Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
EM rot random
| Question | Answer |
|---|---|
| The most common cause of lethal poisoning in the US | carbon monoxide. Colorless, odorless, toxic. |
| What is the MOA of CO poisoning? | CO readily crosses the alveolar-capillary membrane in the lungs and binds to Hgb with a 200x greater affinity than O2 to form HbCO |
| Neurologic toxicity from _______ primarily results in white matter demyelination and hallmark gray matter necrosis within the globus pallidus | Carbon monoxide. Tissue perfusion is reduced, and rhabdomyolysis may occur and cause renal dysfunction |
| Common symptoms of CO poisoning | HA, Malaise, lethargy, fatigue, dyspnea, nausea, mental status change, seizures, angina, "cherry red" skin as HbCO level approaches 80% |
| Pulse oximetry in CO poisoning | Pulse oximeters are unable to distinguish oxyhemoglobin from HbC)3 and thus report a falsely high measurement. Also Oxyhgb saturation is inaccurate since it uses the false PaO2. Check HbCO levels >10% is abnly high. EKG, pregnancy test on women |
| Tx for CO poisoning | Hyperbaric oxygen |
| Activated charcoal does not absorb | alcohols. It should only be used when coingested is suspected. |
| effects of alcohol | First it has a CNS stimulant effect (aggression, confusion, ataxia, nystagmus, dysarthria); followed by depressive effects (lethargy, respiratory depression, hypothermia and sometimes coma) |
| Differential diagnosis of alcohol poisoning | stroke, DKA, hypo/hyperglycemia, seizure or postictal state, CNS infections, Hypoxia, Other toxidromes |
| What labs should be ordered in a pt whom you suspect alcohol poisoning | CBC, electrolytes, glucose, toxicology screen, and ethanol level. CT of the brain looking for traumatic hemorrhage should be considered in patients where a neuro exam cannot be performed and/or the mental status does not correlate with the ethanol level |
| Tx of ethanol intoxication | Largely supportive. Often times, the pt has vitamin deficiencies. Often give IV hydration along with supplemental thiamine, folate, and glucose in the ED. Remember to administer thiamine, a necessary cofactor for glucose metabolism. |
| Isopropyl is a potent CNS depressant (ingestion of more than 200 ml may be lethal in adults). It is also known as | rubbing alcohol and sometimes it is ingested by curious children. It is rapidly absorbed via the GI mucosa and up to 50% is excreted unchanged by the kidneys; the remaineder is metabolized into acetone by the liver. |
| Tx of isopropyl ingestion | largely supportive. Hypotension and coma should be aggressively treated with fluids and pressors |
| Methanol is a clear sweet fluid found in | glass cleaners, de-icing products, and antifreeze. CNS, eyes, and GI tract are the organs primarily affected. Death occurs from respiratory arrest |
| Tx of methanol ingestion | If the pt presents within 1-2 hours of ingestion: gastric lavage may remove residual toxin. Administration of ethanol or 4-methylpyrazole effectively blocks the conversion of methanol (to formic acid, the toxic metabolite of methanol). Dialysis if severe |
| Gastroenteritis caused by Salmonella | typically occurs after ingestion of contaminated eggs, dairy, or poultry. Diarrhea is typically bloody; Sx: tenesmus, fever, abdominal pain. Resolves in 10-14 days usually |
| Causes of bloody diarrhea | Salmonella, Shigella, Campylocbacter, Yersinia, E. Coli |
| The two most serious complications of an 0157:H7 E.Coli infection | hemolytic uremic syndrome and thrombocytic thrombocytopenic purpura |
| Name the viruses to be aware of if you are thinking of viral diarrhea | Norovirus, Rotavirus, Adenovirus, Astrovirus |
| Infectious agents normally cause which two types of diarrhea? | Secretory (increased secretion of fluid and electrolytes into the small intesting) and inflammation (resulting in altered absorption and diarrhea). (as opposed to osmotic diarrhea - an increased osmotic load delivered to the lumen) |
| Signs and Sx of infectious diarrhea | loose stools, fever, abdominal cramping and signs of dehydration |
| Staph aureus and Bacillus cereus cause diarrhea via a preformed toxin that causes sx within ____ hours of ingestion. | 6-8 hours; Viral agents and infection with enterohemorrhagic and enterotoxigenic E. coli typically cause sx 12-24 hours after exposure |
