[MS] Emergency Care

Question 1

What is the initial management for patients who present with poisonings?

Answer 1

ABCDs

Question 2

What are the poisonings associated with pinpoint pupils?

Answer 2

Cholinergics/Clonidine
Opiates/Organophosphates
Phencyclidine
Sedatives

Question 3

What are the poisonings associated with dilated pupils?

Answer 3

Anticholinergics
Antihistamines
Antidepressants
Amphetamine (Cocaine)

Question 4

What poisonings cause diaphoresis?

Answer 4

Sympathomimetics
Organophosphates
Aspirin (Salicylates)
PCP

Question 5

What poisonings cause the skin to appear red?

Answer 5

Carbon Monoxide

Boric Acid

Question 6

What poisonings typically cause blue-colored skin?

Answer 6

Cyanide

Question 7

What is the regimen for giving activated charcoal to a poisoned patient?

Answer 7

Use within the first hour at the dose of 1gm/kg (MAX: 50-100gm)

Question 8

In what ingestion situations is activated charcoal ineffective or contraindicated?

Answer 8

Caustic agents, hydrocarbons, electrolytes, metals, cyanide, alcohols, lithium, camphor, and phosphorous

Question 9

What are the symptoms associated with salicylate poisoning?

Answer 9

Abdominal pain, nausea, vomiting, tachypnea, tinnitus, vertigo, agitation, confusion, coma

Question 10

What kinds of ingestions should concern someone for salicylate poisoning?

Answer 10

OTC Cold Medicine, Antidiarrheal Medicine, and Topical Analgesics

Question 11

What is the metabolic derrangement seen in salicylate poisoning?

Answer 11

pH - normal to high
pCO2 - low
HOC3 - low

Question 12

What medication enhances salicylate clearance?

Answer 12

IV Sodium Bicarbonate to alkalinize the urine

Question 13

What are the effects seen in tricyclic antidepressant medication overdose?

Answer 13

Coma, Seizures, Widened QRS, and Prolonged QT

Question 14

What is the treatment for tricyclic antidepressant poisoning?

Answer 14

IV Sodium Bicarbonate to resolve the hypotension and the QRS widening

Question 15

What drugs can cause the anticholinergic syndrome?

Answer 15

Antihistamines, antidepressants, atropine, antispasmodics, anti-Parkinson drugs

Question 16

What are the symptoms of the anticholinergic toxidrome?

Answer 16

Dry as a bone, red as a beet, blind as a bad, mad as a hatter, and hot as a hare

Question 17

What is akathisa?

Answer 17

Subjective feeling of restlessness

Question 18

What is the presentation and treatment for an acute dystonic reaction?

Answer 18

Presents with twisted necks and protruding tongues. Treated with benzotropine or diphenhydramine.

Question 19

What laboratory findings separates an acute dystonic reaction from neuroleptic malignant syndrome?

Answer 19

An elevated CK

Question 20

What medication is used to treat malignant hyperthermia?

Answer 20

Dantrolene

Question 21

What are the varying degrees of iron ingestion?

Answer 21

Mild - 20mg/kg
Moderate - 40mg/kg
Severe - 60mg/kg

Question 22

What are the four stages of iron toxicity?

Answer 22

GI stage - 30 mins to 6 hours
Stability - 6 hours to 24 hours
Systemic toxicity - 12 hours to 24 hours
Pyloric scarring - 2 to 6 weeks

Question 23

What is the treatment for iron ingestion/toxicity?

Answer 23

Supportive. Use IV Deferoxamine if the iron level is greater than 500.

Question 24

What is the treatment for lead poisoning?

Answer 24

Succimer or EDTA chelation

Question 25

What toxidrome presents with vomiting that is only relieved with hot showers several times per day?

Answer 25

Cannabinoid hyperemesis syndrome

Question 26

What is the characteristic late finding associated with methanol ingestion?

Answer 26

Toxic optic neuropathy leading to blindness

Question 27

What is the treatment of methanol ingestion?

Answer 27

IV Fomepizole

Question 28

What are the three stages of ethylene glycol poisoning?

Answer 28

CNS manifestations within 6 to 12 hours. Hypocalcemic problems within 12 to 36 hours. Acute renal failure within 24 to 72 hours.

Question 29

What is the treatment for ethylene glycol ingestion?

Answer 29

IV Fomepizole or Ethanol

Question 30

What is the treatment for cat bite victims?

Answer 30

Amoxicillin-Clavulanate, or Clindamycin plus Bactrim for allergic patients.

Question 31

What is the causative organism in Cat Scratch Disease?

Answer 31

Bartonella henselae

Question 32

What is the presentation of a Brown Recluse spider bite?

Answer 32

Hemorrhagic blister that develops into a large ulcer

Question 33

What are the symptoms of a Black Widow spider bite?

Answer 33

Chest tightness, vomiting, abdominal pain, sweating, agitation, and hypertension

Question 34

What are the percentages of burns for children over 14 years of age?

Answer 34

``` Head/Neck - 9% Each upper limb - 9% Trunk/Abdomen - 18% front and 18% back Each lower limb - 18% Perineum - 1% ```

Question 35

What is the Parkland formula?

Answer 35

Use 4mL/kg/%TBSA burned and give 50% of that within the first 8 hours, and the remaining for the next 16 hours.

Question 36

What is the concussion grading system?

Answer 36

Grade I - no LOC with symptoms less than 15 min Grade II - no LOC with symptoms more than 15 min Grade III - positive LOC

Question 37

When should athletes return to play post-concussion?

Answer 37

Once asymptomatic for one week

Question 38

Describe the Salter-Harris fractures.

Answer 38

``` I - Through the growth plate II - Growth plate and metaphysis III - Growth plate and epiphysis IV - Growth plate, metaphysis, and epiphysis V - Crush injury ```

Question 39

What is the radiographic sign of a Greenstick fracture?

Answer 39

Incomplete fracture with an intact cortex on one side

Question 40

What is the mechanism of a nursemaid's elbow?

Answer 40

Axial traction on an extended and pronated arm

Question 41

How do you fix a nursemaid's elbow?

Answer 41

Supinate the forearm and flex the elbow, or hyperpronate the arm

Question 42

What is the treatment for a hyphema?

Answer 42

Topical steroids, cycloplegic eye drops, protective eye shield, and bed rest with the head of the bed elevated

Question 43

What is the dose of epinephrine used in pediatric resuscitation?

Answer 43

0. 01mg/kg (1:10,000 [0.1mL/kg]) IV/IO | 0. 1mg/kg (1:1,000 [0.1mL/kg]) ET