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Emergency Medicine: Bioterrorism
Emergency Medicine: Bioterrorism
83
Anatomy
Graduate
02/08/2012

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Term
Drugs that cause Bradycardia:
Definition
PACED
- Propanolol
- Poppies
- Anticholinesterases
- Ethanol
- Digoxin
Term
Drugs that may cause Tachycardia:
Definition
FAST:
- Freebase
- Anticholinergics
- Sympathomimetics
- Solvents
- Theophylline
Term
Drugs that may cause hypothermia:
Definition
COOLS:
- Carbon monoxide
- Oral hypoglycemics
- Opiates
- Liqour
- Sedatives/Hypnotics
Term
Drugs that may cause hyperthermia:
Definition
NASSA:
- N.M.S., Nicotine
- Antihistamines
- Sympathomimetics
- Salicylates
- Anticholinergics
Term
Drugs that cause Hypotension:
Definition
CRAAASH:
- Clonidine, CCBs
- Resperine
- Anti-HTN
- Aminophylline
- Antidepressants
- Sedatives
- Hypnotics/Heroine (opiates)
Term
Drugs that cause hypertension:
Definition
CTSCAN:
- Cocaine
- Thyroid supplements
- Sympathomimetics
- Caffeine
- Anticholinergics
- Amphetamines
- Nicotine
Term
Drugs that cause hypoventilation:
Definition
SLOW:
- Sedatives/hypnotics
- Liqour
- Opiates
- Weed (marijuana)
Term
causes of Miosis:
Definition
COPS
- Clonidine
- Cholinergics
- Organophosphates
- Opiates
- Pontine bleed
- Phenothiazines
- Sedatives/Hypnotics
Term
causes of Mydriasis:
Definition
AAAS
- Antihistamines
- Antidepressants
- Anticholinergics (Atropine)
- Symathomimetics (Cocaine)
Term
Anticholinergics like atropine will cause the pupils to ___.
Definition
dilate

(PNS constricts pupils, so blocking this will cause them to dilate)
Term
Category A agents:
Definition
APSTBV:
- Anthrax
- Plague
- Smallpox
- Tularemia
- Botulinum toxin
- Viral hemorrhagic fevers (ebola, marburg)
Term
Anthrax prophylaxis after exposure:
Definition
60 days of Doxy, Cipro, or Amoxicillin
Term
Cutaneous anthrax tmt:
Definition
- Cipro, Doxy, or PCN for 60 days
Term
Inhalation anthrax tmt:
Definition
CRC:
- Cipro, Rifamin, and Clindamycin x 60 days
Term
Anthrax meningitis tmt:
Definition
- Cipro + Vancomyin x 60 days
Term
High fevers, chills, headaches, coughing up blood, SOB, toxic appearing:
Definition
Plague
Term
Pneumonic plague management:
Definition
- Droplet isolation for 72 hours
- Ciprofloxacin + Doxycycline + Gentamycin
- Post-exposure prophylasis abx for 7 days
Term
Anthrax incubuation:
Definition
2-60 days
Term
Plagu incubation:
Definition
2-3 days
Term
Smallpox incubation:
Definition
7-17 days
Term
High risk for smallpox:
Definition
- Febrile prodome + One of major (backache, headache, chllls, vomiting, abdominal pain, prostration) + classic pox lesions + lesions all in same stage
Term
Moderate risk for small pox:
Definition
- Febrile prodrome + 1 major risk factor OR
- Febrile prodrome + 4-5 minor criteria (centrifugal distribution, firs lesion on oral mucosa/palate, face, or forearms, pts appear toxic, slow evolution of lesions, lesions on palms and soles)
Term
Low risk for small pox:
Definition
- No viral prodrome OR
- Febrile prodrome + less than 4 minor criteria
Term
Smallpox tmt:
Definition
- Supportive
- Cidofovir?
- Vaccination

(isolation and expectant care)
Term
Smallpox prophylaxis:
Definition
- live virus vaccination within 3 days
Term
Isolation for smallpox:
Definition
airborne and contact precautions for 17 days after exposure
Term
Tularemia aka:
Definition
- Rabbit Fever
- Francisella tularensis
Term
Tularemia incubation:
Definition
1-21 days
Term
Dx of Tularemia:
Definition
- culture of blood and sputum (isolation and identification may take several weeks)

