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Rosh > Oral Baords > Flashcards

Oral Baords Flashcards

1
Q

WBI

A

Indicated in Iron Over dose (case showed at 5 hours post ingestion)
especially if see in the stomach on X ray

500 ml/hr in kids
2 L/hr for adults of Polyethelyene gylycol

NO activated charcaol for iron

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2
Q

Iron OD

A

Deforaxmine (if greater than 350, shock, acidosis, seizure)
EKG (rule out TCA)
WBI (NGT needed)
IV/fluids
ASA/Tylenol

HD in very rare cases

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3
Q

Maint fludis in kids

A

can be D51/4 NS

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4
Q

IPH critical actions - AMS

A

If you see Brady and HTN
Airway
IVF
POCG
Coags
Reverse coags - Vit K/FFP or PCC
Head CT
NSGY
NICU

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5
Q

AMS important actions

A

ABG after a tube
Narcan, thiamine, dextrose (if hypoG)
if arrives intubated- check tube

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6
Q

Penetrating chest trauma crtical actions

A

Needle or tube throacostomy
upright cxr
pain
full seocndary survey
surgical consult
IVF (ok to givve in trauma and hypotension?)

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7
Q

Slam dunk cholecystitis- what else to add on?

A

MI for older patients
Pelvic exam for Fitz Hugh Curtis and sexual hisotry
Add Vanc And Zosyn (need full braod coverage)
signs of gangeene is emergent surgery

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8
Q

feb neo always get a

A

Glucose

5/ml/kg D10
4ml/kg D25

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9
Q

feb neo, still lethargic when you get to physcial exam…

A

Intubate- decreases metabolic demands

If you are this sick of a feb neo, an LP can wait if it delays stabilization

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10
Q

vent settings ne

A

10 ml/kg
rate 30
100% fio2

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11
Q

feb neo meds

A

tylenol rectal
Cefotaxime and amicillin
up to 80 ml/kg! our 4 boluses
techincal ICU consult

Discussion with family!

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12
Q

Nec Fasc, Do you get CT or no?

A

No, tell the ocnsultant it would delay care and they need to come in
they will give clue on speed of infection
remeber to add clinda! V/C/C
Gen surg consult
c Can get cardiac enzymes in old chronic disease person
AVOID pressors if you can! reduces blood flow
consider hyeprbarics

Vitals signs were normal!
ANY AMS needs glucose

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13
Q

HyperK actions

A

Ca
Insulin D 50
Albuterol
Sodium Bicarb
Lasix
KAyexolate
Stat lytes

Treat Patient before K is BACK!
COnsider nephrology consult for Dialysis with renal fialure

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14
Q

Acute angle glaucoma

A

Phys Exam: EOM, Pupils, SLIT LAMP!, VA!!!, peripheral vision, IOP, stain, appearance, palpation

Brimonidine
Timolol
Pilocaprine
acetazolimide
mannitol
steroids

optho

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15
Q

Stranglated bowel

A

If your think it is incarcerated dont reduce

NGT placement! be prepared to say how its done

AbdXray!

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16
Q

ASA overdose

A

Dont forget:
1. ABG Resp Alkalosis, then met acidosis
2. Lactate
3. ICU Consult/toxicologist
4. Repeat ASA levels in 2 hours
5. Continue to mintor vitals
6.Poison control
7. MOnitor K, dont want hypoK

Start bicarb drip if over 20
HD over 100 or organ failure
Activated CHARCOAL if right after ingestion

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17
Q

Peds speccifics for Abdominal pain

A

Uright CXR, AXR, Obsturctive series, US
1 IV access “largest bore possible”

Dont worry about exams, if there is bloody poo need to do rectla and GU

for abd pain: ranitidine IV, Steroids IV(HSP) (i was htinking tylenol and fentanyl?)
after a bolus start at a rate (nook says half maint at 1/2 NS?)

