Oral Boards - Critical Actions Taken !!!

Oral Boards - Critical Actions Taken !!! Iron overdose - intentional overdose - CORRECT ANSWER-- Large bore IV access and fluid bolus - EKG (on all psych, exclude TCA OD) - Whole bowel irrigation (polyethylene glycol) - Deferoxamine - ASA and APAP levels - Sitter (suicide watch) Other pearls - symptoms + serum Fe > 350 needs deferoxamine - charcoal doesn't help Pyloric stenosis - vomiting infant - CORRECT ANSWER-- Fluid administration - Abdominal examination - NG tube - NPO - Abd US Other pearls - IO if nurse can't get the line - Hypokalemic, hypochloremic metabolic alkalosis - 2nd-3rd week of life - palpation of an olive is pathognomonic ICH - elderly AMS - CORRECT ANSWER-- Manage airway upon arrival - 2x LBIV and fluids - Bedside serum glucose - Coag factors - Head CT - Reversal of anti-coat w/ Vit K, FFP, PCC - NSGY consult - ICU consult Stab wound to chest - CORRECT ANSWER-- Needle thoracostomy - Tube thoracostomy - Upright CXR - Pain management - Full secondary survey for injuires - Surgical consult Cholecystitis - abdominal pain and vomiting - CORRECT ANSWER-- Large bore IV access - RUQ US - Pain management - Surgery consultation - Antibiotics Neonatal sepsis - weak infant, poor feeding - CORRECT ANSWER-- IV/IO access - multiple fluid boluses - early abx - ICU consult - LP can be deferred until hemodynamically stable - intubation if lethargy not improving Boerhaave syndrome - chest pain - CORRECT ANSWER-- Note crepitus on physical exam - consider esophageal tear in ddx - CXR to evaluate lungs and mediastinum - Emergent GI, ENT, or CT surgeon consult - Fluid resuscitation - Broad spectrum antibiotics Epidural abscess - back pain - CORRECT ANSWER-- Consider dx in patient w/ back pain and fever - obtain rectal temp - obtain stat imaging - NSGY consult - Determine cause 2/2 UTI Necrotizing fasciitis - Leg swelling - CORRECT ANSWER-- Early recognition of sepsis and tx - Aggressive IVF - IV abx - Immediate surgical consult - Insistence on evaluation due to need for debridement Hyperkalemia/ARF - weakness, CP/SOB - CORRECT ANSWER-- EKG - Note hyperkalemia - Calcium administration - The rest of the cocktail, they weren't too specific, just shifters AND depleters - Admission Acute angle closure glaucoma - blurry, painful vision - CORRECT ANSWER-- Thorough eye examination: EOM, pupils, visual acuity, slit lamp, IOP, conjunctiva, fundoscopic - Early administration of meds: timolol, brimonidine, acetazolamide (not in sicklers), mannitol, prednisolone, and pilocarpine once IOP < 40 - Frequent administration until IOP normalizes - Emergent ophthalmology consult Strangulated hernia - abdominal pain and vomiting - CORRECT ANSWER-- Recognition of hernia - Large bore IV access - upright CXR w/ obstructive series - NG tube placement - pain management - Surgery consult ASA toxicity - unintentional OD - CORRECT ANSWER-- Large bore IV access - Pregnancy test - Obtain history of ASA use - Alkalization of urine w/ bicarb bolus and drip - Close monitoring of patient and salicylate levels - ICU admission - (poison control call can't hurt, but wasn't on there) Henoch-Schonlein Purpura - vomiting child - CORRECT ANSWER-- Fluid resuscitation - upright CXR w/ obs series (but no US???) - Pain mgmt - Lab eval of liver and renal injury - Pedi surgery consult snake bite - CORRECT ANSWER-- Assess ABC's - Assess wound thoroughly - Identify snake, risk for venom exposure - Evaluate for lab signs of envenomation - Observe in the ER for physical signs of envenomation - Thorough history and full physical exam including total skin exposure - Contact Poison Control for guidance Vision loss - CRVO - CORRECT ANSWER-- Full ocular exam - VA, EOM, pupils, conjunctiva, slit lamp, ocular pressures, fundoscopy - Ophthalmology consult Pearls: - Optic disc edema and diffuse retinal hemorrhages in all quadrants are pathognomonic for central retinal vein occlusion. - May. or may not have an APD syncope - prolonged QT syndrome > Torsade de Pointes - CORRECT ANSWER-- EKG ordered, recognition of prolonged QT syndrome - Recognition of TdP on. monitor - Resuscitation. per PALS (chest compressions, intubation, magnesium) - Cardiology. consultation sore throat - RPA - CORRECT ANSWER-- Prepare for intubation - antibiotics - soft tissue neck radiograph