Emed Su And Kap

Front 1

Parkland formula

Back 1

4 mL x kg x %
1/2 in first 8 hours and 1/2 in next 16 hours

Front 2

Tx:
- black widow
-brown recluse

Back 2

- antivenin (w/in 30 min.), calcium gluconate (for muscle spasm), methocarbamol (muscle spasms)
-antivenin, dexamethasone, dapsone (<es local necrosis due to leukocyte inhib. prop.s; r/o G6PD def), colchicine

Front 3

Tx for mammal bite (cat, human, etc)

Back 3

-Augmentin (amox clavulanate) or amoxicillin
-tetanus
-rabies prophylax if can't observe animal for 10 days

Front 4

Tetanus booster

Back 4

-every 10 yrs (w/ Tdap nstead of Td btwn 19-64 yo)
-clean wound: if less than complete series (3 tot) then give Td (DT if <7yo)
and if received Td give if has been > 10 yrs since last one
-dirty wound: If < 3 prior immunizations give Td (DT if < 7 yo) + tetanus Ig
if >3 prior tet immunizatons: give Td if > 5 yrs since last dose

Front 5

pulseless vtach or vfib tx steps

Back 5

360 -> CPR -> 360 -> CPR -> Epi or vasopressin (in place of 1st dose of epi) ->360 -> epi + consider antarrhythmics amiodarone or lidocaine

Front 6

tx for stable asymptomatic vtch

Back 6

amiodarone and lidocaine, procainamide

Front 7

SVT tx

Back 7

vagal maneuver and carotid massage -> adenosine (don't give to WPW) -> rate control (beta blocker, CCB, or digox) ->electric cardioversion

Front 8

initial treatment for Afib with rapid ventricular rate of unknown duration

Back 8

-rate control (beta blocker, CCB (diltiazem, verapamil), digoxin)
-anticoag with heparin (then warf)

Front 9

causes of Pulseless electrical activity (PEA)

Back 9

7H:
hypovolemia, hypoglycemia, hypoxia, hypokal, hyperkal, hydrogen ions (acidosis)
6T:
tamponade, tension pneumo, trauma, toxins/tablets, thrombosis, thrombosis (Pulm emb)

Front 10

Tx for pulseless eclectrical activity (PEA)

Back 10

-CPR
-ABC
-Epi
-Atropine (alternate with epi every 2 minutes. can't use after 3 doses and must use only epi)
-treat possible cause H or T
-PEA E=epi A=atropine

Front 11

tx beta blocker OD -> bradycardia

Back 11

-IVF (to fill up preload)
-Atropine
-activated charcoal
If unresponsive then:
-glucagon
-Ca Cl
-Insuline +glucose
-NorEpi

Front 12

theophylline SEs

Back 12

seizures, hyperthermia, hypoTN, tachy arrhythmias

Front 13

Asystole Tx

Back 13

Epi and atropine (only 3 xs) continued CPR, consider transcutaneous pacing

Front 14

Gastric lavage

Back 14

-can be attempted up to 2 hours after ingestion. after 2 hours it is useless
-dangerous in AMS bc -> aspiration
- dangerous in caustic ingestion -> causes burning of esophagus and oropharynx

Front 15

whole bowel irrigation

Back 15

almost always wrong Ans. except with
-massive iron ingestion
-lithium
-swallowing drug-filled packets (smuggling)

Front 16

When answer is not clear and cause of overdose is asked say:

Back 16

-acetaminophen
-ASA
thy're MCC cause of death by OD

Front 17

Pt. took bottle of pills. She's disoriented. what is the best initial management?

Back 17

give her naloxone and dextrose.
OPiate ingestion and diabetes are extreemly common. naloxone and glucose work instantaneoulsy and have no adverse effect.
if they don't work, perform intubation.
-opiate overdose is fatal: give naloxone immediately
-benzodiazepine OD by itself is 't fatal and acute w/drawal causes seizures. DO NOT GIVE FLUMAZENIL

Front 18

when do you give charcoal?

Back 18

give to anyone with pill OD (can remove toxic substances even after they've been absorbed)

Front 19

four Most common acetaminophen OD questions, what do you do if:
1. if a clearly toxic amount of acetaminophen has been ingested (ie more than X grams) what do you do?
2. if OD was > than 24 hours ago?
3. if amount of ingestion is unclear?
4. when do you give charcoal

Back 19

1. (more than 8 grams) N-acetylcystein
2. do nothing. there is No therapy
3. get a drug level
4. charcoal doesn't make N-acetylcysteine ineffective. (no contraindicated, just doesn't work)

Front 20

ASA OD
what does it look like?
what do you do?

