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MTB STEP 2 (R) > MTB 2 CK - Emergency > Flashcards

MTB 2 CK - Emergency Flashcards

1
Q

you see a guy pass out in front of you. you shake him and he is unresponsive. what is the first thing you do?

a. start chest compressions
b. feel for pulse
c. look, listen, and feel for breathing
d. call 911
e. precordial thump

A

d. call 911

ACLS steps:

  1. check responsiveness
  2. activate emergency response + get an AED
  3. circulation (check pulse, start compressions/cpr)
  4. defibrillate (check for shockable rhythm w AED)
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2
Q

CPR

-how many chest compressions per min?

A

100

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3
Q

another term for unsynchronized shock?

another term for synchronized shock?

A

defibrillate

cardiovert

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4
Q

algorithm for Asystole/PEA

pulseless

A

CPR - Epi - Shock

CPR - Epi - Shock

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5
Q

algorithm for Vfib + pulseless Vtach

A

Shock - CPR – Shock - CPR - Epi – Shock
or
Shock - CPR - Epi

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6
Q

pt w Vtach has a pulse + is stable

-next step?

A

IV Amiodarone
or
IV Procainamide, or IV Sotalol

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7
Q

pt w Vtach has a pulse + chest pain

-next step?

A

cardiovert / Synchronized Shock

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8
Q

signs of hemodynamic instability in Vtach - 4

A

SOB / CHF
low BP
chest pain
Confusion

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9
Q

torsades is equal to which type of arrhythmia

A

Vtach

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10
Q

causes of torsades

A

QT prolongation:
hypoMg, hypoK
drugs: TCA’s. Lithium, Antipsychotics, amiodarone/procainamide
macrolides: azithromycin

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11
Q

when is Gastric Lavage most useful

A

ingestion

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12
Q

Dangers of gastric lavage

A

Altered mental status: aspiration

Caustic ingestion: burning of the esophagus and oropharynx

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13
Q

Ipecac Usage

A

Never in the hospital.

Can be used at home

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14
Q

Cathartics

A

Not a good answer (sorbitol). Speeding up GI transit time does not eliminate ingestion without absorption

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15
Q

Forced Diuresis Tx

A

Also not a good answer. Can often lead to pulmonary edema.

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16
Q

pt has acute AMS or unresponsiveness for unknown reason

-best next step?

A
  1. Naloxone + Dextrose + Thiamine

2. Intubate

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17
Q

Benzodiazepine overdose

A

Flumazenil, acute withdrawal can cause seizures so be careful

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18
Q

TX for pt w unknown pill overdose

A

Charcoal
(superior to lavage and ipecac)
toxins in blood drop fast

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19
Q

charcoal will not work in what overdose?

A 
*Lithium*
iron
cyanide
lead
alcohols
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20
Q

what symptoms indicate dialysis?

A 
apnea
*HoTN*
renal failue
liver failure
coma
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21
Q

bicarb diuresis is TX for 2 overdoses

A

aspirin

phenobarbital

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22
Q

Acetaminophen Toxicity & Fatality levels?

-what about in toxicity in alcoholics?

A

Toxicity: 8-10 g
Fatality: 12-15 g
- 4g

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23
Q

what lab value to watch in acetaminophen toxicity?

A

PT

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24
Q

What do with toxic levels of acetaminophen

A

N-acetylcysteine

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25
Q

Overdose of acetaminophen more than 24 hours ago

A

No therapy possible

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26
Q

AST 2500, ALT 1800

- alcohol or acetaminophen?

A

acetaminophen

alcohol is 2:1 & more like 300:150

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27
Q

If amount of ingestion is unclear…

A

Get a drug level

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28
Q

Charcoal and N-acetylcysteine

A

Charcoal won’t make N-acetylcysteine ineffective. No contraindication.

