ALLERGIC REACTION / ASTHMA Scenario Clue Pattern - Onset while eating - Itching neck/chest - Thick tongue - Wheezes - History of asthma Mild Allergic Reaction - Localized rash - Itching - No airway involvement - No hypotension Treatment: - Antihistamine (diphenhydramine) - Monitor Moderate Allergic Reaction - Diffuse urticaria - Mild airway involvement - Wheezing - GI symptoms Treatment: - Epinephrine IM (if systemic) - Antihistamine - Steroids - Albuterol if bronchospasm Severe Anaphylaxis - Thick tongue - Stridor - Hypotension - Altered LOC - Severe bronchospasm FIRST medication: Epinephrine IM Not albuterol. Not Benadryl alone. Then give the other medications. Don't forget about IV epi infusion. Asthma Pathophysiology Asthma = - Bronchoconstriction - Airway inflammation - Mucus production Leads to: - Wheezing - Prolonged expiration - CO₂ retention (late) - Fatigue → silent chest (critical) TOXICOLOGY Man-Made Toxic Gases Examples: - Chlorine - Phosgene - Ammonia - Hydrogen sulfide Test trick: Many industrial gases end similarly (e.g., "-ine" or "-ide") Beta Blocker OD - Bradycardia - Hypotension - Hypoglycemia (especially kids) - Shock Treatment: - Glucagon - Atropine - Fluids Methamphetamine OD - Tachycardia - Hypertension - Hyperthermia - Dilated pupils - Agitation Treatment: - Benzodiazepines - Cooling - Supportive care NEUROLOGY / STROKE Posterior Stroke Signs - Vertigo - Ataxia - Diplopia - Dysphagia - Nystagmus - Normal FAST possible Vertigo vs Stroke Peripheral vertigo: - Severe spinning - Nausea - No focal weakness Stroke: - Ataxia - Weakness - Slurred speech - Vision changes Aphasia + Weakness That does NOT differentiate ischemic vs hemorrhagic. Both can cause: - Aphasia - Unilateral weakness You cannot tell type without imaging. Hemorrhagic Stroke - Severe headache - Vomiting - Rapid decline - Hypertension