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EM Exam 2 > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

A patient presents with a rapid onset rash after eating fish with associated perioral burning/itching and chest tightness. He notes the fish tasted “peppery” and “spicy”. What is the likely diagnosis?

A

Scombroid poisoning

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2
Q

What is the best treatment for scombroid poisoning?

A

H1 and H2 blockers

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3
Q

Anaphylaxis is usually _____ mediated

A

IgE

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4
Q

What is the diagnostic criteria for Anaphylaxis?

A
  • acute onset of an illness involving skin and mucosal tissue
  • AND respiratory compromise
  • OR hypotension
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5
Q

What is the immediate treatment for anaphylaxis? (4 part)

A
  1. Check ABCs
  2. remove the inciting antigen, if possible
  3. epinephrine IM 1 mg/mL repeat 5 to 15 min as needed
  4. add on H1/H2 antihistamines, glucocorticoids, bronchodilators (if respiratory Sx)
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6
Q

What is the most deadly trigger of anaphylaxis?

A
  1. medications
  2. stings
  3. food (in pediatrics #1)
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7
Q

What is biphasic anaphylaxis?

A

recurrence within 12 hours but up to 72 hours after initial anaphylactic event

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8
Q

What is delayed anaphylaxis?

A

onset of anaphylactic event hours later

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9
Q

What are the 5 types of anaphylaxis?

A
  • uniphasic
  • biphasic
  • delayed
  • idiopathic
  • exercise induced
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10
Q

What are the discharge medications for a patient with anaphylaxis? (3 part)

A
  • prednisone
  • H1/H2 blockers
  • EpiPen (0.3 mg)
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11
Q

What blood pressure control medication can result in angioedema?

A

ACE inhibitors

not associated with an IgE mediated response

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12
Q

What is the appropriate management for large local reaction d/t a sting? (3 part)

A
  • cold compress, elevation, antihistamines
  • steroids if severe swelling
  • antibiotics if worse after 3-5 days
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13
Q

What is the most common cause of syncope?

A

vasovagal

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14
Q

In a patient with vasovagal, what are 4 red flags on history that should warrant further workup?

A
  • exertional
  • unheralded
  • associated symptoms (headache, chest pain, abdominal pain)
  • family history of SCD
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15
Q

What are the 2 most common causes of syncope?

A
  • neurocardiogenic (vasovagal)

- orthostasis

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16
Q

What are the 5 can’t miss causes of syncope?

A
  • medications (meds that prolong QT)
  • cardiac = arrhythmias
  • hemorrhage
  • pulmonary = PE
  • neurologic
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17
Q

If a patient presents with exertional syncope what 2 things should you worry about?

A
  • Hypertrophic cardiomyopathy

- Aortic stenosis

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18
Q

A pregnant patient who presents with syncope should have you concerned for this diagnosis unless proven otherwise.

A

ectopic pregnancy

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19
Q

What does unheralded syncope mean and what is it concerning for?

A
  • syncope while at rest

- concerning for arrhythmia

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20
Q

In a healthy patient who presents with syncope they should always get these 3 things for a work-up.

A
  • EKG
  • basic labs
  • HCG
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21
Q

What 2 findings on an ECG in a young patient should have you concerned for LVH? (independent of each other)

A
  • Q waves

- TWI inversion

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22
Q

What 2 findings on an ECG are concerning for WPW?

A
  • short PR interval

- delta wave

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23
Q

A QTc of > ______ is a red flag.

A

> 500

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24
Q

What are the classic medications that cause a prolonged QTc?

A
  • antidepressants

- antibiotics

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25
Q

ST elevation in V1/V2 or “saddle back” ST-T wave configuration in a young patient is concerning for what syndrome?

A

Brugada syndrome

26
Q

An epsilon wave on ECG in a young patient is concerning for what?

A

arrhtyhmogenic RV dysplasia (ARVD)

27
Q

What are the 3 indications to section someone?

A
  • unable to care for themselves
  • risk of harming themselves
  • risk of harming others
28
Q

What are 4 important HPI questions for psychiatric patients?

A
  • suicide risk?
  • homicide risk?
  • auditory hallucinations?
  • visual hallucinations?
29
Q

How are psychiatric patients managed in the ED? (4 part)

A
  • consult psychiatry
  • section 12 as indicated
  • ensure safety
  • offer patients medication early
30
Q

What are the 2 methods of restraint?

