Treatments Flashcards
CRAO treatment
Decrease IOP Gentle massage Hyperventilate (increase PaCO2) Acetazolamide (carbonic anhydrase inhibitor --> decrease aqueous humor) Timoptic Ophtho consult
Carcinoid syndrome treatment
Octreotide
Kawasaki disease treatment
ASA
IVIG
SLE treatment
Steroids
Rocky Mountain Spotted Fever treatment
Doxycycline Or chloramphenicol (CAM) in pregnant women
Diptheria treatment
Equine diphtheria antitoxin
Erythromycin/PCN
Sarcoid treatment
Steroids
Dressler’s syndrome treatment
NSAIDs, steroids
ITP treatment
Pediatrics: none
Adults: steroids –> replace platelets to 50K, high-dose Rho-GAM (anti-D immune globulin)
TTP treatment
Steroids *Plasmapheresis FFP **AVOID PLATELETS** (Unlike ITP give platelets, Rho-GAM; DIC give heparin and blood components)
HELLP treatment
Like pre-eclampsia
Bedrest, delivery, Mg, BP control
No diuretics or ACE inhibitors
Rhabdomyolysis (ATN) treatment
IV hydration
Treat hyperkalemia and hypocalcemia
Alkalinize urine with bicarb
Neuroleptic Malingnancy Syndrome treatment
Dantrolene or bromocriptine
Trichinosis treatment
Antihelmentics - mebendazole/albendazole
Erlichiosis treatment
Doxycyline
Botulism treatment
Antitoxin
Wound –> antitoxin, debridement, high-dose PCN
Tick paralysis treatment
Remove tick
Ascending paralysis and loss of DTRs (similar to GBS but no autonomic instability)
Tetanus prophylaxis
Minor wounds:
> 3 prior immunizations and >10 years –> Tdap
< 3 prior immunizations –> Tdap
Contaminated, puncture, crush, avulsion, burn
< 3 prior immunizations –> Tdap + TIG
> 3 prior immunizations and > 5 years –> Tdap
Wernicke’s treatment
Admission
Thiamine (Vit B1) prior to glucose
Magnesium
Normal pressure hydrocephalus treatment
Shunt
Multiple sclerosis treatment
Steroids, plasma exchange, disease modifying agents
Eaton-Lambert treatment
Remove tumor (50%, especially lung, CA) Plasmapheresis Avoid neuromuscular blocking agents, aminoglycosides, IV contrast, CCBs
Catecholamine crisis treatment (ie pheo, MAOI crisis, cocaine overdose)
Labetalol + phentolamine (non-selective alpha blocker)
Serotonin syndrome treatment
Cooling
Cyproheptidine
Tensilon toxicity treatment
Atropine
bradycardia and syncope
Myasthenia gravis treatment
Pyridostigmine or neostigmine (ACH inhibitors)
Thymectomy (25% associated thymoma)
Prednisone
Plasmapheresis
Warfarin bleeding complications treatments
Stop (2.5 day half-life)
IV Vit K
4-factor prothrombin complex concentrate (II, VII, IX, X) - KCentra vs FFP (10-15 ml/kg)
Heparin reversal
Protamine (1 mg reverses 100 U)
Acetaminophen overdose antidote
Acetylcysteine (NAC)
Arsenic poisoning treatment
Chelation: dimercaprol/BAL, DMS
Aspirin overdose treatment (salicylate poisoning)
Alkaline diuresis, hemodialysis
Sx: tinnitus, ototoxicity, hypokalemia
Metabolic acidosis due to oxidative phosphorylation uncoupling
Beta-blocker overdose treatment
Glucagon (hypoglycemia), intralipids
propanolol can cause seizures
Barbiturate overdose treatment
Alkaline diuresis, hemodialysis
Calcium channel blocker overdose treatment
Calcium, glucagon, glucose/insulin, intralipids
Carbamate overdose treatment
Atropine
Carbon monoxide poisoning treatment
100% O2, HBO
Cyanide poisoning treatment
Sodium nitrite, sodium thiosulfate, hydroxycobalamin (Vit B12)
Avoid nitrites in concomitant CO poisoning
Digitalis poisoning treatment
Digibind (fab antibiodies), avoid transcutaneous pacer (irritability), no calcium –> “stone heart”
Green-yellow vision, halos
EKG: PVCs or bradydysarhythmias
Indication: severe cardiac toxicity with/without hypotension, K > 5.0, digoxin level >10 (acute) or > 4 (chronic) –> 10 vials (5 vials for chronic)
