Term
| What are the ABCs of emergency medicine? |
|
Definition
Airway
Breathing
Circulation
(implies nothing's more important than making sure the patient has an airway) |
|
|
Term
| How is airway-breathing of a poisoned patient assessed/restored? |
|
Definition
1) remove obstruction
2) intubate early
3) ventilate if necessary
4) ABG to assess:
a) oxygenation
b) ventilation
c) acid-base status |
|
|
Term
| How is circulation of a poisoned patient assessed/restored? |
|
Definition
1) Obtained BP & pulse
2) Cardiac monitoring & cardioversion
3) Fluids
4) 12 lead EKG asap
5) Vasopressors |
|
|
Term
| What are the "Other C's"? |
|
Definition
|
|
Term
| What do the ABCs help with in emergency medicine? |
|
Definition
|
|
Term
What 4 substances are immediately given to all ER patients with altered mental status?
Why? |
|
Definition
1) Oxygen
2) Glucose (in case of diabetic shock)
3) Naloxone (in case of narcotic OD)
4) Thiamine (in case it's Wernicke's) |
|
|
Term
| What patient's would NOT get naloxone if altered mental status? |
|
Definition
1) opiod dependent w/o apnea/severe resp. depression
2) Hx of speedball abuse
3) agitated/seizing
4) pregnant & opiod dependent |
|
|
Term
| What is flumazenol used for clinically? |
|
Definition
|
|
Term
| Why isn't flumazenol used regularly? |
|
Definition
| can precipitate benzo withdrawl |
|
|
Term
| What is done after a patient is stablized? |
|
Definition
Disrobe patient and do a thourough PE (always starting with vital signs)
check for:
trauma
odors
burns/tracks
bullae
**neuro exam |
|
|
Term
| What Hx is obtained from the patient? |
|
Definition
complete Hx:
HPI & PMH
(though, you will need to confirm with friends, family, police, paramedics since ~50% of the time it's inaccurate) |
|
|
Term
| What happens if your poisoned patient is tachycardic? |
|
Definition
| It's not very specific, but gives a general area of where to start looking |
|
|
Term
| What happens if your poisoned patient is bradycardic? |
|
Definition
| It's very specific and narrows the list of substances significantly, down to 4 main substances (+ some other rare substances) |
|
|
Term
| What are the 4 drugs you think of poisoning when your patient is bradycardic? |
|
Definition
| 1) β blocker
2) Ca2+ channel blocker
3) clonidine (α2 agonist)
4) digoxin (for digitalis [cardiac glycosides made from foxgloves plants]) |
|
|
Term
| Besides cold exposure, what is the number one cause of hypothermia? |
|
Definition
|
|
Term
| What are the 2 common causes of hyperthermia? |
|
Definition
1) ecstacy
2) anticholinergics (no sweat) |
|
|
Term
| What drugs can cause both hypothermia & hyperthermia depending on the season (no body temp regulation)? |
|
Definition
|
|
Term
| What drugs can cause HTN in OD? |
|
Definition
| same as tachycardic (usually stimulants of some kind) |
|
|
Term
| What 2 drugs should you think of when your patient is hypotensive? |
|
Definition
1) opiates
2) sedative hypnotics |
|
|
Term
| What does hyperventilation tell you about a patient? |
|
Definition
| It's very non-specific, but it could indicate metabloic acidosis |
|
|
Term
| How helpful is it to notice miosis in a patient? |
|
Definition
| Very - tends to be more specific |
|
|
Term
| What drugs should you think of when you have a miotic patient? |
|
Definition
1) opiates
2) cholinergics |
|
|
Term
| How helpful is it to notice mydriasis in a patient? |
|
Definition
| Not so helpful, unless dramatic |
|
|
Term
| What drugs should you think of if your patient has dramatic mydriasis? |
|
Definition
|
|
Term