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18
Q

Snake Bite

A

Not serious:
ABC
Assess Wound
ID the snake (crotalid rattlesnakes and cotton mouthsvs Elapid- corals and cobras)

Crotalid:cytolytic- edema, hemorrhage, necrosis, close to and far away
Elapid:neurotoxic- diplopia, ptosis, resp issues, paresthesias- delayed

Check for compartment syndrome (surgery)
DIC, hemolysis, thrombcoytpoenia
Anitvenin for either bite
TETANUS

No suction, no tourniquet (but maybe consitrciotn band with elastic bandage)

Dry bites need 12 hours obsveration in hopsital - physical exam is normal, labs nromal

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19
Q

Right eye vision loss, blood and edema on fudnoscopic exam, Pupil doesnt conrict to light, consticts in opp eye

A

CRVO
DC home with optho follow up
Ch 16 for review
Loss of vision = loss of light to the brian= no pupil constirciotn, but when in othe other eye, light to brain= consitrction

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20
Q

peds dosing

A

Code epi 0.01 mg/kg epi
Atropine 0.02 mg/kg
Electrciity 1J >2J/kg
adenosine 0.1 mg/kg

morphine:
<6 months - .05 mg/kg IV
>6 month- .1 mg/kg IV
if over 50 kg then you are getting into adult dosing

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21
Q

Peds vent/Peds intubation

A
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22
Q

peds stuff

A

broelow tape

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23
Q

cyanide OD anitdote

A

Hydroxycobalamine

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24
Q

TCA OD anitdote

A

Sodium bicarb

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25
Q

Iron OD anitodte

A

Defroxaimine

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26
Q

HF Acid

A

Calcium gluconate

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27
Q

INH OD antidote

A

Pyridoxine

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28
Q

Ethylene glycol OD

A

Foempizole, pyridoxine, Thiamine

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29
Q

Methanol OD antodote

A

Fomepizole, Folate

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30
Q

RSI things I forget

A

quick neuro check ith pupils
C spine immbolizaion
OG and foley post sedation

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31
Q

what do you do with wounds?

A

irrigate + tdap

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32
Q

PALS!

A

Tube- verify placement
Oxygen- 8-10 breath per minute
CPR thumb enciricling hand at 100/min
22-24 guage IV x 2 or IO
20 cc/kg warmed fluids + rewarming if cold
epi 0.01 mg/kg q 3 min
H&Ts

SIDS- PALS
Assess for abuses
support for family
autopsy w/ blood and urine smapl

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33
Q

POst torsades peds antiarrythmic drip ?

A

lidocaine drip

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34
Q

ORtho stuff

A

Make them NWB status
Make sure to get bilateral films for comparison
Phys exam bilaterally
Lateral views as well

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35
Q

GU exam always in

A

Abdominal pain patient

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36
Q

testicualr pain always get

A

G/c Swab, UA think infeciotn /epipdudmitis

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37
Q
A
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38
Q

Bradycardia

A

Atropine 0.5 mg ip to 3 mg
Place pads on the patient- pace even if sinus
Consider an Epi drip
Cards consult
Glucagon drip for BB OD 10 mg IV

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39
Q

Asthma

A

Things I forgot:
SC .25 mg terbutaline, .3 mg Epi
Bipap
Emiric ABx is recommended against!
Magnesium
Need to say ipratroprium

BIOMES

Tube:
Ams, exhaustion, hypoxia, arrest

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40
Q

SJS

A

Didn’t say steroids
Derm and optho consultations
Stop the offending agent

Can give ppx Abx
(some evidence but not full on IVIG or steroids)

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41
Q

Laceration

A

Repair it, tend to it!

