Fomepizole is the antidote for ethylene glycol only

Can use ethanol drip to treat both ethylene glycol and methanol

Replace folate aggressively and early

Methanol is metabolized to formic acid, if you give folate you can prevent methanol from going down the formic acid pathway

If you intubate this patient, make sure you put her on the correct vent settings to compensate for metabolic acidosis (higher than normal RR)

Acidosis with high anion gap and osmolar gap -> likely toxic alcohol

Epic tip: when you order toxic alcohol panel, ethylene glycol is not part of it, so order separately

Case 2 - 7 yo F, pedestrian struck. Vitals: HR 140s, O2 sat 94% on NRB, BP 90/55. Small amount of blood pooling in the airway. GCS 7-8. Diminished lung sounds with crepitus, abdomen is distended with bruising. R ptx on exam -> needle decompression -> chest tube. Blood transfusion is initiated. + FAST. Repeat vitals: BP 80s/50s, HR 130s. Intubation: ketamine and sux. Repeat BP after 1 u pRBC: 90s/50s

Don't forget to do a full head to toe exam on a trauma patient as you will miss injuries. Don't get distracted by positive findings unless they are life threatening and require immediate intervention.

Intubating on oral boards: name size of tube, technique and induction drugs. Do not forget post intubation management and confirmation of tube position.

Case 3 - 41 yo M with sore throat, T 100.2, P 105, BP 150s/80s, RR 22, O2 sat 92% on NC. Pt appears to be in respiratory distress on exam. Symptoms: pain when eating, shortness of breath and hoarse voice. He is in fast track area, so move him out to get more acute care/monitoring

HEENT exam: trismus, normal posterior oropharynx on limited view, handling secretions. Submandibular tenderness with pain on tracheal manipulation. Stridor on exam and muffled voice, though able to speak in full sentences

VBG is normal

Management: IV fluids, broad spectrum antibiotics (Unasyn), decadron, ENT consult

Differential diagnosis = deep space neck infection vs Ludwig's angina vs angioedema vs epiglottitis

Lateral neck x-ray: thumbprint sign

NP scope: large and swollen epiglottis

Pt desats during attempt at fiberoptic intubation and requires a cricothyrotomy

In epiglottitis, do not use supraglotic airways as this can worsen laryngospasm. Most adult cases of epiglottitis are indolent and will likely not require intubation

Kids who get this are more sick if this is H.flu: tripoding, drooling and will need to go straight to the OR for a trach

Tips: if the examiner is prompting you, they are trying to help you and you are likely missing something or need to talk to the family