MTB 1 Flashcards
Relationship bt Digoxin and Potassium
Both compete for biding at same site on Na/K ATPase
Hypokalemia predisposes to digoxin toxicity
Presentation of Digoxin Toxicity
GI probs: N/V/Abdominal Pain
Hyperkalemia
Confusion
Visual cahnges - yellow halos around objects
Arrhythmias - AV block, A tach, Bradycardia
Most accurate test for Digoxin Toxicity
Digoxin level
Best initial test for Digoxin Toxicity
K level
EKG
EKG of Digoxin Toxicity
Downsloping of ST segment in ALL leads
Atrial Tachycardia w variable AV block = MC
TX for Digoxin Toxicity
Control K+
Digoxin-specific Abs
-Esp if CNS and cardiac involvement
Presentation of Lead Poisoning
Abdominal pain = lead colic ATN Anemia - Sideroblastic Peripheral neuropathy - wrist drop CNS changes - memory loss and confusion
Most Accurate test for Lead poisoning
Lead Level
Best initial diagnostic test in lead poisoning
Increased level of free erythrocyte protoporphyrin
Most accurate test for Sideroblastic anemia
Prussian blue stain
TX for Lead Poisoning
Succimer - oral
Dimercaprol - parenteral
EDTA - parenteral
Presentation of Mercury Poisoning
Neuro problems - nervous, jittery, twitchy, hallucinations
Inhaled - Interstitial fibrosis
TX for Mercury Poisoning
Chelating agents
- Dimercaprol
- Succimer
Methanol and Ethylene glycol poisoning Presentation
Intoxication
Metabolic Acidosis with Increased AG
Cause of Methanol Toxicity
Wood Alcohol
Cleaning solutions
Paint thinner
Cause of Ethylene Glycol Toxicity
Antifreeze
Diff b/t Methanol and Ethylene glycol poisoning
Methanol - ocular toxicity
EG - Renal toxicity
Toxic metabolites of Methanol and Ethylene glycol poisoning
Methanol - Formic Acid/formaldehyde
EG - Oxalic acid/oxalate
How to calculate Osmolar GAp
Serum Osmolality = 2 x Sodium + BUN/2.8 + glucose/18
Best initial TX for toxicity for Methanol and Ethylene glycol poisoning
Fomepizole - inhibits alcohol DH
How do we effectively remove Methanol and Ethylene glycol from body
Dialysis - only this works
TX for snake bite
Pressure
Immobilization decreases venom movement
Antivenin
Presentation of Black widow spider bite
Labs
Abdominal pain
Muscle pain
Labs: Hypocalcemia
Tx for Black widow spider bite
Calcium
Antivenin
Presentation of Brown recluse spider bite
Labs
Local skin necrosis
Bullae
Blebs
No labs
TX for brown recluse spider bite
Debridement
Steroids
Dapsone
Management of Cat, Dog, Human bite
Amoxicillin/Clavulanate
Tetanus Vaccination booster if more than 5 yrs since last
MCC of dog and cat bites
Pasturella
MCC Human bite
Eikenella
When do we admin the rabies vaccine
Animal has AMS/Bizarre behavior
Unprovoked attack by stray dog that cannot be observed
Presentation of concussion
CT findings
TX
No focal neuro abnormalities
Normal CT
None. wait 24 hrs before going back to sports
Presentation of Contusion
CT findings
TX
Sometimes has findings
Ecchymoses on CT
most - none. some surgical debridgement
Presentation of rib fractures
Localized wall tenderness post trauma
Pain causes Hypoventilation -> Atelecstasis and Pneumonia
Management of Rib Fx
Pain management - oral opiates, NSAIDs, intercostal nerve block
Respiratory support
When do we see a lucid interval
Epidural hematoma
Subdural hematoma
Do we need to hospitalize pts with concussion
No
TX of subdural and epidural Hematoma
Small - leave alone Large 1. Intubation and hyperventilation 2. Mannitol 3. Drainage
Why do we hyperventilate pts with sub and epidural hematomas
Hyperventilation decreases pCO2 -> cerebral circulation constricts = decreasing pressure
- Bridge to therapy b/c slows herniation briefly
MOA Mannitol in hematomas
Osmotic diuretic - decreases intravascular volume, decreases ICP
CT of Subdural hematoma
Venous
Crescent
Concave
CT of Epidural hematoma
Arterial
Biconvex or Lens-shaped
When do we give stress ulcer PPX
Head Trauma
Burns
Endotracheal Intubation
Coagulopathy (platelets 1.5) w respiratory failure
Best initial therapy for Burn pts
100% Oxygen to treat smoke inhalation and CO poisoning
When do we intubate burn pts?
Stridor
Hoarseness
Wheezing
Burns inside nasopharynx or mouth
What do use for fluid replacement in burn pts
Ringer lactate
How do we calculate Fluid Replacement in burn pts
Based on BSA Head = 9% Legs = 18% front and back Arms = 9% each Chest/back = 18% Each
How much and when do we give fluids in burn pts
First 1/2 = First 8 hours
1/4 = Second 8 hours
1/4 = Third 8 hours
Fluid replacement Calculation
(4 mL) x (% BSA burned) x Wt in Kg
How to calculate BSA in patchy burns
Use hand width = 1% BSA
Choose largest amount of Ringers or NS listed as answer
MCC of death several days to weeks after a burn
How do we prevent
Infxn
Give PPX topical ABX - Silver sulfadiazine
