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98 Cards in this Set
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basic life support measures |
1) assess responsiveness |
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asystole and dysrhythmia etiology |
"Hi 5, T5": hypoxia, hypo/hyperkalemia, hypothermia, hypoglycemia, hypoveolemia, trauma, toxins, tamponade, tension pneumothorax, thrombosis |
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advanced cardiac support |
if pulseless + shockable --> shock + 5 cycles of CPR + 1mg epi every 3-5min until pulse present |
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shockable rhythms |
ventricular fibrillation and ventricular tachycardia |
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unshockable rhythms |
asystole, pulseless electrical activity |
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signs of hemodynamic instability |
hypotension, chest pain, altered mental status, CHF |
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general measures of tachycardia with pulses |
ABC, O2, identify rhythm on ECG, identify reversible causes |
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hemodynamically unstable patient with pulse and tachycardia |
perform immediate cardioversion |
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hemodynamically stable patient with pulse and tachycardia, narrow QRS, regular rhythm |
vagal maneuvers or adenosine |
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hemodynamically stable patient with pulse and tachycardia, narrow QRS, irregular rhythm |
probable A-fib or MAT; control rate with diltiazem or betablockers |
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hemodynamically stable patient with pulse and tachycardia, wide QRS, regular rhythm |
if VT --> amiodarone 150mg IV over 10min, repeat as needed |
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hemodynamically stable patient with pulse and tachycardia, wide QRS, irregular rhythm |
if WPW --> avoid nodal blocking agents adenosine, digoxin, CCB |
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basic algorhythm for tachycardia with pulses |
general measures --> check if stable --> check QRS --> check rhtyhm regularity |
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miosis as sign of toxicity |
sugests clonidine, barbiturates, opiates, cholinergics, pontine stroke |
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mydriasis as sign of toxicity |
sugests sympathomimetics, anticholinergics |
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dry skin as sign of toxicity |
sugests anticholinergics |
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wet skin as sign of toxicity |
cholinergics, sympathomimetics |
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blisters as sign of toxicity |
barbiturates, carbon monoxide |
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common signs of toxicity |
miosis, mydriasis, dry skin, wet skin, blisters |
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measures for toxic ingestion management |
induced vomiting |
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induced vomitting |
ipecac can only be used 1-2 hours after toxic ingestion (limited use) |
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lavage |
indicated in those with mental status |
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charcoal |
used if patient arrives more than 1-2 hours after ingestion; decreases absorption and increases removal of absorbed substance |
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whole bowel irrigation |
used when many pills are seen on x-ray; 1-2 liters/hour of GoLytely via gastric tube |
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dialysis for toxicity management |
used for ehtylene glycol, lithium overdose, methanol poisoning, aspirin overdose, theophyline overdose and there is coma, hypotension or apnea |
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cathartics |
useful only when charcoal is used; generally wrong answer |
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forced diuresis |
alkaline diuresis is only useful for salicylates and phenobarbital |
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naloxone/dextrose/thiamine administration |
given to any patient who ingested substance and has altered mental status |
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acetaminophen toxicity stages |
gastritis, nausea, vomitting 12-24 hours after ingestion; 24-48 hours: asymptomatic period with subclinical elevation of transaminases and bilirubin; 48-72 hours: jaundice, abdominal pain, hepatic encephalopathy, renal failure and death |
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acetaminophen toxicity treatment |
N-acetyl-cysteine preferably within first 8 hours |
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methanol ingestion sources |
paint thinner, sterno, photocopier fluid, solvents, windshield washer solution |
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ethylene glycol ingestion sources |
car antifreeze |
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methanol and ethylene glycol metabolism |
methanol + alcohol dehydrogenase --> formaldehyde + formic acid |
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general signs of alcohol intoxication |
confusion, ataxia, lethargy, drowsiness, slurred speech |
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isopropyl alcohol intoxication |
ketonuria, ketonemia, without acidosis and no increased anion gap |
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methanol intoxication specific signs |
visual disturbances, blindness |
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ehtylene glycol intoxication specific signs |
renal failure and oxalate crystals/stones in urine |
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alcohol intoxication diagnosis |
determine specific alcohol levels in blood |
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alcohol intoxication treatment |
fomepizole is alcohol dehydrogenase inhibitor which decreases toxic metabolites |
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carbon monoxide poisoning presentation |
dyspnea, tachypnea, shortness of breath, headache, nausea, dizziness, confusion, syncope, chest pain, arrhythmia, hypotension |
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carbon monoxide poisoning diagnosis |
carboxyhemoglobin levels |
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carbon monoxide poisoning treatment |
removal from source of exposure, 100% O2, hyperbaric O2 if CNS or chest pain |
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caustic substance intoxication presentation |
oral pain, drooling, odynophagia, abdominal pain |
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caustic substance intoxication diagnosis |
by history of exposure and upper endoscopy if ingested |
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caustic substance intoxication management |
wash out mouth, eyes or skin with large volumes of cold water |
