Emergency Medicine COMAT

Emergency Medicine COMAT

Antidote for lead - CORRECT ANSWER -EDTA, dimercaprol--for higher levels succimer, penicillamine--for lower levels

Antidote for Nitrites - CORRECT ANSWER -methylene blue

Antidote for Opioids - CORRECT ANSWER -Naloxone (Narcan)

antidote for phenothiazines (antipsychotics) - CORRECT ANSWER -diphenhydramine

Antidote for Salicylates (ASA) and TCAs - CORRECT ANSWER -Sodium Bicarbonate, dialysis--ASA Sodium Bicarbonate (QRS prolong), Benzo (seizures)--TCAs

antidote for tPA and streptokinase - CORRECT ANSWER -Aminocaproic acid

antidote for warfarin - CORRECT ANSWER -Vitamin K, FFP

Antidote for Acetaminophen - CORRECT ANSWER -N-acetylcysteine

antidote for anticholinergics (antimuscarinics- atropine, antinicotinics) - CORRECT ANSWER-Physostigmine

antidote for anticholinesterases (organophosphates) - CORRECT ANSWER -atropine, pralidoxime

Antidote for benzodiazepines - CORRECT ANSWER -Flumazenil (Romazicon)

Antidote for B-blockers - CORRECT ANSWER -glucagon--works by competitive inhibition of the beta receptors in the heart muscle

Antidote for carbon monoxide poisoning - CORRECT ANSWER -100% O2, hyperbaric O2 if CO2 > 20%; diagnosis is made with ABG >15% in smokers and >3% in nonsmokers

antidote for cyanide - CORRECT ANSWER -amyl nitrate, sodium nitrite, sodium thiosulfate, hydroxocobalamin

antidote for digoxin - CORRECT ANSWER -anti-digitalis Fab, magnesium, lidocaine (for torsades)

• / 3

Antidote for Ethylene Glycol (antifreeze), methanol - CORRECT ANSWER -fomepizole, ethanol drip, dialysis, calcium gluconate for ethylene glycol

Antidote for Heparin - CORRECT ANSWER -protamine sulfate

Antidote for Iron - CORRECT ANSWER -Deferoxamine

Antidote for Isoniazid (INH) - CORRECT ANSWER -Pyridoxine (Vit B6)

Withdrawal symptoms of Alcohol? Treatment? - CORRECT ANSWER -6-12 hours:

Tremor

Within 48 hours: Tachycardia, HTN, agitation, seizures

Within 2-7 days: Hallucinations, DTs

Treatement: Benzos, haloperidol for hallucinations, thiamine (B1), Folate, B12, and MV replacement (banana bag)

Withdrawal symptoms and treatment for Barbituates? - CORRECT ANSWER -Anxiety, seizures, delerium, tremors, cardiac and respiratory depression

Tx: Benzo

Withdrawal symptoms and treatment for Benzodiazapines? - CORRECT ANSWER - Rebound anxiety, seizures, tremor

Tx: benzo taper

Withdrawal symptoms and treatment for Cocaine/Amphetamines? What treatment needs to be avoided? - CORRECT ANSWER -Depression, hungry, hypersomnolence

Tx: supportive, avoid B Blokers (may lead to uninhibited alpha cardiac stimulation and HTN)

Withdrawal symptoms and treatment for opioids? - CORRECT ANSWER -Anxiety, insomnia, flulike symptoms, sweating, piloerection, fever, rhinorrhea, nausea, stomach cramps, diarrhea, mydriasis

Tx: Symptomatic, Clonidine and/or buprenorphine for moderate, methadone for severe; Naltrexone when patient drug free for 7-10 days

What organisms are common in Dog Bites? - CORRECT ANSWER -alpha-hemolytic streptococci

• Aureus, Pasteurella multocida

Anaerobes

• / 3

Tx: Amox/Clav OR first gen cephalosporin (Keflex--Cephalexin, Cephazolin) for 5-7 days

doxy or tetracycline if allergy to others and levofloxacin + clindamycin for severe allergic reactions to PCN/Cephala

What organisms are common in Cat bites? - CORRECT ANSWER -P Multocida, anaerobes

Tx: Amox/Clav

What organisms are common in Human bites? - CORRECT ANSWER -Polymicrobial, Viridians streptococci

(Eikenella corrodens, group A Streptococcus, Fusobacterium, Peptostreptococcus, Prevotella, and Porphyromonas spp; and human skin flora such as staphylococci and streptococci)

Tx: Amox/Clav (Amp/Sulbactam, Pip/Tazo)

OR 2nd/3rd gen cephalosporins (Cefuroximine, Cefotetan/Cefdinir, Ceftriaxone)

What organisms are common in Rodent bites? - CORRECT ANSWER -Streptobacillus moniliformis, P Multocida, Leptospira

Tx: PCN

What organisms are common in Bat bites? - CORRECT ANSWER -Rabies

Tx: Vaccination against rabies

What organisms are common in snake bites? - CORRECT ANSWER -pseudomonas aeruginosa, proteus spp, bacteroides fragilis, clostridium, venom

What organisms are common in Spider bites? - CORRECT ANSWER -venom--which can cause tissue necrosis or paralysis

tx: antivenom as appropriate otherwise supportive care with analgesics, antihistamines, and wound debridement

What can reverse epinephrine by vasodilation and alpha-1 adrenergic blockade? - CORRECT ANSWER -Phentolamine

what should be done when the eye is exposed to corrosive chemicals? - CORRECT ANSWER-irrigate with copious amounts of of water for 30 min; monitor pH in tears and continue to irrigate until it normalizes to 6.5-7.5

• / 3