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EM Exam 2 > Miscellaneous > Flashcards

Miscellaneous Flashcards

(60 cards)

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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
ST elevation in V1/V2 or "saddle back" ST-T wave configuration in a young patient is concerning for what syndrome?
Brugada syndrome
26
An epsilon wave on ECG in a young patient is concerning for what?
arrhtyhmogenic RV dysplasia (ARVD)
27
What are the 3 indications to section someone?
- unable to care for themselves - risk of harming themselves - risk of harming others
28
What are 4 important HPI questions for psychiatric patients?
- suicide risk? - homicide risk? - auditory hallucinations? - visual hallucinations?
29
How are psychiatric patients managed in the ED? (4 part)
- consult psychiatry - section 12 as indicated - ensure safety - offer patients medication early
30
What are the 2 methods of restraint?
- Chemical (5 mg Haldol /2 mg Ativan +/- Benadryl) | - Physical
31
Why do you need to get an ECG before administering Haldol?
Haldol causes QT prolongation
32
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
33
What is the word for a small vs. big pupil?
- small pupil = myosis | - big pupil = mydriasis
34
What type of tox screen would you order for alcohol?
serum tox screen
35
What is the mainstay of treatment for OD patients?
supportive care "treat the patient, not the poison"
36
What is the time limit for using activated charcoal?
<1 hour *patient cannot be aspirating*
37
Benzodiazepines is a common cause of what overdose?
sedative-hypnotic toxidrome
38
Quaaludes was originally made to treat what disease?
malaria
39
Why is flumazenil never used for benzo overdose?
reversing benzos can induce a seizure
40
What are the 4 sign/symptoms of opioid toxidrome?
- miosis - respiratory depression - AMS - decreased bowel sounds
41
What is the indication for giving Narcan?
- RR < 10 or hypoxia
42
What are 4 common causes of cholinergic toxidrome?
- organophosphates - carbamates - nicotine - nerve agents
43
Cholinergic toxidrome is caused by binding of what enzyme?
acetylcholinesterase
44
What is the presentation of cholinergic toxidrome? (SLUDGE)
- salivation - lacrimation - urination - diarrhea - GI distress - emesis
45
Cholinergic toxidrome can progress to _________.
seizures
46
Treatment of cholinergic toxidrome consist of these 5 things.
- protect yourself! - decontamination - ABCs - poison control - Valium to prevent seizures
47
What are the 2 antidotes for cholinergic toxidromes?
- Atropine - Pralidoxime (for nerve gas exposure) *give both*
48
Pralidoxime works against nerve gas exposure by reactivating acetylcholinesterase at both the _________ and _________ receptors.
- nicotinic and muscarinic receptors
49
Atropine only competes with acetylcholine at which receptors?
muscarinic receptors
50
What are 4 common medications that result in anti-cholinergic toxidromes?
- antihistamines, cough and cold meds - antipsychotics - antispasmodics - antidepressants
51
What are the 3 vital signs concerning for anti-cholinergic toxidromes?
- hyperthermia - tachycardia - hypertension
52
What is the most important clinical sign concerning for anti-cholinergic toxidrome?
dry skin (anhidrosis)
53
What is the antidote for anti-cholinergic toxidromes?
- physostigmine | * acetylcholinesterase inhibitor (Carbamate)
54
What is the most common cause of sympathomimetic toxidrome?
cocaine
55
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
56
What is the antidote for sympathomimetic toxidrome?
Trick question - No antidote! can give benzos to control agitation
57
What is the main difference between anti-cholinergic and sympathomimetics?
- anti-cholinergic = DRY skin | - sympathomimetics = diaphoretic
58
What is the main difference between sedative-hypnotics and opiates?
- sedative-hypnotics = variable pupils | - opiates = pinpoint pupils
59
What is the correct dose for epinephrine IM in the setting of anaphylaxis?
1mg/mL, 1:1,000
60
The "coma cocktail" involves these 3 things.
- narcan - dextrose - thiamine

EM Exam 2 (5 decks)

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