A
  • Chemical (5 mg Haldol /2 mg Ativan +/- Benadryl)

- Physical

31
Q

Why do you need to get an ECG before administering Haldol?

A

Haldol causes QT prolongation

32
Q

A 40-year-old farmer is evaluated for feeling unwell after a day of working outside with crops. Her vital signs are T 98.4 HR 58 BP 136/70 RR 20 O2 95%. On exam, she is tearful and diaphoretic, with frothing at the mouth. She has constricted pupils. What is the most likely toxidrome?

A

Cholinergic

33
Q

What is the word for a small vs. big pupil?

A
  • small pupil = myosis

- big pupil = mydriasis

34
Q

What type of tox screen would you order for alcohol?

A

serum tox screen

35
Q

What is the mainstay of treatment for OD patients?

A

supportive care

“treat the patient, not the poison”

36
Q

What is the time limit for using activated charcoal?

A

<1 hour

patient cannot be aspirating

37
Q

Benzodiazepines is a common cause of what overdose?

A

sedative-hypnotic toxidrome

38
Q

Quaaludes was originally made to treat what disease?

A

malaria

39
Q

Why is flumazenil never used for benzo overdose?

A

reversing benzos can induce a seizure

40
Q

What are the 4 sign/symptoms of opioid toxidrome?

A
  • miosis
  • respiratory depression
  • AMS
  • decreased bowel sounds
41
Q

What is the indication for giving Narcan?

A
  • RR < 10 or hypoxia
42
Q

What are 4 common causes of cholinergic toxidrome?

A
  • organophosphates
  • carbamates
  • nicotine
  • nerve agents
43
Q

Cholinergic toxidrome is caused by binding of what enzyme?

A

acetylcholinesterase

44
Q

What is the presentation of cholinergic toxidrome? (SLUDGE)

A
  • salivation
  • lacrimation
  • urination
  • diarrhea
  • GI distress
  • emesis
45
Q

Cholinergic toxidrome can progress to _________.

A

seizures

46
Q

Treatment of cholinergic toxidrome consist of these 5 things.

A
  • protect yourself!
  • decontamination
  • ABCs
  • poison control
  • Valium to prevent seizures
47
Q

What are the 2 antidotes for cholinergic toxidromes?

A
  • Atropine
  • Pralidoxime (for nerve gas exposure)

give both

48
Q

Pralidoxime works against nerve gas exposure by reactivating acetylcholinesterase at both the _________ and _________ receptors.

A
  • nicotinic and muscarinic receptors
49
Q

Atropine only competes with acetylcholine at which receptors?

A

muscarinic receptors

50
Q

What are 4 common medications that result in anti-cholinergic toxidromes?

A
  • antihistamines, cough and cold meds
  • antipsychotics
  • antispasmodics
  • antidepressants
51
Q

What are the 3 vital signs concerning for anti-cholinergic toxidromes?

A
  • hyperthermia
  • tachycardia
  • hypertension
52
Q

What is the most important clinical sign concerning for anti-cholinergic toxidrome?

A

dry skin (anhidrosis)

53
Q

What is the antidote for anti-cholinergic toxidromes?

A
  • physostigmine

* acetylcholinesterase inhibitor (Carbamate)

54
Q

What is the most common cause of sympathomimetic toxidrome?

A

cocaine

55
Q

A patient presents with mydriasis, diaphoretic, and agitated. On physical exam you notice bruxism and hyperactive bowel sounds. What is the most likely toxidrome?

A

sympathomimetic toxidrome

56
Q

What is the antidote for sympathomimetic toxidrome?

A

Trick question - No antidote!

can give benzos to control agitation

57
Q

What is the main difference between anti-cholinergic and sympathomimetics?

A
  • anti-cholinergic = DRY skin

- sympathomimetics = diaphoretic

58
Q

What is the main difference between sedative-hypnotics and opiates?

A
  • sedative-hypnotics = variable pupils

- opiates = pinpoint pupils

59
Q

What is the correct dose for epinephrine IM in the setting of anaphylaxis?

A

1mg/mL, 1:1,000

60
Q

The “coma cocktail” involves these 3 things.

A
  • narcan
  • dextrose
  • thiamine

EM Exam 2 (5 decks)

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