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UW Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

iron poisoning - manifestation

A
  1. within 30 mins to 4 days: abd pain, hematemesis, melena, hypotensive shock, met acidosis
  2. within 2 days: hepatic necrosis
  3. within 2-8 wks: pyloric stenosis
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2
Q

iron poisoning - diagnosis

A
  1. radiopaque pills

2. anion gap met acidosis

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3
Q

iron poisoning - treatment

A

1 .whole bowel irrigation

  1. deferoxamine (chelation)
  2. supportive care for circulation, airway and breathing
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4
Q

radiopaque poisons on the stomach

A
  1. iron

2. lead

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5
Q

caustic ingestion - clinical features

A
  1. laryngeal damage: hoarseness, stridor
  2. esophageal damage: dysphagia, odynophagia
  3. gastric damage: epigastric pain, bleeding
    NO ALTERNATION OF CONSCIOUSNESS
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6
Q

caustic ingestion - management

A
  1. ABC
  2. decontamination, remove contaminated clothings + visible chemcals, irrigate exposed skin
  3. chest x-ray if resp symptoms
  4. endoscopy within 24 h
  5. upper GI x-ray with water soluble contrast in suspected perforation
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7
Q

caustic ingestions - complications

A
  1. Upper airway compromise
  2. perforation
  3. strictures/stenosis (2-3 wks)
  4. ulcers
  5. cancer
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8
Q

most reliable and predictive sign for opioids toxicity

A

Low RR

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9
Q

clinical presentation of methemglobinemia - history

A

exposure to oxidizing substance (eg. dapsone, nitrates, loca/topical anesthetics)

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10
Q

clinical examination of methemoglobinemia - clinical examination

A
  1. cyanosis
  2. pulse oximetry saturation 85%
  3. dark chocolate - colored blood
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11
Q

methemoblobinemia - labs findings

A
  1. saturation gap (more than 5% difference between O2 saturaton on pulse oxymetry + ABG)
  2. Normal Pa02
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12
Q

methemoglobinemia - plasma osmolar gap

A

normal

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13
Q

methemoglobinemia - treatment

A

Methylene blue is the antidote for symptomatic methemoglobinemia or high levels of methemoglobin
(also vit C)

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14
Q

lead poisoning in adults - RF

A

occupational exposure (eg. ;lead paint, batteries, ammunition, construction)

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15
Q

Lead poisoning - clinical featurres

A
  1. GI (abd pain, constipation, anorexia)
  2. neurologic (cognitive deficits, peripheral neuropathy)
  3. hematologic (anemia)
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16
Q

lead poisoning in adults - labs

A
  1. anemia
  2. elevated venous lead level
  3. elvated serue zinc protoporhyrin level
  4. basophilic stippling on peripheral smear
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17
Q

arsenic poisoning - mechanism

A

binds 1. to sulfhydryl groups

2. disrupts cellular respiration + gluconeogenesis

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18
Q

arsenic poisoning - sources

A
  1. pesticides / insecticides
  2. contaminated water (often from wells)
  3. pressure treated wood
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19
Q

arsenic poisoning - manifestation

A
  • acute: garlic breath, vomiting, watery diarrhea, WTc prolongation
  • chrnic: hypo/hyperpigmentation/ hyperkeratosis/ stocking-glove neruopathy
  • also pancytopenia, mild elevation of liver enzymes
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20
Q

arsenic poisoning - treatment

A
  1. dimercaprol

2. DMSA (meso-2,3 dimercaprosuccinic acid, succimer)

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21
Q

clinical features of hypothermia

A
  1. mild (32-35): tachycardia, tachypnea, ataxia, dysarthria, increased shivering
  2. moderate (28-32): bradycardia, lethargy, hypoventilation, decreased shivering, atrial arhythmias
  3. severe (under 28): coma, cardiov collapse, ventricular arrhythmia
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22
Q

hypothemia - general treatment

A
  • warmed (42) crystalloid for hypotension

- endotracheal intubation in comatose patients

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23
Q

hypotermia - treatment for mild (32-35)

