Upgrade to remove ads
Emergency Medicine Exam 1
Terms in this set (84)
Vital Sign changes after cocaine use
Euphoria progress to anxiety, agitation, delirium, psychosis
If pt who has taken cocaine is presenting with angina, what should you do?
Calcium channel blockers
If a pt who has taken cocaine is seizing, what should you give them?
If a pt who has taken cocaine is hypertensive, what should you give them?
Phentolamine with Beta-blockers or benzodiazepines
Why should you never give a patient who has hypertension that has taken cocaine beta-blockers alone?
due to that promoting unopposed alpha effects
Vital changes in a person who has taken opiods
Respiratory rate depression - slow and shallow respirations can produce hypercarbia, hypoxia and cyanosis
changes in mood, with feelings of euphoria followd by mental depression leading to coma
What are some other signs that a person has taken opiods?
miosis is very common
nausea and some vomiting
What do you give a patient who has taken a toxic amount of opiods?
naloxone (.4-2 mg IV) or Nalmefene
Vital sign changes in a person who has taken nitrites
Hypotension (due to vasodilation, esp orthostatic hypotension)
Shock, convulsions, coma, death all possible
What are the main toxicities a person may experience who has taken nitrites?
orthostatic hypotension, tachycardia, and throbbing headache
What do you do to treat a person who has ingested to many nitrites?
Maintain ariway, give O2
IV crystalloid fluids, low-dose pressors and supine position to treat hypotension
activated charcoal if conditions are appropriate
Methylene blue if blood methomoglobin level exceeds 30%
Vital sign changes in a person who has taken beta blockers
How do you treat a pt who has taken a toxic amount of beta blockers?
Goals are to increased HR, decrease amount of drug absorbed and improve vascular tone
Orogastric lavage and activated charcoal if given within 1-2 hours
IV fluids, glucagon, catecholamines, phosphodiesterase inhibitors, high dose insulin to treat hypotension and contractility
Atropine, electrical pacing, soidum bicarb if bradycardic
Vital sign changes in a person who has cyanide poisoning
Bradycardia, dysrrhythmias, cardiovascular collapse
Loss of consciousness, HA, lethargy, altered level of consciouness, confusion, coma
How do you treat a pt who has cyanide poisoning?
Lilly Cyanide kit - methamoglobin formers, rodanase reactants
Hydroxocobalamin - combines with cyanide to form cyanocobalamin (vitamin B-12) which is cleared by the kidneys
VItal sign changes in a person who has ingested a toxic amount of salicylates
What are other signs of salicylate toxicity?
acidosis, tinnitus and gastritis
How do you treat a patient who has ingested a toxic amount of salicylates?
Glucose containing fluids
IV NaHCO3 to treat acidosis
Vital sign change sin a person who has ingested a toxic amount of organophosphates
anxiety, emotional lability, restlessness, confusion, ataxia, tremors, seizures, coma
I B SLUDGED
I - miosis
B - bronchorrhea/bradycardia
S - Salivation
L - Lacrimation
U - Urination
G - Gastric..
E - Emptying
D - diaphoresis
all signs of organophosphate toxicity
How do you treat a pt who has ingested a toxic amount of organophosphates
Pralidoxime must be given within 24 hours - can break bond between Org-AChE, but not after 24 hours
What effects do cholinergics have on the pupil?
What effects do anticholinergics have on the pupil?
Bitter almond odor suggests...
Fruity odor suggests....
ethanol, acetone, DKA
Garlic odor suggests...
Wintergreen odor suggests....
What are the ten drugs on the drugs of abuse panel?
What is a toxidrome?
A set of expected, frequently encountered co-pathologies which can help to identify a particular unknown ingestant
Agent - cocaine, amphetamines are common
Presentation - dilates pupils, relaxes bronchi, accelerates heart, inhibits digestion and contracts vessels
Clinical presentation - constricts pupils, constricts bronchi, slows heart beat, stimualtes digestion and dilates vessels
excess AChE at muscarinic and nicotinic receptors
organophosphate insecticide is most common agent
Presentation - I B SLUDGED
Presentation - antiSLUDGE - blind as a bat, dry as a bone, red as a beet, hot as hades, mad as a hatter, tachy as a leisure suit
Agents - scopolamine, antihistamines, antidepressants and jimson weed
Agents - heroine
coma, respiratory depression, miosis (triad)
Presentation - pupillary constriction, decreased respiratory rate, decreased LOC
How to treat patients experiencing narcotic syndrome? What do you have to be concerned about with this treatment?
Narcan - have to titrate carefully to avoid withdrawal symptoms
Side Fx of narcan - anxiety, N&V, Diarrhea, abdominal cramps, piloerection, yawning and rhinorrhea
Household substance ingestion treatment
Ipecac - contraindicated with caustics, hydrocarbons, and in obtunded patients
Gastric lavage - can promote vomiting and injure esophagus and stomach; also aspiration risk for mental status change patient
What are drugs that form concretions?
G - glutethimide
M - meprobamate
E - extended release tablets
SS - salicylates
How does activated charcoal work?
has a big surface area
substances get caught in the holes of carbon an decrease the intestinal absorption of the material
What is the typical dosage of activated charcoal
1 g/kg - usually will give 50- 100 g
What are toxins that are not well absorbed by charcoal?
C- caustics/corrosives (acids/alkali)
H - heavy metals (potassium, iron, lithium)
A - alcohol and glycols (EtOH, MeOH, IOH, EtGOH)
R - rapidly absorbed substances
O - other insoluble drugs
A - aliphatic hydrocarbons
L - laxatives
When is dialysis indicated for toxic overdoses?
reserved for I STUMBLED
I - isopropyl alcohol
S - salicylates
T - theophylline
U - uremia
M - methanol
B - barbiturates
L - lithium
E - ethylene, glycol, ethanol
D - digoxin, dilantin
What is the only medication avaible for the treatment of potentially life-threatening digoxin intoxication?
