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4mL x kg wt x % BSA burned
- 1/2 vol given in initial 8 hr
- Remaining 1/2 given over following 16 hr
MC location for aspirated items
R middle bronchus
Complications of heat stroke
- Brain damage
EKG changes in hypothermia
Treatment of snake bite
- Immobilize extremity
- Clean wound
Treatment of scorpion bite
Treatment of black widow bite
- Ca Gluconate
Treatment of brown recluse bite
Next step. Non tetanus prone wound, LE, clean & minor. Uncertain or 3 prior tetanus immunizations
Td (DT 7 yo) complete series!! (3 total)
Next step. Non tetanus prone wound, LE, clean & minor. 3 prior tetanus immunizations.
Td if 10yrs since last dose
Next step. Tetanus prone wound (dirt contamination, punctures, crush component). Uncertain or 3 prior tetanus immunizations
Td (DT if 7yo) & tetanus immune globulin
250units IM at site other than Td & complete series
Next step. Tetanus prone wound (dirt contamination, punctures, crush component). 3 prior tetanus immunizations.
Td if 5 yrs since last dose
Symptoms of anticholinergic toxicity
- Hot as a hare: hyperpyrexia
- Dry as a bone: secretions
- Red as a beet: cutan flushing
- Blind as a bad: cycloplegia & mydriasis
- Mad as a hatter: disorientation
- Bloated as a toad: constipate & urinary retention
- Tachycardia, Bowel snds
Antidote for anticholinergic
Cherry red skin
Treat CN poisoning
- Soidum thiosulfate
- Amyl nitrate & sodium nitrate
Scooping of ST segments
Therapeutic digoxin levels
MC symptom of digoxin toxicity
Signs of dig toxicity
- Blurry vision, yellow vision
- Anorexia, n/v/d, abd pain
- HA, confusion, delirium, dizzy
EKG changes of digoxin toxicity
- Prolong PR
- Scooping of ST segments
- Atrial tachycardia w/AV block
- Accelerated junctional rhythm
- Bidirectional ventricular tachy
Avoid what in digoxin toxicity
Worsens intracellular hyperkalemia
ABD for ASA od
Respiratory alkalosis mixed respiratory alkalosis and metabolic acidosis with AG
Theophylline OD sxs
Sz, thermia, hypotension, tachy
Treatment for vfib or pulseless vtach
Defib CPRDefibCPR EPI Defib EPI & amiodarone or lidocaine
Drugs for stable, asymptomatic vtach
Vagal/carotid massage adenosine rate control (digoxin, CCB, BB) electrical
CPR Epi Atropine and repeat
Bradycardia due to BB OD
- IVF bolus
- GI decontamination
- If still unresponsive:
Lead poisoning in adults
Lead poisoning in kids
Treat like PEA
CPR epi atropine
At what point with an INR due to warfarin do you give vit k to reverse warfarin?
- Bleeding & INR 5
- INR 9
Physical findings of basilar skull fx
- Racoon eyes
- Battles sign
- CSF of nose
- Raising head of bed
- Decompressive craniectomy
Nausea, hepatic inefficiency. OD? Tx?
Dry mouth, urinary retention, wide QRS. OD? Treatment?
Sedation, respiratory depression. OD? Treatment?
Brady, hypotension, glucose, pulmonary edema. OD? Treatment?
Glucagon, Ca, insulin, dextrose
Bradycardia, hypotension, peripheral edema. OD? Treatment?
Glucagon, Ca, insulin, dextrose
Tachycardia, agitation, HTN, hemorrhagic stroke. OD? Treatment?
HA, n/v, AMS, almond smell. OD? Treatment?
N//v, visual changes, arrhythmia. OD? Treatment?
Excessive bleeding, easy bruising. OD? Treatment?
- Heparin-Protamine Sulfate
- Warfarin- Vit k, FFP
Neuropathy, hepatoxicity. OD? Treatment?
consciousness, nausea, and pain. OD? Treatment?
Ha, visual changes, dizzy. OD? Treatment?
Pinpoint pupils, resp depression. OD? Treatment?
N/v, tinnitus, hyperventilation, AG metabolic acidosis. OD? Treatment?
Hypoglycemia. OD? Treatment?
Tachycardia, dry mouth, urinary retention, wide QRS. OD? Treatment?
Severe oropharyngeal & gastric irritation or burns, drooling, odynophagia, abd pain, gastric perf sx. OD? Treatment?
Caustics-acid or alkali
- Copious irrigation
- Activated charcoal
Ataxia, hallucinations, sz, sweet breath. OD? Treatment?
Ethanol, Fomepizol, Dialysis
Salivation, lacrimation, mitosis, diarrhea, urination, paralysis, consciousness. OD? Treatment?
- Remove clothing!
Nausea, constipation, hepatoxicity. OD? Treatment?
Peripheral neuropathy, anemia. OD? Treatment?
Edta, dimercaprol, succimer
Renal insufficiency, tremor, AMS. OD? Treatment?
Glasgow Coma scale
- Eye response: 1-4
- Verbal response: 1-5
- Motor response: 1-6
Glasgow: eye scores
- 1: none
- 2: open to pain
- 3: open to voice
- 4: spontaneous
Glasgow: verbal score
- 1: none
- 2: incomprehensive
- 3: inappropriate words
- 4: confused
- 5: oriented
Glasgow: motor score
- 1: none
- 2: extend to pain
- 3: flex to pain
- 4: withdraw from pain
- 5: localize pain
- 6: obey command
Zone I of neck: boundaries & contents
Clavicle cricoid cartilage
Great vessels, aortic arch, trachea, esophagus, lung apice, sc, cervical nerve roots
Zone 2 of neck: contents & boundaries
Cricoid cartilage angle of mandble
Carotid & vertebral a, jugular vein, pharynx, larynx, esophagus, cervical spine, sc
Zone 3 of neck: contents & boundaries
angle of mandible base of skull
Salivary & parotid glands, esophagus, trachea, cervical spine, carotid arteries, jugular veins, major crainal nerves
Treatment for zone 1:
Signs of ruptured thoracic aorta
- Widened mediastinum
- Loss of aortic knob
- Pleural cap
- Deviation of trachea & esophagus right
- Depression of L mainstem bronchus
Absent breath sounds. Hyperrresonance to percussion, distended neck veins. Hypotension. Next step
Immediate CT or needle decompression
Needle decompression site for Tension pneumothorax
2nd or 3rd IC space at midclavicular line
5th IC space at midaxillary line
Treatment for flail chest
- O2- bipap, vent
Managing abd stab wound if hypotensive & signs or peritonitis
Manage pt with blunt abd trauma in stable pt
- 1 & 2 survey
- IV access with 2 large bore IVs
- NGT & Foley
- CT abd & pelvis
- H&H, blood type & cross
Manage pt with blunt abd trauma in unstable pt
- 1&2 survey
- Manage pelvic fx
- Blood- emergent lap
- No blood-angiography
- Inconclusive- DPL
If no blood in pelvis & angiography normal CT abd & pelvis
Signs of urethral injury
- Blood at urethral meatus
- High riding ballotabke prostate
- Absense of palpable prostate
Antibiotic prophylaxis for rape victims
- Azithromycin or doxy
- HIV prophylaxis