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Emergency Medicine > MTB > Flashcards

MTB Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

How long after pill ingestion can gastric lavage be attempted

A

2 hours after ingestion

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2
Q

Toxicities that cause Miosis

A 
Clonidine
Barbs
Opiates 
Cholinergics
Pontine stroke
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3
Q

Toxicities that cause Mydriasis

A

Sympathomimetics

Anticholinergics

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4
Q

Toxicity with dry skin

A

Anticholinergics

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5
Q

Toxicity seen with wet skin

A

Anticholinergics

Sympathomimetics

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6
Q

Toxicity seen with blisters

A

Barbituates

CO poisoning

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7
Q

When is gastric lavage dangerous

A

AMS - Aspiration

Caustic ingestion - burning of esophagus/oropharynx

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8
Q

What percentage of pills are removed with gastric lavage

A

1 hour = 50%

2 hour = 15%

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9
Q

When do we use Ipecac in the ER

A

Never

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10
Q

Wrong answers in ER questions

A

Ipecac
Cathartics
Forced diuresis = almost always wrong
Whole bowel irrigation - almost always wrong

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11
Q

When do we do whole bowel irrigation and what do we use

A

Polyethylene glycol-electrolyte solution
Massive Iron ingestion
Lithium
Swallowing drug filled packets

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12
Q

When answer is not clear and cause of OD is asked, answer

A
  1. Acetaminophen
  2. ASA
    MCC death by OD
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13
Q

Best initial management in pt with AMS and toxicity

A

Opiate antagonist - naloxone

Glucose

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14
Q

Presentation of acute benzo withdrawl

A

Seizures

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15
Q

CI in benzo withdrawl

A

Flumazenil

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16
Q

When do we give charcoal
MOA
Route of admin

A

Can be given to anyone w pill OD - benign
Blocks absorption of poisons
Given thru NG tube

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17
Q

What amount of acetaminophen causes toxicity

Fatality?

A

8-10 grams

Fatality if greater than 12-15 grams

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18
Q

Next step in management if a clearly toxic amount of acetaminophen has been ingested

A

N-Acetylcysteine

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19
Q

Next step in management if a clearly toxic amount of acetaminophen has been ingested and it is over 24 hours

A

Nothing

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20
Q

Next step in management if amount of acetaminophen that has been ingested is unclear

A

Get drug level

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21
Q

Does charcoal make N-acetylcysteine ineffective

A

No

22
Q

Does alcohol increase or decrease amount of acetaminophen needed to cause toxicity

A

Decreases amount

23
Q

ASA Overdose Presentation

A 
Tinnitus
Hyperventilation 
Resp Alkalosis progressing to Metabolic Acidosis 
Increased Anion gap
Renal toxicity 
AMS
24
Q

ASA effect on coagulation

A

Increases PT

25
Q

TX for ASA toxicity

A

Alkalinize the urine to increase rate of excretion

26
Q

Blood gas in ASA toxicity

A

Varies depending on time

27
Q

Benzos and TCA effect taken together

A

Benzos can prevent seizures from TCA toxicity

28
Q

TCA toxicity finding on EKG

A

Widening of QRS complex

29
Q

TCA Toxicity Presentation

A

Seizures
Arrhythmia
Dry mouth, Constipation, Urinary retention

30
Q

TX for TCA Toxicity

A

Sodium Bicarbonate

Bicarb protects the heart

31
Q

Caustic ingestion damages what

A

Mechanical damage to oropharynx, esophagus, stomach

Perforation

32
Q

Management for Caustic ingestion

A

Flush out w high volume water

Endoscopy to assess degree of damage

33
Q

Management for Caustic ingestion

A
  1. ABC
  2. Remove contaminated clothing and irrigate exposed skin, Flush out w high volume water
  3. Endoscopy to assess degree of damage
34
Q

MCC of death in fires

A

CO poisoning

35
Q

Management for Caustic ingestion Perforation

A
  1. ABC
  2. Remove contaminated clothing and irrigate exposed skin, Flush out w high volume water
  3. CXR if Respiratory Sx’s
  4. Endoscopy to assess degree of damage within 24 hrs
36
Q

CO poisoning HX

A

Gas heaters
Wood-burning stoves
Automobile exhaust

37
Q

ABG in CO Poisoning

A

Causes lactic acidosis
pH Low
pCO2 Low
HCO3 Low

38
Q

Most accurate DX test for CO Poisoning

A

Carboxyhemoglobin Level

39
Q

Best initial TX for CO Poisoning

A

Remove pt from exposure
Give 100% Oxygen
Hyperbaric oxygen if severe

40
Q

Severe Sx’s of CO Poisoning

A

CNS Sx’s
Cardiac Sx’s
Metabolic Acidosis

41
Q

What causes methemoglobinemia

A

Benzocaine + other anesthetics
Nitrites + Nitroglycerin
Dapsone

42
Q

Presentation of methemoglobinemia

A 
Dypsnea
Cyanosis
HA, confusion, seizures
Metabolic Acidosis 
(SAme as CO poisoning)
43
Q

Difference b/t methemoglobinemia and CO poisoning

A

CO: Blood is RED
Meth: Blood is BROWN

44
Q

What is pCO2 in methemoglobinemia

A

Normal

45
Q

Most accurate test for methemoglobinemia

A

Methemoglobin level

46
Q

Best initial TX for methemoglobinemia

A

100% oxygen

47
Q

Most effective TX for methemoglobinemia

A

Methylene Blue

48
Q

Cyanosis + Normal pO2

A

methemoglobinemia

49
Q

Presentation of Organophosphate poisoning

A 
Salivation
Lacrimation 
Polyuria
Diarrhea
Bronchospasm, bronchorrhea, Resp arrest
50
Q

Management of Organophosphate poisoning

A
  1. Atropine
  2. Remove clothing, wash patient
  3. Pralidoxamine = reactivates acetylcholinesterase
51
Q

MOA Atropine

A

Blocks effects of acetylcholine that is already in body

Dries up respiratory secretions

52
Q

Indications for Dialysis

A 
Renal Failure
CHF
ARDS
Persistent CNS sx's 
Hemodynamic Instability 
Severe acid/base or electrolyte imbalance
Hepatic Failure w coagulopathy
Salicylate level > 100 mg/dL

Emergency Medicine (4 decks)

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