ACNP

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Author:
jtimme
ID:
27889
Filename:
ACNP
Updated:
2010-07-25 21:21:35
Tags:
Common Problems
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Description:
Burn, bites, drug overdose
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  1. Indications for intubation post-burn
    • 1. Burn to the face
    • 2. Singed nares or eyebrows
    • 3. Dark soot/mucus from nares and/or mouth
  2. Management of Acute non-severe burn
    • 1. Submerse in clean water
    • 2. Wrap in clean, wet towel and transport
    • -no ice, lotions, toothpaste, lard, butter

    • 3. Cleanse with NS (no betadine, alcohol, etc)
    • 4. Maintain normal temp
    • 5. Pain management (morphine, hydromorphone) and amnesia (midazolam)
  3. How to remove tar from the skin
    use petroleum based produce i.e. bacitracin, petroleum jelly, mayonnaise
  4. Fluid resuscitation after a burn (Parkland formula)
    • 4 ml/kg x %TBSA burned in the first 24 hours
    • - 1/2 within 8 hours
    • - 1/2 within the next 16 hours
  5. Monitor for what post-burn?
    • 1. Metabolic acidosis (early)
    • 2. Hyperkalemia (first 24-48 hours)
    • 3. Hypokalemia (3 days post-burn)
  6. What % of a patient's TBSA is the palm?
    1%
  7. What type of bite is most infectious?
    Cat
  8. Irrigate bites with what?
    High-pressure NS or LR using an 18-19G needle
  9. Wounds of the hands or lower extremities should be left open, T or F?
    True
  10. What is the time lapse for when a bite should no longer be closed?
    6 hours
  11. What antibiotics should be prescribed for human and animal bites? How long?
    • PO Augmentin for 3-7 days
    • (coverage for staph and anaerobes)
  12. Difference between first and second degree burn?
    Blisters
  13. Third degree burn
    Full thickness burn, all the way to the bone, severed nerve endings
  14. Toxicology Tests (fluids)
    • 1. Serum
    • 2. Gastric
    • 3. Urinary
  15. Agent of choice for forced emesis
    Ipecac
  16. Indication for Ipecac
    "at home" ingestions of solid toxins (e.g. pills, capsules)
  17. Contraindication for Ipecac
    Corrosives, detergents
  18. Indications for gastric lavage
    Ingestions < 30 minutes ago
  19. Method of gastric lavage
    • "lavage until clear"
    • Use 28-28 Fr oro or nasogastric tube

    -may not work with large pill fragments
  20. Dosage of activated charcoal
    1 g/kg up to 50 g mixed with water. Repeat every 4 hours PRN.

    First dose most effective if mixed with a cathartic (i.e. Sorbitol)
  21. Procedures for severe ingestion
    Forced diuresis, dialysis, hemoperfusion, plasmpheresis
  22. S/S of acetaminophen intoxication
    • 1. Usually asymptomatic in the early phase
    • 2. Nausea/vomiting (24-48 hours)
    • 3. RUQ pain
    • 4. Signs of hepatotoxicity: jaundice, elevated LFTs, prolonged PT, AMS, delirium
  23. Management of Acetaminophen toxicity
    • 1. Emesis for recent ingestion: gastric lavage, activated charcoal
    • 2. N-Acetylcysteine (Mucomyst) with a loading dose
  24. S/S of salicylate intoxication
    • 1. N/V
    • 2. Tinnitus, dizziness, headache
    • 3. Dehydration
    • 4. Hyperthermia
    • 5. Apnea, cyanosis, metabolic acidosis
    • 6. Elevated LFTs
  25. Management of salicylate intoxication
    • 1. Emesis for recent ingestions: gastric lavage, activated charcoal
    • 2. Sodium bicarbonate IV to correct severe acidosis
  26. S/S of organophosphate (insecticide) poisoning
    • 1. N/V, cramping, diarrhea
    • 2. Excessive salivation
    • 3. Headache
    • 4. Blurred vision & miosis
    • 5. Bradycardia
    • 6. Mental confusion, slurred speech, coma
  27. Miosis
    Constricted pupils
  28. Mydriasis
    Dilated pupils
  29. Management of organophosphate (insecticide) poisoning
    • 1. Wash skin thoroughly
    • 2. If insecticide was ingested, activated charcoal should be ordered
    • 3. Atropine
    • 4. Pralidoxime reverses nicotinic signs such as muscle weakness and respiratory depression
  30. S/S of antidepressant toxicity
    • 1. Confusion, hallucinations, blurred vision
    • 2. Urinary retention
    • 3. Hypotension, tachycardia, dysrhythmias
    • 4. Hypothermia
    • 5. Seizures
  31. Management of antidepressant toxicity
    • 1. Admit to ICU if CNS or cardiac toxicity evident
    • 2. Gastric lavage, activated charcoal
    • 3. Sodium bicarbonate IV to counter dysrhythmias and maintain pH
    • 4. Benzodiazepine IV PRN to control seizures
    • 5. Treat Serotonin syndrome
  32. Serotonin syndrome
    Hyperthermia from antidepressants
  33. Treatment of Serotonin Syndrome
    Dantrolene sodium (Dantrium) for hyperthermia

