PEM Flashcards
Anticholinergic poisoning
Sxs:
example drugs:
Sxs: Hot as a hare Red as a beet Dry as a bone Blind as a bat Mad as a hatter Full as a flask
example drugs: antihistamines, TCAs, atropine, scopolamine, Benztropine (used for parkinsons)
Cholinergic poisoning
Sxs:
example drugs:
Sxs: can give muscarinic and nicotinic sx
muscarinic: DUMBELLS Diarrhea, diaphoresis Urination Miosis Bradycardia Emesis Lacrimation Lethargy Salivation
nicotinic: adds muscle fasciculations and flaccid paralysis
example drugs: organophosphates, pilocarpine
Sympathomimetic poisoning
Sxs:
example drugs:
Sxs: Mydriasis Tachycardia Hypertension Hyperthermia Seizures
(to differentiate from anticholinergic, sympathomimetic has diaphoresis and increased bowel sounds)
example drugs: cocaine, amphetamines, ephedrine, PCP
Drug poisoning that causes hypotension
CRASH
Clonidine, calcium channel blockers
Rodenticides (containing arsenic, cyanide)
Antidepressants, aminophylline, antihypertensive (beta blockers)
Sedative hypnotics
Heroin or other opioids
Drugs that cause Miosis
COPS
Cholinergics, clonidine
Opiates, organophosphates
Phenothiazides (antipsychotics), pilocarpine, pontine hemorrhage
Sedative-hypnotics
Drugs that cause Mydriasis
SAW
sympathomimetics
anticholinergics
withdrawal
Antidote for TCA overdose
Sodium bicarb
Antidote for organophosphate poisoning
Atropine and pralidoxime
Antidote for beta blockers
glucagon; insulin/glucose
Antidote for calcium channel blockers
insulin/glucose
Antidote for cyanide
hydroxocobalamin
Antidote for methemoglobinemia
methylene blue
works by oxidizing NADPH which is able to convert the methemoglobin to hemoglobin so it is able to carry oxygen again
Antidote for sulfonylureas
octreotide
Antidote for iron
deferoxamine
Gases that can make you quickly pass out
Hydrogen sulfide (manure pit)
Cyanide (tx with:
1.) hydrocobalamin (b12)- converts cyanide to nontoxic form
2.)sodium nitrate (causes methemoglobin which cyanide preferentially bonds to)DONT USE IN FIRES
3.) sodium thiosulfate (converts cyanide to nontoxic form also)
bladder capacity formula
(age+2) x 30
dental abscess tx
can start with amoxicillin or penicillin
If worsening go to augmentin or clindamycin
MAS labs
- super high ferritin
- One characteristic feature of macrophage activation syndrome is a paradoxical decrease in the erythrocyte sedimentation rate. This phenomenon is due to the consumption of serum fibrinogen, which results in more rapid sedimentation of erythrocytes within the laboratory assay.
Ketamine mechanism of action
mechanism of action:
noncompetitive NDMA antagonist and glutamate receptor antagonist, partial agonist on mu opioid receptors
produces dissociative state and provides pain control
watch for resp depression if administered too fast
duration of action 5 to 15 minutes
Dislocation of the AC joint cc measurement
Look at the AP view is the coracoclavicular ligament distance is greater than 1.3 rupture if the CC joint is probable
Bell-van Riet test
Affected arm is passively raises to full adduction to 90 degrees and crossed in front of the patient while maintains extension. Then the pt attempts to elevate the arm against resistance. If have focal pain at the AC joint and inability to keep arm up there is likely an unstable AC joint
ingestion causes of hypoglycemia
ethanol, beta blockers, and oral hypoglycemics
othro injuries least likely to correct without intervention
fractures of the diaphysis, bowing >10 and rotational malalignment
injuries that can be managed initially by the ED with outpt ortho fu
1) nondisplaced salter 1 (excluding femur and proximal tibia)
2) clavicle fractures
3) non displaced upper extremity fractures
4) incomplete, non-displaced fractures of the long bones of the lower extremities
5) non-displaced fractures of the hand and foot
Torus fracture
buckle fracture
bowing deformity management
all should be referred to an orthopedic surgeon
compartment syndrome cause
obstruction in venous outflow leading to increased pressure and then you eventually occlude the arteries and capillaries
antibiotics for open fracture
cefazolin (if large add gentamicin)
OR
ceftriaxone
*can also consider adding ampicillin for coverage against anaerobes if at high risk (like if on a farm)
Nerve injury with humerus injury
Radial nerve injury
Numbness of the dorsum of the hand between 1st and 2nd metacarpals and decrease strength with wrist and thumb extension and forearm supination
Supracondylar fractures look for injury of
Brachial artery
Median (especially anterior interosseous nerve(test strength of thumb when pt says okay)), radial or ulnar nerve
impetigo tx
if localized: topical mupirocin
if large area: oral cephalexin 40-50 mg/kg/day divided TID. (or augmentin 45 mg/kg/day of amox component BID max of 875 BID) Kind of an old study from JAMA 1989 but it had about 30% due to betahemolytic step so that’s why augmentin vs amox.
monteggia fracture
ulnar shaft fracture with radial head dislocation
galeazzi fracture
radius fracture with radioulnar joint dislocation
pyloric stenosis measurements
thickness greater than 3 mm and length greater than 15mm
octreotide
MOA
binds to somatostatin receptors coupled to phospholipase C through G proteins and leads to smooth muscle contraction in the blood vessels
Terbutaline dosing
Inhalation:
0.5 mg
Versed for procedures dosing
IV 0.05- 0.1 mg/kg repeated, max 0.6 mg/kg total no more than 6mg for up to 5 years old and no more than up to 10 mg for older
Intranasal 0.5 mg/kg max at 5mg to 10 mg
Oral 0.5 mg/kg max at 20 mg
acute respiratory failure
HCO3 will increase by 1 for every 10 increase in CO2
chronic respiratory failure
HCO3 will increase by 4 for every 10 increase in CO2
Flumazenil dosing
0.01 mg/kg max of 0.2 mg, repeated as needed up to total of 1mg
dose of albuterol during an exacerbation
0.25 puff/kg
