise
grey feces
Lyme S/S
bulls eye mark
fever
chills
muscle and joint px
Rabies S/S
flu like symptoms numb bite seizures hyperactive delerium bizarre behavior
Anticholinergic Phrase
Blind as a bat- dilated pupils Red as a beet- vasodilation/flushed Hot as a hare- hyperthermia Dry as a bone- dry skin Mad as a hatter- hallucinations/agitated
CO poisoning S/S
N/V Confusion HA Weakness Cherry red face **usually unsurvivable at this point
**check blood sugar to be sure not hypoglycemic
Cyanide poisoning S/S
Lethargy
weakness
breathing will be rapid–>to slow–>arrest
bitter almond smell
Cyanide poisoning tx
Use of antidote
Benzos for seizures
**rapid transport
Esophageal Varices S/S
copious hematemesis
due to portal HTN from EtOH
Esophageal Varices Tx
02
Saline lock
Fluid if hypotensive
**Zofran usually doesn’t work
Mallory Weiss Tx
Bleeding less severe than varices Common from protracted vomiting O2 IV access Fluids for dehydration Zofran to limit vomiting
Appendicitis S/S
Fever
N/V
LRQ px
rebound tenderness
Appendicitis Tx
Position of comfort
IV
Fluids if shock present
Cholecystitis S/S
jaundice
px after eating fatty meal
N/V
RUQ px
Cholecystitis Tx
morphine makes px worse- tightens sphincter
Diverticulitis S/S
n/v Fever malaise LLQ px **easy to turn septic **be prepared for lots of fluids
RAAS
renin (kidney) converts angiotensinogen (liver)–> angiotensin I which is converted by ACE in lungs to angtiotensin II
angtiotensin II promotes release of aldosterone in adrenals—>promotes water retention to increase BP
Dialysis emergencies
Air Embolism
Disequilibrium syndrome
HypoK/HyperK
Hypotension/Shock
Disequilibrium syndrome
Acute haemodialysis is associated with this syndrome due to the reduction of plasma solute level over a limited time. Plasma becomes hypotonic compared to brain cells and water shifts from the plasma into the brain tissue
Systemic and neurological symptoms are associated with disequilibrium syndrome.
Early signs include nausea, headache, vomiting, and restlessness. More serious symptoms can result in seizures and coma.
Heat Stroke Tx
Cool aggressively
Fluids
Cardiac montior
IV
Heat exhaustion Tx
Cool Cardiac monitor IV Fluids 1L over 1 hour Zofran is N/V
Mild Hypothermia
95-90 degrees
Mild Hypothermia tx
remove wet clothes warm warmed fluids cardiac monitor treat hypoglycemia if present **check!! manage seizures IV
Moderate Hypothermia
90-82.4 degrees
Moderate Hypothermia Tx
remove wet clothes warm warm fluids/IV cardiac monitor check hypoglycemia watch for bradycardic rhythms
Severe Hypothermia
82.3 and under
Severe hypothermia Tx
remove wet clothes warm warm fluids and IV cardiac monitor expect V Tach and no pulse CPR until warm and dead
Cold water drowning temps
under 68 degrees
Drowning tx
watch for pulmonary edema EtCO2 SpO2 EKG Albuterol for wheezing be prepared to intubate
Snake bite- pit viper and coral snake
pit viper- immobilize extremity and rapid txp
coral snake- constricting band to slow spread. be prepared to aggressively manage airway
Spider bite tx
benzos for px and paralysis
narcotics for px
Scorpion tx
ABCs intubate if necessary treat cardiac dysrhythmias constricting band to slow lymph return to heart rapid tx
DT S/S
high BP shakes chills irregular HR hallucinations sweating
