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73 Cards in this Set
- Front
- Back
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What is the antidote for Acetaminophen overdose?
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N-acetylcysteine
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What is the antidote for Salicylates (aka Aspirin)?
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Charcoal
Dialysis Sodium bicarbonate |
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What is the antidote for Anticholinesterases, organophosphates?
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Atropine, pralidoxime, supportive care
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What is the antidote for Antimuscarinic, anticholinergic agents (atropine)?
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Physostigmine
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What is the antidote for beta-blockers (or verapamil)?
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Glucagon, calcium chloride, insulin, and dextrose (atropine, NE also for beta blockers)
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What is the antidote for Digoxin?
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Digoxin antibody fragments
Activated charcoal Treat hyperkalemia (for EKG disturbances), and avoid Calcium |
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What is the antidote for Iron?
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Deferoxamine
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What is the antidote for Lead?
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EDTA
Dimercaprol Succimer (for kids) |
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What is the antidote for Mercury?
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Dimercaprol
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What is the antidote for Copper?
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Penicillamine
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What is the antidote for Arsenic?
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Dimercaprol, Succimer, Penicillamine
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What is the antidote for Cyanide?
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Nitrates, hydroxocobalamin, thiosulfates
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What is the antidote for Carbon monoxide?
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100% O2 or hyperbaric O2
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What is the antidote for Methanol (and ethylene glycol)?
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Fomepazole (DOC), Ethanol, dialysis
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What is the antidote for Opioids?
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Naloxone, naltrexone
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What is the antidote for Benzodiazepines?
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Flumazenil
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What is the antidote for TCAs?
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Sodium Bicarbonate (When QRS segment > 150 msec), diazepam (for seizures)
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What is the antidote for Heparin?
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Protamine sulfate
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What is the antidote for Warfarin?
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Vitamin K, FFP
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What is the antidote for tPA, streptokinase?
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Aminocaproic acid
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What is the antidote for Isoniazid?
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Vitamin B6
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What drugs are used in treating a stable, asymptomatic ventricular tachycardia?
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Amiodarone, Lidocaine, Procainamide
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What are the H causes of pulseless electrical activity? T causes?
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H causes:
Hypovolemia Hypoxia Hyperkalemia Hypokalemia Hypomagnesemia Hydrogen ions (acidosis) Hypothermia Hypoglycemia T causes: Tension Pneumothorax Tamponade Thrombosis (MI) Thrombosis (PE) Tablets (drugs) Trauma |
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What EKG abnormality is classic for patients with hypothermia?
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J wave (small positive deflection after QRS wave)
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What is the treatment for lead poisoning in adults? In children?
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Adults: EDTA and dimercaprol
Kids: Succimer |
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What is the Parkland burn formula?
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(4 mL) x (kg body weight) x (% body surface area burned) =
The volume of lactated Ringer solution in first 24 hours (+ maintenance fluid) - First half is given in 8 hours - Second half given over the next 16 hours |
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What is the treatment for a black widow spider bite?
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Wound care, 24 hour observation
Erythromycin Dapsone Steroids 1 week For lactrodectism:Calcium gluconate, methocarbamol, benzos, antivenom |
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What medications should be given to a patient with muscle spasm, abdominal stiffness, altered mental status, and tachycardia due to a spider bite?
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Latrodectism:
Calcium gluconate Benzos Methocarbamol Antivenom |
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What is the treatment for a skin laceration on the dorsum of the hand that resulted from a closed fist hitting a victim's mouth?
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Antibiotics
Do not close wound Copious irrigation X-ray (for tooth chip or foreign body) |
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What is the next step in management of a patient that presents to the ER with organophosphate poisoning?
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Remove clothes from patient, use gloves
Pralidoxime Atropine |
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What classic toxic ingestion management options should NOT be chosen in patients presenting with alkaline fluid ingestion?
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Do not induce vomiting with ipecac
Do not neutralize fluid (thermal injury risk) Do not place the NG tube (risk of perforation) |
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What medications are used in cases of cyanide poisoning?
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Sodium thiosulfate
Hydroxocobalamin Nitrates |
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A COPD patient comes to the ER with tachycardia and hypotension. During the evaluation he begins to have seizures. What is the most likely etiology?
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Theophylline overdose
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What is the ACLS treatment for ventricular fibrillation?
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Start with defibrillation at 360 J
2 minutes CPR Shock 2 minutes CPR Epi or Vasopressin (only once) Shock Repeat Epi every 3-5 minutes Consider antiarrhythmics (Amiodarone or lidocaine) |
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What is the ACLS treatment for asystole?
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Alternate Epinephrine and Atropine, consider transcutaneous pacing
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What medications are used in bradycardia induced by beta-blocker overdose?
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Atropine
Calcium chloride or gluconate Glucagon |
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At what point in a patient with elevated INR due to warfarin would you consider dosing vitamin K to reverse the warfarin?
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Any bleeding -> Vitamin K
INR > 5 -> Consider treatment INR > 9 -> Vitamin K |
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What is Cushing's triad?
