- airway - breathing - circulation - disability/dysfunctional CNS - exposure

Oh My My, I've Lost the Vital Signs - oxygen - monitor (hook up) - IV: two large bore - Labs - Tubes: NG, foley, etc. - Vital signs

Don't Forget - dextrose: give sugar or check fsbs - O2: if hypoxic - Narcan: opiate OD - Thiamine: Wernickes or Korsakoff - Flumazenil: benzo antidote Dont' forget to do a PE!!

AMS Flashcards by Kathleen McKenzie

What is the first step when encounter pt suspected to have AMS?

Prove it!
- 1st option: Get in their ears and YELL “Open your eyes”. Often that is all it takes to wake them up
- Second: noxious stimuli
• Sternal rub (try to keep family from seeing)
• Stimulate nail beds on bilateral hands and feet
• Posturing?
• Purposeful movement?

How well did you know this?

Not at all

Perfectly

Glasgow coma scale

- three sections and number of points each

eyes (4 points)
verbal (talks 5 points)
motor (motors 6 points)

How well did you know this?

Not at all

Perfectly

Glasgow coma scale

- eyes points

4: spontaneous
3: verbal stimuli
2: to pain
1: none

How well did you know this?

Not at all

Perfectly

Glasgow coma scale

- verbal points

5: oriented
4: confused
3: inappropriate words
2: incoherent
1: none

How well did you know this?

Not at all

Perfectly

Glasgow coma scale

- motor points

6: obeys commands
5: localizes pain
4: withdraws from pain
3: flexion to pain/decorticate
2: extension to pain/decerebrate
1: none

How well did you know this?

Not at all

Perfectly

ABCDE define

airway
breathing
circulation
disability/dysfunctional CNS
exposure

How well did you know this?

Not at all

Perfectly

Mnemonic for trauma

Oh My My, I’ve Lost the Vital Signs

oxygen
monitor (hook up)
IV: two large bore
Labs
Tubes: NG, foley, etc.
Vital signs

How well did you know this?

Not at all

Perfectly

Mnemonic for medical

Don’t Forget

dextrose: give sugar or check fsbs
O2: if hypoxic
Narcan: opiate OD
Thiamine: Wernickes or Korsakoff
Flumazenil: benzo antidote
Dont’ forget to do a PE!!

How well did you know this?

Not at all

Perfectly

What to be a careful about when administering Flumazenil

If pt took TCAs and benzo, the benzo will treat the seizures the TCA OD will cause, if block the effect of the benzo via the antidote, pt might start seizing…

How well did you know this?

Not at all

Perfectly

Mnemonic: things to order when patient is comatose

ABCDEFP

How well did you know this?

Not at all

Perfectly

Mnemonic: things to order when patient is comatose

- A

AGB: acidosis vs. alkalosis. Pulse ox works for this too… VBG also an option
Ammonia: alcoholism leads to injury leads to high ammonia. Act funny or comatose

How well did you know this?

Not at all

Perfectly

Mnemonic: things to order when patient is comatose

- B

blood alcohol, are they just drunk?

How well did you know this?

Not at all

Perfectly

Mnemonic: things to order when patient is comatose

- C

CBC: anemia, infection, shift, sepsis evidence, etc.
CMP: hyponatremia, other electrolyte abnl
CO: poisoning
CULTs: urine and/or blood. Will help if they get admitted
CXR: usually a good idea :) pneumonia, pneumothorax
CT: very expensive, should not be a first line test, wait until others come back and then consider if nothing else is helping…

How well did you know this?

Not at all

Perfectly

Mnemonic: things to order when patient is comatose

- D

Drug screen: (urine or blood), Tylenol level, ASA level

- Drug levels: If you know what the patient is on, for example dilantin, phenobarbitol, etc.

How well did you know this?

Not at all

Perfectly

Mnemonic: things to order when patient is comatose

- E

EKG: TCA OD typically presents with tachycardia and widened QRS, bat-wing t-wave with SAH, other dysrhythmias!

How well did you know this?

Not at all

Perfectly

Mnemonic: things to order when patient is comatose

- F

Female: pregnancy test

How well did you know this?

