-
Gastric lavage use
- Best if <30min
- At 1 hour will remove 50%
- at 2 hours will remove 15%
- Useless after 2 hours
- Dangerous in altered mental status and caustic ingestion
-
Acetominophen toxicity levels and tx
- Toxicity at 8-10g
- Fatality at 12-15g
- If >24 hours ago - no tx
- If unclear amount, get drug level
- If >8g, Nacetylcysteine
-
Aspirin overdose presentation and tx
- Tinnitus
- hyperventilation
- resp alkalosis then metabolic acidosis
- Renal toxicity
- altered mental status
- Inc anion gap
- ARDS
- Inc PT
- Tx by alkalinizing urine
-
TCA toxicity and tx
- Seizures
- Arrhythmias - wide QRS precursor
- Dry mouth
- Constipation
- Urinary retention
- Tx with NaBicarb to protect against arrhythmias
-
CO poisoning tests and tx
- Oximetry is falsely normal
- Accurate: carboxyhemoglobin level
- Tx mild with 100% O2. If CNS, Cardiac or metabolic acidosis, hyperbaric O2
-
Methemoglobinemia causes
- Benzocaine and other anesthetics
- Nitrites and nitroglycerin
- Dapsone
-
Methemoglobinemia test, initial therapy, most effective therapy
- Normal pO2, Accurate test is methemoglobin level
- Inital therapy is 100% O2
- Most effective is methylene blue
-
Insecticide poisoning
- Oraganophosphates, like nerve gas
- Inh ACh metabolism leading to inc levels
- Salivation, lacrimation, polyuria, diarrhea, bronchospasm, bronchorrhea, respiratory arrest
- TX with pralidoxime or atropine
-
Digoxin toxicity presentation, dx, tx
- GI, hyperK, confusion, yellow vision
- bradycardia, Atach, AV block, ventricular ectopy, Afib
- Initial is K level and EKG (downsloping of ST segment). Accurate is digoxin level
- Tx is Ab
-
Digoxin and K
- Hypok leads to digoxin toxicity bc they compete for the same site
- Digoxin toxicity leads of hyperK bc ATPase is not working
-
Lead poisoning presentation and dx, tx
- Abdominal pain
- ATN
- Anemia - sideroblastic
- Peripheral neuropathies
- Memory loss, confusion
- Initial test is inc level of free erythrocyte protoporphyrin. Accurate is lead level. Also prussian blue for sideroblastic anemia
- Tx: Succimer is oral chelator. EDTA and BAL (dimercaprol are IV
-
Methanol source, toxic metabolite, toxicity, tx
- Wood alcohol, cleaners, paint thinners
- Formic acid/formaldehyde
- Retinal inflammation and ocular toxicity, met acidosis
- fomepizole and dialysis
-
Ethylene glycol source, toxic metabolite, toxicity, tx
- Antifreeze
- Oxalic acid/oxalate
- HypoCa, oxalate crystals, renal toxicity, met acidosis
- fomepizole and dialysis
-
Serum osmolality
2Na + BUN/2.8 + Glc/18
-
Death from snake bite
- Hemolytic toxins causing DIC
- Neurotoxins causing resp paralysis
-
Black widow spider bite: presentation, labs, tx
- Abd pain, muscle pain
- HypoCa
- Ca, antivenom
-
Brown recluse spider bite: presentation, tx
- Local necorsis nad bullae
- Debride, steroids, dapsone
-
Dog/Human bites tx and bugs
- Amox/clavulanate
- Tetanus if more than 5 years
- Dogs and cats: Pasteurella multocida
- Humans: Eikenella corrodens
-
Large hematoma tx
- Intubation
- Hyperventilation (dec pCO2, constrict cerebral circulation, dec volume, dec pressure)
- Mannitol (dec intravascular volume)
- Drainage
- Stress ulcer prophylaxis with PPI
-
Indications for stress ulcer prophylaxis
- Head trauma
- burns
- endotrach intubation
- coagulopathy with resp failure
-
Prevents stroke after subarachnoid hemorrhage
Nimodipine
-
Burn tx
- 100% O2 first
- Intubation if stridor, mouth burns, etc
- 4mL ringers lactate or NS for each % burned for each kg
- 9% for head, an arm, a leg. 18% for chest or back. 1% for a hand
- Prophylactic topical antibiotics - silver sulfadiazine
-
Best initial for hypothermia
- EKG for cardiac arrhythmias
- Elevated J point
-
Drowning types
- Salt water is CHF like
- Fresh water causes hemolysis
- Tx with positive pressure ventilation for both
-
Precordial thump
Only used in rescusitation if witnessed and recent with no AED
-
Asystole tx
- CPR
- epinephrine
- atropine
- vasopressin is alternate to epi
-
VFib tx
- Defibrilation
- CPR
- Defibrilation
- Epi or vasopressin with defibrilation
- Amiodarone or lidocaine with defibrilation
- Mg
-
VTach tx
- Pulseless: same as VF
- Stable: amiodarone, lidocaine, procainamide. Cardiovert
- Unstable: cardioversion, then amiodarone or lidocaine
-
Hemodynamic instability signs
- Chest pain
- Dyspnea/CHF
- Hypotension
- Confusion
-
Pulseless electrical activity: definition, causes
- normal EKG and no pulse
- Tamponade
- Tension pnx
- hypovolemia and hypoglycemia
- massive PE
- hypoxia, hypothermia, met acidosis
- K high or low
-
Afib/Aflutter tx
- Unstable: synchronized cardioversion
- Chronic: more than 2 days.
- Rate control: betablocker, CCB (diltiazam and verapamil), or digoxin
- Anticoagulate: Warfarin: 2-3. Dabigatran is alternative oral anticoagulation. ASA if low risk from stroke
-
Afib stroke rate
- without warfarin, 6% per year
- INR 2-3, 2-3%
-
Atrial contribution to cardiac output
- Normally 10-15%
- Diseased, 30-50%
-
Low risk of stroke with Afib
- aka Lone atrial fibrilation
- No heart disease or atherosclerosis
- No HTN
- <75
- No DM
- No past stroke
-
Supraventricular tachycardia tx
- Vagal
- Adenosine
- Metoprolol, Diltiazem, or digoxin
-
Wolfe-Parkinson-White syndrome presentations, test
- -SVT alternating with VTach
- SVT worsened by diltiazem or digoxin
- delta wave
- -Accurate test is EP study
-
WPW tx
- Acute: procainamide or amiodarone
- Chronic: ablation
- Dont give digoxin or CCB
-
MAT association, tx
- Chronic lung disease
- Tx lung disease and as would AFib
- Avoid betablockers bc of lungs
-
Sinus brady or 1st dewgree AV block tx
- Asymptomatic: nothing
- Best initial: atropine
- Most effective: pacemaker
-
Wenckebach block
- Mobitz I
- progressive lengthening then drop
- Normal aging
- No tx if asymptomatic
-
Mobitz II block
- Dropped beats
- Tx like 3rd degree block
- Pacemaker for all
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