[MS] Emergency Care Flashcards
What is the initial management for patients who present with poisonings?
ABCDs
What are the poisonings associated with pinpoint pupils?
Cholinergics/Clonidine
Opiates/Organophosphates
Phencyclidine
Sedatives
What are the poisonings associated with dilated pupils?
Anticholinergics
Antihistamines
Antidepressants
Amphetamine (Cocaine)
What poisonings cause diaphoresis?
Sympathomimetics
Organophosphates
Aspirin (Salicylates)
PCP
What poisonings cause the skin to appear red?
Carbon Monoxide
Boric Acid
What poisonings typically cause blue-colored skin?
Cyanide
What is the regimen for giving activated charcoal to a poisoned patient?
Use within the first hour at the dose of 1gm/kg (MAX: 50-100gm)
In what ingestion situations is activated charcoal ineffective or contraindicated?
Caustic agents, hydrocarbons, electrolytes, metals, cyanide, alcohols, lithium, camphor, and phosphorous
What are the symptoms associated with salicylate poisoning?
Abdominal pain, nausea, vomiting, tachypnea, tinnitus, vertigo, agitation, confusion, coma
What kinds of ingestions should concern someone for salicylate poisoning?
OTC Cold Medicine, Antidiarrheal Medicine, and Topical Analgesics
What is the metabolic derrangement seen in salicylate poisoning?
pH - normal to high
pCO2 - low
HOC3 - low
What medication enhances salicylate clearance?
IV Sodium Bicarbonate to alkalinize the urine
What are the effects seen in tricyclic antidepressant medication overdose?
Coma, Seizures, Widened QRS, and Prolonged QT
What is the treatment for tricyclic antidepressant poisoning?
IV Sodium Bicarbonate to resolve the hypotension and the QRS widening
What drugs can cause the anticholinergic syndrome?
Antihistamines, antidepressants, atropine, antispasmodics, anti-Parkinson drugs
What are the symptoms of the anticholinergic toxidrome?
Dry as a bone, red as a beet, blind as a bad, mad as a hatter, and hot as a hare
What is akathisa?
Subjective feeling of restlessness
What is the presentation and treatment for an acute dystonic reaction?
Presents with twisted necks and protruding tongues. Treated with benzotropine or diphenhydramine.
What laboratory findings separates an acute dystonic reaction from neuroleptic malignant syndrome?
An elevated CK
What medication is used to treat malignant hyperthermia?
Dantrolene
What are the varying degrees of iron ingestion?
Mild - 20mg/kg
Moderate - 40mg/kg
Severe - 60mg/kg
What are the four stages of iron toxicity?
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
What is the treatment for iron ingestion/toxicity?
Supportive. Use IV Deferoxamine if the iron level is greater than 500.
What is the treatment for lead poisoning?
Succimer or EDTA chelation
What toxidrome presents with vomiting that is only relieved with hot showers several times per day?
Cannabinoid hyperemesis syndrome
What is the characteristic late finding associated with methanol ingestion?
Toxic optic neuropathy leading to blindness
What is the treatment of methanol ingestion?
IV Fomepizole
What are the three stages of ethylene glycol poisoning?
CNS manifestations within 6 to 12 hours.
Hypocalcemic problems within 12 to 36 hours.
Acute renal failure within 24 to 72 hours.
What is the treatment for ethylene glycol ingestion?
IV Fomepizole or Ethanol
What is the treatment for cat bite victims?
Amoxicillin-Clavulanate, or Clindamycin plus Bactrim for allergic patients.
What is the causative organism in Cat Scratch Disease?
Bartonella henselae
What is the presentation of a Brown Recluse spider bite?
Hemorrhagic blister that develops into a large ulcer
What are the symptoms of a Black Widow spider bite?
Chest tightness, vomiting, abdominal pain, sweating, agitation, and hypertension
What are the percentages of burns for children over 14 years of age?
Head/Neck - 9% Each upper limb - 9% Trunk/Abdomen - 18% front and 18% back Each lower limb - 18% Perineum - 1%
What is the Parkland formula?
Use 4mL/kg/%TBSA burned and give 50% of that within the first 8 hours, and the remaining for the next 16 hours.
What is the concussion grading system?
Grade I - no LOC with symptoms less than 15 min
Grade II - no LOC with symptoms more than 15 min
Grade III - positive LOC
When should athletes return to play post-concussion?
Once asymptomatic for one week
Describe the Salter-Harris fractures.
I - Through the growth plate II - Growth plate and metaphysis III - Growth plate and epiphysis IV - Growth plate, metaphysis, and epiphysis V - Crush injury
What is the radiographic sign of a Greenstick fracture?
Incomplete fracture with an intact cortex on one side
What is the mechanism of a nursemaid’s elbow?
Axial traction on an extended and pronated arm
How do you fix a nursemaid’s elbow?
Supinate the forearm and flex the elbow, or hyperpronate the arm
What is the treatment for a hyphema?
Topical steroids, cycloplegic eye drops, protective eye shield, and bed rest with the head of the bed elevated
What is the dose of epinephrine used in pediatric resuscitation?
- 01mg/kg (1:10,000 [0.1mL/kg]) IV/IO
0. 1mg/kg (1:1,000 [0.1mL/kg]) ET
