D\'s ER

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Author:
JCremer
ID:
29310
Filename:
D\'s ER
Updated:
2010-08-08 13:48:18
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USMLE Step
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ER
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  1. Parkland formula
    4mL x kg wt x % BSA burned

    • 1/2 vol given in initial 8 hr
    • Remaining 1/2 given over following 16 hr
  2. MC location for aspirated items
    R middle bronchus
  3. Complications of heat stroke
    • Rhabdo
    • Sz
    • Brain damage
    • Death
  4. EKG changes in hypothermia
    • J waves
    • Vtach
    • Vfib
  5. Treatment of snake bite
    • Immobilize extremity
    • Clean wound
    • Antivenin
  6. Treatment of scorpion bite
    • Antivenin
    • Atropine
    • Phenobarbital
  7. Treatment of black widow bite
    • Ca Gluconate
    • Methocarbamol
  8. Treatment of brown recluse bite
    • Dexamethasone
    • Dapsone
  9. Next step. Non tetanus prone wound, LE, clean & minor. Uncertain or  3 prior tetanus immunizations
    Td (DT  7 yo)  complete series!! (3 total)
  10. Next step. Non tetanus prone wound, LE, clean & minor.  3 prior tetanus immunizations.
    Td if  10yrs since last dose
  11. 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
  12. Next step. Tetanus prone wound (dirt contamination, punctures, crush component).  3 prior tetanus immunizations.
    Td if  5 yrs since last dose
  13. 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
  14. Antidote for anticholinergic
    Physostigmine
  15. Almond smell
    Cyanide ingestion
  16. Cherry red skin
    CO poisoning
  17. Treat CN poisoning
    • Soidum thiosulfate
    • B12
    • Amyl nitrate & sodium nitrate
  18. Methemoglobinemia
    Methylene blue
  19. Scooping of ST segments
    Therapeutic digoxin levels
  20. MC symptom of digoxin toxicity
    Brady 
  21. Signs of dig toxicity
    • Fatigue
    • Blurry vision, yellow vision
    • Anorexia, n/v/d, abd pain
    • HA, confusion, delirium, dizzy

    •  K
    • EKG changes
  22. EKG changes of digoxin toxicity
    • Prolong PR
    • Scooping of ST segments
    • Brady 
    • Atrial tachycardia w/AV block
    • Accelerated junctional rhythm
    • Bidirectional ventricular tachy
  23. Avoid what in digoxin toxicity
    Calcium

    Worsens intracellular hyperkalemia
  24. ABD for ASA od
    Respiratory alkalosis  mixed respiratory alkalosis and metabolic acidosis with  AG
  25. Theophylline OD sxs
    Sz,  thermia, hypotension, tachy 
  26. Treatment for vfib or pulseless vtach
    Defib  CPRDefibCPR EPI Defib EPI & amiodarone or lidocaine
  27. Drugs for stable, asymptomatic vtach
    • Amiodarone
    • Lidocaine
    • Procainamide
  28. SVT treatment
    Vagal/carotid massage  adenosine  rate control (digoxin, CCB, BB)  electrical
  29. PEA tx
    CPR  Epi  Atropine and repeat
  30. Bradycardia due to BB OD
    • IVF bolus
    • Atropine
    • GI decontamination

    • If still unresponsive:
    • Glucagon
    • CaCl
    • Insulin
    • Glucose
    • Norepi
  31. Lead poisoning in adults
    EDta, dimercaprol
  32. Lead poisoning in kids
    Succimer
  33. Asystole treatment
    Treat like PEA

    CPR  epi  atropine
  34. At what point with an  INR due to warfarin do you give vit k to reverse warfarin?
    • Bleeding & INR  5
    • INR  9
  35. Cushings triad
    • Bradycardia
    • HTN
    • Bradypnea

    Signs of  ICP
  36. Physical findings of basilar skull fx
    • Racoon eyes
    • Battles sign
    • Hemotympanium
    • CSF of nose
  37. Lower ICP
    • Raising head of bed
    • Mannitol
    • Hyoerventilate
    • Decompressive craniectomy
  38. Nausea, hepatic inefficiency. OD? Tx?
    Acetaminophen

    N-acetylcysteine
  39. Dry mouth, urinary retention, wide QRS. OD? Treatment?
    Anticholinergics (atropine)

    Physostigmine
  40. Sedation, respiratory depression. OD? Treatment?
    Benzo

    Flumazenil
  41. Brady, hypotension,  glucose, pulmonary edema. OD? Treatment?
    BB

    Glucagon, Ca, insulin, dextrose
  42. Bradycardia, hypotension, peripheral edema. OD? Treatment?
    CCB

    Glucagon, Ca, insulin, dextrose
  43. Tachycardia, agitation, HTN, hemorrhagic stroke. OD? Treatment?
    Cocaine

    • Supportive
    • Benzo
    • CCB
  44. HA, n/v, AMS, almond smell. OD? Treatment?
    Cyanide