A

passive external warming (remove wet clothing, cover with blankets

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24
Q

hypothermia - treatment for moderate (28-32)

A

active external warming (warm blankets, heating pads, warm baths)

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25
Q

hypothermia - treatment for severe (under 28)

A

active internal rewarming (warmed pleural or peritoneal irrigation, warmed humidivied oxygen)

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26
Q

bradycardia of hypothermia

A
  • refractory to pacing or atropine

- treat hypothermia

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27
Q

Benzo - resp depression if

A

with other substance (opioid, alcohol) or if IV

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28
Q

CNS toxicity of TCA

A
  1. mental status changes
  2. seizures
  3. resp depression
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29
Q

Cardiovascular toxicity of TCA

A
  1. sinus tachycardia, hypotenesion
  2. prolonged PR/QRS/QT
  3. arrhythmas (VT, VF)
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30
Q

anticholinergic effects of TCA

A

Dry mouth, blurred vision, dilated pupils, Urinary retention, flushing, hypertehermia

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31
Q

TCA overdose - management

A
  • O2 / intubation
  • IV fluids
    3. activated charcoal within 2 hours (unless ileus present)
  • IV sodium biocarbonate for QRS or ventric arrhythmia (IF QRS MORE THAN 100)
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32
Q

major products of poisoning in fires

A
  1. CO

2. Cyanide

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33
Q

treatment of cyanide toxicity - generally

A
  1. decontamination
  2. Resp support
  3. cardiovascular support
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34
Q

cyanide poisoning - decontamination

A

derma; exposure: removal of clothing, skin decontamination

  • ingestion: activated charcoal
  • all exposures: antidote: hydroxycobolamin preferred, sodium thiosulfate (alternative), if antidote not availble (nitrates)
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35
Q

cyanide poisoning - resp support

A
  • no mouth to mouth resuscitation
  • supplemental oxygen
  • airway protection
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36
Q

cyanide poisoning - cardiovascular support

A

IV fluids in hypotension

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37
Q

methanol intoxitation - most severe consequences

A

vision loss + coma

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38
Q

methanol intoxication - physical exam

A

optic disc hyperemia

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39
Q

methanol intoxitation - labs

A

anion gap metabolic acidosis

- increased osm gap

40
Q

ethylen glycol vs methanol poisoning

A
  • both are ingested as a substitute for ethanol and both can cause anion gap met acidosis + increased osm gap
  • methanol damages eyes, ethylene glycol damages kidneys
41
Q

opioid intoxication - miosis

A

its absence does not exclude the diagnosis. Normal or even enlarged pupils may be seen in patients who have co-exposures to other agents that can counteract miosis
- the most reliable sign is low RR

42
Q

acetaminophen intoxitation - management

A

single dose 7.5g ore more (pediatric 150mg.kg)?
YES –> if less than 4 hours give charcoal –> check acetaminophen levels
NO (or indeterminate) –> if chronic ingestion check acetaminophen levels
after levels –> if above treatemtn line in nomogram or more than 10μg/ml if timing of ingestion unclear or any evidence of liver injury –> administer N. acetylysteine + monitor for liver injury

43
Q

NaHCO3 mechanism as an antidote of TCA

A

increases serum ph and extracellular sodium –> alleviating the cardio-depressant action of Na2+ channel

44
Q

pink red skin?

A

carbon monoxide or Cyanide tox

45
Q

lead poisoning - management

A
  • obtain venous sample (if screening perfomerd by capillary sample)
  • enviromental surveilance (identify + remove lead sources)
  • notify public health department
  • nutritional counseling
  • chelation therapy if lead level more than 45
46
Q

opioid withdrawal - management

A

opioid agonists: methadone (preferred) or buprenorphine

- nonopioid: clonidine or adjunctive medication (antiemetics, antidiarrheals, benzodiazepines)

47
Q

CO poisoning - epidemiology

A
  • smoke inhalation
  • defective heating systems
  • motors operating in poorly ventilated areas
48
Q