Back 20

-tinnitus, hyperventaliation, Respiratory alkalosis progressing to metabolic acidosis (from lactate, by interfering with oxidative phosphorylation -> anaerobic glucose metabolism)
-Treatment is alkalinizing urine (w/ Na bicarb) which increases the rate of ASA urinary excretion.

Front 21

for pt. who may have TCA:
-toxicity what is the best initial test ?
-what is the 1st thing you do in Tx?

Back 21

give EKG . if there is toxicity you'll see widening of QRS complex ->torsades de pointes
- give Na bicarb to protect heart (doesn't > urinary excretion like it does for ASA)

Front 22

Caustic
what do you do?

Back 22

-flush out with high volumes of H2O and endoscopy to assess damage

Front 23

how do poeple with CO poisoning die?

Back 23

MI

Front 24

what will you see on ABG with CO poisoning?

Back 24

low bicarb and low pH (metab acid)

Front 25

methemogloinemia:
-what causes this intoxication?
-on ABG?
-most accurate test?
-best initial therapy?
-most effective therapy

Back 25

-anesthetics, nitrates, nitroglycerin, dapsone
-metabolic acidosis
-methemoglobin level
-100% O2
-methyliene blue (decreases half-life of methemoglobin)

Front 26

Digoxin tox:
1.MC presentation
2.most accurate test
3. best initial test
4. what will EKG show?
5.Tx

Back 26

1. GI problems
2.digoxin level
3. EKG and potassium level
4. scooped ST segments
5. control K level and dig fab if there is cardiac or CNS involvment

Front 27

lead poisoning:
1. pt. presents with :
2. most accurate test
3. best initial diagnositic test
4. most accurate test for sideroblastic anemia

Back 27

1. abdo pain (lead colic), renal tubule toxicity (ATN), anemia (sideroblastic), wrist drop, memory loss
2. lead level
3. increased level of free erythrocyte protoporphyrin
4.prussian blue stain

Front 28

snake bite:
1. most common injury
2.death from snake bites is from

Back 28

1.local wound
2. hemolytic toxin: hemolysis and DIC; neurotoxin -> respiratory paralysis

Front 29

the only clear indications for stress ulcer prophylaxis:
*what do you do to prophylax?

Back 29

-head trauma
-burns
-endotrach intubation
-respiratory failure with coagulopathy (platelets < 50,000 or INR over 1.5)
*PPI given to prevent stress ulcers

Front 30

Burns:
-volume fluid replacement
- most common cause of death several days to weeks after a burn? what do you do to prevent this?

Back 30

-ringer lactate (or NS if ringer not available)
*give larges amount listed as a choice. it is probably the right answer
-infxn. prophylax with TOPICAL ABX (not IV abx)

Front 31

Hypothermia:
-best initial step
-MCC of death

Back 31

-EKG
-cardia arrhythmia
-J waves on EKG (where QRS hits ST segment)

Front 32

whe is the answer "precordial thump"?

Back 32

--when onset of arrest was less than 10 minutes and no defibrillator is available
-and you know it was recent bc. it was witnessed

Front 33

Asystole Tx

Back 33

CPR, epi(vasopressin is alternative) and atropine

Front 34

Vfib and pulseless Vtach Tx

Back 34

-360 J unsynchronized cardioversion (ie defibrillation) (these are only 2 to get unsynchronized bc. there isn't any organized electrical activity to synchroize with) -> CPR -> 360J -> CPR -> Vasopressin or Epi -> 360 J -> epi + amiodarone/lidocane/magnesium -> 360

Front 35

Vtach Txs
1. pulseless
2.hemodynamically stable with pulse
3. hemodynamically unstable with pulse

Back 35

1.follow Vfib protocol
2.Amiodarone -> lidocaine -> procainamide -> cardiovert (ie ALP)
3. electrical cardioversion followed by amiodarone or lidocaine

Front 36

hemodynamic instability is defined as

Back 36

-CP
-dyspnea/CHF
-hypoTN
-confusion

Front 37

Afib:
1.chronic
2. acute
3. lone Afib

Back 37

1. >48 hours. 1st rate control (BCDE), 2nd TEE +hep or Coumadin until INR is 2-3, 3rd cardiovert
2. 1st Rate control, 2nd cardiovert
3. prevent stroke from ASA

Front 38

Pt. had acute MI and has been Tx.d. On 2nd day of hospital develops Vtach even though she's on ASA, hep, lisinopril and metoprolol. What do you do?

