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3. E Med & Surgery > 1- Environmental Emergencies > Flashcards

1- Environmental Emergencies Flashcards

1
Q

What injury is associated w/ prolonged stationary posture, dehydration, wet clothings, lack of head/hand protection or footwear?

A

Frostbite

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2
Q

How is a frostbite injury classified?

A

By depth of injury and amount of tissues damage on appearance AFTER rewarming

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3
Q

Can freezing alone cause tissue death?

A

No, thawing also causes damage

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4
Q

The formation of arachidonic acid (promoting vasoconstriction), platelet aggregation (V/ATE), and subsequent ischemia, necrosis and gangrene are all part of what?

A

Thawing process of frostbite

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5
Q

What is the depth of freezing dependent on?

A

Temperature, velocity, and duration of exposure

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6
Q

Frostbite can occur anywhere is most common where?

A

Distal extremities (face, noses, ears, fingers, toes)

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7
Q

Pt presents with pale, waxy, hard and cold skin. Why dx are you concerning of and what is the initial tx?

A

Frostbite (clinical dx), tx w/ rewarming

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8
Q

What are the sx of first degree degree frostbite?

A

No blisters, numbness, central pallor w/ surrounding erythema, edema, desquamation, dysesthesia

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9
Q

What are the sx of 2nd degree frost bite?

A

Blisters of the skin w/ surround erythema and erythema

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10
Q

What are the sx of 3rd degree frost bite?

A

Tissue loss involving entire thickness of the skin, hemorrhagic blisters

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11
Q

What are the sx of 4th degree frost bite?

A

Tissue loss involving the entire thickness of the part, including deep structures, resulting in the loss of the part

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12
Q

What is the initial tx for frostbite?

A

Immersion in water b/w 101.5-102.2˚F until erythematous and pliable (20-30 min)
+/- IV opioids for pain (anticipated severe pain w/ rewarming

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13
Q

If pt w/ frostbite w/ cyanosis proximal to ITP joints, what imaging should you consider to assess circulation/tissue viability?

A

CTA or bone scan

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14
Q

If pt presents w/in 24hrs of frostbite injury w/ high risk of amputation and w/o any C/I what tx should you consider?

A

tPA followed by lovenox

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15
Q

After rewarming area of frostbite what is the next tx?

A
  1. Aloe cream 1 6 hrs w/ non-occlusive dressing
  2. Ibuprofen

ABX only if signs of infection
Td immunization if needed

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16
Q

What should not be done acutely after rewarming area of frost bite?

A

No blister or soft tissue debridement acutely

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17
Q

When can a pt w/ frostbite be d/c home?

A

Superficial frostbite

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18
Q

What are the d/c instructions for pt w/ superficial frostbite?

A

Ibuprofen, aloe, smoking cessation, close follow up

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19
Q

What is the tx course for deep tissue injuries associated w/ frost bite?

A

Admission + ortho/hang surgeon consults

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20
Q

Hypothermia is due to an involuntary drop in body temp below what?

A

95˚F

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21
Q

What are primary causes of hypothermia?

A

Due to exposure (wind, rain, water, snow)

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22
Q

What are secondary causes of hypothermia?

A

Lack of thermoregulation (alcoholism, DKA, meds, burns, shock, sepsis, cold IV infusions, newborns, NM disease)

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23
Q

Mild or HT 1 is classified by what body temps and sx?

A

Core temp 89.6-95˚F

Conscious, tachycardia, increased shivering

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24
Q

Mild or HT 2 is classified by what body temps and sx?

A

Core tempe 82.4-89.6˚F

Lethargy, bradycardia, loss of pupillary reflexes, decreased shivering

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25
Q

Mild or HT 3 is classified by what body temps and sx?

A

Core temp < 82.4˚F

Vital signs presents, unconscious, hypotension. pulmonary edema, rigidity

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26
Q

Mild or HT 4 is classified by what body temps and sx?

A

Core tempe 82.4-89.6˚F

Absent vital signs, cardiac arrests

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27
Q

What tool will assist in the dx of hypothermia?

A

Low reading thermometer (do not use oral or infrared TM thermometers)

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28
Q

Where should you take the temp in a conscious pt w/ hypothermia?

A

Rectal or bladder (no accurate if pt in rewarming)

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29
Q

If pt w/ severe hypothermia, what temperature location is recommended?

A

Esophageal temp probe

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30
Q

If pt w/ moderate to severe hypothermia what Labs should your order?

A

Insulin, ECG, CXR, BMP, CBC w/ diff

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31
Q

What hormone is ineffective below 86˚F?

A

INsulin

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32
Q

What impact does hypothermia have on glucose levels?

A

Initial hyperglycemia followed by normalization or hypoglycemia after rewarming

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33
Q

What will be masked on EKG in pt w/ hypothermia?

A

Hyperkalemia (masked until pt is rewarmed)

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34
Q

Why do you order a BMP for pt w/ hypothermia?

A

Lyte abns, cold blood prone to hemolysis

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35
Q

What will increase by 2% for every 1˚C drop in tempe?

A

HCT

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36
Q

What tests are recommended in pt w/ mod to severe hypothermia?

A

Coag studies, O2 sat, ABG

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37
Q

What is the tx for Mild HT 1?

A

Remove wet clothes, passive external warming, (warm drinks, cover w/ blankets), encourage active movements

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38
Q

What is the tx for moderate HT II?

A

Manage ABCs, avoid rough movements (may induce arrhythmias), active external and internal rewarming, +/- ET intubations, monitor for hypotension from rewarming

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39
Q

Why do pts tx for hypothermia have paradoxical drop in core temp while rewarming?

A

Cold blood from extremities is returning to core (rewarm core first to minimize risk)

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40
Q

What is th tx for severe HT III?

