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EM Final Study Guide > Pages 41-52 > Flashcards

Pages 41-52 Flashcards

1
Q

Labs in DKA?

A 
Plasma glucose: over 250
Arterial pH:  under 7.30
Serum bicarb: under 18
Urine ketones: +++
Serum ketones: +++
Serum osmolality: increased 
Anion gap: over 12
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2
Q

Labs in HHS?

A 
Plasma glucose (mg/dL): over 600
Arterial pH: over 7.30
Serum bicarbonate: over 18
Urine ketones: negative
Serum ketones: negative 
Serum osmolality: greatly increased
Anion gap: Normal (12-16)
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3
Q

Average fluid loss in KDA and HHS?

A

DKA: 3-6 liters
HHS: 8-10 liters

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4
Q

How to correct fluids in DKA and HHS?

A
  1. Start with isotonic saline 15-20 ml/kg per hour
  2. Switch to one-half isotonic saline serum Na
  3. Add dextrose to IVF when serum glucose reaches 250
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5
Q

How to administer insulin in DKA and HHS?

A
  1. Only after adequate fluid resuscitation
  2. Start with an infusion of regular insulin at 0.1 U/kg/hr.
  3. Double dose if glucose doesn’t fall by 50-70 mg/dL in first hour
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6
Q

How to correct K in HHS and DKA?

A
  1. If the K under 3.3, DELAY insulin therapy until fluid and potassium replacement
  2. Administer K w/ initial IVF if K is normal or low and maintain between 4 - 5 mEq/L
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7
Q

When is bicarb administration needed in DKA and HHS?

A
  1. Severe acidosis with pH < 6.90
  2. Severe life-threatening hyperkalemia
  3. Seizures
  4. Cardiac or persistently hypotensive patient
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8
Q

Monitoring of labs in HHS and DKA?

A
  1. Glucose every hr. until stable, then every 2 - 4

2. BMP and blood pH every 2 - 4 hours until patient stabilizes

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9
Q

What can HYPOglycemia mimic?

A
  1. Coma
  2. Stroke
  3. Seizures
  4. Syncope
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10
Q

Oral administration of glucose in hypoglycemia?

A

300g (1200cal) of carbohydrate should be given:

  • Soda, juice, sandwich, snacks
  • Complex carbohydrates better at maintaining levels
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11
Q

IV administration of glucose in hypoglycemia?

A

Adults: 50 ml of 50% Dextrose in Water (D50)
Peds: 1 ml/kg of 25% Dextrose in water

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12
Q

What needs to be given to alcoholics with glucose?

A

Thiamine to prevent Wernicke’s Encephalopathy

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13
Q

Use of glucagon in hypoglycemia?

A

Can be used when no IV access

  • Adults: administer 1 mg IM
  • Kids: 0.5 mg if under 20 kg
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14
Q

Use of octreotide in hypoglycemia?

A

May be useful in the setting of sulfonylurea-induced hypoglycemia not responsive to other therapies

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15
Q

Triad thyroid storm?

A
  1. High fever (sometimes as high as 106)
  2. Exaggerated tachycardia
  3. CNS dysfunction
    Also
  4. Tremulousness
  5. Agitation
  6. Psychosis
  7. N/V
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16
Q

Diagnosis thyroid storm?

A
  1. Elevated T3/T4
  2. Elevated T3 uptake
  3. LOW TSH
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17
Q

How does PTU work?

A

Blocks synthesis of thyroid hormone

- Preferred over methimazole because PTU also reduces peripheral conversion of T4 to T3

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18
Q

How do you block release of thyroid hormone?

A
  1. Inorganic iodine at least 1 hour after antithyroid meds
  2. Lugol’s solution
  3. Can use lithium if allergic to iodine
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19
Q

How do you stop effects of thyroid hormone?

A

Propranolol - antagonizes the hyperadrenergic effects of thyroid hormone

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20
Q

How to treat hyperthermia in thyroid storm?

A

Acetaminophen

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21
Q

Definition hyperkalemia?

A

Serum potassium of greater than 5.5 mEq/L

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22
Q

Effect of hyperkalemia on the heart?

A

2nd and 3rd degree heart block, wide complex tachy, and progression to v-fib and asystole

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23
Q

Diseases leading to hyper K?

A
  1. CKD
  2. DKA
  3. Rhabdo
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24
Q

Hyper K on EKG?

A
  1. Peaked T waves: 6.5-7.5
  2. Wide QRS, decreased amplitude of P: 7.5-8.0
  3. Sine wave, v. fib, asystole - K 10-12
25
Q

How to stabilize cardiac membrane in hyper K?

A
  1. Calcium gluconate: 10ml IV over 2-5 minutes

- May be repeated after 5 minutes if no improvement

26
Q

How to redistribute K?

A
  1. Insulin + D50: 10-20 units IV: if glucose less than 250

2. Albuterol 2.5-10 mg Nebulized

27
Q

How to reduce total body K?

