Term
| what are "dry drownings"? what % of drownings are dry? |
|
Definition
| dry drowning: laryngospasms prevent water from entering lungs. 20% of submersion injuries |
|
|
Term
| things to consider for pt thats coming in from drowning: |
|
Definition
1. spinal cord injuries
2. what caused them to drown (sz, etoh, MI)?
3. electrolyte abnormalities
4. acid base dist
5. airway |
|
|
Term
| what would you order for drowning patient? |
|
Definition
1. CXR
2. ABG
3. CBC/CHEM
4. UA (myoglobin) |
|
|
Term
| which abx for drowning victims? |
|
Definition
| none - unless extremely dirty water |
|
|
Term
|
Definition
1. EYES (4)
2. MOTORS (6)
3. TALKS(5) |
|
|
Term
|
Definition
1. head 9%
2. Arm 9%
3. Torso 36%
4. Leg 18% |
|
|
Term
| major concern for facial burns |
|
Definition
| airway management; burns of airway and smoke inhalation which causes bronchospams and edema |
|
|
Term
| describe 1st degree burn: |
|
Definition
| red painful dry without blister, heals wn 7d |
|
|
Term
| describe superficial partial thickness burn |
|
Definition
| blister, very painful, red, moist, capillary refill in tact, heals in 14-21d |
|
|
Term
| Deep partial thickness burns |
|
Definition
| white to yellow in color, 2 point discrimination diminished, capillary refil and pain sensation absent, heals in 3wks to 3mo |
|
|
Term
|
Definition
| chared pale leathery painless, surgical repair and grafting needed |
|
|
Term
|
Definition
| extends through fat, muscle, bone, amputation likely required |
|
|
Term
| what is considered a major burn? |
|
Definition
1. partial thickness >20% in adults or 10% in children/adults >50yo
2. full thickness in >5%
3. significant burns to: face, eyes, ears, genitals, hands feet or major joints
4. smoke inhalation/ trauma |
|
|
Term
| work up for burn patient: |
|
Definition
1. CXR
2. CBC/CHEM/ABG/CarboxyHGb
3. bronchoscopy
4. place 100% O2
5. parkland formula IVFs
6. foley
7. morphine
8. tetanus |
|
|
Term
| what is the concern in circumfrential burns? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Parkland fluid formula for burns |
|
Definition
1. 2-4ml/%BSA burned/kg/24h
2. 1/2 over the first 8h; 1/2 over 16h
3. lactated ringers |
|
|
Term
| complications of heat stroke |
|
Definition
1. AMS
2. rhabdo
3. >K+
4. >Phos
5. 6. >Mg+
7. |
|
|
Term
|
Definition
1. ABCs
2. EKG
3. O2
4. fans/spray w RT water
5. BZOs for shivering/sz
6. IVFs |
|
|
Term
|
Definition
| paresthesias, carpopedal spasms from hyperventilation |
|
|
Term
|
Definition
| maculopapular rash from inflammation and obstruction of sweat ducts |
|
|
Term
| ruptured TM and fern-like erythematous skin markings |
|
Definition
|
|
Term
|
Definition
1. bzo for agitation and sz
2. physostigmine 1-2mg |
|
|
Term
| when should someones stomach be pumped in the case of an OD? |
|
Definition
| if ingestion was <1hr ago |
|
|
Term
|
Definition
1. flu like: HA,dizzy,NV
2. dyspnea
3. AMS
4. sz
5. CP, palpitations
CO level does not correlate w sx |
|
|
Term
| in CO inhalation, who is candidate for hyperbaric chamber? |
|
Definition
1. abnormal neuro exam
2. syncope
3. sz
4. cerebellar dysfunction |
|
|
Term
| what dose indicates SEVERE aspirin tox |
|
Definition
|
|
Term
|
Definition
1. NV
2. abd pain
3. sweating
4. tinnitus
5. resp alk
6. met acidosis
7. ARDS
8. rhabdo |
|
|
Term
|
Definition
| bicarb, charcoal, NS, HD, |
|
|
Term
| what bodily function must be present brfore replacing potassium? |
|
Definition
|
|
Term
| what dose of iron can induce tox |
|
Definition
|
|
Term
| absence of these sx within 6hrs of ingestion essentially EXCLUDES iron tox |
|
Definition
1. abdominal pain
2. NVD
3. hematemesis |
|
|
Term
| complications of iron tox |
|
Definition
1. met acidosis
2. coagulopathy
3. hepatocardiorenal dysfxn |
|
|