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Hypertension
Bradycardia Bradypnea (respiratory depression) |
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What are the classic physical findings in a basilar skull fracture?
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Raccoon eyes
Battle sign (Bruising over mastoid process) Blood behind tympanic membranes CSF from ears or nose |
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What interventions can be used to lower intracranial pressure in a head injury patient?
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Head of bed at 30 degrees
If patient needs intubation, pretreat with lidocaine to minimize ICP elevations Mannitol IV load (check serum Na and osmolarity; hold mannitol if Na > 152 or osmolarity > 305) Intubate and hyperventilation until pCO2 is 25-30. Decreasing pCO2 by 5-10 mmHg will lower ICP by 20-30 mmHg. This effect is temporary. Decompressive craniectomy |
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What studies do you use to assess damage to the neck?
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Zone I: assess with 4 vessel arteriogram (CT arteriogram)
Zone II: surgical exploration or doppler US + selective exploration Zone III: 4 vessel arteriogram + triple endoscopy |
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What CXR findings might indicate a ruptured thoracic aorta?
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Widened mediastinum, loss of aortic knob, pleural cap, deviation of trachea and esophagus to the right, and depression of the left main stem bronchus.
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What is the treatment for tension pneumothorax?
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Immediate chest tube placement
If delay in chest tube placement, needle decompression on the affected side (2nd or 3rd IC space at midclavicular line or 5th IC space at midaxillary line) |
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What is the treatment for a flail chest?
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Oxygen supplementation, close monitoring for early signs of respiratory compromise
BiPap by mask or endtracheal intubation with mechanical ventilation Analgesia (to prevent hypoxia from limited breathing) Placing an object (eg sandbag) to the affected region to stabilize the segment is no longer done |
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What are the next steps in the management of blunt abdominal trauma in a patient with stable vital signs?
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ABC (Primary survey then secondary survey)
Establish IV access at two sites with large bore IVs NG tube and Foley CT abdomen and pelvis Stat H&H +/- Blood type and cross |
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What are the next steps in the management of blunt abdominal trauma in a patient with unstable vital signs?
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ABC (Primary and secondary survey)
Assess for and manage pelvic fracture FAST (Focused Assessment with Sonography for Trauma) - if blood in pelvis: emergent laparotomy - if no blood in pelvis: possible retroperitoneal hemorrhage -> angiography with possible embolization - If FAST inconclusive: diagnostic peritoneal lavage If no blood in pelvis and angiography is normal, then CT scan of abdomen and pelvis + observation +/- admission |
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What is the treatment for a retroperitoneal hematoma?
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If penetrating injury or exsanguination into abdomen (bloody peritoneal aspirate): surgical exploration and repair
If blunt trauma without blood in the abdomen: - Follow H&H - If hemodynamically unstable of falling H&H: Angiography with possible embolization |
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What antibiotic prophylaxis should be provided for rape victims?
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Ceftriaxone (gonorrhea)
Azithromycin or Doxycycline (chlamydia) Metronidazole (trichomonas) Hep B vaccine #1 of 3 (if not yet vaccinated) +/- Hep B immune globulin HIV prophylaxis for 3-7 days with follow-up for further counseling Levonorgestrel (Plan B) -> repeat dose in 12 hours |
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What radiographic study is used to diagnose injury to the urethra?
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Retrograde cystourethrogram
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What are the symptoms of a basilar skull fracture?
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Raccoon eyes
Battle sign Blood behind tympanic membrane CSF coming from ears and nose |
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Chest trauma + hypotension + JVD + distant heart sounds -> What is the next step in the management of this patient?
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Cardiac tamponade:
Pericardiocentesis |
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Chest trauma + hypotension + JVD + respiratory distress -> What is the next step in the management of this patient?
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Tension pneumothorax:
Chest tube placement or needle decompression |
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What is the next step in the evaluation of penetrating injuries to the different zones of the neck?
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Zone I: 4 vessel arteriogram (CT angiogram)
Zone II: surgical exploration Zone III: 4 vessel arteriogram, triple endoscopy |
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What interventions are effective in the management of elevated intracranial pressure?
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Head of bed at 30 degrees
Intubation and hyperventilation (lidocaine prior to intubation) Mannitol Decompressive craniectomy |
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What criteria must be met prior to discharge of a pregnant woman being observed after a traumatic event?
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Contractions no more frequent than every 10 minutes, no vaginal bleeding, no abdominal pain, and a normal fetal heart tracing.
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What is the next step in the evaluation of the following patients?
Pelvic fracture + DPL shows blood in pelvis Pelvic fracture + DPL shows urine in pelvis Pelvic fracture + DPL shows nothing + hemodynamic instability Blunt abdominal trauma + unstable vital signs + FAST shows fluid in pelvis |
Pelvic fracture + DPL shows blood in pelvis
Emergency laparotomy Pelvic fracture + DPL shows urine in pelvis Urgent laparotomy for bladder repair Pelvic fracture + DPL shows nothing + hemodynamic instability Angiography with possible embolization Blunt abdominal trauma + unstable vital signs + FAST shows fluid in pelvis Emergent laparotomy |
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What is the next step in the evaluation of the following patients?
