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113 Cards in this Set
- Front
- Back
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Breath odor of bitter almonds
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cyanide
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Breath odor of violets
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turpentine
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Breath odor of mothballs
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camphor, naphthalene
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Breath odor of garlic
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organophosphates
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Breath odor of pear
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chloral hydrate
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Constricted pupils
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COPS - clonidine, opiates, pontine bleed, sedative-hypnotics
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Dilated pupils
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amphetamines, anticholinergics, cocaine
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pulmonary edema
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opioids, salicylates, toxic inhalations, cocaine, organophosphates, ethylene glycol
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increased bowel sounds
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sympathomimetics, opiate withdrawal
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decreased bowel sounds
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anticholinergics, opiate toxicity
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needle tracks on skin
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opioids
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diaphoresis
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salicylates, organphosphates, sympathomimetics
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jaundice
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acetaminophen, mushroom poisoning
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alopecia
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arsenic, thallium, chemotherapeutic agents
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cyanosis
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drugs causing methemoglobinemia (nitrates / nitrites, "caine" anesthetics, aniline dyes, chlorates, dapsone, sulfonamides
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cholinergics toxidrome
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DUMBBELS - diarrhea, urination, miosis, bradycardia, bronchospasm, emesis, lacrimation, salivation
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anticholinergics toxidrome
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hot as stove, red as beet, dry as bone, mad as hatter (fever, skin flushing, dry mucous membrane, psychosis, mydriasis, tachycardia, urinary retention)
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opioid toxidrom (triad)
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coma, respiratory depression miosis
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sedative-hyptonics toxidrome
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CNS depression, respiratory depression, coma
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extrapyramidal toxidrome
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parkinsonian symptoms: tremor, torticollis, trismus, rigidity, oculogyric crysis, opisthotonus, dystonia, dysphagia
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examples of cholinergics
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organophosphates, pilocarpine, pyridostigmine, muscarine-containing mushrooms
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examples of anticholinergics
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TCAs, atropine, scopolamine, antihistamines, Jimson weed
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examples of opioids
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morphine, oxycodone, heroin
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examples of sedative-hypnotics
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alcohol, barbiturates, benzodiazepines
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name the toxidromes
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cholinergics, anticholinergics, opioids, sedative hypnotics, extrapyramidal
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Treatment for poisoning / toxin-exposure
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elimination, removal of unabsorbed toxin, removal of absorbed toxin
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2 methods of eliminating toxins
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activated charcoal, whole bowel irrigation
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two methods of removal of unabsorbed toxin
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emesis, gastric lavage
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three methods of removing absorbed toxin
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alkalization methods, charcoal hemoperfusion, HD
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polyethylene glycol with electrolytes to wash toxins from GI tract
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whole bowel irrigation
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first line treatment of poisoning
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activated charcoal: 1g/kg BW
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how to perform emesis
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ipecac 30cc for adults, 15 cc for children
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indication for emesis in poisoning
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patient awake, ingstion recent (30-60 minutes) ingestion moderately or highly toxic
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contraindications to emesis in poisoning
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AMS, absent gag reflex, caustic agents, agents that are easily aspirated, nontoxic ingestion
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indications for gastric lavage
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ingestion suspected or known to be seroius, ingestion recent, patient awake and cooperative or intubated, patient can be placed in LLD position
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how is alkalization performed in poisoning
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mixing D5W with 2-3 amps of NaHCO3
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when is alkalization done in poisoning
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TCA poisoning, alkalinzation of urine to ph >8 ionizes weak acids into ionized molecules, increasing excretion of salicylates, phenobarbital adn chlorpropamide
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procedure that increases absorption of toxic substances in the blood by filtering blood from a shunt through a column of activated charcoal
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charcoal hemoperfusion
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when is charcoal hemoperfusion indicated?
