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Glossary of Emergency Medicine

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Side effects of:
ACEI
rash
cough
taste changes
teratogenic
proteinuria
angioedema
Side effects of:
amantidine
Livido reticularis (skin appears mottled L>UE)
ataxia
Side effects of:
aminoglycosides
ototoxicity
nephrotoxicity (ATN)
Amiodarone
pulm fibrosis
peripheral deposition causing bluish discolouration
arrhythmias
hypo/hyperthyroidism
corneal deposition
Side effects of:
amphotericin
fever/chills
nephrotoxicity
bone marrow suppression
anemia
Side effects of:
antipsychotics
tardive dyskinesia
sedation
acute dystonic rxn
akathisia
parkinsonism
neuroleptic malignant syndrome
acute dystonia
involuntary m cont/spasm - torticollis, oculogyric crisis)
Rx
anticholinergic (benztropine) or diphenhydramine
Prevent
prophylatic benztropine
akathisia
subjective/objective restlessness
Rx
↓neuroleptic
βblocker (propranolol)
+/- benzos, anticholinergics
dyskinesia
pseudoparkinsonism
Rx
anticholinergic (benztropine)
or DA agonist (amantidine)
↓neuroleptic or d/c
tardive dyskinesia
stereotypic oral-facial mvts
likely d/t DA receptor sensitization
50% irreversible
Rx
↓neuroleptic or d/c or change drugs
giving anticholinergics or ↓neuroleptic may initially WORSEN TD
Neuroleptic Malignant syndrome
fever
muscle rigidity
autonomic instability
clouded consciousness
↑CPK, WBCs
Rx
stop neuroleptic
dantrolene/bromocriptine
IV fluids
Evolution of EPS
4 hours
acute dystonia
4 days
akathisia
4 weeks
akathisia
4 months
tardive dyskinesia
Side effects of:
-azoles (fluconazole)
inhibition of P450
P450 inducers
carbamazepine
EtOH
glucocorticoids
griseofulvin
omeprazole 1A2)
phenobarbital
phenytoin
primidone
quinine
rifampin
P450 inhibitors
amniodarone
cimetidine
erythromycin
grape fruit
INH
ketoconazole
metronidazole
omeprazole (2C8)
quinidine
sulfonamides
Side effects of:
AZT
TCP
megaloblastic anemia
Side effects of:
β-blockers
asthma exacerbation
masking of hypoglycemia
impotence
Side effects of:
benzos
sedation
dependence
respiratory depression
Side effects of:
Bile acid resins
GI upset
malabsorption of vitamens & medications
Side effects of:
CCBs
peripheral edema
constipation
cardiac depression
Side effects of:
carbemazepine
P450 induction
agranulocytosis
aplastic anemia
Side effects of:
choramphenicol
grey baby syndrome
aplastic anemia
Side effects of:
Cisplatin
nephrotoxicity
acoustic nerve damage
Side effects of:
Clonidine
dry mouth
severe rebound h/a
rebound HTN
Side effects of:
clozapine
agranulocytosis
Side effects of:
Corticosteroids
mania (acute)
thin skin
easy bruising
immunosuppression
bone mineral loss
cataracts
myopathy (late)
Side effects of:
cyclophosphamide
myelosuppression
hemorrhagic cystitis*
Side effects of:
Digoxin
GI disturbances
yellow visual changes
arrhythmias - junctional SVT
Side effects of:
Doxorubicin
cardiotoxicity - cardiomyopathy
Side effects of:
ethyl alcohol
renal dysfunction
Side effects of:
fluoroquinolones
cartilage damage in kids
achilles tendon rupture in adults
Side effects of:
furosemide
ototoxicity
hypokalemia
nephritis
Side effects of:
gemfibrozil
myositis
reversible ↑LFTs
Side effects of:
Gold
renal dysfunction
leukopenia
rash
Side effects of:
halothane
hepatotoxicity
malignant hyperthermia*
Side effects of:
HMG-CoA reductase inhibitors
myositis
reversible ↑LFTs
Side effects of:
hydralazine
drug induced SLE
Side effects of:
HCTZ
hypokalemia