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digoxin toxicity etiology |
from suicide attempt or accidental overdose; hypokalemia predisposes to toxicity |
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digoxin toxicity presentation |
nausea, vomitting, diarrhea, anorexia |
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digoxin toxicity diagnosis |
history + ECG looking for any arrhythmia |
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digoxin toxicity management |
repeated doses of charcoal, digoxin antibodies, potassium correction |
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opiate intoxication |
respiratory depression |
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cocaine intoxication |
hypertension, hemorrhagic stroke, MI, arrhythmia, seizures |
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benzodiazepine intoxication |
somnolence, dysarthria, ataxia, stupor |
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barbiturate intoxication |
hypothermia, loss of deep tendon reflexes |
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hallucinogens |
marijuana, LSD, mescaline, peyote, psilocybin, PCP (angel dust) |
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hallucinogen toxicity |
delirium and bizarre behavior |
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lead sources |
ingested paint, soil, dust, drinking water |
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lead metabolism |
absorbed from GI tract, skin or inhalation |
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lead poisoning presentation |
adults: abdominal pain, anemia, renal disease, neurologic manifestations |
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lead poisoning diagnosis |
best test is blood lead levels (<10ug/dL is normal) |
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lead poisoning treatment |
removal of source |
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mercury poisoning |
interstitial pneumonitis from inhalation |
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salicylates intoxication presentation |
tinnitus |
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salicylates intoxication diagnosis |
most specific test is aspirin level |
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salicylates intoxication management |
if within 1 hour of ingestion, gastric decontamination + charcoal |
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tricyclic antidepressant intoxication presentation |
anticholinergic (dry mouth, tachycardia, dilated pupils, flushed skin) |
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tricyclic antidepressant intoxication diagnosis |
serum drug levels is most specific but EKG is more important to do first |
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tricyclic antidepressant intoxication management |
within hours --> charcoal |
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head trauma presentation |
headache, amnesia, loss of consciousness |
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head trauma diagnosis |
CT scan always |
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head trauma treatment |
if intracrannial hemorrhage --> hyperventilation to a PCO2 of 30-35 |
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subarachnoid hemorrhage presentation |
acute --> sudden headache, loss of consiousness (50%), focal neurologic symptoms (30%) |
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subarachnoid hemorrhage diagnosis |
intial best test is CT scan which has 90-95% sensitivity within first 24 hours |
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subarachnoid hemorrhage management |
maintain blood pressur at 110-160mmHg |
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skin burns classification |
first-degree --> skin is intact |
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burn presentation |
altered mental status, dyspnea, headache and chest pain suggest carbon monoxide poisoning |
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rule of nines for burns |
arms and head are 9% each |
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diagnosis work-up of burns |
aside from actual burn, determine carboxyhemoglobin levels in severe burns |
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definition of severe burns |
combined second and third-degree burns >20% in adults or >10% in old or young |
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burn injury management |
if signs of respiratory injury --> intubation is initial step |
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Parkland formula |
4ml of ringer lactate for each % BSA burned per Kg; give 1/2 in first 8 hours, 1/4 in second 8 hours, 1/4 in third |
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heat stroke |
lost ability to romeve heat from body |
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malignant hyperthermia |
idiopathic reaction to any anesthetic specially halothane and succinylcholine |
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neuroleptic malignant syndrome |
reaction to phenothiazines, chlorpromazine, haloperidol |
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hypothermia |
core body temperature <35C |
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nonionizing radiation |
infrared, ultraviolet and microwave; present primarily as burns |
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ionizing radiation |
bone marrow depression with infections and bleeding |
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electrocution presentation |
local 1st, 2nd and 3rd degree burns |
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electrocution treatment |
cardiopulmonary resuscitation, fluid replacement, local wound care |
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types of drowinig |
dry drowning from laryngospasm, fresh water drowning, sea water drowning |
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fresh water drowning |
hypotonic water alters surfactanct and causes collapse |
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sea water drowning |
hypertonic water draws fluid into lungs resulting in pulmonary edema, systemic hypovolemia, hemoconcentration |
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near drowning presentation |
coma |
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near drowning lab exams |
arterial blood gases show hypoxia and hypercabia and metabolic acidosis |
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drowning management |
removal from water |
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drowning ineffective treatments |
abdominal thrusts, antibiotics, steroids |
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anaphylaxis presentation |
hives rash (urticaria), angioedema and swelling, dyspnea, stridor, tachycardia, hypotension, hemodynamic collapse |
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anaphylaxis management |
antihistamine diphenhydramine |
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cat and dog bites |
treat with exploration, debridement, irrigation, proper wound care |