    • Nitrates
    • B12
    • Thiosulfates
  45. N//v, visual changes, arrhythmia. OD? Treatment?
    Digoxin

    Digoxin antibodies
  46. Excessive bleeding, easy bruising. OD? Treatment?
    • Heparin-Protamine Sulfate
    • Warfarin- Vit k, FFP
  47. Neuropathy, hepatoxicity. OD? Treatment?
    INH

    B6
  48.  consciousness, nausea, and pain. OD? Treatment?
    Isopropyl alcohol

    Supportive
  49. Ha, visual changes, dizzy. OD? Treatment?
    Methanol

    • Ethanol
    • Fomepizol
    • Dialysis
  50. Pinpoint pupils, resp depression. OD? Treatment?
    Opiod

    Naloxone
  51. N/v, tinnitus, hyperventilation, AG metabolic acidosis. OD? Treatment?
    Salicylates

    • Charcoal
    • Dialysis
    • NaHco3
  52. Hypoglycemia. OD? Treatment?
    Sulfonylureas

    • Ocreotide
    • Dextrose
  53. Tachycardia, dry mouth, urinary retention, wide QRS. OD? Treatment?
    TCA

    • NaHco3-QrS
    • Diazepam-sz
  54. Severe oropharyngeal & gastric irritation or burns, drooling, odynophagia, abd pain, gastric perf sx. OD? Treatment?
    Caustics-acid or alkali

    • EGD
    • Copious irrigation
    • Activated charcoal
  55. Ataxia, hallucinations, sz, sweet breath. OD? Treatment?
    Ethylene Glycol

    Ethanol, Fomepizol, Dialysis
  56. Salivation, lacrimation, mitosis, diarrhea,  urination, paralysis,  consciousness. OD? Treatment?
    Organophosphates

    • Remove clothing!
    • Atropine
    • Pralidoximine
    • Supportive
  57. Nausea, constipation, hepatoxicity. OD? Treatment?
    Iron

    Deferoxamine
  58. Peripheral neuropathy, anemia. OD? Treatment?
    Lead

    Edta, dimercaprol, succimer
  59. Renal insufficiency, tremor, AMS. OD? Treatment?
    Mercury

    Dimercaprol
  60. Glasgow Coma scale
    • Eye response: 1-4
    • Verbal response: 1-5
    • Motor response: 1-6
  61. Glasgow: eye scores
    • 1: none
    • 2: open to pain
    • 3: open to voice
    • 4: spontaneous
  62. Glasgow: verbal score
    • 1: none
    • 2: incomprehensive
    • 3: inappropriate words
    • 4: confused
    • 5: oriented
  63. Glasgow: motor score
    • 1: none
    • 2: extend to pain
    • 3: flex to pain
    • 4: withdraw from pain
    • 5: localize pain
    • 6: obey command
  64. Zone I of neck: boundaries & contents
    Clavicle  cricoid cartilage

    Great vessels, aortic arch, trachea, esophagus, lung apice, sc, cervical nerve roots
  65. Zone 2 of neck: contents & boundaries
    Cricoid cartilage  angle of mandble

    Carotid & vertebral a, jugular vein, pharynx, larynx, esophagus, cervical spine, sc
  66. 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
  67. Treatment for zone 1:
    4v CTA
  68. Treatment for zone 2
    • Sx exploration
    • Doppler US


    Easiest to operate on!
  69. Treatment for zone 3
    • 4v CTA
    • Triple endoscopy
  70. Signs of ruptured thoracic aorta
    • Widened mediastinum
    • Loss of aortic knob
    • Pleural cap
    • Deviation of trachea & esophagus right
    • Depression of L mainstem bronchus
  71. Absent breath sounds. Hyperrresonance to percussion, distended neck veins. Hypotension. Next step
    Tension pntx

    Immediate CT or needle decompression
  72. Needle decompression site for Tension pneumothorax
    2nd or 3rd IC space at midclavicular line

    5th IC space at midaxillary line
  73. Treatment for flail chest
    • O2- bipap, vent
    • Monitor
    • Analgesia
  74. Managing abd stab wound if hypotensive & signs or peritonitis
    Sx exploration
  75. 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
  76. Manage pt with blunt abd trauma in unstable pt
    • 1&2 survey
    • Manage pelvic fx
    • FAST:
    • Blood- emergent lap
    • No blood-angiography
    • Inconclusive- DPL

    If no blood in pelvis & angiography normal CT abd & pelvis
  77. Signs of urethral injury
    • Blood at urethral meatus
    • High riding ballotabke prostate
    • Absense of palpable prostate

    Retrograde urethrogram!
  78. Antibiotic prophylaxis for rape victims
    • Ceftraixone
    • Azithromycin or doxy
    • Metronidazole
    • HIV prophylaxis
    • Antiemetic
    • Levonorgestrel
  79. Septic shock tx
    Norepi
  80. Anaphylactic shock
    Epi
  81. Cardiogenic shock
    Dobutamine

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