| How specific is nystagmus in a poisoned patient? |
|
Definition
| Not too specific, but you do think of sedative hypnotics |
|
|
Term
| What drugs cause rotational nystagmus? |
|
Definition
|
|
Term
| What odor is smelled with heavy metals? |
|
Definition
|
|
Term
| What happens if you smell bitter almonds? |
|
Definition
|
|
Term
Toxidrome
Anticholinergics
(Pulse, BP, Resp., Temp., Bowel Sounds) |
|
Definition
Pulse: ↑
BP: ↑
Resp.: ↑
Temp: ↑
Bowel Sounds: ↓ |
|
|
Term
Toxidrome
Anticholinergics
(Skin, Mental Status, Pupils, Other) |
|
Definition
Skin: dry, red, hot (as a bone, as a beet, as a hare)
Mental Status: altered
Pupils: mydriasis
Other: urinary retention |
|
|
Term
Toxidrome
Sympathomimetic
(Pulse, BP, Resp., Temp., Bowel Sounds) |
|
Definition
Pulse: ↑
BP: ↑
Resp.: ↑
Temp: ↑
Bowel Sounds: normal |
|
|
Term
Toxidrome
Sympathomimetic
(Skin, Mental Status, Pupils, Other) |
|
Definition
Skin: sweaty
Mental Status: altered
Pupils: mydriasis
Other: bruxism |
|
|
Term
Toxidrome
Cholinergic
(Pulse, BP, Resp., Temp., Bowel Sounds) |
|
Definition
Pulse: ↓
BP: normal
Resp.: normal
Temp: ↓
Bowel Sounds: ↑ |
|
|
Term
Toxidrome
Cholinergic
(Skin, Mental Status, Pupils, Other) |
|
Definition
Skin: sweaty
Mental Status: normal
Pupils: miosis
Other: fasciulations, weakness, odors |
|
|
Term
Toxidrome
Opioids
(Pulse, BP, Resp., Temp., Bowel Sounds) |
|
Definition
Pulse: ↓
BP: ↓
Resp.: ↓
Temp: ↓
Bowel Sounds: ↓ |
|
|
Term
Toxidrome
Opioids
(Skin, Mental Status, Pupils, Other) |
|
Definition
Skin: sweaty
Mental Status: ↓
Pupils: miosis
Other: track marks |
|
|
Term
| What 5 options do ED doctors have to decrease further absorption in a poisoned patient? |
|
Definition
1) skin/eye decontamination
2) gut decontamination
3) activated charcoal
4) cathartics
5) whole bowel irrigation |
|
|
Term
| What is the #1 decontamination rule? |
|
Definition
| Protect yourself & your staff |
|
|
Term
| How is eye decontamination done? |
|
Definition
| iirgate with copious amounts of saline |
|
|
Term
| How is skin decontamination done? |
|
Definition
Begin with wounds and you can use:
water
mild soap
50/50 detergent/corn starch
dilute bleach |
|
|
Term
| How do you decontaminate GI tract from a corrosive substance? |
|
Definition
Children: 4oz water only
Adults: 8oz water, then go to ED |
|
|
Term
|
Definition
|
|
Term
| Though Ipecac is not really used anymore, when should you NOT use it for sure? |
|
Definition
<1 yr
CNS depression (vomiting unconscious child = bad)
corrosive agent (burns on the way down & up) |
|
|
Term
|
Definition
| placement of lg. bore orogastric tube into stomach & pump 2+ L saline |
|
|
Term
| When is gastric lavage used clinically? |
|
Definition
1) patients who have come to ED within 1 hr of ingestion
2) patients who have ingested copious amounts of a sunbstance |
|
|
Term
| Why isn't gastric lavage used more frequently? |
|
Definition
| risk of airway blockage & aspiration |
|
|
Term
| When is gastric lavage contraindicated? |
|
Definition
1) unprotected airway
2) ingestion of corrosive substance |
|
|
Term
| What is your "friend" when trated poisons ingested? |
|
Definition
|
|
Term
|
Definition
1) direct absorption of material
2) interrupt enterohepatic recirculation
3) gut dialysis |
|
|
Term
| When in charcoal contraindicated? |
|
Definition
1) certain substances s.a. hydrocarbons & metals (Fe, Li) that don't bind to it
2) corrosive agents
3) intestinal obstruction |
|
|
Term
| When would multiple doses of charcoal be needed? |
|
Definition
| drugs that have enterohepatic recirculation |
|