hyperuricemia
hyperglyemia
Side effects of:
hydroxychloroquine
retinopathy
Side effects of:
INH
peripheral neuropathy - prevent with Vit B6
inhibits P450
hepatotoxicity
seizures with OD
Side effects of:
MAOIs
hypertensive tyramine rxn
serotonin syndrome (with meperidine)
Serotonin syndrome
MAOIs used with meperidine, SSRIs, TCAs, and indirect sympathomimetics (in main OTC cold remedies)
Serotonin syndrome S/S
Triad:
1. altered MS
2. autonomic dysfunction
3. neuromuscular abnormalities
restlessness
confusion
lethargy
euphoria - feeling drunk & dizzy
rapid eye mvt
hyperreflexia
myoclonus
hypertonicity
clumsiness
Common symptoms of NMS and Sertonin syndrome
excitement
diaphoresis
rigidity
hyperthermia
↑HR, BP
Side effects of:
methanol
blindness
Side effects of:
MTX
hepatic fibrosis
pneumonitis
anemia
Side effects of:
methyldopa
+ve Coomb's test
drug induced SLE
Coombs' test
direct
measures presence of Ab on RBC SURFACE
- detects autoAb against RBCs
Indirect
measures presence of Ab to RBCs in BLOOD
- detects Ab in blood capable of attaching to RBCs (other than ABO & Rh)
+ve direct Coombs' test DDx
autoimmune hemolytic anemia
drug-induced hemolytic anemia (procainamide, quinidine, methyldopa)
infectious mono
mycoplasma infection
syphilis
CLL
SLE
transfusion rxn
+ve Indirect Coomb's test DDx
incompatible xmatched blood (test in blood bank)
Erythroblastosis fetalis
Side effects of:
metronidazole
disulfuram rxn
vestibular dysfunction
metallic taste*
Side effects of:
Niacin
cutaneous flushing
Side effects of:
Nitroglycerin
hypotension
h/a
↑HR
tolerance
Side effects of:
Penicillins/βLactams
hypersensitivity rxns
Side effects of: penicillamine
drug induced SLE
Side effects of:
phenytoin
nystagmus
diplopia
gingival hyperplasia*
ataxia
hirsutism
Side effects of:
Prazosin
1st dose hypotension
Side effects of:
Procainamide
Drug induced SLE
Side effects of:
PTU
agranulocytosis
Side effects of:
Quinidine
Cinchonism - h/a, tinnitus
TCP
arrhythmias (torsade)
Side effects of:
Reserpine
depression
Side effects of:
rifampin
induction of P450
red-orange secretions
Side effects of:
salicylates
fever
hyperventilation with resp alkalosis and met acidosis*
dehydration
diaphoresis
hemorrhagic gastritis
Side effects of:
SSRIs
anxiety
sexual dysfunction*
Side effects of:
Succinylcholine
Malignant hyperthermia
Side effects of:
tetracyclines
tooth discolouration
photosensitivity
Fanconi's syndrome
Fanconi's syndrome
polyuria, polydipsia, dehydration
dilute urine
proteinuria
hypokalemia
hypophosphatemia
hyperchloremic metabolic acidosis
Rickett's (defect in Vit D conversion)
FTT*
variable mode of inheritance
Side effects of:
TCAs
sedation coma
anticholinergic effects
seizures
arrhythmias
Side effects of:
valproic acid
NTD
Side effects of:
Vancomycin
nephrotoxicity
ototoxicity
"red man syndrome" - histamine release (not allergy)
Side effects of:
Vinblastine
severe myelosuppression
Side effects of:
Vincristine
peripheral neuropathy
EtOH withdrawl syndrome
Mild withdrawl (6-24h from last drink)
tremor, anxiety, N/V, insomnia
Major Withdrawl (10-72h)
visual/auditory hallucinations, whole body tremor, vomiting, diaphoresis,↑BP
Withdrawl seizures - 6-48hrs
DTs - 2-7d
severe autonomic instability/hyperactivity
(↑HR, BP)
delerium, confusion, agitation, hallucinations
fever
positional nystagmus
death - mortality 15-20%
EtOH withdrawl Rx including DTs
benzos* (DOC)
haloperidol for hallucinations
clonidine, BBs for hyperadrenergic state