Blut abdominal trauma + unstable vital signs + FAST shows no fluid in pelvis Blut abdominal trauma + unstable vital signs + FAST inconclusive Blunt abdominal trauma + stable vital signs Abdominal stab wound + hypotensive or signs of peritonitis |
Blut abdominal trauma + unstable vital signs + FAST shows no fluid in pelvis
Angiogram with possible embolization Blut abdominal trauma + unstable vital signs + FAST inconclusive DPL Blunt abdominal trauma + stable vital signs CT abdomen and pelvis Abdominal stab wound + hypotensive or signs of peritonitis Emergency surgical exploration |
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What additional studies can be performed in the case of a stable patient with an abdominal stab wound that penetrated the peritoneum?
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DPL
Upright chest xray Diagnostic ultrasound Abdominal CT scan with contrast Diagnostic laparoscopy |
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What is the typical ER lab work-up for a patient with acute abdominal pain?
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CBC
Electrolytes LFTs Amylase, lipase Glucose BUN/Cr UA Stool guaiac beta-hCG (for women) if > 45, EKG +/- cardiac enzymes |
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What is the treatment for acute mesenteric ischemia?
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General care:
- Hemodynamic monitoring and support. Dobutamine or dopamine if necessary. - Broad spectrum antibiotics - NG tube decompression - Angiogram for diagnosis and treatment Specific care - Heparin anticoagulation - Papaverine infusion to decrease arterial vasospasm - If embolism: embolectomy and resection of necrotic bowel -> second look laparotomy in 24-48 hours to remove additional necrotic bowel - If thrombus: thrombectomy and revascularization -> resection of necrotic bowel, second look -> aspirin daily - Resection of necrotic bowel and bypass |
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What are the treatment options of chronic mesenteric ischemia?
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Bypass
Endarterectomy Angioplasty/stenting |
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What are the causes of fever in the post-op period?
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Wind: Atelectasis, Pneumonia
Water: UTI Wound/Wein: Wound infection, Thrombophlebitis Walking: DVT, PE Wonder drugs: antibiotics and Sinusitis (due to NG tube) |
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What is the usual lab panel in a patient presenting to the ER with generalized abdominal pain?
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CBC
Electrolytes LFTs Amylase, lipase Glucose BUN/Cr UA Stool guaiac beta-hCG (for women) if > 45, EKG +/- cardiac enzymes |
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What is the usual time frame for stopping warfarin prior to surgery?
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Stop warfarin 3-4 days prior to surgery
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What interventions are helpful in optimizing lung function in the post-op period in patients with preexisting lung disease?
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Incentive spirometry
Early ambulation Pain control Deep breathing Bronchodilators (albuterol) Inhaled steroids |
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When is the greatest risk for a postoperative MI? What is recommended perioperatively for patients with known CAD?
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48 hours post-op
Perioperative beta-blockers, telemetry monitoring |
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Which vasopressor matches the following statements?
- Theoretically causes renal vasodilation - High doses optimize the alpha-1 vasoconstriction - ADH analogue - Best choice for anaphylactic shock - Best choice for septic shock - Best choice for cardiogenic shock - Causes vasoconstriction but with bradycardia |
Theoretically causes renal vasodilation
- Dopamine High doses optimize the alpha-1 vasoconstriction - Epinephrine ADH analogue - Vasopressin Best choice for anaphylactic shock - Epinephrine Best choice for septic shock - Norepinephrine Best choice for cardiogenic shock - Dobutamine Causes vasoconstriction but with bradycardia - Phenylephrine |
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What type of immunodeficiency increases the risk of anaphylactic transfusion reaction?
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IgA deficiency
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Which blood product is most appropriate in the following scenarios?
- Severe anemia due to autoimmune hemolytic anemia - Hemophilia - DIC - Shock due to trauma or postpartum hemorrhage - To maintain blood pressure during large volume paracentesis - Hemorrhage due to warfarin overdose - Need for vWF rich blood product - Thrombocytopenia |
Severe anemia due to autoimmune hemolytic anemia
- Packed RBCs Hemophilia - Specific clotting factors DIC - FFP Shock due to trauma or postpartum hemorrhage - Whole blood or Packed RBCs To maintain blood pressure during large volume paracentesis - Albumin Hemorrhage due to warfarin overdose - FFP Need for vWF rich blood product - Cryoprecipitate Thrombocytopenia - Platelets |
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What are the preferred vessels in the placement of a Swan-Ganz catheter?
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Right Internal Jugular
Left Subclavian artery |
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What lab findings suggest hepatic disease during a pre-operative work-up?
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Increased PT/PTT
Decreased albumin Decreased platelets Elevated bilirubin LFTs (could be elevated or normal) Decreased lipids |
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What interventions can be used to protect the kidneys in times of anticipated insult?
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N-Acetylcysteine, IV fluids (+/- sodium bicarbonate)
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What is the typical initial post-op fever work-up?
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CXR
CBC with Differential UA Urine and blood cultures Assess patient for DVT, sinusitis |
