Master the board step 3

Emergency Medicine/Toxicology
After giving oxygen, intubate the patient if any of the following is present:
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Hoarseness
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Wheezing
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Stridor
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Burns inside the nose or the mouth
If evidence of respiratory injury is not present, then the most important step
in management is to give fluids as follows:
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4 mL of lactated Ringers or normal saline for
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each percentage with a second- or third-degree burn for
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each kilogram.
The most common cause of death late is infection.
Hypothermia
Look for an alcoholic falling asleep outside in winter. Hypothermia kills with
rhythm disturbance.
The most urgent step is to perform an EKG: “J-waves of Osborn,” which look
like ST segment elevation, are the most specific finding.
Ophthalmology
Glaucoma
Acute angle closure glaucoma is an ophthalmologic emergency that presents
with a red eye and a fixed midpoint pupil.
Treatment
The best initial therapy is pilocarpine drops to constrict the pupil. Mannitol
can be used as an osmotic diuretic to help open the angle. Following are other
therapies that are used:
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Acetazolamide: Decreases production of aqueous humor
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Prostaglandin analogs: Latanoprost, travoprost
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Beta blockers topically: Timolol
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Alpha agonists: Apraclonidine
Retinal Detachment
This presents with a sudden loss of vision like “a curtain coming down.”
Consult ophthalmology and perform a dilated retinal examination.
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