Opposing the silly
Potpourri
Your last patient before the big weekend
I need the antidote doc
Tetanus
100
16-month-old boy was found to have taken an unidentified amount of his mother’s medication. Two hours later he presented to the hospital when he was noted to be irritable and felt “hot”. Medical history was unremarkable and he was not on any other drug treatment. The rectal temperature measured 37.8 C and there was mild tachycardia and tachypnoea, with resting rates of 160 beats per minute and 30 breaths per minute, respectively. Blood pressure and percutaneous oxygen saturation were normal. Pupils were dilated at 5 mm diameter bilaterally, and response to light was sluggish. Localising or lateralising neurological signs were absent. Abdominal examination was normal and the bladder was not palpable Name the Antidote
What is Physostigmine (It's anticholinergic poisioning)
100
Most important diagnostic test when evaluating suicide patient.
What is Acetaminophen level
100
Teen brought in to the ED by paramedics when found unresponsive at a local mall. Patient on exam is very anxious he is lying on the exam table. The patient states he complained of shortness of breath earlier, then collapsed. He is currently responsive to painful stimuli and on oxygen via non-rebreather mask at 12 liters per minute. He is pale and diaphoretic with poor pulses. After you quickly apply a cardiac monitor, he is in ventricular tachycardia at a rate of 184. What's the next treatment. with ventricular tachycardia
What is cardioversion/Amiodarone
100
Acetaminophen poisoning
What is N-acetylcysteine
100
14 year old with clean wound HX 3 DTaPs in past Also had tetanus booster within 5-10 years. Tell which vaccines and if tetanus immunoglobulin needed.
What is NO vaccines needed and no tetanus immunoglobulins needed
200
Teen brought into ED by friends with chief complaint of dizziness, confusion,blurred vision, and slight anxiety. Vital signs show depresed respiration and hypotension. On exam patient is nystagmus,hypotonia, generalized weakness. The antidote please.
What is Flumanazenil (Benzodiazepine poisiong)
200
Distributive shock (Ex anaphylaxis, neurogenic, drugs, and sepsis) has what variables on the following variables. Heart Rate Cardiac Output Systemic Vascular resistance Mean arterial pressure Central venous pressure
What is Heart Rate:High Cardiac Output:Low Systemic Vascular resistance:Low Mean arterial pressure:Normal or LOW Central venous pressure:Normal or LOW
200
Teen brought in to the ED by paramedics when found unresponsive at a local mall. Patient on exam is very anxious he is lying on the exam table. The patient states he complained of shortness of breath earlier, then collapsed. He is currently responsive to painful stimuli and on oxygen via non-rebreather mask at 12 liters per minute. He is pale and diaphoretic with poor pulses. After you quickly apply a cardiac monitor, he is in Supraventricular tachycardia at a rate of 240. What's the next treatment.
What is Adenosine/Cardiovert!
200
Anticholinergic toxin
What is Physostigmine
200
17 year old teen who does not speak english. Trnalator reports patient is here illeglly from Central America and does not know immunization status. Patient presents to your walk in center following a puncture wound receved following fighting off an animal (Bad luck) What should be done regarding tetanus vaccine and tetanus immunoglobulin
What is Give tetanus vaccine and tetanus immunoglobulin now
300
Parents brought their 5-year-old son to the emergency department (ED) with a 24-hour history of fever, cough, and frontal headache. Physical examination, vital signs, and laboratory evaluation were unremarkable. The patient was discharged with a diagnosis of viral syndrome after receiving one dose of acetaminophen in liquid form. Two days later, the patient returned to the ED with continuing fever and new rigors, vomiting, lethargy, and right upper quadrant abdominal pain. Parents report they gave multiple doses of 20 mL (48 mg/mL solution equaling 960 mg per dose)acetaminophen and denied giving any other meds. The antidote please.
What is N-acetylcysteine
300
Cushing's triad consists of....
Systemic arterial hypertension, bradycardia, depressed or irregular respirations.
