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130 Cards in this Set
- Front
- Back
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What drug to avoid in a cholinergic overdose ? |
Succinylcholine |
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Treatment for cholinergic overdose? |
Atropine Atrovent Pralidoxime |
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What effect does jimson weed have? |
Anti cholinergic |
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Anti cholinergic presentation? |
Dry, red, warm, tachycardic, blind, dilated pupils |
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When do you give sodium bicarbonate for anticholinergics? |
Sodium bicarbonate if prolonged QRS in TCA overdose |
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Nystagmus while awake? |
PCP |
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Agonal respirations, prolonged QT and QRS, and somnolence? |
Loperamide |
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When to not give charcoal |
Potassium Iron Solvents Alcohols Lithium Hydrocarbon |
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Beta blocker antidote? |
Glucagon |
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What does a metformin OD look like? |
Normal glucose lactic acidosis |
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How many hours to start NAC within from ingestion for benefit? |
8 hours |
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When would you not alkalize urine in salicylates and go straight to dialysis? |
CNS symptoms like seizures |
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Ketosis without acidosis ingestion? |
Isopropyl alcohol |
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Ketosis without acidosis ingestion? |
Isopropyl alcohol |
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Methanol breakdown product causing the eye problems |
Formic acid |
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When is sodium bicarb given in TCA? (Qrs length) |
>100 |
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Treatment for CCB overdose? |
Atropine And insulin |
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What is the shock limit in arrest under 30 degrees? |
3 |
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3 non IV options for first line seizure therapy |
IN or IM midazolam Rectal diazepam SL, IO lorazepam |
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Patient seizing with glucose <2.6. Treatment? |
0.5 g/kg of dextrose (2ml/kg of D25) |
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Side effects of fosphenytoin? |
cardiac arrhythmia bradycardia hypotension |
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Drug to not use in toxic ingestion or withdrawal seizures? |
Dilantin/fosphenytoin |
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Two good indications for phenobarbitol |
Prolonged febrile seizures or seizures from toxic ingestions |
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Which kids cannot get VPA as a second line agent for seizures? |
<2 years with developmental delay of unknown ethology, liver disease, or suspected metabolic/mitochondrial disorders
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Definition of refractory seizures? |
An hour in length or second line didn't work |
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Class of hemorrhage and % of blood loss with: minimal symptoms, min-mild tachycardia only |
Class 1 <15% |
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Class of hemorrhage and % of blood loss with: incr HR, RR. Decr PP, CNS (subtle) |
Class 2 15-30% |
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What % of blood loss does BP start to change? |
>30% |
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What % of blood loss do you lose consciousness? |
>50% |
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Class of hemorrhage and % of blood loss with: hypoperfusion significant incr HR/RR, altered, decr sBP |
Class 3: 30-40% |
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Class of hemorrhage and % of blood loss with: immediately life threatening, marked tachy, hypotension/narrow PP, depressed LOC |
Class 4 >40% |
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How do you differentiate class 3 and 4 hemorrhage? |
CNS change- depressed LOC, marked hypotension |
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Management for the 4 classes of hemorrhage? |
Class 1: minimal Class 2: bolus Class 3: transfuse, bolus, control source Class 4: major transfusion protocol, surgery |
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Antidote for Sulfonylurea |
Octreotide |
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Antidote for beta blocker? |
Glucagon |
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Antidote for CCB? |
Insulin |
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Isoniazid antidote? |
Pyridoxine |
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Antidote for cyanide? |
Hydroxycobalamin, thiosulfate |
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You test a Tylenol level at 2 hours ingestion and it is 100. Next step? |
Repeat at 4 hours if even detectable before then |
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Four steps of Tylenol overdose? |
1– first 24hours - GI symptoms 2 – 24-48hrs - Quiescent phase, RUQ pain/tender, liver injury 3 – 3-5days – Liver failure/MODS/death or recovery 4 – 4-14d – resolution |
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pH to keep urine above in TCA overdose management? |
>7.5 |
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Dose of iron considered toxic? |
>40mg/kg |
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Indications for iron chelation in overdose? |
Any severe symptoms/MAGA Any level>90mcmol/L 60-90 and symptoms/lab injury |
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Reasons to be reassured/discharge patient with iron overdose? |
Consumed <20 mg/kg Normal exam Observed 6-8 hours and asymptomatic |
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Period of observation for hydrocarbons and changes seen on CXR? |
4-6 hours
perihilar infiltrates, and pneumatocoeles |
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What can metformin cause? |
Metabolic acidosis |
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What stage is maximal hepatotoxicity for Tylenol overdose and what hours is this? |
Stage 3 72-96 hours |
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When should NAC be started by for best outcomes? |
within 8 hours |
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5 radio opaque drugs?