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42
Q

SDF

A

FSG
HIstory of fall
Non CT
Labs
pain
NSGY
ICU

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43
Q

Perianal abscess

A

Pain
Rule out fistulas
ID
Post drainage education: sitz bath, stool softener, frequent dressing changes
follow up

no abx if no systemtic or or overlying cellulitis

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44
Q

Ectopic pregnancy

A

IV
Blood type and corss match
Rhogam
hcg
pelvic exam
pelvic us
pain
OBGYN

DONT FORGET TO DO A FAST
O NEG= RHOGAM

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45
Q

Alcohol intoxication

A

FSG
non con head
LAc repair

!!! ANion gap, Osmol gap
toxic alcohols
dont forget about ASA/Tylenol OD
Still give thiamine, folate D5 for AKA

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46
Q

DKA + UTI

A

FSG
Fluids (this says NS then 1/2 NS
insulin drip
replete potassium (even if nromal)
EKG
ICU
Abx

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47
Q

STEMI

A

EKG
GET a right sided EKG (or posterior)
IV access and fluid bolus if right sided (dont give nitro)
ASA
Avoid nitro
cards consult
activate cath lab

remember you may need to do thrombolysis!
fluids up to 1-2L and then pressors

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48
Q

Ovarian torsion

A

Preggo test
pelvic exam
pelvic US
OBGYN
analgesia

CT is not definitive

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49
Q

Opiate OD

A

FSG
Naloxone admin
EKG
CXR
Reassess

ALSO: tox consult
admit or observe for long time
Get co ingestion labs!!!
still get a work up

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50
Q

Travelers diarrhea

A

Social hisotry
OP
fecal leukocytes
Giadria anitgen
C diff toxic
Fecal stool sample
rehydrate, replete Lytes! even if it potassium 3.2!!!!!!!!!!!!
Abx Ciprofloxacin 3 days or metronidazole or rifaxmin or bactirm

COnatact CDC
loperamide for loose stools
oral rehdryation

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51
Q

TTP

A

Need pripheral smear
PEtiachia on exam
Interpret labs
steroids!
PLasampheresis
Hematology consult
Admit to icu

haptogllobin, high retic, high idnrieect bili

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52
Q

ludwigs angina

A

airway management- diffcult airway to the bedside
abx
ENT couslt (dont techincially need imaging- trismus is all you need)
Admit

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53
Q

Pericardial tamponade trauma

A

Intubate early! and get stuff to thebedisde when they are still alive (you intubating them shoudlnt kill them)
fluids (Acitvate MTP)
Blood transfusion
Surgical cosnult

THrocotomy- describe procsure
pericardiocentesis- nto sufficicent

extras: ancef, tdap, foley, Bedside US

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54
Q

Cat bite hand

A

Abx- Augmentin or (CLinda + Doxy/cipro)
tdap
follow up wound check

Assess for FB in hand(X ray)
tendon, Neuro, vascula rinjury
assess for rabies risk and contact CDC
irrigate

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55
Q

TOA

A

everything you think of + G/C sent

discuss with PMD if need fo radmission

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56
Q

Cavernous venous sinus thrombosis

A

Early abx
lumbar puncture
MRI
ICU

+++ Neuro
+optho
+steroids
+heaprin (in consultation)

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57
Q

Kawaskai Kids

A

ASA (100mg/kg/day)
IVIG!!! (2g/kg)
Ped rheum
Ped ID
Ped card- Echo , anusyrusm
family

inflammatory markers
rapid strep!
Consider meningitis (LP is appropriate here)

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58
Q

SIDS

A
  1. PALS
  2. Assess for signs of trauma and abuse
  3. Resuscitate and ensure temperature is normal before ending code
  4. Support for family

Case 55! start there

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59
Q

Septic arthritis

A

pain
arthocentesis
abx after fluid reuslts
x ray

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60
Q

Tx of rmsf in preggos and kids

A

Doxy!

only other agent that works is chloramphenicol (nly in anaphylaxis for tetras)

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61
Q

Acute chest syndrome

A

o2
ivf
pain
cxr
abx
EXCHANGE transfusion
MICU

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62
Q

Meningitis

A

Abx before LP
LP
Isolation admission to ICU
Public health concerns! (discuss with close ones for ppx and rpeort to dept of health/cdc