|
Term
| Why is sorbitol given when charcoal is administered? |
|
Definition
| to move the charcoal (bound to poison) through the stomach and out |
|
|
Term
|
Definition
|
|
Term
def
whole bowel irrigation |
|
Definition
|
|
Term
| When would you do a massive bowel irrigation? |
|
Definition
| When charcoal won't work, body packers |
|
|
Term
| When is whole bowel irrigation contraindicated? |
|
Definition
|
|
Term
| Why are drugs that cause concretions "annoying"? |
|
Definition
| Can cause prolonged intoxication |
|
|
Term
| What lab diagonostic tests can be done to help with deciding on a toxicant? |
|
Definition
1) EKG
2) UA
3) few bedside tests |
|
|
Term
| How do you calculate the anion gap? |
|
Definition
| AG = Na - (HCO3 + Cl)
with normal ~ 12 |
|
|
Term
| What is the mnemonic for an increaed anion gap? |
|
Definition
|
|
Term
|
Definition
MeOH
Uremia
Diabetes
Paraldehyde/phenformin
Iron/isoniazid
Lactate
Ethylene Glycol
Salicylates
(anything that causes lactic acidosis) |
|
|
Term
| What are the 2 causes of decreased anion gap? |
|
Definition
|
|
Term
| How do you calculate osmolality? |
|
Definition
| Os = 2Na + (Glucose/18) + (BUN/2.8) |
|
|
Term
| How do you calculate the osmolol gap? |
|
Definition
OG = measured os - calculated os
normal ~ 10 |
|
|
Term
| What sm. osmols can increase the osmolal gap? |
|
Definition
|
|
Term
| Why are drug screens unreliable? |
|
Definition
| not necessarily specific or sensitive for what was the poison |
|
|
Term
| How are drugs of abuse drug screened? |
|
Definition
|
|
Term
| Why are urine drug tests unreliable? |
|
Definition
| Just say what the patient has used, not necessarily why they're there today |
|
|
Term
| What drug screens are more useful? |
|
Definition
|
|
Term
| What tox screen method is the "gold standard" (very sensitive & specific)? |
|
Definition
|
|
Term
| How is xray helpful in Dx of a toxicant? |
|
Definition
| some toxicants are radiopaque |
|
|
Term
|
Definition
| enhanced elimation where drugs that are weak acids or weak bases can be trapped alkalinization or acidification (not reccomended) of urine |
|
|
Term
| Why is hemodialysis not used frequently? |
|
Definition
| only a small list of drugs can be removed this way (sm. molecular wt., low protein binding, sm. volume of distribution s.a. salicylates, MeOH, Li, ethylene glycol) |
|
|
Term
| When would you use hemoperfusion? |
|
Definition
| when a substance meets the criteria for hemodialysis, but is highly protein bound |
|
|
Term
|
Definition
| pump charcoal cartridge thru blood |
|
|
Term
| What are the 2 "bread & butter" antidotes? |
|
Definition
1) N-acetylcysteine => acetaminophen
2) Naloxone => opiates |
|
|
Term
| When is sodium bicarbonate given in OD situations? |
|
Definition
|
|
Term
| What is the antidote for digoxin? |
|
Definition
|
|
Term
| What toxins do you think of in house fires? |
|
Definition
|
|
Term
| What intoxicant are you thinking for a patient passed out with a needle in their arm? |
|
Definition
|
|
Term
| What is the antidote for an opioid? |
|
Definition
|
|
Term
| What toxicant are you thinking if someone's hands are blue & their blood is brown? |
|
Definition
| some type of oxidant s.a. methemoglobulinemia |
|
|
Term
| What is the antidote for methemoglobulimemia? |
|
Definition
|
|
Term
| What is the antidote for ethylene glycol poisoning (antifreeze)? |
|
Definition
| either EtOH or a chemical blocker antizol |
|
|
Term
| What is the anitdote for a rattlesnake bite? |
|
Definition
|
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