LAB MUST BE NOTIFIED IF TULAREMIA IS SUSPECTED AS IT POSES A CONTAGIOUS RISK TO THE LAB PERSONEL
Term
Tularemia tmt:
Definition
- Gentamycin OR Streptomycin

TularEMIA is Meana so treat with aminoglycosides.
Term
Tularemia prophylaxis:
Definition
Doxycycline or Ciprofloxacin for 14 days
Term
Botulinum toxin presentatin:
Definition
- 24-36 hours after inhalation
- weakness
- dizziness
- dry mouth
- blurred vision
- double vision
- slurred speech
- difficulty swallowing
- descending paralysis
- paralysis of facial musles and then respiratory muscles
Term
Botulinum toxin tmt:
Definition
- supportive care
- ventilator
- anti-toxin- prevents further damage, but does not alter current damage, available through state health department
Term
Category B Agents:
Definition
1. Food saftey threats
2. Water safety threats
3. RICIN
4. Staphylococcal enterotoxin B
5. Viral encephalitis
Term
Category C Agents:
Definition
NHS
- Nipah virus
- Hantavirus
- SARS
Term
SARS incubation period:
Definition
2-7 days (but may be up to 10 days)
Term
SARS isolation includes:
Definition
1. Standard precautions (hand hygiene)
2. Contact precautions (gowns, gloves)
3. Airborne precautions (negative pressure room and N-95 or better mask)
4. Eye protection
Term
4 broad categories of chemicals:
Definition
1. Choking
2. Blister
3. Blood
4. Nerve
Term
Choking chemical agents:
Definition
1. Phosgene
2. Chlorine
Term
Blister chemical agents:
Definition
1. Mustard
2. Lewisite
3. Phosgene oxime
Term
Blood chemical agents:
Definition
hydrogen cyanide
Term
Nerve chemical agents:
Definition
- Tabun
- Sarin
- Suman
- VX
Term
Nerve gas tmt:
Definition
- Atropine + 2-PAM (pralidoxime)
Term
Anthrax decontamination:
Definition
soap and water for exposed persons
Term
Vapor or gas chemical decontamination:
Definition
leave area
Term
Hot zone:
Definition
- area immediately adjacent to location of incident
- minimal traige and limited medical care activities occur herre
- all staff here are in protective gear
Term
Warm zone:
Definition
- distance of at least 300 feet uphill and upwind from the outer perimeter of the hot zone
Term
common causes of Pharyngitis/Tonsilitis:
Definition
- H. flu
- S. pneumo
- M. cat
Term
Tmt of Pharyngitis/Tonsilitis:
Definition
- Penicillin po x 10 days OR Single IM injection of PCN G
- Eryhtromycin for PCN allergic pts
- Second line abx: Amoxicillin, Clindamycin, and oral Cephalosporins
Term
Tmt of Peritonsilar abscess:
Definition
- I&D
- Amoxicillin/Augmentin
- Biaxin/Bactrim
- Cefuroxime (Ceftin)/Cefprozil (Cefzil)
Term
Pts with mono almost always get a rash if placed on ___, this can be dx.
Definition
amoxicillin
Term
Diptheria tmt:
Definition
- Diptheria antitoxin
- Airway support
- PCN or Erythromycin
Term
Diptheria antibiotic tmt:
Definition
- Erythromycin (po or IM) for 14 days (40 mg/kg per day with mag of 2 g/day) OR
- Procaine Penicillin G IM for 14 days

Patients with allergies to PCN or Erythromycin can use RIFAMPIN OR CLINDAMYCIN
Term
Etiology of ludwig's angina:
Definition
- Strep
- Staph
- Mixed: B. fragilis

about 40% are resistant to beta lacatamases
Term
Ludwig's Angina tmt:
Definition
- Extended spectrum PCN (Amoxicillin/Sulbactam, Ticarcilli/Vlavulate, Piperacillin/Tazobactam)
- PCN allergy> Cipro + Clindamycin
- B. fragilis> Metronidazole
- Plus steroids (dexamethasone 10-20 mg IV then 4-6 mg every 6 hours for 8 doses)
Term
Shock goals:
Definition
- Urine output > 0.5 ml/kg/hr
- Central Venous Pressure (CVP) 8-12 mmHg
- Mean Arterial Pressure (MAP) 65-90mmHg
- Central Venous Oxygen Saturation (ScvO2): >70%
- Potassium 3.5-5.0
Term
Formula for bicarb deficit:
Definition
- bicarb deficit = (normal bicarb-pts bicarb) x 0.5 x weight(kg)
- give first half over 10-20 minutes and second half over next 6-8 hours
- stop when arterial pH is greater than or equal to 7.25
Term
GI bleeding shock tmt:
Definition
- nasogastric tube
- PPI
- H2 blockade (for gastric bleeding)
- Octreotide (for variceal bleeding)