Ethylene glycol (anti-freeze, pain, solvents)
Bicarb, ethanol, dialysis, 4-MP (fomepizole)
Binds to calcium –> calcium oxalate crystals –> renal failure
Iron poisoning treatment
Deferoxamine, WBI
Isoniazid (INH) overdose treatment
Pyridoxine (Vit B-6)
Lead poisoning treatment
BAL, DMS, EDTA
Mercury poisoning treatment
BAL, DMS
Methemoglobin treatment
Methylene blue
Methanol treatment (paint thinner, solvents, gas additive)
Bicarbonate, ethanol, dialysis, 4-MP (fomepizole)
Blindness
Nitrites treatment
Methylene blue
Opiate overdose treatment
Narcan
Organophosphate treatment
Atropine, 2-PAM
Oral hypoglycemia agent (ie sulfonylurea) overdose treatment
Glucose, glucagon, octreotide
TCA overdose treatment
Sodium bicarb, intralipids No physostigmine (may precipitate seizures or asystole)
Timing of thromboses hemorrhoid tx
Less 72 hours: I&D
> 72 hours: Sitz baths
Fat emboli treatment
High-dose steroids
Signs/symptoms: CNS (HA, AMS, sz, coma), petechiae, dyspnea
Mycobactrium marinae treatment
(papules to hands/feet/elbows)
Tx: clarithromycin + ethambutol/rifampin
Or minocycline, clarithromycin, doxy, Bactrim
Vs swimmer’s itch –> supportive
Spigelium hernia
Absence of posterior rectus sheath –> hernia along semi-lunar line between 2 muscle layers
Tx: if incarcerated –> surgery
Lyme disease treatment
Doxycycline (or ceferoxime/amoxicillin) x 2-3 weeks
Syphillis treatment
Primary and secondary: benzathine PCN 2.4 million units IM x 1
Tertiary: x 3
Yersinia treatment
Pneumonic (bubonic) plague
Isolation, streptomycin/gentamycin/chlorphenicol, doxy
ARDS treatment
Low tidal volume, permissive hypercapnia, high PEEP
Cryptococcal meningitis treatment
Dx: india ink stain, high opening pressure (LP)
Tx: amphotericin B + flucytosine or fluconazole
Hydrocarbon toxicity treatment
Beta-blockers
Sniffing, huffing, bagging –> myocardial sensitization –> VF/VT
Hydrofluoric acid toxicity treatment
Glass etching, brick or wheel cleaners, rust removers
Pain out of proportion
Dysrhythmias from hypocalcemia and hyperkalemia
Tx: calcium gluconate
Salicylate toxicity treatment
Metabolic acidosis with respiratory alkalosis
Tx: alkalization of urine, dialyze (pulm/cerebral edema, renal failure)
Hypercalcemia treatment
Hydration, loop diuretics (ie furosemide), calcitonin (increases renal excretion, works fastest), bisphosphonates (interferes with osteoclasts function, long term control), steroids (increases renal excretion and decreases GI absorption)
Thyroid storm treatment
1) anti-hormone, 2) blunt systemic effects, 3) treat precipitant, 4) prevent decompensation
1) PTU/methimazole (blocks synthesis) –> iodine (blocks release)
2) beta-blocker (propanalol), steroids (blocks conversion of T4 to T3
3) treat precipitant
4) prevent decompensation (ie, fluids, dextrose, cooling, Tylenol)
Peds VT/VF treatment
2-4 J/kg (max 10 J/kg)
Peds SVT treatment (>220 infants, >180 kids)
Vagal maneuvers
Adenosine 0.1 mg/kg
Cardioversion 0.5-1J/kg
Avoid diltiazem –> hypotension
Croup treatment
Cool air
Nebulized epi
Dexamethasone 0.15 - 0.6 mg/kg
Peds hyponatremia treatment
If seizing, 3% NaCl 5 ml/kg over 20 minutes
Peds hypocalcemia treatment
If seizing, 10% calcium gluconate 0.3/kg.kg over 5-10 minutes
Glucose replacement in peds
Rule of 50
5 mL/kg D10W (infant) or 2 mL/kg of D25W or 1 mL/kg of D50W (adolescent)
Epiglottitis treatment
Humidified oxygen, IV ceftriaxone (2nd or 3rd generation cephalosporin, early intubation
No role for IV steroids or racemic epi
Causes: *H flu, strep, gram-neg organisms
Uremic bleeding treatment
IV desmopression (dDAVP) –> release vonWillibrand factor