thiamine, folate, vitamens
replace lytes
IV fluids
Barbituate withdrawl
anxiety
seizures
delerium
tremor
cardiac & resp depression
Rx
benzos
Benzodiazepine withdrawl
rebound anxiety
seizures
tremor
instability
Rx
benzos
Cocaine/amphetamine withdrawl
depression
hyperphagia
hypersomnolence
Rx
supportive
avoid BBs (results in excess uninhibited cardiac activation)
Opioid withdrawl
anxiety
insomnina
flu-like symptoms*
sweating
piloerection
fever
rhinorrhea
stomach cramps
diarrhea
mydriasis
Rx
clonidine +/or buprenorphine for mod withdrawl
methadone for severe
naltrexone in pts drug-free for 7-10d
metabolism by P450 enzymes
benzos
amide anaesthetics
metoprolol, propranolol
nifedipine
phenytoin
quinidine
theophylline
warfarin
barbituates
induction of P450
barbituates
phenytoin
carbamazepine
rifampin
inhibition of P450
cimetidine
ketoconazole
INH
increasing risk of digoxin toxicity
quinidine
cimetidine
amniodarone
CCB
competition for albumin binding sites
warfarin
ASA
phenytoin
drug induced blood dyscrasias
ibuprophen
quinidine
methyldopa
chemo agents
Drug induced hemolysis in G6PD deficiency
sulfonamides
INH
primaquine
ASA
ibuprofen
nitrofurantoin
drug induced gynecomastia
cimetidine
spironolactone
ketoconazole
Drug induced Steven Johnson syndrome
ethosuximide
sulphonamides
penicillins
phenytoin
carbamazepine
barbituates
Steven Johnson syndrome
= erythma multiforme major
immune-complex mediated hypersensitivity disorder
3-15% mortality
Steven Johnson syndrome S/S
non-specific URTI 1-14d prodrome (fever, pharyngitis, chills, h/a, malaise +/- V/D)
abrupt onset non-pruritic mucocutaneous rash (most often truncal)
- begins as macules → papules, vesicles, bullae, urticarial plaques or confluent erythema
"target lesion" pathognomonic
involvement of: oral, nasal, eye, vaginal, urethral, GI, lower resp
Steven Johnson syndrome causes
1. infectious
2. drug induced
3. malignancy related
4. idiopathic
drug induced photosensitivity
tetracycline
amniodarone
sulphonamides
Drug induced SLE
procainamide
penicillamine
hydralazine
INH
Name the antidote:
Acetominophen
N-acetylcystine
Name the antidote:
anticholinesterases, organophosphates
atropine
pralidoxime
Name the antidote:
antimuscarinic, anticholinergic agents
physostigmine
Name the antidote:
black widow bite
Ca gluconate
Name the antidote:
Iron
defuroximine
Name the antidote:
methanol, ethylene glycol
EtOH
fomepizole
dialysis
Name the antidote:
Lead
Succimer
CaEDTA
dimercaprol
penicillamine
Name the antidote:
arsenic
Hg
Gold
succimer
dimercaprol
Name the antidote:
Copper
arsenic
lead
gold
penicillamine
Name the antidote:
cyanide
Na thiosulfate
nitrate
Name the antidote:
salicylates
alkalinize urine
dialysis
activated charcoal
Name the antidote:
heparin
protamine sulfate
Name the antidote:
methemoglobin
methylene blue
Name the antidote:
opioids
naloxone
Name the antidote:
benzos
flumazenil
Name the antidote:
barbituates
alkalinize urine
dialysis
activated charcoal
Name the antidote:
TCAs
benzos for seizures
cardiac monitor
NaHCO3 for QRS prolongation
Name the antidote:
warfarin
FFPs
Vit K
Name the antidote:
carbon monoxide
hyperbaric/100% O2
Name the antidote:
tPA, streptokinase
aminocaproic acid
Name the antidote:
Digitalis
digitalis specific Fab
lidocaine for torsades
stop dig
normalize K+
Name the antidote:
Beta-blockers
glucagon
Name the antidote:
PCP
NG suction
Name the antidote:
theophylline
activated charcoal
Name the antidote:
acid/alkali ingestion
upper endoscopy to evaluate for strictures
S/S of Deficiency of:
Vitamin A
night blindness
dry skin
S/S of Deficiency of:
B1 (thiamine)
Beriberi
polyneuritis, DCM, high-output CHF, edema
Wernicke-Korsakoff
S/S of Deficiency of:
B2 (riboflavin)
angular stomatitis
corneal vascularization
cheilosis
S/S of Deficiency of:
B3 (niacin)
Pellagra
3d's
diarrhea
dermatitis
dementia
S/S of Deficiency of:
B5 (pantothenate)
dermatitis
enteritis
adrenal insufficiency
alopecia
S/S of Deficiency of:
B6 (pyridoxine)
convulsions
irritability
given prophylactically with INH
S/S of Deficiency of:
B12 (cobalamin)
macrocytic, megaloblastic anemia
glossitis
neuro symp
optic neuropathy, subacute combined degeneration, P/N
S/S of Deficiency of:
Vitamen C
Scurvy
swollen gums
bruising
anemia
poor wound healing
S/S of Deficiency of:
Vitamin D
Ricketts
bending bones
Osteomalacia
soft bones
hypocalcemic tetany
S/S of Deficiency of:
Vitamin E
Increased fragility RBCs
S/S of Deficiency of:
Vitamin K
neonatal hemorrhage
↑PT, PTT
N bleeding time
S/S of Deficiency of:
Biotin
dermatitis
enteritis
Can be caused by eating RAW EGGS
S/S of Deficiency of:
Folic acid
Most common Vitamin deficiency
macrocytic, megaloblastic anemia without neuro signs
sprue
S/S of Deficiency of:
Magnesium
weakness
muscle cramps
exacerbation of hypocalcemic tetany
CNS hyperirritability leading to:
tremors
choreoathetoid mvt
+ve Babinski
S/S of Deficiency of:
Selenium
Keshan's syndrome (dilated cardiomyopathy)
Aortic disruption CXR
widened mediastinum
pleural cap
loss of aortic knob
deviation of trachea to R
depression of L main stem bronchus
Always suspect with R1-2#s
aortography - gold standard
Arrhythmia Rx:
asystole
epi
atropine
Arrhythmia Rx:
Vfib
desynchronized shock → epi or vasopressin → shock → lido or amio → shock → procainamide or Mg
Arrhythmia Rx:
VTach
if unstable/pulseless - desynchronized shock
if stable - lido or amio
Arrhythmia Rx:
PEA
identify & Rx underlying
+/- epi +/or atropine
Arrhythmia Rx:
Afib/flutter
if unstable shock at 100J
If stable
- control rate (CCB, dig, BB)
- +/- rhythm conversion
- anticoagulate
Arrhythmia Rx:
SVT
Control rate
valsalva, carotid sinus massage, cold stim
- adenosine (procainamide)
Arrhythmia Rx:
bradycardia
if symptomatic consider atropine
if Mobitz II/AVB pace
Acutely, unstable - atropine/dopamine/dobutamine or transvenous pacing
hypovolemic shock
↓CO
↓PCWP
↑PVR
cardiogenic shock
Causes:
tension PTX
cardiac tamponade
arrhythmia
structural hrt dz
MI
↓CO
↑PCWP
↑PVR
Septic shock
↑CO
↓PCWP
↓PVR
anaphylactic shock
↑CO
↓PCWP
↓PVR
Rx for malignant HTN
nitroprusside
test to r/o urethral injury
retrograde cystourethrogram
Radiographic indications for Sx in pts with acute abd
free air under diaphragm
extravasation of contrast
severe bowel distension
SOL
mesenteric occlusion (angiography)
Cannon a waves
complete AVB
signs of neurogenic shock
hypotension
bradycardia
Cushing's triad
Signs of ↑ICP
HTN
bradycardia
abnormal respirations
Signs of air embolism
pt with chest truma previously stable suddenly dies
Organims/Rx of strep pharyngitis
Org
GAS, S. pneumo
Rx
Pen V
Amoxicillin
erythromycin
Organisms causing sinusitis
S. pneumo
H. flu
M. catarrhalis
GAS
anaerobes
S. aureus
Rx for sinusitis
1st line - Amoxicillin
(TMP-SMX if pen allergic)
2nd line - Amox/clav
3rd line clarithromycin
Acute OM pathogens
Viral
S. pneumo
H. flu
M. catarrhalis

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