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98 Cards in this Set
- Front
- Back
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basic life support measures
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1) assess responsiveness
2) call for help 3) postiion face up on flat surface 4) open the airway 5) assess breathing (if no breathing, perform 2 rescue breaths) 6) check carotid pulse 5-10 seconds (if no pulse, give 30 compressions and two ventilations until help arrives) |
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asystole and dysrhythmia etiology
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"Hi 5, T5": hypoxia, hypo/hyperkalemia, hypothermia, hypoglycemia, hypoveolemia, trauma, toxins, tamponade, tension pneumothorax, thrombosis
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advanced cardiac support
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if pulseless + shockable --> shock + 5 cycles of CPR + 1mg epi every 3-5min until pulse present
if pulseless + not shockable --> 5 cycles of CPR + 1mg epi + 1mg atropine until electrical activity then check pulse; |
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shockable rhythms
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ventricular fibrillation and ventricular tachycardia
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unshockable rhythms
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asystole, pulseless electrical activity
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signs of hemodynamic instability
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hypotension, chest pain, altered mental status, CHF
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general measures of tachycardia with pulses
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ABC, O2, identify rhythm on ECG, identify reversible causes
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hemodynamically unstable patient with pulse and tachycardia
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perform immediate cardioversion
IV access and sedation until stable |
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hemodynamically stable patient with pulse and tachycardia, narrow QRS, regular rhythm
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vagal maneuvers or adenosine
if converts --> probable SVT, treat recurrence with adenosine if doesn’t convert --> probable atrial flutter, ectopic atrial tachycardia control rate with diltiazem or betablockers |
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hemodynamically stable patient with pulse and tachycardia, narrow QRS, irregular rhythm
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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
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if VT --> amiodarone 150mg IV over 10min, repeat as needed
if SVT --> adenosine and check for rhythm conversion |
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hemodynamically stable patient with pulse and tachycardia, wide QRS, irregular rhythm
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if WPW --> avoid nodal blocking agents adenosine, digoxin, CCB
consider amiodarone 150mg over 10min |
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basic algorhythm for tachycardia with pulses
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general measures --> check if stable --> check QRS --> check rhtyhm regularity
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miosis as sign of toxicity
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sugests clonidine, barbiturates, opiates, cholinergics, pontine stroke
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mydriasis as sign of toxicity
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sugests sympathomimetics, anticholinergics
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dry skin as sign of toxicity
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sugests anticholinergics
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wet skin as sign of toxicity
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cholinergics, sympathomimetics
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blisters as sign of toxicity
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barbiturates, carbon monoxide
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common signs of toxicity
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miosis, mydriasis, dry skin, wet skin, blisters
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measures for toxic ingestion management
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induced vomiting
lavage charcoal whole bowel irrigation dialysis cathartics forced diuresis naloxone/dextrose/thiamine |
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induced vomitting
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ipecac can only be used 1-2 hours after toxic ingestion (limited use)
not indicated in children or for caustic substances |
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lavage
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indicated in those with mental status
preceded by intubation used 1 hour after ingestion (limited use) contraindicated for caustic substances |
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charcoal
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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
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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
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used for ehtylene glycol, lithium overdose, methanol poisoning, aspirin overdose, theophyline overdose and there is coma, hypotension or apnea
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cathartics
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useful only when charcoal is used; generally wrong answer
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forced diuresis
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alkaline diuresis is only useful for salicylates and phenobarbital
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naloxone/dextrose/thiamine administration
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given to any patient who ingested substance and has altered mental status
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acetaminophen toxicity stages
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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
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N-acetyl-cysteine preferably within first 8 hours
activated charcoal no gastric emptying after 24 hours of ingestion no treatment can prevent or reverse toxicity |
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methanol ingestion sources
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paint thinner, sterno, photocopier fluid, solvents, windshield washer solution
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ethylene glycol ingestion sources
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car antifreeze
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methanol and ethylene glycol metabolism
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methanol + alcohol dehydrogenase --> formaldehyde + formic acid
ethylene glycol + alcohol dehydrogenase --> oxallic acid/oxalate |
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general signs of alcohol intoxication
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confusion, ataxia, lethargy, drowsiness, slurred speech
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isopropyl alcohol intoxication
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ketonuria, ketonemia, without acidosis and no increased anion gap
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methanol intoxication specific signs
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visual disturbances, blindness
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ehtylene glycol intoxication specific signs
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renal failure and oxalate crystals/stones in urine
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alcohol intoxication diagnosis
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determine specific alcohol levels in blood
oxalate crystals in urine and ↑BUN/creatinine are characteristic of ethylene glycol ethylene glycol and methanol produce increased anion gap metabolic aciosis different from isopropyl alcohol which is normal |