CO poisoning - manifestations

A
  1. mid-moderate: headache, confusion, malaise, dizziness, nausea
  2. severe: seizure, sycope, coma, MI, arrhthmias
49
Q

CO poisoning - treatment

A

high flow 100% O2

2. intubation/hyperbaric O2 therapy (if severe)

50
Q

management of anticholinergic overdose

A

pysostigmine (cholinestarase inh)

51
Q

toxic alcohols - types

A
  1. alcohol ketoacidosis
  2. methanol ingestion
  3. ethylene glycol ingestion
  4. isopropyl alcohol ingestion
52
Q

alcohol ketoacidosis - clinical features

A

slurred speech, unsteady gait, altered mentation

53
Q

alcohol ketoacidosis - labs

A
  1. high osmolar gap

2. increased anion gap metabolic acidosis

54
Q

methanol ingestion - clinical features

A

visual blurring, central scotomas, afferent upillary defect, altereled mentation

55
Q

methanol ingestion - labs

A
  1. high osm gap

2. increased anion gap metabolic acidosis

56
Q

ethylene glycol ingestion 0 clinical features

A
  1. flank pain, hematuria, oliguria
  2. CN paliseis
  3. tetany
57
Q

ethylene glycol ingestion - labs

A
  1. high osm gap
  2. increased anion gap metab acidosis
  3. calcium oxalate crystals in urine
58
Q

isopropyl alcohol ingestion - clinical features

A
  1. CNS depression
  2. disconjugate gaze
  3. absent ciliary reflex
59
Q

isopropyl alcohol ingestion - labs

A
  1. high osm gap

2. no increased anion gap or met acidosis

60
Q

chemicals in the eye - best primary course

A

flush the eye with water - best achieved under a faucet of ranning water for at least 15 minutes (1st water and then medical care vs cut scratches or foreign bodies)

61
Q

caustic ingestion - charcoal

A

NO:

  • caustic cause damage on the GI (not systemic)
  • charcoal is contraindicated as it will obstruct the view during endoscopy
62
Q

frostbite - clinical findings

A
  1. superficial pallor + anesthesia
  2. blistering, eschar formation
  3. deep tissue necrosis + mummification
63
Q

frostbite - management

A
  • rapid rewarming in 37-39 C IN WATER BATH (NOT HOT AIR)
  • analgesia + wound care
  • thrombolysis in severe, limb threatening cases
64
Q

attempt of suicide with unknown pill - most appropriate next step

A

gastric lavage

65
Q

gastric lavage - dangerous in … (and why)

A
  1. altered mental status: may cause aspiration
  2. caustic ingestion: caustic ingestion: causes burning of the esophagus and oropharynx
  3. acetaminophen overdose (delay the administration of overdose - N-acetylcysteine)
66
Q

pills ingestion - whole bowel irrigation

A
  • placing a gastric tube and flushing out the GI tract with polythylene glycol-electolyte solution (GoLYTELY: Braintree Laboratories, Braintree Massachusetts) is always wrong.
  • indications are very narrow and limited to massive iron ingestion, lithium and swallowing drug-filled packets (eg. smuggling)
67
Q

whole bowel irrigation - indications

A
  1. massive iron ingestion
  2. lithium
  3. swallowing drug-filled packets (eg. smuggling)
68
Q

attempt of suicide with unknown pill and altered mental status - most appropriate next step

A

naloxone and dextrose

69
Q

overdose - opiate vs benzodiazepine management

A

opiate overdose is fatal –> give naloxone immediately

benzodiazepine is not –> acute withdrawal causes seizures. DO NOT give flumazenil

70
Q

pills overdose - charcoal

A
  • should be given to anyone with a pill overdose
  • may not be effective for every overdose, but it never dangerous
  • remove toxic substance even after they have been absorbed
  • blood levels of toxins drop faster in those given repeated doses of charcoal
  • it is superior to lavage and ipecac
71
Q

acetaminophen and alcohol

A

alcoholism decreases the amount of acetaminophen needed to cause toxicity

72
Q

aspirin overdose can cause … (severe situation)

A

ARDS

73
Q

MCC of death in fires

A

CO: 60% of deaths on the first day after a fire

74
Q

CO poisoning death due to

A

MI

75
Q

CO vs methemoglobinemia according to blood color

A

CO –> red

Methem –> brown

76
Q

methemoglobinemia diagnosis

A
  • normal pO2

- the most accurate test is methemoglobin level

77
Q

cyanosis + normal p02 = ….