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63
Q

pericarditis

A

EKG
exam
ECHO!
NSAIDS
admit

64
Q

Hypolgycemia sulfonurea

A

IV
FSG
D50
oral feeding or octreotide
admit

65
Q

High altitude cerebal edema

A

Dexamethasone
rapid decent
oxygen
(possible hyperbarics)

66
Q

Digoxin toxicity

A

EKG
Atropine or pacr pads
dig fab
Treat hyperK
CCU

the dig EKG looks like laternans
levels over 5.5 and looks funky

66
Q

CHF exacerbation

A

NItro drip if HTN
lasix
aspirin
ccu

67
Q

aortic coarctation

A

Oxygen and intubate
IV access, ekg,cxr
recognize cardiomegaly
cards ocnsult
prostalgnic administration!!! to KEEEEEP it open. Indomethacin closes it

68
Q

Status Epilepticus

A

FSG
IV access
IV benzos Start with 4 then give another 4!
I do keppra but then phenytoin load too
Neuro for EEG
Head CT
a bunch of labs and tox labs

69
Q

Intuss in a kid

A

NS bolus 20 cc/kg
complete physical
barium enema!
peds surg consult

70
Q

HIV PJP pneuminia

A

dont forgrt reps isolation

71
Q

SVT

A

talk about adenosine wiht patient
6 then 12 mg with 3 way stop cock
defib at the bedside
repeat EKG

72
Q

Neuogenic shock from c spine injury

A

IV access and fluid bolus
c spine precautions
ct c spine
nsgy
tube
pressors

dont forget you can start a central line in cricitally ill patients

73
Q

Tpa blood pressure stroke
general stroke bp

A

185/110

210/130!!! I dont do this!

74
Q

Pevic fx and hypotensive

A

IV
blood
trauma
FAST
cxr-pelvis x ray
reduce pelvis
consult IR

74
Q

thyrotoxicosis

A

Ct and LP for possible meningitis!?
serum tox labs?!
Propranol. PTU or methimazole, Iodine (steroids)
Abx for possible meningiits

75
Q

Start on pg 364

A
76
Q

Headache, elevated Cr plus high BP

A

HTN emergency
IV antihyerensives]pain control (25 % reduction in MAP)
LP to rule out SAH
ct head
admit to tele

77
Q

Hypothermia perals for rewarming

A

get partient naked, look for trauma and wet clothes off
blankets, bair, humidified an dwarm air, warm IVF
+ Foley and NGT with warmed fluids

avoid big movements that could give an arrythmia, under 30 celcius is severe and leads to fixed pupils, v fib etc.

If unstable and cold= coded or v fib then do the thoacic and peritolnela lavage or dialsysis!!

Abx can be given in drownings

78
Q

What to do after intubation

A

CXR
OGT
Foley
Set the vent
get a gas and ent tidal capnopgraphy to confirm
Sedation

79
Q

potassium 3.3, diarrhea, bloody diarrhea, good vitals

A

IVF
still give potassium
abx
talk about diet and edcuation on diarrhea

80
Q

PJP PNA in HIV

A

Steroids (if pa02 less than 70 on ABG)
Cftx plus azithro
add bactrim
consider TB tx

81
Q

NAT 3 yr old abd pain

A

pain (morphine)
CT abd for serious injury
inconsisitn story recongition
surgery conuslt (splenic lac)
optho conuslt (rule out retinal hemorgahes)
Social work
talk with family
full skeletal survery
tell the authorities

82
Q

5 yo old, abd pain, cola urine, bloody diarrhea

A

HUS
get smear for schistocytes
Abx may make this worse!
DONT give anti motility agents
watch out for hyperK
EKG (lytes)
not necesssary to give platelts usually but type an cross

  1. IVF
  2. family
  3. admit
  4. peds heme and nephology consult
  5. supportive care
  6. if very severe think plasma exchange
83
Q

2 yo sudden resp distress

A

FB in airway

Oxygen, BVM if necessary
Prepare for intubation but dotn intubate
think about abdominal thrusts (if over a year)
INs and exp x ray for FB
ENT consult
talk with family