endoscopy for upper GI bleed
Term
Tmt of shock from fluid loss (V/D):
Definition
crystalloid infusion
Term
cardiogenic shock from tachydysrhytmias tmt:
Definition
cardioversion
Term
Tmt for cardiogenic shock from bradydysrhythmias:
Definition
- immediate Transcutaneous pacing
- but Atropine may be tried first for sinus bradycardia or second degree type I Wencebach block
Term
general tmt of cardiogenic shock:
Definition
- oxygen
- aspirin
- heparin
- gentle fluid challenge (250 cc) if there is no overt pulmonary edema
- echo search for fixable cause

(but first cardioversion if tachy, or pacing if brady)

pulmonary artery cath for fluid and pressor therapy
Term
drugs to be avoided in cardiogenic shock:
Definition
- Nitro
- Beta blockers
- CCBs
Term
Anaphylactic shock tmt:
Definition
- beta agonist aerosol
- epinephrine
- crystalloids fluid
- H1 and H2 histamine receptor blockade (Diphenhydramine, Ranintidine, Famotidine)
- steroids
Term
Hallmark of septic shock:
Definition
SIRS (systemic inflammatory response syndrome) characterized by at least 2 of the following:
1. Temp > 38C or < 36C
2. HR> 90 bpm
3. RR > 20 bpm
4. PaCO2< 32
5. WBC > 12000, < 4000, or >10% bands
Term
early evidence of hypoprofusion:
Definition
elevated serum lactate
Term
SIRS is associate with __ SVR.
Definition
decreased
Term
MCC of septic shock:
Definition
gram negative rods
Term
Toxic Shock Syndrome:
Definition
- SIRS
- hypotension
- erythematous rash
Term
frequent sites of occult infection leading to sepsis:
Definition
- biliary tree
- urinary tract
- retoperitoneum
- perirectal areas
Term
drugs that can be used for induction with septic shock:
Definition
- Etomidate- neutral hemodynamic effect and can be used once
- Ketamine- sedative agent during inductinon, favorable hemodynamic effect in critically ill
Term
optimized CVP with :
Definition
fluids, goal CVP: 8-12
Term
optimize MAP with:
Definition
vasopressors
Term
optimize venous oxygen content:
Definition
- vasopressors or transufion of hematocrit > 30

goal venous oxygen saturation > 70%
Term
good abx for immunocompetent septic shock:
Definition
- 3rd or 4th Cephalosporin + Vancomycin
Term
drugs to avoid in septic shock:
Definition
steroids
glucose control with insulin
antiendotoxin antibodies
nitric oxide synthase inhibitors
Term
Drug to give in septic shock:
Definition
- Recombinant human activated Protein C (drotrecogin alfa or RHAPC)
- CI in pts with increased risk of bleeding, those with history recent surgery or intracranial hemorrhage
Term
hallmark of drug-induced vasodilation shock:
Definition
- hypotension
- warm skin
- NO compensatory tachycardia
Term
tmt of drug induced vasodilation shock:
Definition
- Glucagon 5-10 mg will imporove beta blocker and CCB toxicity
- Calcium gluconate good for CCB toxicity
- Atropine or pacing
- Decontamination with charcoal
- Fluid resuscitation
Term
causes of obstructive shock:
Definition
- tension pneumothorax
- pericardial tamponade
- massive PE

all 3 impair ventricular filling and CO
Term
Pericardial tamponade signs:
Definition
- Hypotension
- Elevated JVD
- Pulsus paradoxus (fall in systolic bp with inspiration)
- Kussmaul's sign (increased jugular venous pressure on inspiration)
Term
good test to look for pericardial effusion:
Definition
ultrasound
Term
Shock complicating PE is an indication for:
Definition
thrombolytics if no CI
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