A

methemoglobinemia

78
Q

organophosphate (insecticide) poisoning and Nerve gas - absorbed through

A

skin

79
Q

digoxin toxicity - etiology

A
  1. hypokalemia predisposes to digoxin toxicity (K+ and digoxin compete for binding at the same site on the pump –> less K+ more digoxin is bound
  2. renal failure –> decreased excretion
80
Q

Rhythm disturbance of digoxin toxicity

A

ANY ARRHYTHMIA
bradycardia, Atrial tachycardia, AV block, ventricular ectopy, AF with slow rate
Atrial arrhythmia with variable AV block is the MC

81
Q

mercury toxicity - presentation

A

orally ingested –> neurological problems: nervous, jittery, twitchy, sometimes hallucinatory
inhaled –> lung toxicity: interstitial fibrosis

82
Q

methanol vs ethylene glycol - source

A

methanol: wood alcohol, cleaning solutions, paint thinner

ethylene glycol: antifreeze

83
Q

osmolar gap?

A

the difference between the measured serum osm and calculated osm
if u calc serm osm 300 but on measurement u find 350, it is possible that a toxic alcohol such as methanol or ethylene glycol is accounting for the extra osmoles
Ordinary alcohol (ETHANOL) also increases the osm gap

84
Q

methanol vs ethylene glycol - treatment

A

the best initial is fomepizole (inhibits alcohol dehydrogenase and prevents production of the toxic metabolie) –> it does not remove the substance from the body
Only dialysis will effectively remve methanol and ethylene glycol from the body

85
Q

beneficial therapy of snake bites

A
  1. pressure
  2. immobilization decreases movement of venom
  3. antivenin
86
Q

ineffective or dangerous treatment

A
  1. tourniquets blocking arterial flow
  2. ice
  3. incision and suction, esp bu month
87
Q

dog, cat and hyuman bites - microbes

A

dogs and cats: Pasteurella mustocida

humans: Eikenella corrodens

88
Q

warning rate in hypothermia - target

A

1-2 C/hour

89
Q

how to confirm CO poisoning

A

elevated HbCO:
- more than 3% in nonsmoker
- more than 10% in smoker
standard oxymetry is unreliable

90
Q

source of cyanide

A

burning of rubber or plastic (NOT WOOD)

91
Q

a characteristc of inhaled cyanide

A

bitter almond breath

92
Q

lead poisoning - emergency vs non emergency

A
  1. succimer: 45-69

2. dimercaprol plus EDTA on emergency, more tha n70, or acute encephalopathy

93
Q

toxic alcohols - types and clinical features

A
  1. alcohol ketoacidosis: slurred speech, unsteady gait, altered mentation
  2. methanol ingestion: visual blurring, central scotomas, afferent pup defect, altered mentation
  3. ethylene glycol ingestion: flank pain, hematuria, oliguria, CNS palsy, tetany
  4. isopropyl alcohol ingestion: CNS depression, disconjugate gaze, absent ciliary reflex
94
Q

toxic alcohols - types, which of them has high osm gap

A
  1. alcohol ketoacidosis
  2. methanol ingestion
  3. ethylene glycol ingestion
  4. isopropyl alcohol ingestion
    high osm gap in all
95
Q

toxic alcohols - types, which of them has increased anion gap met acidosis

A
  1. alcohol ketoacidosis
  2. methanol ingestion
  3. ethylene glycol ingestion
  4. isopropyl alcohol ingestion
    only isopropyl alcohol ingestion does not have

Emergency medicine (2 decks)

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