Pheochromocytoma treatment
Phentolamine or phenoxybenzamine
Neurocysterosis (taenea solium) treatment
Pork tape worm –> ring-enhancing brain lesions –> seizure
Tx: praziquantel and steroids
Schisotomiasis treatment
Praziquantel
Vibrio vulnificans treatment
Salt water or brackish water
*Hemorrhagic bull
Tx: ceftriaxone + doxycycline
Hook worm treatment
Ivermectin or albendazole
Pertussis treatment
Erythromycin (azithromycin or clarithromycin or Bactrim)
Prophylaxis for adults
Kleihauer-Betke (KBT) test
Detects presence and quantifies volume of fetal RBCs in maternal circulation (minimum of 5mL of fetal hemorrhage)
Use in significant trauma
Maternal-fetal hemorrhage >30 mL –> 2nd dose of 300 umg Rhogam
Anticholinergic crisis treatment
Jimson weed, atropine, scopolamine
IV hydration, supportive care, benzodiazepines
Physostigmine is select cases
NSTEMI undergoing immediate PCI
Bivalirudin - direct thrombin inhibitor and inhibits platelet aggregation
Does not cause thrombocytopenia
Less incidence of major bleeding
Jellyfish sting treatment
Vinegar
No fresh water
PCP pneumonia treatment
Bactrim + steroids if PaO2 < 70
or primaquine + clindamycin or pentamidine (IV or inhaled)
Cryptospyridium diarrhea in AIDS treatment
HAART (get CD4 > 100)
Rattlesnake (crotalid) bite treatment
Antivenom (CroFab)
Pain and swelling can mimic compartment syndrome (no indication for fasciotomy unless swelling not responsive)
Abnormal PT/PTT, LFTs, CBC –> treat until symptoms improve
Start with 4-6 vials –> redoes 4-6 vials if necessary then 2 vials q6 hour for 18 hours
Mechanism of acetazolmide in acute mountain sickness treatment
Carbonic anhydrase inhibitor –> induces metabolic acidosis –> compensatory hyperventilation –> speeds of acclimation
Also give dexamethasone, NSAIDs, decent
Vs HACE –> higher altitude (>4k), lethargy, AMS seizures
Factor VIII replacement dosing
% x 0.5 units/kg
Major 50 units/kg
Minor 25 units/kg
Traveler’s diarrhea
Cipro 750 mg PO x 2 or azithromycin 1g PO x 1
Unstable VT vs pulseless VT/VF treatment
Synchronized cardioversion vs shock
Swimmer’s itch treatment vs mycoplasma marinum treatment
Supportive vs clarithromycin + ethambutol or rifampin
Toxic shock syndrome (TSS) treatment
IVF, antibiotics –> not responsive, give IVIG
Endocarditis treatment
Vancomycin + amino glycoside +rifampin (prosthetic valve)
Endocarditis prophylaxis
History of prosthetic valves, prior IE, congenital heart disease, cardiac transplant with valve disease
Amoxicillin 2g PO or ampicillin 2g IV
Allergic to PCN: clindamycin 600 mg PO/IV, cephalexin 2g PO or azithromycin 500 mg PO or cefazolin/ceftriaxone 1g IV
Toxoplasmosis treatment
Pyrimethamine, sulfadiazine + folinic acid
Or IV trimethoprim-sulfamethoxazole
Or dapsone + pyrimethamine
Psittacosis treatment
Flu-like illness, headache, exposure to bird droppings
Doxycycline or tetracycline
Transfusion Related Acute Lung Injury (TRALI) treatment
Sudden onset non-cardiogenic pulmonary edema
Respiratory support, supportive care, IVF, pressors
No role for nitroglycerine or furosemide
Chilblains treatment
Rewarming and drying –> nifedipine (also use in high altitude pulmonary edema, Raynauds)
No debridement
Stingray treatment
Remove barb, irrigate wound, no wound closure, hot water immersion (toxin is heat labile), tetanus, Keflex and doxy
No antitoxin
Meningitis prophylaxis
Rifampin, cipro or ceftriaxone
Lidocaine toxicity
Bicarb, IV fat emulsion (intralipids)
Adverse effect of malaria treatment
Quinine IV –> hypoglycemia
Giardia treatment
Hiker’s diarrhea
Metronidazole TID
Dx: stool antigen or O&P
Yersinia treatment
Mimics acute appendicitis
Ciprofloxacin