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alcohol intoxication treatment
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fomepizole is alcohol dehydrogenase inhibitor which decreases toxic metabolites
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carbon monoxide poisoning presentation
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dyspnea, tachypnea, shortness of breath, headache, nausea, dizziness, confusion, syncope, chest pain, arrhythmia, hypotension
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carbon monoxide poisoning diagnosis
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carboxyhemoglobin levels
arterial blood gases (metabolic acidosis with normal PO2) ↑CPK pulse oximetry not helpful CO poisoning might present similar to hypoglycemia, if glucose is normal, raise suspicion of CO |
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carbon monoxide poisoning treatment
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removal from source of exposure, 100% O2, hyperbaric O2 if CNS or chest pain
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caustic substance intoxication presentation
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oral pain, drooling, odynophagia, abdominal pain
esophageal injury and gastric perforation may occur |
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caustic substance intoxication diagnosis
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by history of exposure and upper endoscopy if ingested
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caustic substance intoxication management
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wash out mouth, eyes or skin with large volumes of cold water
follow eye wash out with fluorescein corneal exam don't induce emesis or neutralize substance charcoal and steroids are not effective |
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digoxin toxicity etiology
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from suicide attempt or accidental overdose; hypokalemia predisposes to toxicity
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digoxin toxicity presentation
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nausea, vomitting, diarrhea, anorexia
blurred vision, color abnormalities hallucinations confusion arrhythmia |
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digoxin toxicity diagnosis
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history + ECG looking for any arrhythmia
check for hyperkalemia |
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digoxin toxicity management
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repeated doses of charcoal, digoxin antibodies, potassium correction
pacemaker might be necessary for refractory bradycardia or 3rd degree heart block |
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opiate intoxication
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respiratory depression
respiratory acidosis miosis constipation bradycardia hypothermia hypotension treat with naloxone |
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cocaine intoxication
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hypertension, hemorrhagic stroke, MI, arrhythmia, seizures
pulmonary edema is specific to crack treat with benzodiazepines for acute agitation combined alpha/beta blockers such as labetalol or alpha blockers such as phentolamine avoid beta blockers |
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benzodiazepine intoxication
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somnolence, dysarthria, ataxia, stupor
death is not from respiratory depression but concomitant ethanol or barbiturates flumazenil antidote is not always used due to seizures from withdrawal |
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barbiturate intoxication
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hypothermia, loss of deep tendon reflexes
loss of corneal reflexes, coma and death from respiratory depression no EEG activity can be seen no specific antidote but increase urinary excretion with bicarbonate |
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hallucinogens
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marijuana, LSD, mescaline, peyote, psilocybin, PCP (angel dust)
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hallucinogen toxicity
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delirium and bizarre behavior
anticholinergic effects (flushed skin, dry mouth, dilated pupils, urinary retention) PCP may cause seizures treat severe intoxication with benzodiazepines |
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lead sources
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ingested paint, soil, dust, drinking water
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lead metabolism
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absorbed from GI tract, skin or inhalation
5-10% in blood (mostly in RBC) 80-90% in bones, remainder in brain and kidneys |
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lead poisoning presentation
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adults: abdominal pain, anemia, renal disease, neurologic manifestations
children: abdominal pain, anemia, lethargy, seizures, coma, irreversible mental retardation and cognitive damage |
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lead poisoning diagnosis
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best test is blood lead levels (<10ug/dL is normal)
lead lines at metaphyseal plate of long bones in children anemia azotemia |
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lead poisoning treatment
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removal of source
chelators (EDTA, dimercaprol, penicillamine or succimer) acute poisoning: charcoal + urination |
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mercury poisoning
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interstitial pneumonitis from inhalation
irreversible neurologic symptoms (tremors, excitability, memory loss, delirium, insomnia) GI symptoms from ingestion treat with succimer or dimercarprol |
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salicylates intoxication presentation
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tinnitus
nausea, vomitting, gastritis hyperventilation, noncardiogenic pulmonary edema hyperthermia, CNS toxicity lactic metabolic acidosis with increased anion gap |
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salicylates intoxication diagnosis
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most specific test is aspirin level
suggestive is elevated anion gap metabolic acidosis but blood may have ↑pH, ↓pH or normal chest x-ray may be normal or pulmonary edema |
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salicylates intoxication management
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if within 1 hour of ingestion, gastric decontamination + charcoal
mainstay of therapy is alkalinization of urine with aggressive fluid resuscitation dialysis is sometimes used |
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tricyclic antidepressant intoxication presentation
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anticholinergic (dry mouth, tachycardia, dilated pupils, flushed skin)
cardiac (wide QRS, ventricular tachycardia) CNS (altered mental status, seizures) |
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tricyclic antidepressant intoxication diagnosis
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serum drug levels is most specific but EKG is more important to do first
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tricyclic antidepressant intoxication management
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within hours --> charcoal
bicarbonate if cardiac toxicity don't use flumazenil to reverse concomitant benzodiazepine overdose because it leads to seizures |
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head trauma presentation
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headache, amnesia, loss of consciousness
focal findings are most common with epidural hematomas, then subdural hematomas and contusion |
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head trauma diagnosis
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CT scan always