Term
| serum iron >___ indicates tox |
|
Definition
|
|
Term
| if ingestion of iron was within 1h, tx = |
|
Definition
| gastric lavage, NO charcoal... >1h is whole bowel irrigation w PEG |
|
|
Term
|
Definition
| deferoxamine 15mg/kg (turns pee red) |
|
|
Term
|
Definition
| cocain and amphetamines pts |
|
|
Term
|
Definition
|
|
Term
| cardiovascular complications of cocaine (5) |
|
Definition
1. dysrhythmias
2. myocarditis
3. cardiomyopathy
4. coronary vasospasm
5. aortic rupture/dissection |
|
|
Term
| smoking crack and pulmonary complication |
|
Definition
1. pulmonary hemorrhage
2. pneumonitis
3. pulmonary edema
4. pneumotx, pneumomediastinum, pneumopercarium |
|
|
Term
| GI complications of cocaine/amphetamines |
|
Definition
1. intestinal ischemia
2. bowel perforation
3. splenic infarction |
|
|
Term
| UDS will pick up cocaine use within the las __ hrs |
|
Definition
|
|
Term
| what lab to order for cocaine/amphetamine intoxication? |
|
Definition
1. CHEM
2. CK
3. UA, UDS, UHCG
4. EKG
5. CXR
6. CArdiac enz |
|
|
Term
| Tx for cocaine/amphetamine tox |
|
Definition
1. BZO - improve HTN and Tachy; 2-4mg IV Lorazepam
2. mist and fanning for hyperthermia
3. phenobarb for sz; 10mg/kg IV repeat if nec
4. MONA for CP
5. NO BETABLOCKERS (contraindicated)
6. sodium bicard will narrow QRS/QT |
|
|
Term
| fatal BZO OD mostly occur with short acting agents, such as: |
|
Definition
1. Triazolam
2. alprazolam (xanax)
3. temazepam (restoril) |
|
|
Term
| what do you give if YOU gave someone too much BZO |
|
Definition
|
|
Term
| why would you not give flumazenil to someone who is suspected of BZO OD |
|
Definition
| if chronic user may send them into sz |
|
|
Term
|
Definition
|
|
Term
|
Definition
| pain thinners, winshield wiper soln, antifreeze |
|
|
Term
|
Definition
| antifreeze, polishes, detergents |
|
|
Term
| isopropanol's metabolite = |
|
Definition
|
|
Term
| ethylene glycol metabolite = |
|
Definition
|
|
Term
| which of the alcohols can cause retinal edema, vision loss |
|
Definition
|
|
Term
| findings in ethylene glycol tox |
|
Definition
1. AMS
2. formaldehyde odor
3. >HR, HTN, RR
4. CVA c ATN
5. HYPOcalcemia w CaOX crystals |
|
|
Term
| composition of a banana bag for alcoholism tx |
|
Definition
The typical composition of a banana bag is 1 liter of normal saline with:
Thiamine 100 mg
Folic acid 1 mg
MVI 1 amp (in English: multivitamin for infusion, 1 ampoule)
3 grams of magnesium sulfate
The solution is typically infused over four to eight hours |
|
|
Term
| tx for isopropanol ingestion |
|
Definition
1. D5, thiamine, naloxone
2. HD if level >400 |
|
|
Term
| tx for methanol & ethylene glycol ingestion |
|
Definition
Femepizole (inhibits metabolism)
if not available then 10%EtOH IV with D5 |
|
|
Term
| how is it that an intra-abd hemorrhage can present with bradycardia? |
|
Definition
|
|
Term
|
Definition
HR/SBP: nml = 0.5-0.7
>1.0 impaired LV fxn |
|
|
Term
| acid base disturbances in sepsis |
|
Definition
| metabolin (lactic) acidosis, resp alk |
|
|
Term
|
Definition
1. T >38 or <36
2. HR >90
3. RR >20 or PCO2 <32
4. WBC >12 or <4 or >10% bands |
|
|
Term
| appropriate UOP for adults, kids, infants. |
|
Definition
Adults: 0.5ml/kg/h
Kids: 1.0ml/kg/h
infants:2.0ml/kg/h |
|
|
Term
|
Definition
| no response to fluid bolus (usually x3) SBP approaching 70 give DA 2.5-20mcg/kg/min or NE 2-4mcg/min maintain MAP at >60 |
|
|
Term
|
Definition
Mean Arterial Pressure: MAP=DP+1/3PP
>60 needed to perfuse organs |
|
|
Term
| tx for mild to moderate hypoTN without hypovolemia |
|
Definition
|
|
Term
| tx for mild to moderate hypoTN without hypovolemia |
|
Definition
|
|
Term
|
Definition
1. Morphine
2. O2
3. Nitro
4. Aspirin
1. Beta blocker
2. ACEi
3. Statin
4. Heparin & Plavix |
|
|