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aminophylline, barbiturates, carbamazepine, digoxin
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procedure that filter small, ionized molecules in cases of poisoning
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HD
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when is HD indicated
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salicylates, theophylline, methanol, lithium, barbiturates, ethylene glycol
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treatment for alcohol withdrawal
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benzodiazepines, haloperidol for hallucinations, thiamine, folate and MV replacement
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treatment of barbiturates withdrawal
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BDZ
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treatment for BDZ withdrawal
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BDZ
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treatment of cocaine / amphetamine withdrawal
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supportive (avoid Beta blockers)
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why should B blockers be avoided in cocaine use
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uninhibited alpha-cardiac stimulation with cocaine use
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treatment of opioid withdrawal
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symptom management, clonidine / buprenorphine for moderate withdrawal, methadone for severe symptoms
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symptoms of cocaine or MAP withdrawal
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depression, hyperphagia, hypersomnolence
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symptoms of BDZ withdrawal
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rebound anxiety, seizures, tremor, DTs
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symptoms of opioid withdrawal
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anxiety, insomnia, flulike symptoms, sweating piloerection, fever, rhinorrhea, nausea, stomach cramps, diarrhea, mydriasis
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medically indicated tests after sexual assault
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HIV, gonorrhea, chlamydia culture, syphilis culture, HBC, HCV testing, pregnancy test
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evidence to be collected after sexual assault
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saliva sample, oral, anal, vaginal smears, nasal mucus sample, blood sample, fingernail scraping and clipped fingernails, combed and plucked head and pubic hairs, debris and dried secretions from skin
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treatment of sexual assault
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treat infection (plus HBV and HIV prophylaxis) treat injuries, prevent pregnancy, counseling
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how to prevent pregnancy in sexual assault
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two Ovral tablets PO stat and in 12 hours
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What is AVPU?
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alert, visual stimuli, painful stimuli, unresponsive
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ABCDE
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airway maintenance with cervical spine control, breathing with ventilation, circulation with hemorrhage control, disability / brief neuro exam, exposure / environmental control
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what is the secondary survey?
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total patient evaluation
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what is AMPLE
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inquire about Allergies, Medications, PMH, Last meal eaten, Events / Environment related to the injury (during secondary survey)
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motor response in Glasgow coma scale
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obeys commands, localizes, withdraws, abnormal flexion, abnormal extension, NR
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verbal response in GCS
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oriented, confused spech, inappropriate speech, incomprehensible, NR
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eye opening in GCS
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spontaneous, to voice, to pain, NR
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most commonly injured solid organ in blunt abdominal trauma
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spleen
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when to transfer to OR in abdominal trauma
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presence of penetrating wound to abdomen deeper than the fascia or with any significant bleeding or bowel injury
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maximum shock for VF/VT
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up to 360J if monophasic, 250 J if biphasic
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other drugs aside from epinephrine that can be used in VF/VT
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procainamide, amiodarone, lidocaine, magnesium
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5 Hs of PEA
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H+ acidosis, hyper or hypokalemia, hypoxia, hypovolemia, hypothermia
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5 Ts of PEA
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tablets, tamponade, tension pneumothorax, thrombosis (coronary), thrombosis (pulmonary embolism)
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treatment of PEA
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epi q3-5m x 3; atropine q3-5m x 3 if slow PEA rate
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treatment of asystole
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epi q3-5m x 3 or vasopressin x 1, atropine q3-5m x 3, consider pacemaker
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treatment of bradycardia
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atropine q3-5m x 3; transcutaneous pacemaker, eopa, epi, isoproterenol drip
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treatment of supraventricular tachycardia
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vagal stim; adenosine 6mg IV, adenosine 12mg IV, IV diltiazem if no CHF; adenosine 12mg IV
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treatment of stable monomorphic VT
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procainamide or sotalol, amiodarone or lidocaine; if with CHF, amiodarone or lidocaine then DC cardioversion
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treatment of stable wide-complex tachycardia
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DC cardioversion, procainamide, amiodarone; if with CHF, no procainamide
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differentiate heat exhaustion from heat stroke
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heat exhaustion - extreme fatigue with profuse sweating, body temperature is normal or slightly elevated; heat stroke is a true emergency, presents with increased body temperature and altered mental status, no sweating
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treatment of heat exhaustion
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IV NS and a cool environment
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treatment of heat stroke
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aggressive cooling; undress; atomized tepid water spray; apply ice packs to groin and axillae
