Emergency Step2

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Author:
gm1147
ID:
166147
Filename:
Emergency Step2
Updated:
2012-08-15 13:57:00
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Emergency EM ED step2
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Kaplan
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  1. Gastric lavage use
    • Best if <30min
    • At 1 hour will remove 50%
    • at 2 hours will remove 15%
    • Useless after 2 hours
    • Dangerous in altered mental status and caustic ingestion
  2. Acetominophen toxicity levels and tx
    • Toxicity at 8-10g
    • Fatality at 12-15g
    • If >24 hours ago - no tx
    • If unclear amount, get drug level
    • If >8g, Nacetylcysteine
  3. Aspirin overdose presentation and tx
    • Tinnitus
    • hyperventilation
    • resp alkalosis then metabolic acidosis
    • Renal toxicity
    • altered mental status
    • Inc anion gap
    • ARDS
    • Inc PT
    • Tx by alkalinizing urine
  4. TCA toxicity and tx
    • Seizures
    • Arrhythmias - wide QRS precursor
    • Dry mouth
    • Constipation
    • Urinary retention
    • Tx with NaBicarb to protect against arrhythmias
  5. CO poisoning tests and tx
    • Oximetry is falsely normal
    • Accurate: carboxyhemoglobin level
    • Tx mild with 100% O2. If CNS, Cardiac or metabolic acidosis, hyperbaric O2
  6. Methemoglobinemia causes
    • Benzocaine and other anesthetics
    • Nitrites and nitroglycerin
    • Dapsone
  7. Methemoglobinemia test, initial therapy, most effective therapy
    • Normal pO2, Accurate test is methemoglobin level
    • Inital therapy is 100% O2
    • Most effective is methylene blue
  8. Insecticide poisoning
    • Oraganophosphates, like nerve gas
    • Inh ACh metabolism leading to inc levels
    • Salivation, lacrimation, polyuria, diarrhea, bronchospasm, bronchorrhea, respiratory arrest
    • TX with pralidoxime or atropine
  9. Digoxin toxicity presentation, dx, tx
    • GI, hyperK, confusion, yellow vision
    • bradycardia, Atach, AV block, ventricular ectopy, Afib
    • Initial is K level and EKG (downsloping of ST segment). Accurate is digoxin level
    • Tx is Ab
  10. Digoxin and K
    • Hypok leads to digoxin toxicity bc they compete for the same site
    • Digoxin toxicity leads of hyperK bc ATPase is not working
  11. Lead poisoning presentation and dx, tx
    • Abdominal pain
    • ATN
    • Anemia - sideroblastic
    • Peripheral neuropathies
    • Memory loss, confusion
    • Initial test is inc level of free erythrocyte protoporphyrin. Accurate is lead level. Also prussian blue for sideroblastic anemia
    • Tx: Succimer is oral chelator. EDTA and BAL (dimercaprol are IV
  12. Methanol source, toxic metabolite, toxicity, tx
    • Wood alcohol, cleaners, paint thinners
    • Formic acid/formaldehyde
    • Retinal inflammation and ocular toxicity, met acidosis
    • fomepizole and dialysis
  13. Ethylene glycol source, toxic metabolite, toxicity, tx
    • Antifreeze
    • Oxalic acid/oxalate
    • HypoCa, oxalate crystals, renal toxicity, met acidosis
    • fomepizole and dialysis
  14. Serum osmolality
    2Na + BUN/2.8 + Glc/18
  15. Death from snake bite
    • Hemolytic toxins causing DIC
    • Neurotoxins causing resp paralysis
  16. Black widow spider bite: presentation, labs, tx
    • Abd pain, muscle pain
    • HypoCa
    • Ca, antivenom
  17. Brown recluse spider bite: presentation, tx
    • Local necorsis nad bullae
    • Debride, steroids, dapsone
