Let it Snow
What is the mainstay of treating cocaine toxicity
IV benzodiapenes
What are the two types of heat stroke
Classic
Exertional
Name one chemical that you should NOT irrigate with water
Dry Lime
Elemental metals/reactive metal compounds
Phenols
Which vaccines are not recommended for a post-transplant px?
Live vaccines
MMR, varicella, BCG, Zostavax, nasal inflluenza vaccine
Which unique sport does jack play apart from hockey?
Ringette
Describe speedballing
Taking IV opioid and cocaine together
They may be initially sedated, and administration of naloxone may precipitously reveal the underlying cocaine toxicity
What are the two types/causes of heat exhaustion
Salt depletion
Water depletion
What kind of necrosis does alkali compounds cause and how does it affect its penetration?
Liquefactive
No eschar formation so penetrates deeper
What are the three sources of infections in an early post-transplant patient (0-1 months)
Preexisting in transplant patient (Bacterial colonization, Viral or fungal)
Donor-derived
Nosocomial (surgical site infection, ventilator-associated pneumonia, UTIs, C. difficile, MRSA, VRE, respiratory viruses, Legionella species)
Which of our residents has played a part in an obscure horror movie?
Shayan!
Name five sympathomimetic street drugs other than cocaine
Amphetamines • MDMA • Methamphetamine • Ephedrine • Khat • Bath Salts
What is wet buld globe temperature
A comprehensive measure of heat stress that accounts for temperature, humidity, wind speed, sun angle, and cloud cover
Which substance, despite being an acid, causes liquefactive necrosis
100 Bonus points: What is a unique intervention we can employ for an exposure to this substance
Hydrofluoric acid
Bonus points: Calcium gluconate (gel. controversial benefit for infusion/injection)
Name 2 organisms (from two different categories) that can be expected to cause infections in the 1-6 months post transplant
Viral infections (e.g., CMV, EBV, HBV, HCV, BK virus, respiratory viruses, HSV, VZV)
Opportunistic infections (e.g. Listeria, Mycobacterium, Candida, Aspergillus)
Which one of our residents once got stuck on a zipline in the middle of a valley?
Rey
List 3 pathophysiologic effects of cocaine-induced MI
Accelerated atherosclerosis
Enhanced platelet aggregation
Vasospasm
Increased demand (increased HR and afterload)
LVH with time
List the four types of minor heat illness
Prickly heat
Heat cramps
Heat edema
Heat syncope
What is the appropriate management for exposure to phenol and phenol derivative substances
1. Polyethylene glycol therapy - Wiping down skin and tissue exposed to phenol with PEG sponges decreases toxicity
2. Use MEGA-LARGE amounts of water (if not better penetration)
3. Use bicarb for acidosis
Name one complication of an organ transplant from each of the 4 main categories
1) Anatomic • Vascular, nonvascular anastomoses, and complications related to surgery. • E.g., Hepatic artery thrombosis in liver transplant.
2) Rejection • Hyperacute (days) • Acute (months) • Chronic (years)
3) Infection • E.g., CMV (risk 1 - 6 months), see next question
4) Drug Toxicity • E.g., Drug-drug interactions
Which of our residents can touch their nose with their tongue?
Bryden
Describe the administration of benzodiazepines to someone with acute cocaine intoxication
Diazepam can be administered intravenously in increments of 5 to 10 mg every 5 minutes in adults until sedation is achieved
Name 5 medication classes that put you at an increased risk of developing heat exhaustion
Anticholinergic agents • Antiepileptic agents • Antihistamines • Decongestants • Phenothiazines • Tricyclic antidepressants • Amphetamines • Ergogenic stimulants (eg, ephedrine, dimethylamylamine) • Lithium • Diuretics • Beta blockers • Ethanol
What are the 4 categories of ocular burns and their descriptions (Roper-Hall classification)
Grades 1-4
1- corneal epithelial damage
2- Corneal haze but iris details visible
3- total epithelial loss, iris details obscured
4- cornea opaque, pupil obscured
What are the three categories of immunosuppresants and give one example of each
1) Calcineurin inhibitors (e.g. Cyclosporine, Tacrolimus)
2) Mammalian target of Rapamycin inhibitors (e.g. Sirolimus)
3) Antimetabolites (e.g. Azathioprine, Mycophenolate mofetil (MMF)) PLUS, Corticosteroids (e.g. Prednisone)
Which of our residents once had two teeth pulled out by the leader of a drug-smuggling ring?
Richard!!