Preventative and EM MTB Chapters Flashcards
Ingestions of unknown substance– time window for lavage + when to avoid
first two hours
not for caustic ingestion or with altered mental status
Treatments that are almost always bad options for ingestion
- diuretics
- cathartics
- whole bowel irrigation
- ipecac (this is pre hospital)
Treatment that is is almost always a decent option in ingestion
charcoal
Most common causes of death by overdose nationwide
aspirin and acetaminophen LOL
Person with AMS of unclear etiology– first two steps
naloxone and dextrose (these do no harm)
Amount of acetaminophen that is dangerous? lethal?
8-10 = danger 12-15 = fatal
When is NAC safe for acetaminophen
first 24 hours
Metabolic disturbance in acetaminophen tox?
respiratory alkalosis and metabolic acidosis
Benefit of OD with BDZ + TCA
BDZ prevents seizing from TCA but if you give flumazenil all bets are off.
TCA EKG change
wide QT –> Torsades
TCA OD signs & tx
dry everything; sodium bicarb
Treatment caustic ingestion
endoscopy, flush with water
COD in CO poisoning
MI
Metabolic disturbance in CO poisoning
lactic acidosis
Lab to check first for CO poisoning
ABG (check for low pH 2/2 lactic acidosis…. low bicarb)
Two common drugs causing methemoglobinemia
anesthetics
nitrites
Treatment for methemoglobinemia
100% O2 and Methemoglobinemia
Color of blood in CO poisoning vs methemoglobinemia
CO- red
Met- brown
Nerve gas pathophys
blocks acetylcholinesterase …. ^ Ach ….^ secretions
COD in nerve gas + first step in treatment
bronchorhea –> bronchospasm –> respiratory arrest
*first give atropine
What predisposes to dig tox?
What lab is seen in dig tox
hypokalemia = risk factor HYPER= lab finding (blocks Na/K ATPase and Dig competes with K+)
Dig tox symptom + tx
visual disturbance
Can give dig specific antibodies if CNS/ Cards Involvement
Specific signs of lead tox
ATN
wrist drop
Treatment lead tox
chelating agents (ie succimer, EDTA, dimercaprol)
Treatment of mercury tox
chelating agents (same as lead)
Methanol/ ethylene glycol tox treatment
fomepizole, dialysis
Tox metabolite in methanol/ethylene glycol tox?
methanol - formic acid
ethylene glycol- oxalate
Methanol/ethylene glycol organs effects
methanol -eyeballs
ethylene- kidneys
Osmolality equation
sosm= (2Na) + (BUN/2.8) + (Glu/18)
actual should = calculated else you have extra osmoles.
How do snake bites kill?
hemolysis/ DIC and respiratory paralysis
Treatment of snake bites
pressure, immobilization, antivenin PRN
Lab finding in black widow bite?
hypocalcemia… can cause muscle/ abdominal pain
Treatment black widow bite?
antivenin, calcium PRN
Treatment brown recluse bite?
Dapsone, steroids, debride
Abx for dog, cat, human bites?
augmentin for all.
Concussion vs contusion management
observe contusion inpatient
Indications for GI px
intubation
head trauma, burns
coagulopathy with respiratory failure
Burns first two steps
assess airway –> give fluids
Equation for fluid replacement in burns
4x % BSA X kg
Rate and type of fluids for burns
normal saline 1/2 first 8 hours, 1/4 next 8, 1/4 next 8
Equations for BSA burnt
arm and head are 9
leg chest and back are 18 each
*Hand width = 1%
Common px abx in burns
topical (ie silver sulfadiazine)
Difference between NMS and Malignant hyperthermia
both have high CPK/ Temp and can get dantrolene. But NMS is by antipsychotics and could also get a dopamine agonist. MHTN is from anesthetics
Hypothermia cause of death
arrhythmia
Cause of death in salt water vs fresh water drowning
salt- CHF
fresh- hemolysis (hypotonic fluid in vasculature, cells burst)
Management of drowning
positive pressure ventilation
What is basically never the right answer in cardiac arrest
precordial thump
Which two rhythms can get unsynchronized cardioversion?
vfib, pulseless vtach
Besides CPR, whats treatment of asystole?
epi
Drugs for unstable vtach and vfib
epi/amio alternations
Some common causes of pulseless electrical activity x4
TPTX
PE
tamponade
K+ disorder
Unstable afib treatment
chronic stable afib treatment
unstable- Synch cardioversion
stable/chronic- rate control and either anticoagulate or asa if low risk
Whats the CHADS score for afib anticoagulation?
C-CHF/cardiomyopathy H- HTN A-Age above 75 D- DM S- Stroke/ TIA = 2
SVT treatment
vagal maneuvers –> adenosine –> BBer/CCB/Dig
Least safe for anticoagulating in afib?
least safe is warfarin… can do dabigatran/rivaroxaban/apixaban
Two drugs to avoid in WPW
dig and CCB
Two antiarrythmics to use in WPW
procainamide or amio
Cure for WPW
ablation
EKG findings in WPW
short PR
Delta wave
Vtach soon after MI… what do you need?
remove the clot
how to assess risk for repeat ventricular arrhythmia?
echo
Before you can implant defibrillator….. what type of ventricular arrhythmia must be present?
sustained.. can do EP studies to try and provoke sustained v tach.
Cancer screen with largest mortality decrease-
mammo after 50
How to benefit asx pt with many first degree relatives that have breast cx
SERMs- tamoxifen/raloxifene
Age group for paps
21-65 every 3 years or q5 with cotest after 30
Age group for chlamydia screening
15-25
When is PSA the right answer?
patient asks for it
Age for lipids in males vs females
males 35; females 45… or with CAD/equivalent… or DM, HTN etc.
When to screen for DM
people with HTN, HLP
Caveat to flu over age 50
has to be inactivated at 50 or with chronic disease
Order of the two PNA vaccines
13 –> 23
Who gets PNA vaccines before 65
chronic disease, CSF leak, cochlear implant, alcohol/tobacco, etc.
When does someone get the PNA vaccines twive?
If their first dose was before 65… or if theyre immunocompromised. Wait at least 5 years before dosing again
Who gets Hep A and B as adults
chronic liver disease; household contact; MSM; IVDU….
A: travelers
B: Health Care, DM, ESRD
Age for DEXA/AAA screen
65