A
  1. Kayexalate: binding resin that exchanges sodium for potassium in colon
  2. Furosemide 20-40mg IV: rapid acting
  3. Hemodialysis - indicated if hemodynamically unstable.
28
Q

What is the coma cocktail?

A
  1. Hypoxia: 100% O2 non rebreather
  2. Hypoglycemia: POC fingerstick
  3. Opioids: administer Narcan 0.4- 2mg IV
29
Q

Signs of sympathomimetics?

A
  1. Tachycardia
  2. Hypertension
  3. Mydriasis
  4. Diaphoresis
  5. Hyperthermia
  6. Agitation
30
Q

Drugs causing sympathomimetics signs?

A
  1. OTC cold agents (containing ephedrine)
  2. Cocaine
  3. Amphetamines
  4. Methamphetamine
  5. Dietary supplements (ephedra)
  6. MDMA: “ecstasy”
31
Q

Signs of sedative hypnotic ODs?

A
  1. Hypothermia
  2. Bradypnea
  3. Hypotension
  4. Drowsiness / lethargy / coma
  5. Dysarthria
  6. Ataxia
  7. Miosis
  8. Nystagmus
  9. Hyporeflexia
32
Q

Signs anticholinergic OD?

A
  1. Mad as a hatter - AMS
  2. Blind as a bat: mydriasis=DILATION
  3. Hot as Hades
  4. Red as a beat
  5. Dry as a bone
33
Q

Toxins with anticholinergic properties?

A
  1. TCA’s Tricyclic antidepressants (TX WITH BICARB)
  2. Antihistamines
  3. Overactive bladder medication
34
Q

Rx TXA overdose?

35
Q

Signs cholinergic toxicity?

A 
"SLUDGE"
Salivation
Lacrimation
Urination
Diaphoresis and defecation
Gastrointestinal upset
Excessive bradycardia or tachycardia
36
Q

Sources for cholinergic toxicity?

A
  1. Organophosphate poisoning (pesticides)

2. Nerve agents

37
Q

Rx Cholinergic Toxicity?

A
  1. Atropine
  2. 2 PAM
  3. Decontaminate
38
Q

What is a toxic dose of acetaminophen?

A

Acute ingestion: 140-200 mg/kg or 7.5 gm

Chronic: 4 gm in 24 hours as a chronic ingestion

39
Q

Antidote Acetaminophen toxicity?

A

NAC - N-acetylcysteine

40
Q

When does NAC need to be given to be hepatoprotective?

A

Within 8 hours

41
Q

What are heat cramps?

A

Brief intermittent / involuntary contraction (usually calves), from prolonged exercise in heat, from hydration with hypotonic fluids
Rx: REST AND REPLACE FLUIDS/LYTES

42
Q

What is heat stroke?

A
  1. Prodrome: light-headedness, dizziness, N, postural hypotension
    - Resolves when lying horizontal and with cooling measures
  2. Tachycardia / tachypnea
  3. Confusion / bizarre behavior / lethargy
  4. Ataxia / seizures / coma
    - A TRUE MEDICAL EMERGENCY. Core temp over 105 or 40.5 C rectal,
43
Q

Temp for heat stroke?

A

Core temp over 105 or 40.5 C rectal

44
Q

Rx heat stroke?

A

ACTIVE COOLING: Tepid water and fans, cooled IVFs, cooling blankets or ice packs to groin/axilla

45
Q

Goal Rx in heat stroke?

A

Drop temp to 100-102 (STOP AT THIS POINT to AVOID OVERCOOLING)
- NO ANTIPYRETICS

46
Q

Temps in HYPOthermia?

A

Mild: 32-35 C or 92-95F

47
Q

Rx frostbite?

A

Slow thaw in warm circulating water (100-104) with pain control

48
Q

Grades frostbite?

A

3rd through muscle, 4th frozen to bone

49
Q

Most common injury in lightning strike?

A

Ruptured tympanic membrane

50
Q

Different in paralysis in Lyme and RMSF?

A
  1. Tick paralysis: ascending paralysis that stops when tick removed
  2. RMSF (centrifugal spread)
51
Q

Abx in animal bites?

A

Amoxicillin-clavulanate

52
Q

Sub Q Suture?

A

5-0 Polysorb or Dexon

53
Q

Scalp thin suture?

A

4-0, 5-0 monofilament nylon or polyporlylene

54
Q

Scalp thick suture and duration?

A

5-0 (5-7 days)

55
Q

Face suture and days?

A

5-0, 6-0 (3-5days)

56
Q

Mouth sutures?

A

5-0 Polysorb or Dexon, 4-0, 5-0 plain

57
Q

Trunk sutures?

A

3-0, 4-0, 5-0 non absorbable (6-10 days)

58
Q

Extremity sutures?

59
Q

Palm and sole sutures?

A

3-0, 4-0, 5-0 na (7-12 days)

EM Final Study Guide (29 decks)

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