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Emergency Medicine: Derm and Tox
Terms in this set (50)
Which burn sites are considered major? (need referral to burn center)
Hands & Feet
Presence of Circumferential burns
Age, major underlying medical problems, associated injuries
>10% Partial thickness burns in children and elderly
Wound Care & Pain control
Copius Room temp saline
Saline soaked gauze
Parkland formula for fluid for burns
4 X TSBA X weight in Kg
When burn patients receive more resuscitation fluid than predicted by Parkland's formula
Abdominal Compartment Syndrome (ACS)
What two gastrointestinal sequelae can occur after major burns?
Illeus usually when > 20%
Curlings ulcer (gastric ulcer) - prophylax with PPI
Clinical findings of smoke inhalation burn
obvious burns to face, neck soot around nares, direct thermal injury upper airway, cabonaceous sputum, burned facial hairs
Look out for CO poisoining
Hydrofluoric Acid burns
Cover burns with calcium gluconate (2.5%) gel
Remove & rise gel after 15 minutes
Repeat until pain relief
Fingertip burns - remove nail
Calcium gluconate 10%
For burns what prophylaxis should be given?
Tetanus, and possibly antistaph abx?
Which type chemical burns are worse?
Alkali - they penetrate more rapidly, deeply and remain present longer
Ex. Ammonia (household cleaners)
Why don't acids penetrate as deep?
Body develops "coagulum" as it liquifies
WHat are less serious chemical pH's?
>2 and <14
How long should you irrigate and eye?
30 minutes or more than 1-2 liters
treatment for snow blindness or welder's eye?
Topical anesthetic, cyclogel, topical antibx ointment, patching
Healing occurs 24 to 36 hours
Glucose 50 mL of a 50% solution (25 g of glucose) IV 3-4 minutes
Narcotic overdose treatment?
Naloxone 2 mg q 1-2 mins up to 10-20mg
ETOH malnutrition treatment?
Glucose and Thiamine 100 mg
Alcohols will cause what on lab work
Met acidosis w/ large anion gap
often Unrecognized complication of intoxication
Alcohol withdrawl (6 hours) can cause what?
Treatment for alcoholic hallucination
Delerium tremors treatment
Wernickes encephalopothy triad?
Tachycardia, oculomotor abnormalities, ataxia, global confusion
irreversible sequelae to wernickes encephalopathy
Methanol poisoning symptoms
metabolic acidosis as well as eye problems - optic neuritis
treatment for methanol poisoning
fomepizole and ethanol (it competes)
Ethylene glycol poisoning def
moonshine from car radiator distillery
Intoxication without the smell of alcohol
<1hr CNS depression
2nd heart failure or pulmonary edema
3rd 24-72 hrs renal tubule necrosis
Flank pain, hematuria, renal failure
treatment for ethylene glycol poinsoning
Fomepizole, ethanol, Hemodialysis
No acidosis, but high osmolar gapabdominal pain, NV, diarrhea, GI bleed, AMS
supportive or dialysis or levels greater than 400
TCA poisoning findings
Cardiac abnormalities, convulsion, coma
TCA poisoning cause
sodium channel blockade - causes torsades de pointe
activated charcoal, NA+ bicarb IV bolus, treat seizures
who should you treat for APAP (tylenol) poisoning
Use the Rumack-Matthew nomogram to help decide who needs treatment
Must be between 4-24 hours from single acute ingestion of non-extended release product
Treatment for APAP
Activated charcoal, N-acytelcysteine. 100% effective if initiated within 8 hours
Aspirin overdose symptoms
hyperventilation, Tinnitus, and GI irritation
Treatment for aspirin overdose
Urinary alkalization (IV sodium Bicarb)
INH Poisoning symptoms
Seizures, metabolic acidosis
INH poisoning treatment
Treat seizures + Vitamin B6 infusion
Lithium poisoning treatment
hydration and dialysis
Symptoms of CO poisoning
Neurological signs can range from headache -confusion -seizures -focal neurologic findings - coma
Visual disturbances, Vomiting, Ataxia, syncope
Retinal hemorrhage - severe poisoning
Bullous skin lesions - prolonged immobility
Causes of cyanide poisoning
inhalation of burning plastics from house fire or occupational exposure
sodium nitroprusside infusion can cause what?
Hallmark of cyanide poisoning
hypoxia without cyanosis
*also metabolic acidosis
antidote to cyanide poisoning
amyl nitrite, sodium nitrite, sodium thiosulfate
Miosis, decreased mental status, respiratory depression
Limbic encephalitis Hallmark
hallmark: short term memory deficit, personality & behavioral changes, psychosis and aggression
Schizophrenia decompensation into psychosis occurs over what time period?
Weeks (difference between drugs and schizo)
how to treat dyskinesias from haldol?
Neuroleptic malignant syndrome
Hypertension, tachycardia, hyperthermia, muscle rigidity
Treatment: cool by evaporation, hydrate with crystalloid, IV benzo (muscle relaxer)
Bromocriptine replenish dopamine in CNS
THIS SET IS OFTEN IN FOLDERS WITH...
Head and Neck Trauma
Emergency Medicine: Dermatology
Trauma: Vertebrae and Spinal Cord
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