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29
Q

Most likely dx:
Tinnitus and hyperventilation
Respiratory alkalosis progressing to metabolic acidosis
Rental toxicity and altered mental status
Increased anion gap

A

Aspirin overdose

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30
Q

Aspirin and lactate production

A

Interferes with oxidative phosphorylation and results in anaerobic glucose metabolism (producing lactate)

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31
Q

Aspirin multisystem toxicity

A

Causes ARDS
Interferes with PT production and raises PT time
Metabolic acidosis from lactate

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32
Q

Tx of Aspirin Toxicity

A

Alkalize Urine

-increase rate of aspirin excretion.

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33
Q

Blood gas in aspirin overdose

A

Respiratory alkalosis with a decreased CO2 and bicarb level (because of metabolic acidosis rising)

Ex: 7.46, CO2 22, Bicarb 16

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34
Q 
pill overdose:
confusion & lethargy
mydriasis
RR 7
HR 115
EKG - wide QRS
DX?
next step?
A

TCA overdose

-bicarb

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35
Q

Tricyclic Overdose Suppression of Seizures

A

Benzodiazepines. So if you reverse benzos with flumazenil and the pt ingestion a lot of TCAs you open them up for seizing.

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36
Q

Best initial test to detect TCA toxicity

A

EKG will show widening of QRS complex. QT prolongs as well until torsade de pointes.

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37
Q

Sodium bicarbonate in TCA overdose

A

Bicarbonate protects heart against arrhythmia, has no effect on increased urinary excretion (as in aspirin)

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38
Q

TCA toxicity symptoms leading to death

A

Seizures and arrythmia

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39
Q

TCA toxicity smptoms

A

Anticholinergic effects:
Dry mouth
Constipation
Urinary retention

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40
Q

Caustics ingestion (drain cleaner, acids, alkali)
TX?
-next step?

A

Fluids
-Endoscopy
(Giving the opposite will cause an exothermic reaction and make the perforation/damage worse)

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41
Q

Most common cause of death in fires

A

CO poisoning

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42
Q

Cause of death in CO poisoining

A

MI

CO is like anemia in that it removes carrying capacity/functional RBCs

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43
Q

Blood gas in CO poisoining

A

PO2 is normal because it can’t release. Because oxygen not released to tissues you get lactic/metabolic acidosis.

Ex: 7.35, pCO2 26, HCO3 18

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44
Q

Most accurate test in carbon monoxide toxicity

A

Level of carboxyhemoglobin

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45
Q

Best initial tx for carbon monoxide toxicity

A

100% oxygen

hyperbaric oxygen - CNS & cardiac symptoms, metabolic acidosis

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46
Q

Methemoglobinemia

A

Oxidized hemoglobin that is locked in the ferric state.

Brown and will not carry oxygen

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47
Q

Which drugs can cause methemoglobinemia

A

Benzocaine and other anesthetics
Nitrites and nitroglycerin
Dapsone

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48
Q

Blood color in CO vs. Methemoglobinemia

A

CO - abnormally red

Meth - abnormally brown

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49
Q

Dx Test and Tx for Methemoglobinemia

A

Methemoglobin level
Best initial tx is 100% oxygen
Most effective therapy is methylene blue (decreased half life of methemoglobin)

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50
Q 
DX:
diarrhea
urinary incontinence
muscle weakness
bradycardia
bronchospasm
emesis
lacrimation
salivation
sweating
seizures
A

organophosphates
Nerve gas
(prevents breakdown of ACh)

flu-like sxs w/o fever

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51
Q

First step in organophosphate tx

A
  1. Atropine
    (blocks effects of ACh that is already increased. Dries up respiratory secretion.)
  2. Pralidoxime
    (reactivates acetylcholinesterase, which won’t act fast enough in an acute reaction.)
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52
Q

pt w HTN, DM, & systolic dysfunction is admitted for 2 days of NVD. he is dehydrated, and his glucose is 180.
-next best step

A

digoxin level

have to think that pt is on dig in systolic HF

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53
Q

which electrolyte value leads to digoxin toxicity?