Back 38

Angiography for angioplasty or bypass.
MCC of death in 72 hours surrounding acute MI is Vent. arrythmia

Front 39

What test do you do to determine risk of Vent. arrythmia 72 hours post MI?

Back 39

Echocardiography to check left vent. fnxn
MCC of death in 72 hours surrounding acute MI is Vent. arrythmia

Front 40

Blunt abdo trauma in pt. w/:
stable vs. unstable vital signs

Back 40

Stable vitals:
1. ABCs
2. establish IV access with 2 large bore IVs
3. NG tube and foley
4. CT abdo and pelvis
5. Stat H&H and blood qcross and type

Hint 40

unstable vitals:
1.do primary and secondary survey (same as 1-3 in stable VS scenario)
2.FAST (focused asessment with sonography for Trauma)
-if blood in pelvis ->emergent lap
-if no blood in pelvis then this could mean possible retroperitoneal hemorrhage -> angiography w/ possible angiographic embolization. If angiography is normal -> CT of pelvis and abdo + observation.
-if FAST inconclusive -> diagnostic peritoneal lavage

Front 41

1. Causes of gastric outlet obstrxn:
2. clinical presentation
3. dx confirmation
4. Tx

Back 41

1.strictures (PYLORIC STRIC -> stenosis 2ndary to ingestion of caustic agent or bezoar), gastric CA, PUD, Crohns
2. postprandial pain and nonbilious vomiting w/ early satiety, wt. loss. PE shows abdo succussion splash
3. upper endoscopy
4. Qx

Front 42

criteria that can indicate sepsis:

Back 42

worsening hyperglycemia (due to worsening insulin resistance), leukocytosis, thrombocytopenia, and mild hypothermia (T < 36), tachypnea and tachycard

Front 43

Managing splenic trauma due to blunt abdo injury

Back 43

Hemo stable vs unstable:
1. hemo unstable and unresponsive to fluid admin: ermergent exploratory lap
2. hemo stable (responds to fluids, SBP > 100) and doesn't require blood: NEXT BEST STEP IS ABDO CT. if CT shows splenic injury -> Qx. then post-op immunization

Front 44

complication of Aortic aneurysm Qx:

Back 44

spinal cord ischemia - presents /spastic paraplegia, weakness, and bowel/bladder dysfxn

Front 45

pt. presents w/ abdo pain, dyschezia, tender, boggy and fluctuant bulging mass on rectal exam, fever, leukocytosis.
what is it? if male, if female

Back 45

male: appendicitis is common cause of pelvic abscess
female: gyno issue

Front 46

complication of abdo aortic aneurysm repair

Back 46

bowel ischemia and infarction

Front 47

volkmann ischemic contracture

Back 47

is the final sequel of compartment syndrome in which the dead muscle has been replaced with fibrous tissue

Front 48

avascular necrosis of femoral head in kid from 4 - 10 yo. insidious-onset hip or knee pain and antalgic gait

Back 48

legg calve perthes dz

Front 49

pt. w/ massive hemoptysis (> 100 mL blood / 24 hr).
steps to treat?

Back 49

1. intubate to protect airway
2. place pt. in dependent position (so functioning lung can work)
3. administer fluids and perform emergent bedside FLEXIBLE BRONCHOSCOPY to visualize lesion and control bleeding

Front 50

bone tumor w/ spiculated sunburst pattern and periosteal elevation (codman's triangle)

Back 50

osteosarcoma, the most common primary malignancy of bone usually btwn ages of 10 and 19

Front 51

suspicion of ileus caused by vagal rxn due to ureteral colic from renal stones. needle shaped crystals present in urine.
1. next best step
2 how to treat ileus
3. what size stone will pass spontaneously w/ hydration and analgesia

Back 51

1. CT of abdomen to dx bc uric acid stones are radiolucent
2. tx the ureterolithiasis
3. stones < 0.6 cm

Front 52

pt. was intubated and now has pneumothorax and subQ emphysema.
what happened?

Back 52

bronchial rupture

Front 53

elderly pt. comes in w/ hip fracture what do you do?

Back 53

1st treat for pain control and dvt prophylaxis
2nd discover etiology of pt's fall (EKG, CXR, cardiac enzymes)

Front 54

what/s the first thing you do after placing a central venous cath/

Back 54

CXR to confirm proper placement of catheter tip