300
Name some causes of MIOSIS (need any 3 for credit)
What is Pilocarpine, phenothiazines, clonidine. Any sedative (barbiturate, opiates), organophosphate, or cholinergic.
300
Benzodiazepine toxcity
What is Flumazenil
300
19 year old presents to your walk in following clean wound. Patient reports unsure of previous immunization status. What houls be done regarding tetanus vaccine status and tetanus immunoglobulin
What is Yes needs tetanus vaccine and NO tetanus immunoglobulin needed
400
16 year old teen brought into ED by EMS after being discovered uncouncious in bed with an unidentified empty pill bottle next to patient. On exam patient with depressed level of consciousness, CNS depression, respiratory depression, and pupillary miosis are present. Staff has begun steps to intubate patient The antidote please
What is Naloxone (Opiate posioning)
400
Most common burn injury in young kids, resulting in hospitalizations.
What is Hot food/drink
400
Name some causes of pulseless arrest (any 4 for credit)
What is Hypoxemia, Hypovolemia, Hypothermia, Hyper/Hypo kalemia, Tension pneumothorax, toxins, thromboembolism, and tamponade.
400
Opiate poisoning
What is Nalaxone
400
21 year old with wound secondary to animal bite. Patients shot record reveal DTaP up to date. However it has been > 10 years since paptient has had booster tetanus. What should be done regarding patient's tetanus vaccine and tetanus immunoglobulins
YES needs tetanus vaccine (booster) and No tetanus immunoglobulin needed
500
8-year-old male presents to a rural emergency department complaining of blurred vision, difficulty walking, vomiting, and sweating. The symptoms have been present for an hour. He denies headache, shortness of air, chest pain, abdominal pain, myalgias, or arthralgias. He lives with his parents and 2 younger sisters on a local farm. Immunizations are up to date. He has no past medical history, and he is doing well in the third grade. Prior to the onset of symptoms, he had been in the barn doing some chores. On exam, the patient is a well-developed, well-nourished white male who is slightly pale and moderately diaphoretic. His vital signs are as follows: HR 70 per minute and regular, BP 96/50 mmHg, respirations 20 per minute and shallow, and temperature 98.4 F orally. Pupils are 2mm, equal and reactive. Extraocular muscles are all intact; fundoscopic exam is grossly normal but is limited due to miosis. Vision is 20/50 bilaterally. Oropharynx is clear with very prominent secretions. Neck is supple; lungs are clear; heart sounds are regular with S1/S2 without murmurs, rubs, or gallops. Abdomen is soft and non-tender with hyperactive bowel sounds. Extremities are without rash or edema with diffuse mild weakness. The antidote please
What is Atropine On more detailed questioning, the parents reported that they had recently had their crops dusted with chlorpyrifos, and that unused bags had been stored in the barn. Organophosphate posiong
500
For warfarin toxcity was is antidote
What is Vitamin K
500
What type of shock would give you decreased systemoc vascular resistance, decreased cardiac output, and increased heart rate.
What is distributive shock
500
Digitalis poisoning
What is Digoxin specific fab
500
Name some physical exam findings for tetanus infection
What is (need at least lock jaw plus two of the following) Generalized tetanus: Sustained trismus may result in the characteristic sardonic smile (risus sardonicus) and persistent spasm of the back musculature may cause opisthotonus. Waves of opisthotonus are highly characteristic of the disease. With progression, the extremities become involved in episodes of painful flexion and adduction of the arms, clenched fists, and extension of the legs. Noise or tactile stimuli may precipitate spasms and generalized convulsions. Involvement of the autonomic nervous system may result in severe arrhythmias, oscillation of the blood pressure, profound diaphoresis, hyperthermia, rhabdomyolysis, laryngeal spasm, and urinary retention. In most cases, the patient remains lucid. Localized tetanus: In mild cases, patients may have weakness of the involved extremity, presumably due to partial immunity. In more severe cases, intense painful spasms occur and usually progress to generalized tetanus. Cephalic tetanus: Cranial nerve findings and rapid progression are typical. This form may remain localized or progress to generalized tetanus.
M
e
n
u