A

Hypok

incr digoxin binding

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54
Q

Digoxin toxicity leads to what electrolyte abnormality?

-next step?

A

HyperK
(digoxin has taken up all binding sites)
tx - digoxin Ab’s + bicarb/insulin

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55
Q

Most common presentation for digoxin toxicity

A

GI problems (N/V/abdominal pain)
Hyperkalemia
Confusion
Visual disturbance such as yellow halos around objects
Rhythm disturbance (bradycardia, atrial tacycardia, AV block, ventricular ectopy)

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56
Q

most Accurate test for digoxin toxicity

A

Digoxin level!

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57
Q

Best initial test for digoxin toxicity

A

EKG + potassium level

EKG shows downsloping of the ST segment

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58
Q

Most common arrhythmia in digoxin toxicity

A

Atrial tachycardia w variable AV block

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59
Q

indication for digibind

A

CNS sxs
Cardiac sxs
K >5 + sxs

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60
Q

Most likely dx:
Abdominal pain
Renal tube toxicity (ATN)
Anemia
Peripheral neuropathies such as wrist drop
CNS abnormalities such as memory loss and confusion

A

Consider lead poisoning

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61
Q

Most accurate test for lead poisoning

A

Lead level

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62
Q

BEst initial diagnostic test for lead poisoning

A

Increased level of free erythrocyte protoporphyrin

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63
Q

Most accurate test for sideroblastic aenmia

A

Prussian blue stain, detects increased iron built up in RBC mitochondria

64
Q

Tx of lead poisoning

A 
Chelating agents. Succimer is he only oral form of lead chelator. 
Ethylenediaminetetraacetic acid (EDTA) and dimercaprol (BAL) are parenteral agents.
65
Q

Adverse effects of mercury poisoning

A

Inhaled mercury vapor - lung toxicity presenting as interstitial fibrosis
Neurological problems - nervous, jittery, twitchy, sometimes hallucinatory

66
Q

Tx for mercury poisoning

A

No therapy to reverse pulmonary toxicity

Chelating agents: dimercaprol and succimer can be effective

67
Q

intoxication + blurry vision?

A

Methanol

- causes blindness

68
Q

Similarities with Methanol and Ethylene Glycol

A 
Intoxication
Metabolic acidosis
INcreased anion gap
Osmolar gap
Treated wtih fomepizole and dialysis
69
Q

Sources of Methanol vs. Ethylene Glycol

A

Methanol - wood alcohol, cleaning solutions, paint thinner

Ethylene glycol - antifreeze

70
Q

Toxic metabolite in Methanol vs. Ethylene Glycol

A

Methanol - formic acid/formaldehyde

Ethylene glycol - oxalic acid/oxalate

71
Q

Presentation of the Methanol vs. Ethylene Glycol

A

Methanol - ocular toxicity

Ethylene Glycol - renal toxicity

72
Q

Initial diagnostic abnormality of Methanol vs. Ethylene Glyco.l

A

Methanol - retinal inflammation

Ethylene glycol - hypocalcemai, envelope shaped oxalate crystals in urine

73
Q

Osmolar Gap

A

Increased in methanol and ethylene glycol. Also regular alcohol.

Expected osmolarity:
Serum osm = 2Na + BUN/2.8 + glucose/18

74
Q

Best intial tx for methanol and ethylene glycol toxicity

A 
Fomepizole
-(inhibiting alcohol dehydrogenase
prevents production of toxic metabolites)
Dialysis
- remove toxins
75
Q

TX of Snake Bites?

A

Immobilization (decr movement of venom)

Tx - antivenim

76
Q

Black widow Spider bite

A

Abdominal pain, muscle pain
Hypocalcemia
Tx. Calcium, antivenin

77
Q

Brown recluse spider bite

A

Local skin necrosis, bullae, and blebs
No lab abnormalities
Tx with debridement, steroids, and dapsone

78
Q

Dog, cat, and human bites
TX?
infections?