84
Q

what is needed to jet venitlate a kid

A

14 g needle
3 cc synrige
7.0 Ett adapter
BVM

84
Q

tylenol overdose

A
  1. timing of ingestion
  2. 150 mg/kg of NAC
  3. get tlyneol leveland oco ignestion (anf ABG)
  4. EKG
  5. suicide precations

psych
poison control
Urine tox

85
Q

STEMI

A

ASA, Oxygen, morphine and or nitro (avoid in right side)
HEparin drip +/- tal with cards about ticagrelor
cardiac cath lab

86
Q

sepsis in old lady

A

IVF (30 cc kg)
lactate
cbc
Bcx ucx
cxr
look for sourcres includes skin, decubitus ulcers, UA (plevic exam?)
Early abx in these patients

87
Q

You are dead on for hyperthermia - here are other things you dont think of

A

once they go down 3ish degrees celisum start to pull back to not overshoot
benzos treat shivering
tachydsyrhtimias respond to cooling, dont cardiovert just yet
DONT give tylenol -disrupts hypothalamus
only 500 cc bolus (to a L) then 250 cc/hr! DONT give a ton of fluids

LAbs to check: TSH, CK, myoglobin, tox screen
LP!
Abx for sure
FOley to guide urine out put

88
Q

ESRD hypotenion

A

Pericardial tamponade
pulsus paroxus(10 drop inBp with insipriation)
electiral alternans!

89
Q

always think US when hypotenion

A

grab Your FAST and be done with it

90
Q

Tension PTX

A

Needle to tube (clinical)
CXR to conifrm tube, Ancef, Tdap
EFAST
pain

surgery consult
CT
fulls econdary survbery
give fluids and blood

91
Q

Ct scan abd with….

A

Can do PO, IV and rectal contrasgt!

92
Q

diverticulitis

A

pelvic exam
admit (if fever or vitals signs or pain)
Abx
surgry consult

93
Q

Stable V tach

A

Amio 150 x 2 then a drip of 1 mg/min
synch cardiovert for unstable at 100 J bipahsic
cards and admit ccu

93
Q

Eclampsia

A

IV labetalol
4 g mag over 15 mins
still give lorazepam
CT head!!!
OB GYN
UA!!!!

look for bradydysrhthamis, hypreflexia, respirotory
140/90 BP

94
Q

ACLS Stuff!

A

When do you give amio after what shock? 3 (300 then 150). Give epi after 2nd shock.
End tidal cprnhprahy monitoring!

95
Q

When to give acitvated charcoal

A

quickly after tylenol or TCA OD
MUST intubate tho! for apsiration

96
Q

TCA OD

A

Sodium bicarb drip
EKG and then repat EKG after bicarb
CO-ingestion
FLuids boluses > Noorepi if needed
stabiliz first then think charocaol

97
Q

Liver transplant Fever

A
  1. V/Z/Fluc
  2. PAra to ruel out SBP
  3. talk with transplant team
  4. cultuters before abx
  5. admit isolation

Other: think possible TB, liver abscess, cholangiits - need imaging CT/US or REJECTION

98
Q

unstable trauma

A

PAN scan
EFAST
blood
okay to give quick liter
Logroll ith c spine immobilization for full exam
CXR, pelvic x ray - still labs
adovacate or ex lap if big spleni lac or something

99
Q

20 day old, fussy, bloody poop

A

Nectorziing entoerolciites

Spetic baby work up + Abd upright and possible abd US
V/C/clinda
peds surgery
fludi boluses

100
Q

farmer, cough, wide mediastinum

A

POssible tube
Levofloxacin + Vanc (NO CFTX!)
Cipro to ALL healthcare workers
CDC
admit siolation

101
Q

anaphylaxis kid

A

airway if needed
o2
EPI 0.01 mg/kg/dose up to x 3
LOTS of fluid- assume hypotenin
adjunct meds
obs for 6 hours! at least or admit and if dc avoid trigger and give epipen