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differentiate superficial and deep frostbite
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superficial is injury to cutaneous and subcutaneous tissue; skin is soft under frozen surface; deep injury is to deep structures (muscle and bone) and skin is hard under a frozen surface
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treatment of frostbite
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rapid rewarming once refreezing can be prevented; circulating water at 40C, wound care, tetanus prophylaxis
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define hypothermia
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core body temperature <35C of <95F
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ECG findings in hypothermia
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Osborn or J waves
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treatment of hypothermia (rewarming)
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passive external (blankets), active external (warmed blankets, hot water bottles; active internal (warm O2, heated IV fluids, colonic bladder or peritoneal lavage, extracorporeal warming)
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when to pronounce death in hypothermia
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not until patients have been rewarmed to 35C
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cardiac complications of hypothermia
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dysrhythmias esp VF at core temperatures <30C
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drug of choice for dysrhythmias due to hypothermia
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bretylium
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indication for fluid resuscitation in burns
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if >20% BSA second-degree burns
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Parkland formula
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4cc/kg per % total BSA over 24 hours; 1/2 over first 8 hours and second half over next 16 hours
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what to monitor during fluid resuscitation in burns
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urine output; 1cc/kg/hr
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disposition in burns
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minor burns - discharge with pain meds; moderate burns - hospitalize; major burns - burn center
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define moderate burns
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partial thickness 15-25% BSA or full thickness <10%BSA
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define major burns
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partial thickness >25% BSA of full thickness >10%; burns to face, hands, joints, feet, perineum; electrical or circumferential burns
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describe electrical injuries due to AC
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explosive exit wounds, VF more common
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describe electrical injuries due to DC (industrial / batteries / lightning)
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discrete exit wounds, asystole more common
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what to monitor with IV fluid ersuscitation in electrical burns to prevent myoglobinuria
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UO 1.5-2 cc/kg/hr
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which electrical burn patients can be discharged?
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asymptomatic low-voltage (<1000-V) burn victims
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antibiotic of choice for tetanus
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metronidazole
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active immunization for animal bites
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HDCV human diploid cell vaccine
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passive immunization for animal bites
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HRIG human rabies immune globulin
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likely organism for dog bites
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alpha hemolytic strep, staph aureus, pasteurella multocida
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likely organism for cat bites
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P. moltocida
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likely organism for human bites
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polymicrobial; viridans strep most frequently implicated
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antibiotic treatment for dog bites
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amoxiclav or first gen ceph +/- tetanus and rabies prophylaxis
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antibiotic treatment for cat bites
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augmentin +/- tetanus
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antibiotic treatment for human bites
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second or third-gen ceph; dicloxa + pen, amoxiclav or clarithromycin +/- tetanus prophylaxis, HBV vaccine, HZBIG and HIV PEP
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symptoms of corneal abrasion
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pain out of proportion with exam, foreign-body sensation, photophobia
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diagnostics for corneal abrasion
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fluorescein staining (cobalt blue light source via slit-lamp or Wood's lamp examination) reveals abraded area
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treatment of corneal abration
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topical broad-spectrum antibiotics (genta, sulfacetamide, bacitracin) tetanus prophylaxis, oral analgesics
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laterality of viral vs bacterial conjunctivitis
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viral is usually bilateral, bacterial is usually unilateral
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organisms causing bacterial conjunctivitis
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staph, strep, neisseria gonorrhea, chlamydia trachomatis (newborns and sexually active)
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treatment of bacterial conjunctivitis
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staph and strep - topical 10% sulfacetamide or AG; N gonorrhea with IV ceftri and topical erythromycin or tetracycline; chlamydia - IV and topical erythromycin
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PE findings in allergic conjunctivitis
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diffuse conjunctival injection with normal visual acuity, lid edema, cobblestone papillae under upper lid
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treatment of allergic conjunctivitis
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topical antihistamine / vasoconstrictor preparations (naphazoline / pheniramine) or mast cell stabilizers (cromolyn or olopatadine); cool compresses
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how to differentiate alkali from acid chemical conjunctivitis
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litmus paper - coag necrosis with acid burns; liquefaction in alkali burns
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treatment of chemical conjunctivitis
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copious irrigation with Morgan lens until pH neutral; tetanus prophylaxis
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