Digibind is the only one!
Binds to molecules of digoxin, making them unavailable for binding at their usual sites of action in the body
causes direct liver damage
140-150 mg/kg is low end range of toxic dose
What are the main symptoms alerting health care providers to salicylate poisoning?
What is treatment for salicylate poisoning?
Pearls of salicylate poisoning treatment
need to vent settings of intubation to maintain a RR adequate to keep the pH of the blood close to normal
What is the hallmark of NSAID toxicity?
How do you treat NSAID toxicity?
Antiemetics, H2 blockers
What is the narcotic toxidrome?
miosis, depressed level of consciousness and bradypnea
What are some treatment options and appropriate dosing for narcotic toxicity?
Narcan/Nalmefene - smallest dose to alter consciousness -2 is full dose - best to start with .1 or .2 esp if cancer pt with too much narcotics
Time cocaine is present in urine and how it is ingested
present for 48 hours
can be snorting, smoked or injected (can be mixed with heroin and injected)
What are symptoms of cocaine toxicity?
- lethargy and deep sleep after cocaine binges
Cardiac - fatal arrhythmias, HTN, coronary artery spasm and thrombosis
What is the most common MDMA derivative?
What are other abused MDMA derivatives?
Signs and Symptoms of MDMA use?
people often describe feeling "at peace" or experiencing happiness
empathogenesis (feeling of emotional closeness to others)
SIgns and symptoms of MDMA toxicity
CNS - euphoria, talkativeness, agitations, restlessness, anxiety
CV - tachycardia, HTN
Hyperthermia and dehydration are common in ectasy users
How do you treat MDMA toxicity?
HTN and agitation can be treated with benzodiazepines
IV hydration and peripheral cooling
What is the most common problem seen with isopropyl alcohol ingestion and what is the treatment?
Problem: Respiratory depression
Tx: CV/Resp support and dialysis if sx severe
What is the most common problem seen with methanol ingestion and what is the treatment?
Problem: Blindness, anion gap acidosis
Tx: ethanol or 4-methylpyrazole (Fomepizole) to competitively inhibit conversion of MeOH to formic acid
What is the most common problem seen with Ethylene glycol ingestion and what is the treatment?
Problem: VERY TOXIC! ATN/myocardial depression
Tx: Ethanol/Fomepizole; hemodialysis with serious symptoms
Classic physical exam findings of a pt with tricyclic antidepressant poisoning?
Hypotension, seizures, resp depression, dysrrhythmias, ARDS
: widened QRS (>100ms), positively deflected terminal .04 s of QRS in AVR
How do you treat a pt with TCA poisoning?
Alkalinize - sodium bicab to keep pH >7.5
Treat dysrhythmias - phenytoin, lidocaine, bretylium
Treat seizures - benzos
Toxic effects are rarely seen even at doses > 10x therapetuic doses in what medications? What is the exception?
Selective Serotonin Reuptake Inhibitors
is the exception - seizures in OD and even with therapeutic doses
CNS SSRI toxicity symptoms
depression at high doses
Agitation seen with bupropion
What is serotonin syndrome?
confusion, hypomania, restlessness, myoclonus, hyperreflexia, diaphoresis, shivering, tremor, incoordination, hyperthermia
What criteria used for serotonin syndrome?
Hunter criteria: must have one of the following and have taken a SSRI
1. spontaneous clonus
2. indicuble clonus plus agitation or diaphoresis
3. ocular clonus plus agitation or diaphoresis
4. tremor or hyperreflexia
6. temp > 38 C plus ocular clonus or inducible clonus
How do you treat SSRI toxicity?
Serotonin antagonists - cyproheptadine, methylsergide
Describe the mechanism of toxicity of carbon monoxide
tasteless, colorless, odorless gas which is liberated by the incomplete combustion of carbon containing compounds; reversibly bonds to Hgb creating carboxyhemoglobin, which limits O2 transport in the blood stream; also acts at the cellular level causing lipid peroxidation
What are signs and symptoms of CO toxicity?
HA - ask about heating and live alone, check venous blood gas and CO
CP is possible
Cherry red skin
Pearl - affects family members in parallel
Pulse ox is usually normal
How do you diagnose and treat CO poisoning?
obtain carboxy-Hgb levels
CO > 10 is banormal
CO > 25 is toxic
CO > 50 is lethal
treat with 100% O2 with nonrebreather for 360 minutes (T1/2 = 90 minutes); hyperbaric oxygen chamber
Black widow spider antidote
atropine, glycopyrrolate, pralidoxime
Coumarins and Warfarin antidote
Phytonadione (Vit K)
Digoxin, Cardioactive Steroids antidote
Digoxin FAB ("Digiband")
Ethylene glycol antidote
Fomepizole, ethanol, thiamine, pyridoxine
Tricyclic antidepressants, sodium channel blockers, weak acids antidote
THIS SET IS OFTEN IN FOLDERS WITH...
EM: Non-ACS Chest Pain
EM: Environmental Emergencies II
EM: Difficult Airway
EM: Approach to Dyspnea
YOU MIGHT ALSO LIKE...
Psychiatry: Psychoactive drug intoxication and wit…
First Aid 2018 Psych-ER-Intox-Withdrawal
OTHER SETS BY THIS CREATOR
PANCE: Pulmonary II
PANCE: Pulmonary I
OTHER QUIZLET SETS
Bio Lab 2- Understanding Evolution and Phylogeny
Economics Exam 2 Review (from quizzes)