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COINS Chloral hydrate Opioid packets Iron Neuroleptics Sustained release tablets and salicylates |
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What stage of iron ingestion gives you metabolic acidosis and shock? |
Stage 3 12-24 hours |
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What stage of iron ingestions gives you ARDS and liver failure? |
Stage 4 2-3 days |
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What differentiates isopropyl alcohol from other toxic alcohols? |
All have a high osmolar gap but this one causes ketosis * |
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Key feature of methanol on labs? |
Profound metabolic acidosis with AG late around 24 hours |
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Limitation of the osmolar gap in toxic alcohol ingestions? |
It only rises with the parental alcohol so once metabolizing will not show |
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Ethylene glycol findings? |
Hypocalcemia, prolonged QT Cardiac issues Metabolic acidosis with AG Elevated osmolar gap Oxalate crystals |
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What is the presentation of cholinergic? |
Diarrhea Urination Miosis Bronchospasm Bradycardia Emesis Lacrimation Salivation Also get weakness |
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Fasting recommendation before sedation in cps? |
1 hour for clear liquids 4 hours for human milk 6 hours for infant formula and meals |
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What ASA level should you involve anaesthesia? 3+4. What clinically is a 3 or 4? |
Severe systemic disease +/- a constant threat to life |
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What does trek recommend for non painful procedures (ex CT scan)? |
Propofol or midazolam |
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What does TREK recommend for minor painful procedures( quick laceration, dental extraction)? |
Fentanyl and midazolam Nitrous oxide |
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What does TREK recommend for major painful procedures? (large laceration, reduction) |
Ketamine Propofol and fentanyl Propofol and ketamine |
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When does TREK say NOT to use ketamine? |
In infants <3 months or schizophrenia |
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What size of pneumothorax is considered large and should be managed? |
>30%
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How late is a presentation considered that you need to culture all bites regardless of animal species? |
8 hours |
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How to tell PCP from other similar drugs? |
Nystagmus |
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Location of needle decompression and chest tube insertion? |
Needle: 2-3 ICS mid clavicular line Chest tube: 5th ICS mid axillary line |
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List some contraindications to succinylcholine? |
Family hx of malignant hyperthermia Chronic skeletal muscle disease (i.e. DMD, BMD) Denervating neuromuscular disease (i.e. CP with paralysis) 48-72 hrs after burns multiple trauma or an acute denervating event (i.e. stroke or spinal cord injury) Extensive crush injury with rhabdomyolysis\\ Significant hyperkalemia (suggested by characteristic changes on ECG) |
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If temp is <30 degrees, limit of shocks? |
3 |
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Potassium issue with ASA overdose? |
hypokalemia |
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Acid base disturbance with ASA overdose? |
Respiratory alkalosis and metabolic acidosis |
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Most common cause of childhood fracture? |
Torus |
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Sedation med NOT good in increased ICP? |
Ketamine |
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Definition of refractory status epilepticus |
Seizing for an hour or no response to second line meds
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Dose of phenytoin and side effects? |
20mg/kg Hypotension, arrhythmia and bradycardia |
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What % of SBP drop is considered low for anaphylaxis criteria? |
30%
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3 mortality risk factors for anaphylaxis? |
Asthma Delayed dx Time to epi pen delayed |
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Medication that may be given in an attempt to reverse the cardiovascular effects of anaphylaxis. |
Glucagon |
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Dose of anaphylactic epi? |
IM epi 0.01mg/kg 1:1000 to lateral thigh q5 minutes |
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After a concussion occurs, how long do you have to wait before even considering going back to school? |
24-48 hours |
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When is second impact syndrome for concussion its highest risk? |
first 2 weeks
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Main reason for the return to school pathway? |
Lowers risk of prolonged sx |
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4 lowest risk sports for concussions? |
Baseball, volleyball, gymnastics and softball are lowest risk sports. |
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Most common symptom of a concussion? |
Headache |
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What mechanisms of head injury are considered high risk and you need a CT? |
MVC Fall of bike without helmet Fall from 3+ feet 5 Stairs |
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GCS considered moderate TBI? |
GCS 9-13 |
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Most common mechanism for a epidural hematoma? |
Skull # causing middle meningeal artery tear |
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Under 8 years old what cervical vertebrae are most at risk. |
C1-C3 |
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Over 8 year olds what cervical vertebrae are most at risk? |
C5-C7 |