102
Q

simple febrile sziure

A

still give antipyretics
good HP to rule out serious illness (get a workup still!)
counsel paretns

103
Q

cocaine chesg tpain

A

EKG-O2-
Benzos and nitrates
trop
cxr
obs admit

104
Q

SBO

A

You can still give abx here

105
Q

Guillan BArre

A

FSG, neuro exam (sensory intact, weak) DDx
Neurolgy cosnult
LP
intubate and get a NIF to recofnize it
PLasma excahnge or IVIG
ICU

106
Q

PALS adenosine doses

A

0.1 mg/kg

1J then 2 J sync

sinus tach Infants <220, chilren under 180- find and treat cause

107
Q

PALS VT Greater than .08 or 80

A

May attempt adneoinse Then 1J then 2 J sync

Amio 5 mg/kg

108
Q

PALS bradycardia

A

BAsically all supprtive with oxygenation and ventialtion and if there ARE signs of poor perfusion, AMS, shock & HR <60 then:
1. CPR
2. Atropine .02 mg/kg
2. epi .01 mg/kg

Think hyothermia, hypoxia, OD

109
Q

PALS arrest

A

no breath but a pulse= rescue breathes q 5 seconds- acitvate EMS and check pulses

no pulse, no breath:
1. CPR
- 30:2 singles
-15:2 doubles
used AED as soon as it arrives to go down:
wide or narrow
tachy vs brady
Shockable vs non shockable

110
Q

All the Hs and Ts

A

Hypo/er K
Hypo/er G
Acidosis
Hypoxia
Hypovolemia
Hypo/er thermia

Toxins
Thrombosis - PE, STEMI
Tension PTX
Tamponade

Trauma?

111
Q

PJP PNA to-dos

A

Add on resp isolation
consider TB tx

112
Q

Isonizad toxicity

A

B6
Airway (if you need to)
POC glucose
Serum tox workup!
Non con of the head

neuro consult
ID consult?
charcoal if immediately
Sodium bicarb if there is lactic acidosis

113
Q

92 yo M eder neglect with stage 3 decub

A
  1. report for elder abuse
  2. social work consult
  3. IV hydartion / po nourhishment
  4. Check for rhabdo
  5. EKG
  6. Work up sepsis and infection

SKIN CARE/WOUND CARE!
check for sexual abuse as well

114
Q

Acute gout

A
  1. arhtorcentesis
  2. Pain (colchincine/NSADIS)
  3. COunsleing on alcohol reduction

X rays
uric acid
lab work up

115
Q

Carotid artery dissection

A
  1. CT non cons
  2. CT angio (they are separate) or MRA
  3. Neurology consult? (vascular)
  4. Heparin (aspirin)
  5. pain

remmeber this can gice you anisocoria! (anhidorisis would be horner syndrome)

116
Q

Sigmoid volvus, OLDY

A
  1. pain
  2. Xray obsutrtive sereies
  3. NG tube
  4. Gastroenterolgy and surgery consult

Abx
Sigmoidocsy and rectal tube for decompression

117
Q

LVAD

A
  1. Infection (or hypovolemia)- pressors needed
  2. Bleeding (On history)
  3. Thrombosis (tea colored urine)
  4. Failure (hypervolemia)
  5. Tamponade
  6. Arrythmia, VT/VF (cardioveriosn vs shock)

A. Doppler BP for MAP (or art line
B. Bedside Echo
c. CXR
CC. EKG
D. Exam (volume status, leads, hum, pump/battery failure)
E> VAD Team consult
F> labs (COags, trop, BNP, hemolysis)
G. Heparin? for pump thrombosis or possible ECMO!!

118
Q

Sepssis w/ DIC actions

A

Book says Trsnfuse platelets to 50k (but only if need surgery or bleed risk), otherwise 10k transfusion threshold
Give Cryporecitpate for fibrinogen <100, if >100 and coagulopathic then FFP (especially if INR is sky high)- basically if they are supe r low then transfuse
Repeat labs and lactate!