A

Amoxicillin/clavulanate - (Augmentin)
Tetanus vaccination booster if more than 5 years

Dogs and cats: Pasteurella multocida
Humans: Eikenella corrodens

79
Q

prophylaxis after human bites?

animal bite?

A

HIV + HBV

tetanus + rabies

80
Q

Rabbies prophylaxis includes what?

A

human diploid cell vaccine
+
HR16 passive immunity

81
Q

Head trauma with LOC management

A

Head CT first, without contrast.

82
Q

Subdural and epidural hemotoma

A

Can only be distinguished with CT.

Epidural related to head fracture

83
Q

Lucid interval

A

Second LOC occurring soon after initial.

Epidural + subdural hematoma

84
Q

Concussion TX?

A

wait 24 hrs before returning to work

observe for mental status changes

85
Q

Contusion Tx

A

Majority no treatment needed, severe may need surgical debridement

86
Q

Subdural and epidural TX

Large hematoma

A

Intubation + hyperventilation
Mannitol
Drainage

87
Q

Hyperventilation in Hemotoma

A

Decreases pCO2, leading to a constriction of cerebral circulation. This decreases volume and decreases pressure.

88
Q

Mannitol

A

Osmotic diuretic that decreases intravascular volume. Limited benefit.

89
Q

Definition of Intracranial Hemorrhage

A

Compression of ventricles or sulci
Herniation with abnormal breathing/unilateral dilation of pupil
Worsening mental status or focal findings

90
Q 
Most likely dx and tx:
Head trauma
No focal finding
No lucid interval
Normal CT
A

Concussion

Tx: No specific tx, observe at home for lucid interval or new focal findings

91
Q 
Most likely dx:
Head trauma
Rarely focal
No lucid interval
Ecchymoses on CT
A

Contusion

Tx: No specific treatment; observe in hospital

92
Q 
Most likely dx:
Head trauma
\+/- focal findings
\+/- lucid interval
Venous, crescent
A

Subdural

Tx: Drain large ones

93
Q

Most likely dx:
+/- focal findings
+/- lucid interval
Arterial, biconvex or lens shaped hematoma

A

Epidural

Drain large ones

94
Q

Indications for stress ulcer prophylaxis

A

Head trauma
Burns
Endotracheal intubation
Coagulopathy (platelets

95
Q

Best initial therapy for burns

A

100% oxygen to treat smoke inhalation and carbon monoxide toxicity

96
Q

Etiology of death in burns

A

Airway burn or volume loss.

97
Q

Intubation of Burn Pts Indications

A

Stridor, Hoarseness, Wheezing
(indicate Laryngeal edema)
Burns inside the nasopharynx or mouth

98
Q

Volume replacement in burns

A

Lactate ringers
1/2 required in the first 8 hours
1/4 in second 8 hours
1/4 in third 8 hours

4 mL for each percent of surface area

99
Q

Surface area percentages of burn victims

A

Head - 9%
Arms - 9% each
Legs 18% each
Chest or back - 18% each

Each hadn width is one percent of BSA

100
Q

Most common cause of death several weeks after burn

A

Infection - give prophylactic topical antibiotics (silver sulfadiazine) NOT IV antibiotics

101
Q 
Most likely dx and tx:
Exertion
High outside temperatures
*Normal body temp*
Normal CPK and potassium level
A

Heat cramps/exhaustion

Tx - oral fluids + electrolytes

102
Q 
Most likely dx and tx:
Exertion
High outside temperatures
*Elevated body temp*
Elevated CPK and potassium
A

Heatstroke

Tx - cool down - (spray w water)

103
Q

Most likely dx and tx:
Antipsychotic medications
Elevated temperature
Elevated CPK and potassium