  18. Dog/Human bites tx and bugs
    • Amox/clavulanate
    • Tetanus if more than 5 years
    • Dogs and cats: Pasteurella multocida
    • Humans: Eikenella corrodens
  19. Large hematoma tx
    • Intubation
    • Hyperventilation (dec pCO2, constrict cerebral circulation, dec volume, dec pressure)
    • Mannitol (dec intravascular volume)
    • Drainage
    • Stress ulcer prophylaxis with PPI
  20. Indications for stress ulcer prophylaxis
    • Head trauma
    • burns
    • endotrach intubation
    • coagulopathy with resp failure
  21. Prevents stroke after subarachnoid hemorrhage
    Nimodipine
  22. Burn tx
    • 100% O2 first
    • Intubation if stridor, mouth burns, etc
    • 4mL ringers lactate or NS for each % burned for each kg
    • 9% for head, an arm, a leg. 18% for chest or back. 1% for a hand
    • Prophylactic topical antibiotics - silver sulfadiazine
  23. Best initial for hypothermia
    • EKG for cardiac arrhythmias
    • Elevated J point
  24. Drowning types
    • Salt water is CHF like
    • Fresh water causes hemolysis
    • Tx with positive pressure ventilation for both
  25. Precordial thump
    Only used in rescusitation if witnessed and recent with no AED
  26. Asystole tx
    • CPR
    • epinephrine
    • atropine
    • vasopressin is alternate to epi
  27. VFib tx
    • Defibrilation
    • CPR
    • Defibrilation
    • Epi or vasopressin with defibrilation
    • Amiodarone or lidocaine with defibrilation
    • Mg
  28. VTach tx
    • Pulseless: same as VF
    • Stable: amiodarone, lidocaine, procainamide. Cardiovert
    • Unstable: cardioversion, then amiodarone or lidocaine
  29. Hemodynamic instability signs
    • Chest pain
    • Dyspnea/CHF
    • Hypotension
    • Confusion
  30. Pulseless electrical activity: definition, causes
    • normal EKG and no pulse
    • Tamponade
    • Tension pnx
    • hypovolemia and hypoglycemia
    • massive PE
    • hypoxia, hypothermia, met acidosis
    • K high or low
  31. Afib/Aflutter tx
    • Unstable: synchronized cardioversion
    • Chronic: more than 2 days.
    • Rate control: betablocker, CCB (diltiazam and verapamil), or digoxin
    • Anticoagulate: Warfarin: 2-3. Dabigatran is alternative oral anticoagulation. ASA if low risk from stroke
  32. Afib stroke rate
    • without warfarin, 6% per year
    • INR 2-3, 2-3%
  33. Atrial contribution to cardiac output
    • Normally 10-15%
    • Diseased, 30-50%
  34. Low risk of stroke with Afib
    • aka Lone atrial fibrilation
    • No heart disease or atherosclerosis
    • No HTN
    • <75
    • No DM
    • No past stroke
  35. Supraventricular tachycardia tx
    • Vagal
    • Adenosine
    • Metoprolol, Diltiazem, or digoxin
  36. Wolfe-Parkinson-White syndrome presentations, test
    • -SVT alternating with VTach
    • SVT worsened by diltiazem or digoxin
    • delta wave
    • -Accurate test is EP study
  37. WPW tx
    • Acute: procainamide or amiodarone
    • Chronic: ablation
    • Dont give digoxin or CCB
  38. MAT association, tx
    • Chronic lung disease
    • Tx lung disease and as would AFib
    • Avoid betablockers bc of lungs
  39. Sinus brady or 1st dewgree AV block tx
    • Asymptomatic: nothing
    • Best initial: atropine
    • Most effective: pacemaker
  40. Wenckebach block
    • Mobitz I
    • progressive lengthening then drop
    • Normal aging
    • No tx if asymptomatic
  41. Mobitz II block
    • Dropped beats
    • Tx like 3rd degree block
    • Pacemaker for all

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