119
Q

Cool the patient or no?

A

PERFORM A NEURO EXAM POST CODE! IF THEY SHOW SIGNS OF BRAIN INJURY START IT
Definitely say normothothermia!
SDome evidence to suggest 36degrees after a code with evidence of some brain injury (ice pack and cooling blankets) with rectal probe or Foley catheter probe

Complications:
Shivering= meperideine
Electrolyte problems

120
Q

Post arrest care

A

NEURO EXAM! Reflexes, painful stimuli,posturing
Airway: ETCO2, CXR, vent (confirm of already)
FSG
CENTRAL LINE
ART LINE
OG/FOley
Core temp monitoring
GI Ppx
Sedation

If you think it is a stem I- aspirin, possible heparin, Cards CONUSLT AND push for going to the cath lab

121
Q

DVT TRX

A

Rivaroxaban 15 mg BID - follow up in several days wit PCP for lab and symptom monitoring
Pain management

122
Q

Superior vena cava syndrome

A
  1. LAsix!
  2. Elevate head of bed’
  3. Surg Onc, IR, VAscular for resection and stent placement of veins and biopsy

Possible steriods,

123
Q

tox HF acid

A
  1. Get Ca
  2. Get Mg
  3. IV calcium glucvonate or topical calcium gel 5%
  4. Copious irrigation
  5. If no improvement then intraarticular calcium gluconate with art line
  6. EKG dyshrthymia
  7. Analgesia
    8.Burn or fox consult
124
Q

BEER potomonia cerebral edema

A
  1. NGT
  2. HypoNa to 113, AMS, 100 cc 3% HTN saline
  3. Serum/urine osm (hypoosmolar,hyponatremia)
  4. Slow Sodium correction (avoid central pontine) 2-3 quickly then 0.5/hr after that not going over 10 in 24 hrs
125
Q

Hypercalcemia SSCL

A
  1. Fluids bonus then 200 cc/hr
    ‘2. Zolendronic acid 4 mg over 15 min
  2. Calcitonin 4 IU
  3. Replete other lytes
  4. Get iCal

Look for short QT
Possible kidney stones- get CT. STONEs, bones, moans AMS, groans PUD

126
Q

Cushing syndrome

A
  1. Labs
  2. Random cortisol
  3. Follow up endocrine- high risk HTN, dm2, bone disease

Causes: adrenal tumor (coortisol), Lung or Pituitary mass (ACTH tumor), or too much steroids

127
Q

Aplastic crisis

A

CBC
Transfusion prbcs
Cxr
Pain control
Admit-heme consult

ABX!

Retic count >3 means bone marrow is trying

128
Q

Rhabdo with Heat exhaustion

A
  1. Cool with ice packs
  2. Fluids
  3. EKG
  4. Cardiac history
  5. Renal for possible dialysis’
  6. ICU
    READ ALL LAB VALUES! You have. Missed diagnses by skimming
129
Q

Migraine

A

Prochloperazine 10 mg
Benadryl
Sumatriptan 6 mg IM
Neuro exam
Possible neuro imagine

130
Q

Acute ischemic stroke posterior

A
  1. BP goals < 220/120
  2. Neuro consult, NSGY (edema,herniating risk), IR for clot retrieval
  3. Stroke protocols, MRI/MRA (if neg then….
  4. Aspirin!!!!
  5. Zofran
  6. Detailed neuro exam, Establsihing onset of time
131
Q

Myasthenia Gravis

A
  1. Baseline labs, CT head
  2. Neuro consult
  3. Tox works up, TSH
  4. Ice pack test for improvement of ptosis (no tension test anymore)
  5. Pyridostigmine +/- steroids, plasma exchange, IVIG(If organophospahsetes then praldoxime and atropine)
    NIF for reps depression

Try to avoid paralytics

132
Q

Ethylene glycol

A
  1. Low calcium! Correct
  2. EKG, prolonged QT
  3. Fomepizole
  4. GAP GAP! Anion and osmolarity gap
  5. B6 b1 Foempizole
  6. HD!!!!
    EKG
    Sodium bicarbonate for serve acidosis
    TRY NOT TO INTUBATE FOR KUSSMUAL ACIDOSIS!
133
Q

All toxic alcohols have an anion gap, and osmolarity gap- which one doesn’t?

