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Emergency Medicine > Toxidromes And Levels Of Consciousness > Flashcards

Toxidromes And Levels Of Consciousness Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Levels of consciousness in order

A

alert, lethargic or somnolent, obtunded, stupor or semi-coma, coma

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2
Q

Coma cocktail

A

Thiamine 100mg slow IV push
D50 50ml IV over 3-5 minutes
Naloxone 0.8-2mg IV push

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3
Q

ABC’s?

A 
Airway
Breathing
Circulation
Disability
Exposure
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4
Q

Symptoms of cholinergic (organophosphate) poisoning

A

salivation, lacrimation, urination, defecation, GI pain, Emesis, bradycardia, bronchorrhea, bronchospasms

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5
Q

Treatment of cholinergic (organophosphate) poisoning

A

2-PAM (pralidoxime) or Atropine

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6
Q

Common causes of anti-cholinergic poisoning

A

TCA, antipsychotics, antihistamines

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7
Q

Symptoms of anti-cholinergic poisoning

A

flushing (red as a beet)
fever (hot as a hare)
urinary retention, dry mucous membranes (dry as a bone)
toxic psychosis (mad as a hatter)

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8
Q

Symptoms of TCA poisoning

A

Pulmonary edema, anti-cholinergic effects, AV blocks, hypotension, confusion, agitation, hallucination, seizure or coma

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9
Q

Treatment of TCA poisoning

A

ECG monitoring, charcoal, sodium bicarbonate, benzodiazepines

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10
Q

Opioid (Heroin, morphine) poisoning symptoms

A

CNS depression, miosis, respiratory depression

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11
Q

Treatment of opioid poisoning

A

Naloxone and ventilation

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12
Q

Sympathomimetics (cocaine, meth) poisoning symptoms

A

psychomotor agitation, mydriasis, diaphoresis (sweating), tachycardia, hypertension

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13
Q

Treatment of sympathomimetic poisoning

A

Cooling, sedation (benzodiazepines), hydration

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14
Q

Antidote to acetaminophen

A

Acetylcysteine

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15
Q

Antidote to anti-cholinergics

A

Physostigmine

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16
Q

Antidote to benzodiazepines

A

Flumazenil

17
Q

Antidote to beta-blockers

A

Glucagon

18
Q

Antidote to calcium channel blockers

A

Calcium

19
Q

Antidote to digoxin

A

Digibind

20
Q

Antidote to heavy metals

A

chelating agents

21
Q

Antidote to narcotics

A

naloxone

22
Q

Symptoms of withdrawal from sedative hypnotics

A

agitation, tremor, N/V, tachycardia, hallucinations, flushing

23
Q

Treatment of withdrawal from sedative hypnotics

A

introduce pentobarbital, switch to phenobarbital PO then taper slowly over 10 days

24
Q

90% of withdrawal seizures occur how long after abstinence?

A

6 to 48 hours
these seizures are usually focal seizures
if repetitive (DT) , tx is Valium or Phenobarbital IV

25
Q

Most common electrolyte abnormality

A

Hyponatremia

Na < 120 mEq/L; pts present with delirium, drowsiness, lethargy and can progress to seizures and coma

26
Q

How to distinguish psychotic and organic altered mental status?

A

difficult
orientation to person is rare in organic disease
psychotic patient usually have recent memory and can perform single calculations

27
Q

Presentation of strokes

A

Altered mental status, dysphasic or slurred speech, loss of movement/strength of one or both sides of the body, asymmetrical facial features.

28
Q

Thrombotic Thrombocytiopenia Purpura: presentation and tx

A

neurologic changes, acute fever, bleeding/rash, renal failure
Women 20-40; related to pregnancy, lupus, von Willebrand factor clots
Tx: plasma exchange and steroids

29
Q

You CANNOT clear a C-spine if:

A 
intoxication
distracting injuries
midline posterior point tenderness
any alteration in mental status
focal neurological deficits
30
Q

Presentation of Hypothermia

A

skin temp near 91 F
peripheral vasoconstriction, shivering, altered mental status, apathy, lethargy, ataxia (loss of control of body movements)

31
Q

Presentation of heat exhaustion

A

Core temperature is normal or less than 106 F

orthostatic hypotension, tachycardia, sweating

32
Q

Presentation of heat stroke

A

Core temperature is above 106 F;

orthostatic hypotension, tachycardia, CNS dysfunction, may lose the ability to sweat.

33
Q

Presentation of acute alcohol intoxication

A

Peripheral vasodilatation, tachycardia, hypotension, hypothermia
Stupor occurs when blood alcohol level reaches 250-300 mg/dL

34
Q

Presentation and treatment of Wernicke’s Encephalopathy

A

Caused by acute thiamine deficiency + carbohydrates, associated with alcoholism, malnutrition;
nystagmus, palsy of CN 6 - opthalmoplegia; truncal ataxia, unsteady gait; confusion, delirium, apathy, tachycardia, DOE, orthostatic hypotension, peripheral neuropathy;
Tx: Thiamine 100 mg IV slow push STAT; continued IV infusion + vitamins (magnesium), “banana bag,” bedrest

35
Q

Presentation of Delirium Tremens

A

Appears 3-4 days after abstinence form alcohol in alcoholics;
profoundly delirious state, tremulousness, agitation, excessive motor activity, purposeless activity; hallucinations, tachycardia, dilated pupils, fever, excess sweating, not orientated to situation.
Tx: Librium, thiamine, multivitamin

Emergency Medicine (1 decks)

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