hemorrahge is visible immediately subdural hematoma is crescent-shaped epidural hematoma is lens-shaped if focal findings consistent with radiculopathy or spinal tenderness --> cervical spine x-ray concussion diagnosis is loss of consiousness + normal head CT |
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head trauma treatment
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if intracrannial hemorrhage --> hyperventilation to a PCO2 of 30-35
osmotic diuretics and elevation of head of the bed maintain cerebral perfusion by keeping blood pressure 110-160mmHg |
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subarachnoid hemorrhage presentation
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acute --> sudden headache, loss of consiousness (50%), focal neurologic symptoms (30%)
long-term --> focal deficits, seizures, rebleeding, hydrocephalus, stroke |
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subarachnoid hemorrhage diagnosis
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intial best test is CT scan which has 90-95% sensitivity within first 24 hours
if CT is normal and SAH is still suspect --> lumbar puncture for absence of red cells angiography to determine site for surgery inverted or enlarged T-waves on ECG are not alarming |
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subarachnoid hemorrhage management
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maintain blood pressur at 110-160mmHg
nimodipine to prevent spasm and stroke angiography to determine site of bleeding for surgical correction shunt if hydrocephalus is present |
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skin burns classification
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first-degree --> skin is intact
second-degree --> blister formation third-degree --> destruction of skin appendages and pain receptors which result in relative lack of pain |
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burn presentation
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altered mental status, dyspnea, headache and chest pain suggest carbon monoxide poisoning
stridor, hoarseness and dyspnea suggest laryngeal edema soot in nose and mouth suggests impending airway compromise |
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rule of nines for burns
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arms and head are 9% each
chest, back and legs are 18% each patchy burns estimated with width of hand which is 1% watch out for circumferential burns which compromise circulation |
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diagnosis work-up of burns
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aside from actual burn, determine carboxyhemoglobin levels in severe burns
chest x-ray and/or bronchoscopy to determine respiratory injury extent |
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definition of severe burns
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combined second and third-degree burns >20% in adults or >10% in old or young
OR third-degree burns >5% of body surface |
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burn injury management
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if signs of respiratory injury --> intubation is initial step
if carboxyhemoglobin is elevated --> 100% O2 Ringer lactate fluid rescucitation using Parkland formula H2 blocker prophylaxis, topical silver sulfadiazine to prevent infections grafts as needed |
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Parkland formula
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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
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lost ability to romeve heat from body
excessive body temperature elevation confusion, disorientation, nausea, blurred vision, seizures hemoconcentration, ↑BUN/creatinine, rhabdomyolysis, anuria, DIC, lactic acidosis place body in cool temperature, water and fan + IV fluid replacement |
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malignant hyperthermia
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idiopathic reaction to any anesthetic specially halothane and succinylcholine
rhabdomyolysis and hyperthermia treat with dantrolene |
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neuroleptic malignant syndrome
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reaction to phenothiazines, chlorpromazine, haloperidol
muscular rigidity, hyperthermia, ↑CPK, encephalopathy, rhabdomyolysis treat by removing agent + bromocriptine or dantrolene |
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hypothermia
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core body temperature <35C
lethargy, confusion, weakness, arrhythmias with J-wave elevation (may mimic ST elevation) treat with warm bed, bath or blankets rescucitation efforts from pulselessness can go on beyond 10 minutes until temperature >35C |
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nonionizing radiation
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infrared, ultraviolet and microwave; present primarily as burns
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ionizing radiation
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bone marrow depression with infections and bleeding
permanent sterility in males around 4-5Gy nausea and vomitting 100% at 3Gy supportive therapy with antiemetics, transfusions, colony-stimulating factors, antibiotics as needed |
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electrocution presentation
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local 1st, 2nd and 3rd degree burns
ventricular fibrillation (AC current) aystole (DC current, lightning) respiratory arrest (injury to medulla or respiratory muscle paralysis) neurologic damage loss of consiousness and amnesia in 75% of lightning cases renal failure from dehydration and rhabdomyolysis cataracts in 5-30% |
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electrocution treatment
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cardiopulmonary resuscitation, fluid replacement, local wound care
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types of drowinig
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dry drowning from laryngospasm, fresh water drowning, sea water drowning
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fresh water drowning
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hypotonic water alters surfactanct and causes collapse
water is absorbed and results in hypervolemia, hemodilution and hemolysis lungs have little water |
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sea water drowning
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hypertonic water draws fluid into lungs resulting in pulmonary edema, systemic hypovolemia, hemoconcentration
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near drowning presentation
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coma
agitation cyanosis coughing sings of pulmonary edema (tachypnea, tachycardia, rales) |
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near drowning lab exams
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arterial blood gases show hypoxia and hypercabia and metabolic acidosis
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drowning management
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removal from water
ABCs (first step) endotracheal intubation O2 positive pressure mechanical ventilation (most effective) |
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drowning ineffective treatments
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abdominal thrusts, antibiotics, steroids
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anaphylaxis presentation
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hives rash (urticaria), angioedema and swelling, dyspnea, stridor, tachycardia, hypotension, hemodynamic collapse
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anaphylaxis management
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antihistamine diphenhydramine
if hemodynamic instability --> epinephrine, IV fluids, antihistamines and steroids |
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cat and dog bites
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treat with exploration, debridement, irrigation, proper wound care
prohylactic antibiotic of choice is amoxicillin/clavulanate |
