Emergency Medicine
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| DKA vs HHNS | HHNS: no ketosis/acidosis; both: dehydration, hypotension
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| DKA labs | glucose >250, HCO3 <15, pH<7.3
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| HHNS labs | glu >600, serum osmo >320; prerenal azotemia
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| DKA/HHNS tx | ABCs, cards monitor, pulse ox, O2, IV insulin
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| thyroid storm | monitor, cooling, tx dehydration, PTU, dexamethasone
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| myxedema coma testing | high TSH, low T4, low glucose/sodium /chloride; CXR: pulmo edema, lg card silhouette; EKG: brady, long PR, TWI
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| adrenal crisis labs: | low Na, high K+, hypoglycemia
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| sutures stay in for: | Face and Neck: 3–5 days; Trunk: 7–10 days; Upper extremities: 10–12 days; Lower extremities: 12–16 days
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| hypokalemia | areflexia, paralysis, ortho hypotension, ileus; EKG: U waves, ST flattening, TWI, ST depression
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| hyperkalemia | short QT, wide QRS, peaked TW; bicarb; Ca CO3 / Ca gluconate; IV insulin/glucose
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| Rumack-Matthew nomogram assesses: | APAP toxicity level
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| ASA tox dx/tx | tachy, hyperpnea/resp alkalosis, metab acidosis, hyperthermia; charcoal, IV urine alkalization, HD?
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| cocaine tox tx | NO beta blockers; tx w/benzos
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| methanol / ethylene glycol toxicity tx | gastric lavage in 1st 2 hrs; ethanol or 4-MP; HD if severe
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| For general OD: coma cocktail = | glucose, thiamine, naloxone, and O2
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| ketosis without acidosis may be due to: | isopropyl toxicity
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| hot as a hare, dry as a bone, mad as a hatter, blind as a bat = | anticholinergic toxicity (benadryl, flexeril, atropine, cogentin); tx with charcoal, poss physostigmine
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| AMPLE | Allergy/Airway; Medications; PMHx; Last meal; Event: what happened?
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| Venomous members of crotaline snake family include: | Pit vipers: rattlesnakes, copperheads, water moccasins
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| Pit viper venom | Enzyme mixture causing coagulopathy and neuromuscular dysfunction (CN weakness, resp failure, AMS)
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| Elapid snake venom is: | coral snakes: neurotoxin
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| SLUDGE syndrome | Seen in plant/mushroom toxicity: salivation, lacrimation, urination, defecation, GI hypermotility, emesis
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| Hypothermia definition | Core temp of <35C (95F)
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| ECG changes seen in hypothermia | T-wave inversion. PR/QRS/QT prolongation. Osborn (J) wave. May also see sinus brady, AVB, AF/flutter, PVCs, V fib
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| 1st degree frostbite | edema, burning, erythema, stinging
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| 2nd degree frostbite | 1st degree symptoms plus blistering
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| 3rd degree frostbite | involves deeper layers of skin; hemorrhagic blisters; necrosis; blue-gray discoloration
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| 4th degree frostbite | involves deep tissue injuries of subcutaneous tissue, muscle, bone
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| Frostbite mgmt | Rapid rewarming in water at 107F. Pain control. Pen G 500,000U Q6h x48-72h. ABCs, ECG. Leave hemorrhagic blisters intact.
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