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Misc Emergency Med

Emergency Medicine

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