Emergency/Trauma Medicine

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Author:
flucas
ID:
265982
Filename:
Emergency/Trauma Medicine
Updated:
2014-04-01 16:25:53
Tags:
emergency medicine trauma
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Description:
emergency medicine, trauma medicine
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  1. Symptoms of organophosphate toxicity and/or PNS overstimulation
    • SLUDGE-M2B:
    • Salivation
    • Lacrimation
    • Urination
    • Defecation/Diarrhea
    • GI upset
    • Emesis
    • Muscle spasms
    • Miosis
    • Bradycardia
  2. Antidote for: opioids
    naloxone
  3. Antidote for: phenothiazines
    • diphenhydramine
    • benztropine
  4. Antidote for: lead
    • chelation tx:
    • calcium
    • EDTA
    • dimercaprol (BAL)
    • succimer
    • penicillamine
  5. Presentation of lead poisoning:
    • abdominal pain
    • anemia
    • headache
    • memory loss
    • cosntipation
    • AMS
    • renal dysfxn
    • chronic: mental retardation, cog dysfxn
  6. Presentation of ASA toxicity:
    • tinnitus
    • metabolic acidosis with anion gap and respiratory alkalosis
    • N/V
    • AMS
    • seizures
    • hyperthermia
    • encephalopathy
  7. Causes of anion gap metabolic acidosis:
    • Methanol, Metformin
    • Uremia
    • DKA
    • Propylene glycol, phenformin
    • Isoniazid, Iron, Idiopathic
    • Lactic acidosis (cyanide)
    • Ethalene glycol
    • Rabdomyolisis
    • Salicylates, Strychnine
    • Alcoholic Ketoacidosis
  8. Presentation of TCA toxicity:
    • EKG: QRS widening, prolonged QT interval
    • Anticholinergic effects:
    • tachycardia
    • mydriasis
    • flushed skin
    • dry mouth
    • AMS
    • seizures
  9. Antidote for: TCA
    bicarbonate
  10. Antidote for: ACTN
    N-acetylcysteine
  11. Antidote for: ASA
    bicarbonate
  12. Antidote for: carbon monoxide
    100% oxygen
  13. Antidote for: warfarin
    • FFP
    • Vit K
  14. Antidote for: organophosphates
    • atropine
    • pralidoxime/2-PAM
  15. Antidote for: arsenic or mercury
    • dimercaprol (BAL)
    • succimer
  16. Antidote for: benzo's
    Flumazenil
  17. Antidote for: beta-blockers
    glucagon
  18. Antidote for: atropine
    physostigmine
  19. Antidote for: cyanide
    • sodium nitrite
    • thiosulphate
    • hydroxycobalamin
  20. Antidote for: heparin
    protamine sulfate
  21. Antidote for: methanol or ethylene glycol
    • fomepizole
    • (ethanol infusion)
  22. Antidote for: nitrites
    methylene blue
  23. Antidote for: digoxin
    digoxin-specific antibodies
  24. Antidote for: iron
    deferoxamine
  25. Treatment for cocaine overdose
    • symptomatic, control HTN:
    • alpha-blocker (phentolamine)
    • alpha/beta-blocker (labetolol)

    (AVOID pure beta-blocker)
  26. Presentation of digoxin overdose:
    • yellowing of vision
    • blurred vision
    • N/V/D
    • cardiac arrythmias (paroxysmal atrial tachy)
    • hyperkalemia
    • AMS +/- hallucinations
  27. How does an "anticholinergic" toxidrome present and what are the main culprits? Tx?
    • present:
    • mydriasis
    • dry, flushed skin
    • dry mucous membranes
    • sedation, agitation, hallucinations
    • urinary retention

    • causes:
    • Benedryl
    • Phergan
    • Jimson Weed
    • Scopalamine

    Tx = supportive, +/- benzos 2/2 agitation
  28. What substances can cause an increased osmolol gap?
    • ethanol
    • ethylene glycol*
    • isopropanol
    • methanol*
    • acetone
    • ketoacidosis*
    • renal failure*
    • mannitol
    • sorbitol
    • hyperlipidemia
    • hyperproteinemia

    * = double gap acidosis
  29. With what types of OD would multidose activated charcoal be a good option?
    • phenobarbital
    • salicylates
    • theophyline
    • carbamazepine
    • digoxin
    • phenytoin
  30. Antidote for: calcium channel blockers
    • calcium
    • glucagon
    • insulin/glucose
  31. What are physiologic criteria for being sent to a trauma center?
    • GCS <14
    • RR <10 or >29 bpm
    • SBP <90 mmHg (or pediatric equivalent)
  32. What areĀ anatomic criteria for being sent to a trauma center?
    • (injuries only need be suspected)
    • flail chest
    • >2 long-bone fractures
    • amputations proximal to wrist/ankle
    • penetrating trauma in head, neck, chest, abd, or proximal extremity (i.e. above knee/elbow)
    • limb paralysis
    • pelvic fractures
    • significant trauma + burns
  33. What types/mechanisms of injury should be transferred to trauma center?
    • ejection from vehicle
    • death of other person in same vehicle
    • pedestrian vs vehicle
    • high-speed MVC
    • falls >20ft
    • MVC with rollover
    • patient entrapped >20 min
    • motorcycle crash >20mph
    • separation/ejection from motorcycle
  34. What types of patients are at high risk of serious injury with minor injury mechanisms?
    • elderly
    • very young
    • people with coagulopathies
    • people reduced physiologic reserve 2/2 chronic disease or acute intoxication

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