    Clonazepam (Klonopin) to treat rigor

    Cooling blankets
  34. S/S of narcotic toxicity
    • 1. Drowsiness
    • 2. Hypothermia
    • 3. Respiratory depression, shallow respirations
    • 4. Miosis
    • 5. Coma
  35. Management of narcotic toxicity
    • 1. No emetics
    • 2. Gastric lavage/activated charcoal
    • 3. Naloxone (Narcan) IV
    • 4. Butorphanol (Stadol)
  36. S/S of benzodiazepine overdose
    • 1. Drowsiness, confusion
    • 2. Slurred speech
    • 3. Respiratory depression
    • 4. Hyporeflexia
  37. Management of benzodiazepine overdose
    • 1. Respiratory and blood pressure support
    • 2. Flumazenil (Romazicon) IV
    • 3. Gastric lavage, activated charcoal
  38. Examples of benzodiazepines
    • 1. diazepam (Valium)
    • 2. clonazepam (Klonopin)
    • 3. lorazepam (Ativan)
  39. Examples of antidepressants
    • 1. Amitriptyline
    • 2. Fluoxetine
    • 3. Imipramine
    • 4. Nortriptyline
    • 5. Bupropion
  40. Examples of organophosphate
    (insecticide)
    • Malathion
    • Parathion
  41. Acute vesicular eruption due to infection with varicella-zoster virus
    Herpes Zoster (shingles)
  42. S/S of herpes zoster
    • 1. Pain along a dermatomal distribution
    • 2. Grouped vesicle eruption along the dermatomal pathway
    • 3. Regional lymphadenopathy may be present
  43. Management of Herpes Zoster
    • 1. Pharm: acyclovir, famciclovir, valaciclovir
    • 2. IV acyclovir for immunocompromised host
    • 3. Foscarnet for acyclovir-resistant herpes zoster
    • 4. For suspected ocular involvement, consult ophthalmology
    • 5. Post-herpetic neuralgia: gabapentin (Neurontin), pregabalin (Lyrica)
  44. S/S of acute rejection
    • 1. Immediate failure of that organ
    • 2. Flu-like symptoms (fever, chills, malaise)
  45. Management of acute rejection
    • 1. Immediate biopsy ASAP
    • 2. Anti-rejection medications

    • calcineurin inhibitor: Tacrolimus, cyclosporine
    • +
    • antimetabolite: azathioprine (Imuran), mycophenolate mofetil (Cellcept)
    • +
    • steroid: prednisone (Deltasone, Orasone, Meticorten)
  46. Actinic ketatosis
    • -small patches on sun-exposed parts of the body
    • -premalignant, progresses to squamous cell carcinoma
    • -rough, flesh-colored, pink, or hyperpigmented
  47. Squamous cell carcinoma
    • -From actinic keratoses
    • -Firm irregular papule or nodule
    • -develop over a few months
    • -prolonged, sun-exposed areas in fair skin people
    • -keratictic, scaly bleeding

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