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PEM Flashcards

1
Q

Anticholinergic poisoning

Sxs:
example drugs:

A 
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)

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2
Q

Cholinergic poisoning

Sxs:
example drugs:

A

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

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3
Q

Sympathomimetic poisoning

Sxs:
example drugs:

A 
Sxs:
Mydriasis
Tachycardia
Hypertension
Hyperthermia
Seizures

(to differentiate from anticholinergic, sympathomimetic has diaphoresis and increased bowel sounds)

example drugs: cocaine, amphetamines, ephedrine, PCP

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4
Q

Drug poisoning that causes hypotension

A

CRASH

Clonidine, calcium channel blockers
Rodenticides (containing arsenic, cyanide)
Antidepressants, aminophylline, antihypertensive (beta blockers)
Sedative hypnotics
Heroin or other opioids

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5
Q

Drugs that cause Miosis

A

COPS

Cholinergics, clonidine
Opiates, organophosphates
Phenothiazides (antipsychotics), pilocarpine, pontine hemorrhage
Sedative-hypnotics

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6
Q

Drugs that cause Mydriasis

A

SAW

sympathomimetics
anticholinergics
withdrawal

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7
Q

Antidote for TCA overdose

A

Sodium bicarb

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8
Q

Antidote for organophosphate poisoning

A

Atropine and pralidoxime

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9
Q

Antidote for beta blockers

A

glucagon; insulin/glucose

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10
Q

Antidote for calcium channel blockers

A

insulin/glucose

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11
Q

Antidote for cyanide

A

hydroxocobalamin

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12
Q

Antidote for methemoglobinemia

A

methylene blue

works by oxidizing NADPH which is able to convert the methemoglobin to hemoglobin so it is able to carry oxygen again

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13
Q

Antidote for sulfonylureas

A

octreotide

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14
Q

Antidote for iron

A

deferoxamine

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15
Q

Gases that can make you quickly pass out

A

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)

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16
Q

bladder capacity formula

A

(age+2) x 30

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17
Q

dental abscess tx

A

can start with amoxicillin or penicillin

If worsening go to augmentin or clindamycin

18
Q

MAS labs

A
  • 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.
19
Q

Ketamine mechanism of action

A

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

20
Q

Dislocation of the AC joint cc measurement

A

Look at the AP view is the coracoclavicular ligament distance is greater than 1.3 rupture if the CC joint is probable

21
Q

Bell-van Riet test

A

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

22
Q

ingestion causes of hypoglycemia

A

ethanol, beta blockers, and oral hypoglycemics

23
Q

othro injuries least likely to correct without intervention

A

fractures of the diaphysis, bowing >10 and rotational malalignment

24
Q

injuries that can be managed initially by the ED with outpt ortho fu

A

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

25
Q

Torus fracture

A

buckle fracture

26
Q

bowing deformity management

A

all should be referred to an orthopedic surgeon

27
Q

compartment syndrome cause

A

obstruction in venous outflow leading to increased pressure and then you eventually occlude the arteries and capillaries

28
Q

antibiotics for open fracture

A

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)

29
Q

Nerve injury with humerus injury

A

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

30
Q

Supracondylar fractures look for injury of

A

Brachial artery

Median (especially anterior interosseous nerve(test strength of thumb when pt says okay)), radial or ulnar nerve

31
Q

impetigo tx

A

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.

32
Q

monteggia fracture

A

ulnar shaft fracture with radial head dislocation

33
Q

galeazzi fracture

A

radius fracture with radioulnar joint dislocation

34
Q

pyloric stenosis measurements

A

thickness greater than 3 mm and length greater than 15mm

35
Q

octreotide

MOA

A

binds to somatostatin receptors coupled to phospholipase C through G proteins and leads to smooth muscle contraction in the blood vessels

36
Q

Terbutaline dosing

A

Inhalation:

0.5 mg

37
Q

Versed for procedures dosing

A

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

38
Q

acute respiratory failure

A

HCO3 will increase by 1 for every 10 increase in CO2

39
Q

chronic respiratory failure

A

HCO3 will increase by 4 for every 10 increase in CO2

40
Q

Flumazenil dosing

A

0.01 mg/kg max of 0.2 mg, repeated as needed up to total of 1mg

41
Q

dose of albuterol during an exacerbation

A

0.25 puff/kg

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