| The differential diagosis of infectious diarrhea | Mesenteric ischemia, GIB, Inflammatory bowel disease, colon carcinoma, laxative abuse, malabsorptive syndromes (celiac sprue, lactose intolerance), thyrotoxicosis |
| Diagnostic evaluation of diarrhea | Stool sent for culture (culture can identify: salmonella, shigella, campylobacter, yersinia); Ova and Parasites (for Giardia, E. histolytica, and Cryptosporidium AKA Protozoa). Abdominal X-ray or CT may be indicated to r/o other causes of sx |
| Diarrhea caused by _____ can mimic acute appendicitis | Yersinia |
| Which infectious causes of diarrhea are associated with Daycare centers? | Shigella, Rotavirus, Giardia, Cryptosporidium |
| The combination of rapidly progressive symmetrical weakness in the arms and legs with or without sensory disturbances, hypoflexia or areflexia, in the absence of a CSF cellular reaction, remains the hallmark for the clinical diagnosis of | Guillain-Barre Syndrome |
| Tx for GBS | IVIg and Plasma Exchange. |
| Dx of GBS | primarily clinical, but LP is done. CSF examination typically shows increased protein with normal CSF white-cell count. |
| CSF in GBS | A common misunderstanding is that CSF protein should always be increased in GBS; CSF protein concentrations in patients with GBS are often normal in the first week, but increased in more than 90% of the patients at the end of the second week. |
| Lidocaine 1% can be used in wound care in what kind of dose? | 5mg/kg, not to exceed 300mg. Doses of >5mg/kg can cause lidocaine toxicity (dysrhythmias, hypotension, seizure) |
| Lidocaine with Epi can be used in what kind of doses? | 7mg/kg |
| Anesthesia with lidocaine develops w/in seconds and lasts | typically 20-60 minutes. Bupivacaine (marcaine) is another local anesthetic with similar onset time but lasts 4-8 times longer |
| Contraindications to wound closure | heavy contamination, bites (except on the face), retained foreign bodies, unresectable devitalized tissue, wounds older than 12 hours, infection and tissue defects that would require excessive tension if closure was attempted |
| What kinds of wounds should receive antibiotic prophylaxis? | dog, cat and human bites. Full thickness oral lacerations; wounds contaminated by fresh water; and plantar puncture wounds because these are more prone to infection. |
| After wound closure, patients should be instructed to keep their wounds clean and dry for _____ hours b/c ______ | 24-48 hours, because this gives time for epithelialization to protect the wound from contamination |
| Name the processes of wound healing | Hemostasis, inflammation, epithelialization, angiogenesis, fibroplasia, wound contraction, scar maturation |
| Wounds at high risk for infection should be reevaluated within 24-48 hours. Patients should be instructed to return if what occurs? | erythma, warmth, swelling, drainage, dehiscence. Most patients are discharged home and should f/u w/ their primary care provider |
| Name the number of days to removal for face, scalp, chest, forearm, fingers/hand, and lower extremity | face:3-5 days, scalp:7, Chest:8-10, Forearm:10-14, Fingers/Hand:8-10, Lower extremities: 8-12 |
| Which suture size should be used on the face? | 6 or 7 |
| When would a pt receive TIG? | when they have a wound that is not considered clean and minor and when they have <3 Tetanus shots or are uncertain of their tetanus shot hx |
| Organisms found in cat bites | Mainly Pasturella multocida. Also Staphylococcus and Streptococcus species |
| What is the recommended antibiotic prophylaxis for cat bites? | Amoxicillin with clavulanate |
| Abx prophylaxis in dog bites | Seven of Eight randomized trials showed no benefit with abx. It may be logical to limit abx to high-risk wounds such as hand injuries |
| Organisms in human/fight bites | Streptococcus species and Staphylococcus species are common, but Eikenella corrodens and Bacteroides species are the typical pathogens. Tx with amoxicillin and clavulanate |
| ABX for intraoral lacerations | Penicillin |
| Puncture wounds of the foot make you consider which organism? | Pseudomonas. Significant infections include: septic arthritis, abscesses, and osteomyelitis |
Created by:
ltm12