A

No osmolarity gap in isopropyl alcohol (ketones)- supportive care!

134
Q

30-60 day feb kid

A

CFTX
Amp for listeria
Vanc possibly
possibly acylovir

> 60 days is vanc cefepime

134
Q

feb neo abx

A

AMp and gent

ask for risk of HSV!
YOU CAN GIVE VANC IF NEEDED!

135
Q

Post arrest care- first 4 things to do

A
  1. Ensure airway, vent settings (normo oxixxa, morno carbia yada yada)
  2. Ensure BP doesnt need support
  3. EKG/Unstable cardio= Possible cath lab
  4. Neuro exam
    - if bad neuro exam cool to 32-36 for 24 hours, avoid fever, foley monitirnig
    - Head CT
    - NEuro, EEG monitoring
136
Q

Next step post arrest care after firt 4?

A

OG, FOley, CXR
Sedation if needed
Temp monitoring
Art line
Central line
FSG

GI PPX

137
Q

Tox- No acidosis, but ketosis

A

Isopropyl alcohol- supportive care

138
Q

tox-Acidosis, osmol gap, eyes

A

Methanol, folate

139
Q

tox, acidosis, osmol gap, Kidneys, cacium disurption

A

ethlyene glycol, b1, b6 foemipzile

140
Q

tox Dry as a bone, red as beet, blind as bat, mad as hatter, hottter than a hare=

A

Anticholinergic/muscarinic toxicity
GIve pyhsostigmine

141
Q

tox Slaivating, vomiting, diarrhea, lacrimating, bronchrrhea, miosis

A

Organophopsate posioning
GIve atropine and praldixoime and decomtaminate

142
Q

tox BB/CCB OD Rx

A

C FAG PIL

Fluids
Calcium
Atropine
Gulcagon
Insuline and D50
Pressors-epi
Lipid emulsion

WBI if ER formulation

143
Q

tox, dig toxciity

A
  1. K managemaget
  2. Dig FAb
  3. Charcaol maybe

HD is not inidicated and nor is Ca

144
Q

tox-Baby botulism

weak and consitpated

A

Human derived Immunoglobulin therpay

If adult- equine heptavalent

CDC

145
Q

Tox CO posioning

A

High flow oxygen
Co-ox and levels
Poisslbe Hyperbarics (25%, 15% preggo, LOC, Acidosis <7.25!!, end organ damage)

Talk about post neuropyschiatric disorders

Need EKG, cardaic biomarkers etc

146
Q

Cynaide

A

Hydorxycobalamin
Big acidosis on labs

147
Q

Fever Non infectious DDX

A

Need phys exam, hx and lab clues:
EXtnernally cool all of them!

SSS (from RX)- Cyprohepatidine, benzos
NMS- supportive, benzos, dantorlene
Thyrod Storm
Malignant hyperthermia - DANTROLENE
External
ASA OD, Anticholinergics OD
Drugs- COcaine, Meth BENZOS

148
Q

tox lithium

A

FLuids
WBI if recent
HD

149
Q

Tox metthgb

A

CHoclate blood, i think stuck at 85%
from nitrites
Give emthlyene blue

150
Q

tox sulfonureS

A

Octreotide
glucose drip

151
Q

TCA OD

A
  1. Sodium Bicarb
  2. Benzos if seizure
  3. Charcoal if quick

NO physotigmine, no flumazeil

152
Q

what is parkland paofrmula

A

KG X TBSA X4

half over the next 8 hours

Rosh (14 decks)

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