A

Neuroleptic malignant syndrome
Dantrolene or dopamine agonist:
Bromocriptine or cabergoline

104
Q

Most likely dx and tx:
Anesthetics administered systemically
Elevated temperature
Elevated CPK and potassium

A

Malignant hyperthermia

Tx: Dantrolene

105
Q 
Most likely DX?
Intoxicated person
Low body temperature
J waves on EKG
-*next step?*
A

Hypothermia

-fingerstick glucose
most common 2ndary cause of hypothermia is hypoglycemia

106
Q

most common secondary causes of hypothermia? - 3

A

hypoglycemia
hypoThyroid
sepsis

107
Q

Best initial test for hypothermia?

MCC of death?

A

EKG

Cardiac arrhythmia

108
Q

Management of Drowning

A

Positive Pressure Ventilation

NO STEROIDS OR ANTIBIOTICS

109
Q

Specific types of drowning

A

Salt: acts like CHF - wet, heavy, lungs

Fresh water: causes hemolysis from absorbing hypotonic fluid into the vasculture

110
Q

Initial management of cardiac arrest

A

Open airway, head tilt, chin lift, jaw thrust.
GIve rescue breaths if not breathing
Check pulse and start ches tcompressions if pulseless.

111
Q

When to give precordial thump

A

Within 10 minutes of witnessed arrest.

112
Q

Management of pulseless activity

A

CPR

113
Q

Asystole tx

A

After CPR
Epinephrine (or vasopressin)
Will shunt blood to critical areas like heart and brain

114
Q

Unsynchronized Cardioversion

A

VF and VTach without pulse

115
Q

When to give epinephrine during arrest (VF)

A

Two unsynchronized cardioversions, then epinephrine/vasopressin followed by another electrical shock.

116
Q

When to give amiodarone/lidocaine (VF)

A

Given after 2 shocks, epi, schock. Amiodarone first choice.

117
Q

Managing VTach

A

Pulseless VT: Same way as VF

Hemodynamically Stable: Amiodarone, lidocaine, procainamide, THEN cardiovert.

118
Q

VF management

A

Shock, drug, shock, drug, shock, drug, CPR the whole time

119
Q

Hemodynamically unstable Vtach

A

Perform electrical cardioversion several times, followed by medications such as amiodarone, lidocaine, or procainamide.

120
Q

Hemodynamically unstable definition

A

chest Pain
Dyspnea
Low BP
Confusion/AMS

121
Q

VT with a pulse

A

SYNCHRONIZED CARDIOVERSION

122
Q

pt is unresponsive, no pulse + sinus bradycardia EKG
DX?
next 2 steps?

A 
Pulseless Electrical Activity (PEA)
(heart electrically normal, no motor contraction)
1. CPR 
2. *IV Epinephrine* (up to 3 x)
-- same as Asystole --
123
Q

which 2 causes of pulselessness are non-shockable?

A

Asystole + PEA

124
Q

Most likely arrhythmia:
Palpitations, dizziness, lightheadedness
Exercise intolerance/dyspnea
Embolic stroke

A

Atrial

AFib most common arrhythmia in the Untied States

125
Q

causes of Asystole & PEA

A

Hypoxia, Hypothermia, Hypovolemia, Hypoglycemia, Hyper/HypoK+

Tamponade, Tension pneumothorax,, Toxins (metabolic acidosis), Thrombosis (PE, ACS)

126
Q

Tx of hemodynamically unstable atrial arrhythmias

A

Synchronized cardioversion (prevents deterioration into VT and VF)

127
Q

pt has Afib & is stable

-next step?