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PECARN low abdominal risk criteria for blunt trauma? |
No bruising GCS>13 Non tender No Thoracic wall injury No c/o abdo pain No decreased breath sounds No vomiting |
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Parkland formula? |
4x kg x %BSA = ml total
Divide in half and give that over 8hr and then second half over 16 hr |
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Burn that is red and blistering? |
Superficial partial |
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Burn that is pale, dry, speckled, still tender? |
Deep partial |
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Lightning causes what arrhythmia? |
Asystole |
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High voltage causes what arrhythmia? |
V fib |
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Concern with lateral commissural burn? |
Superior labial artery can hemorrhage 5-21 days later |
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Which burns should be admitted? |
Burns >10%, with smoke inhalation, from high tension electrical, or child abuse Also - certain regions like perianal, enclosed space or face/neck burns |
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What % burn do you have to avoid oral fluids? |
>15% |
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What burns need a tetanus booster? |
>10% |
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How long to observe a drowning incident? |
6-8 hr |
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Contraindications to charcoal? |
Hydrocarbon (high baseline aspiration risk) caustic ingestion (high risk perforation, need for scope – higher risk aspiration/can’t see) intestinal obstruction lower GCS, not protected airway |
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Antidote for Benzos |
Flumazenil |
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Naloxone dose? |
0.1mg/kg max 10 mg |
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Pupils for LSD? |
Dilated |
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PCP pupils? |
Small |
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What is the concern with using physostigmine for anticholinergics? |
It is contraindicated if any sodium channel blockade. TCA overdose has both this and anticholinergic and so you need to be careful it isn't the culprit. |
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Bowels in serotonin syndrome? |
up |
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Worst two SSRIs for QT prolongation? |
Citalopram, escitalopram |
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3 differentiators between serotonin syndrome and NMS? |
NMS - rigidity and SS- hyperreflexia NMS- pupils normal, and SS - wide NMS- stupor and SS- agitated |
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Two main ECG concerns for TCA overdose? |
QT prolongation and long QRS |
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Top two categories of ingestions causing seizure? |
Benzos and TCA |
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High dose of Tylenol? |
200mg/kg OR >7.5g in adol/adults |
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Quiescent phase for Tylenol is when and what happens? |
24-48 hours
RUQ pain and liver injury |
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When do you need dialysis for ASA objectively serum level wise even if they aren't symptomatic? |
>7.2 >4.3 if chronic |
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Charcoal window for ASA? |
Up to 6 hours |
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When to do a serum iron level?
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4-6 hours from ingestion |
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When is a WBI warranted for iron? |
if tablets seen on AXR or if < 6 hours from ingestion |
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What are the labs suggestive of MIS-C? |
CRP >50 + one of the following: Ferritin >500Lymphopenia <1 Neutrophilia Thrombocytopenia <150 hypoalbuminemia |
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What is one lab that differentiates KD from MIS-C? |
Platelets - low in MIS-C, High in KD |
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List the kinds of bite wounds that need abx? |
Moderate or severe bite wounds, especially if edema or crush injury is present Puncture wounds, especially if penetration of bone, tendon sheath, or joint has occurred Face, hand, foot, and genital bites Wounds in immunocompromised asplenic persons Wounds with signs of infection |
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severe sepsis + persistence of hypoperfusion or hypotension despite adequate fluid resuscitation or vasoactive need
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Septic shock |
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Sepsis + organ dysfunction (cardiac or two or more other organs) |
Severe sepsis |
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Dose of synchronized cardio version? |
0.5-1 J/kg |
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If no advanced airway, compression ratio? |
15:2 |
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Post cardiac arrest care sat goals? |
94-99% |
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Calculation for depth of endotracheal tube for intubation? |
<1 = age +6 >1 = age +10 |
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What component of spirometry does PEEP help? |
Increased FRC |
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Two timeline definitions of persistent vegetative state? |
3 months following nontraumatic brain injury 12 months following TBI |
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Definition of ALF? |
Coagulopathy not corrected with vitamin KINR > 1.5 w/ encephalopathy or >2 if no encephalopathy |
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Two features about button battery ingestions that can allow you to watch them in the stomach? |
5+ years old or <20 mm |
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How do you decide if a button battery in the stomach needs to be XR at 48 hours or 10-14 days if not passed? |
48 hours- 20+mm 10-14 days - <20 mm |
