Miscellaneous Flashcards
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?
Scombroid poisoning
What is the best treatment for scombroid poisoning?
H1 and H2 blockers
Anaphylaxis is usually _____ mediated
IgE
What is the diagnostic criteria for Anaphylaxis?
- acute onset of an illness involving skin and mucosal tissue
- AND respiratory compromise
- OR hypotension
What is the immediate treatment for anaphylaxis? (4 part)
- Check ABCs
- remove the inciting antigen, if possible
- epinephrine IM 1 mg/mL repeat 5 to 15 min as needed
- add on H1/H2 antihistamines, glucocorticoids, bronchodilators (if respiratory Sx)
What is the most deadly trigger of anaphylaxis?
- medications
- stings
- food (in pediatrics #1)
What is biphasic anaphylaxis?
recurrence within 12 hours but up to 72 hours after initial anaphylactic event
What is delayed anaphylaxis?
onset of anaphylactic event hours later
What are the 5 types of anaphylaxis?
- uniphasic
- biphasic
- delayed
- idiopathic
- exercise induced
What are the discharge medications for a patient with anaphylaxis? (3 part)
- prednisone
- H1/H2 blockers
- EpiPen (0.3 mg)
What blood pressure control medication can result in angioedema?
ACE inhibitors
not associated with an IgE mediated response
What is the appropriate management for large local reaction d/t a sting? (3 part)
- cold compress, elevation, antihistamines
- steroids if severe swelling
- antibiotics if worse after 3-5 days
What is the most common cause of syncope?
vasovagal
In a patient with vasovagal, what are 4 red flags on history that should warrant further workup?
- exertional
- unheralded
- associated symptoms (headache, chest pain, abdominal pain)
- family history of SCD
What are the 2 most common causes of syncope?
- neurocardiogenic (vasovagal)
- orthostasis
What are the 5 can’t miss causes of syncope?
- medications (meds that prolong QT)
- cardiac = arrhythmias
- hemorrhage
- pulmonary = PE
- neurologic
If a patient presents with exertional syncope what 2 things should you worry about?
- Hypertrophic cardiomyopathy
- Aortic stenosis
A pregnant patient who presents with syncope should have you concerned for this diagnosis unless proven otherwise.
ectopic pregnancy
What does unheralded syncope mean and what is it concerning for?
- syncope while at rest
- concerning for arrhythmia
In a healthy patient who presents with syncope they should always get these 3 things for a work-up.
- EKG
- basic labs
- HCG
What 2 findings on an ECG in a young patient should have you concerned for LVH? (independent of each other)
- Q waves
- TWI inversion
What 2 findings on an ECG are concerning for WPW?
- short PR interval
- delta wave
A QTc of > ______ is a red flag.
> 500
What are the classic medications that cause a prolonged QTc?
- antidepressants
- antibiotics
ST elevation in V1/V2 or “saddle back” ST-T wave configuration in a young patient is concerning for what syndrome?
Brugada syndrome
An epsilon wave on ECG in a young patient is concerning for what?
arrhtyhmogenic RV dysplasia (ARVD)
What are the 3 indications to section someone?
- unable to care for themselves
- risk of harming themselves
- risk of harming others
What are 4 important HPI questions for psychiatric patients?
- suicide risk?
- homicide risk?
- auditory hallucinations?
- visual hallucinations?
How are psychiatric patients managed in the ED? (4 part)
- consult psychiatry
- section 12 as indicated
- ensure safety
- offer patients medication early
What are the 2 methods of restraint?
- Chemical (5 mg Haldol /2 mg Ativan +/- Benadryl)
- Physical
Why do you need to get an ECG before administering Haldol?
Haldol causes QT prolongation
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?
Cholinergic
What is the word for a small vs. big pupil?
- small pupil = myosis
- big pupil = mydriasis
What type of tox screen would you order for alcohol?
serum tox screen
What is the mainstay of treatment for OD patients?
supportive care
“treat the patient, not the poison”
What is the time limit for using activated charcoal?
<1 hour
patient cannot be aspirating
Benzodiazepines is a common cause of what overdose?
sedative-hypnotic toxidrome
Quaaludes was originally made to treat what disease?
malaria
Why is flumazenil never used for benzo overdose?
reversing benzos can induce a seizure
What are the 4 sign/symptoms of opioid toxidrome?
- miosis
- respiratory depression
- AMS
- decreased bowel sounds
What is the indication for giving Narcan?
- RR < 10 or hypoxia
What are 4 common causes of cholinergic toxidrome?
- organophosphates
- carbamates
- nicotine
- nerve agents
Cholinergic toxidrome is caused by binding of what enzyme?
acetylcholinesterase
What is the presentation of cholinergic toxidrome? (SLUDGE)
- salivation
- lacrimation
- urination
- diarrhea
- GI distress
- emesis
Cholinergic toxidrome can progress to _________.
seizures
Treatment of cholinergic toxidrome consist of these 5 things.
- protect yourself!
- decontamination
- ABCs
- poison control
- Valium to prevent seizures
What are the 2 antidotes for cholinergic toxidromes?
- Atropine
- Pralidoxime (for nerve gas exposure)
give both
Pralidoxime works against nerve gas exposure by reactivating acetylcholinesterase at both the _________ and _________ receptors.
- nicotinic and muscarinic receptors
Atropine only competes with acetylcholine at which receptors?
muscarinic receptors
What are 4 common medications that result in anti-cholinergic toxidromes?
- antihistamines, cough and cold meds
- antipsychotics
- antispasmodics
- antidepressants
What are the 3 vital signs concerning for anti-cholinergic toxidromes?
- hyperthermia
- tachycardia
- hypertension
What is the most important clinical sign concerning for anti-cholinergic toxidrome?
dry skin (anhidrosis)
What is the antidote for anti-cholinergic toxidromes?
- physostigmine
* acetylcholinesterase inhibitor (Carbamate)
What is the most common cause of sympathomimetic toxidrome?
cocaine
A patient presents with mydriasis, diaphoretic, and agitated. On physical exam you notice bruxism and hyperactive bowel sounds. What is the most likely toxidrome?
sympathomimetic toxidrome
What is the antidote for sympathomimetic toxidrome?
Trick question - No antidote!
can give benzos to control agitation
What is the main difference between anti-cholinergic and sympathomimetics?
- anti-cholinergic = DRY skin
- sympathomimetics = diaphoretic
What is the main difference between sedative-hypnotics and opiates?
- sedative-hypnotics = variable pupils
- opiates = pinpoint pupils
What is the correct dose for epinephrine IM in the setting of anaphylaxis?
1mg/mL, 1:1,000
The “coma cocktail” involves these 3 things.
- narcan
- dextrose
- thiamine