A 
IV *Diltiazem* / Verapamil
or
IV *Metoprolol / Esmolol*
or 
Digoxin (*EF
128
Q

Next step fter rate control, in AFib

A 
*Aspirin* (CHADS of 1)
or 
*Warfarin* (CHADS of 2+)
or
Dabigatran (Pradaxa)
or
Rivaroxaban (Xarelto)

(ANTICOAGULATE)

129
Q

what conditions indicate electrical cardioversion in a pt w Afib? - 3
(after rate control & anticoagulation)

A

1st episode of AFib
worsening sxs
hemodynamically unstable

(RHYTHM)

130
Q

which drugs can be used for cardioversion?

electrical cardioversion is preferred

A 
Ibutilide, flecainide, procainamide
or
sotalol - (*CAD* w/ normal EF)
or
amiodarone, Dofetilide -w (CAD w *EF
131
Q

Afib for > 2days

-what can you do before discharge?

A
  • TEE*
    a. NO CLOT?
  • IV Heparin + Cardioversion
    b. CLOT?
  • IV Heparin + Return in 3 wks
132
Q

when to use Heparin in Afib

A

Current Visible Clot in atrium

133
Q

Non-anatomical causes of Afib

A

Alcohol
caffeine
cocaine
transient ischemia.

134
Q

CHADS2

A

Aspirin

If it were 2 or higher, warfarin, dabigatran, rivaroxaban

135
Q

SVT Tx

A
  1. valsalva, carotid massage, dive reflex, ice immersion
  2. Adenosine
    BB (metoprolol), CCB (diltiazem) or digoxin if adenosine not effective
136
Q

Most likely dx:
SVT alternating with ventricular tachycardia
SVT that gets worse after diltiazem or digoxin
Observing the delta wave on the EKG

A

Wolff-Parkinson-White Syndrome

Preexcitation syndrome with early depolarization of the ventricle

137
Q

Most accurate test for WPW

A

Cardiac electrophysiology (EP) studies

138
Q

Acute therapy of WPW

A

Procainamide or amiodarone

only if WPW currently presenting

139
Q

Chronic therapy for WPW

A

Radiofrequency catheter ablation, curative for WPW.

EP studies tell you where anatomic defect is

140
Q

contraindicated drugs in WPW

A

Digoxin and CCB

block normal AV node and promote alternate pathways

141
Q

arrhythmia in a COPD pt?

TX?

A

Multifocal Atrial Tachycardia

tx - O2, IV Diltiazem or Verapamil

(avoid BB’s)

142
Q

pt w HR of 52 is lethargic

-next step?

A

IV Atropine

2nd line: Transcutaneous pacing, Epi, Dopamine

143
Q

pt w HR of 19 has normal hx & physical

-next step?

A

nothing

  • only treat symptomatic pt’s*
  • fatigue
  • HoTN
  • LOC
  • dizzy
144
Q

which AV blocks get a pacemaker?

A

Mobitz II

3rd degree

145
Q

Third degree AV block Tx

A

Pacemaker (most effective tx for bradycardia)

146
Q

First Degree AV Block Tx

A

Extended PR - can treat sx with atropine

147
Q

Second degree Type I

A

Mobitz I or Wenckebach - progressively lengthening that leads to a dropped beat. Commonly a part of normal aging.

148
Q

Second degree Type II

A

Mobitz II - just drops a beat with no lengthening (warning). Mobitz II can progress into a third degree AV block. EVERYONE GETS A PACEMAKER

149
Q

Tx for post MI VTach

A

Fix ischemia, do an angiography for angioplasty or bypass

150
Q

Risk of recurrence of VTach factor

A

Left ventricular function is the most important correlate of the risk of recurrence

151
Q

Caustic ingestion managament

A

Check for perforation (CXR or lung sounds). Endoscopy to assess damage. Don’t give charcoal because caustic ingestion causes DAMAGE and you’re not trying to prevent systemic absorption.

152
Q

TX for BB overdose?

A

glucagon

153
Q

TX for CCB overdose?

A

calcium

154
Q

mj juice - aka?

joke

A

propofol

155
Q

EKG changes in SAH?

A

diffuse T wave inversions

MTB STEP 2 (R) (12 decks)

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