Not at all

Perfectly

Mnemonic: things to order when patient is comatose

- P

Study These Flashcards

Pee: UA

- pb (lead): lead level

Anion gap calculation

Study These Flashcards

Na - (bicarb + Cl)

normal is about 12

Mnemonic for ddx for increased anion gap acidosis

Study These Flashcards

MUD PILE CATS

Mnemonic for increased anion gap acidosis

- M: ddx and how to test

Study These Flashcards

Methanol: methanol level, takes a long time to get results

- Metformin: lactic acid level

Mnemonic for increased anion gap acidosis

- M: tx

Study These Flashcards

Methanol itself is not toxic but alcohol dehydrogenase breaks it down into formic acid, which is toxic. First aim is to prevent breakdown of methanol. Tie up all their alcohol dehydrogenase by giving them alcohol to a blood alcohol level of 150. Can buy booze or an alcohol drip. Can also use fomepizole but it is very expensive
To get rid of methanol: hemodialysis. Dialysis will also take off the alcohol so have to increase the drip (get them more drunk)

Mnemonic for increased anion gap acidosis

- U: ddx and how to test

Study These Flashcards

Uremia: BUN, Cr

Mnemonic for increased anion gap acidosis

- U: tx

Study These Flashcards

Admit to hospital and let internist take care of it

Mnemonic for increased anion gap acidosis

- D: ddx and how to test

Study These Flashcards

DKA: ketones, blood sugar

Mnemonic for increased anion gap acidosis | - D: tx

Admit to hospital and let internist take care of it | **If have to pick ONE treatment, pick fluids (not insulin or K)

Mnemonic for increased anion gap acidosis | - P: ddx

- Paraldahyde | - Phenformin

Mnemonic for increased anion gap acidosis | - I: ddx and how to treat

- INH (isoniazid): CXR to look for TB | - Iron: iron level and TIBC (total iron binding capacity). If Iron > TIBC, then have iron OD

Mnemonic for increased anion gap acidosis | - I: tx

- INH: bicarb

Mnemonic for increased anion gap acidosis | - L: ddx and how to test

Lactic acidosis: caused by lots of things (sepsis, bowel infarct, etc.) if get positive result, more tests to run to find cause

Mnemonic for increased anion gap acidosis | - E: ddx and how to test

Ethylene glycol - Fluorescein urine (glows) - Serum osmolality (see below) * Calculated (not as good) * Measured (using freeing point depression method) * Gaps between measured and calculated are caused by methanol and ethylene glycol

Mnemonic for increased anion gap acidosis | - E: tx

- Very similar to methanol treatment. | - Byproduct is hypuric acid not formic acid

Mnemonic for increased anion gap acidosis | - C: ddx and how to test

- Cyanide: breath smells like bitter almonds, only 1/3 people can smell it - Cocaine: drug screen

Mnemonic for increased anion gap acidosis | - C: tx

- Cyanide: try try leave it up to fate (Amyl nitrate, sodium nitrate, sodium thiosulfate) - Cocaine: bicarb

Mnemonic for increased anion gap acidosis | - A: ddx and how to test

- Alcoholic ketoacidosis (dt malnourishment, not alcohol) | - ASA: ASA level

Mnemonic for increased anion gap acidosis | - A: tx

- Etoh ketoacidosis: Admit to hospital and let internist take care of it - ASA: bicarb

Mnemonic for increased anion gap acidosis | - T: ddx and how to test

Toluene (paint and whiteout), will see paint on face, metallic colors worst

Mnemonic for increased anion gap acidosis | - S: ddx, test, tx

- Starvation ketosis: usually dx on hx: fasting a long time | - Tx: feed them

What three compounds determine plasma osmolality?

- Na - glucose - BUN

How to calculate osmolar gap

= calculated osmolality - measured osmolality

what does an osmolar gap suggest?

- presence of extra solutes including methanol and ethylene glycol

What is the magic of 140?

Tylenol level - if over 140 (4 hours later) they are toxic - if calculate what they took and it was 140 mg/kg they are toxic - tx is 140 mg/kg n-acetylcysteine

Mnemonic for ODs Bicarb can treat

SPLIT C - Salicylates - Phenobarbs - Lithium - INH (isoniazid) - TCA ** KNOW THIS - Cocaine

AMS Flashcards

(42 cards)