A

ABCs, active internal and external rewarming + pleural and peritoneal irrigation w/ warm saline, extracorporeal options, tx any arrhythmias

Extracorporeal options: hemodialysis, CP bypass, continuous AV rewarming

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41
Q

What tx is rarely successful at txing heart arrhythmias for HT II-III pt w/ core temp < 86˚F?

A

Defibrillation

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42
Q

What is the tx for HT IV?

A

CPR, prevent further heat loss/extracorporeal options, thoracic lavage w/ NS, ACLS protocol

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43
Q

How many cycles of advanced ACLS are reasonable to attempt before defering until core tempe is increased/pt improved?

A

3 cycles

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44
Q

Hypotension, lyte abn, rhabdomyolysis/multi organ failure (pulm, renal, neuro) are all complications of what?

A

Rewarming tx for hypothermia

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45
Q

What causes hypotension sx w/ rewarming?

A

Fluid shifts and dehydration

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46
Q

What is the 1st line tx for hypotension as a result of rewarming from hypothermia?

A

Isotonic crystalloid

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47
Q

What is the leading cause of death in young athletes in the US?

A

Heat emergencies

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48
Q

Cramps are associated w/ what environmental emergency

A

Heat

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49
Q

The following all result from what and cause what? - Intense muscle pain (w/o other signs of exertional heat stroke)

  • “Salty sweater” (sweat w/ high salt concentration)
  • Heavy sweating w/ hypotonic fluid replacement
  • Lack of heat acclimation
A

Result from heat exertional illness, cause Heat cramps

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50
Q

What is the tx of heal illness/ cramps?

A

Rest in cool place, hydrate/replace Na loss (oral or IV), relax/stretch, future preventative measures

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51
Q

What will result secondary to to water and Na depletion?

A

Heat stress (exhaustion)

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52
Q

Sx of heat stress will include sx of heat cramps + what?

A

HA, N/V, dizziness, orthostatic hypotension

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53
Q

What + exam findings are concerning for heat stress?

A

Body temp normal/elevated (<104˚F), NO signs of CNS impairments

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54
Q

What labs should be ordered for pt in heat stress?

A

BMP (lyte abn), CBC (hemoconcentration common)

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55
Q

What is the tx for pt w/ heat stress?

A
  1. Remove from hot enviroment

2. Bolus infusion of IV fluids (1-2 L short term, 1.5 increase in maintenance fluids, NS while waiting for labs)

56
Q

What is tx for pt w/ CHF or abn lytes heat stress?

A

Longer fluid replacements, possible admission

57
Q

If pt is not responding w/in 30 minutes of fluid replacements and removal from hot environments what is the next tx?

A

External cooling until core temp reaches 102.2˚F

58
Q

What exam findings are concerning for heat stroke?

A

Tempe > 104˚F & AMS

59
Q

What is the progression of heat emergencies from least to most severe?

A

Heat cramps, heat stress/exhaustion, heat stroke

60
Q

What is the tx goal for pt w/ heat stroke?

A

Cool quickly w/o inducing hypothermia (goal 102.2˚F)

61
Q

Evaporative cooling, ice packs to axilla, neck, groin, immersive cooling, and invasive cooling are tx for what?

A

Heat stroke

62
Q

What is evaporative cooling tx?

A

Remove clothes, spray skin w/ water, direct fan over pt

63
Q

What is invasive cooling?

A

Cardiopulmonary bypass

64
Q

What injury is common, usually accidental, and more common in men and young children?

A

Electrical injury

65
Q

What is the effect of direct contact w/ electrical current?

A

Conversion of electrical to thermal energy along w/ blunt mechanical trauma that can result in tissue or organ damage

66
Q

The physiological effect of electric shock are dependent on what?

A

amount, duration, type of current

67
Q

What current is more common in homes and short distance power lines?

A

Alternating current (AC)

68
Q

What current is found in lightning, batteries and long distance power lines?

A

Direct current (DC)

69
Q

What type of current will cause repetitive muscle contraction w/ pt can not let go of electrical sources?

A

AC current

70
Q

What type of current w/ cause a single muscle spasm that will hurl the victim away from the current source?

A

DC (shorten duration of exposure vs AC current)

71
Q

What current will cause an injury w/ an entrance and exit wound?

A

DC

72
Q

What current will cause an injury w/ an entrance wound only?

A

AC

73
Q

Via what mechanisms does electricity induce injury? (3)

A
  1. Direct tissue damage from electrical energy
  2. Tissue damage from thermal energy
  3. Mechanical injury from trauma induced by fall or muscle contraction
74
Q

In what class of electrical injury does the body become part of the circuit w/ entry and exit wounds?

A

Classic Injury

  • Wounds do no predict path of current
  • Degree of internal thermal injury can be underestimated
75
Q

In what class of electrical injury does the current arc strike skin but does not enter the body?

A

Flash (arc) Injury

76
Q

In what class of electrical injury does clothing catch fire in the presence of an electrical source?

A

Flame injury

77
Q

In what class of electrical injury is a DC current shock wave transmitted through the body resulting in mechanical trauma and Lichtenberg figures (flowers)?

A

Lightening injury

78
Q

Electrical injuries can present w/ what cardiac abnormality?

A

Cardiac dysrhythmias

79
Q

If pt that has sustained a low voltage electrical injury is asx and has a normal EKG in the ED, will they typically develop a dysrhythmia later?

A

No

*Fatalities due to Vfib or asystole typically occur prior to arrival in ED

80
Q

What type of injury is common following a high voltage electrical injury?

A

Neuro injury (CNS, spinal cord, PNS) & Vascular and muscle injury

*LOC may be followed by seizures, focal neuro deficits may be present

81
Q

If pt touched the power source resulting in an electrical injury, how might they present?

A

Cutaneous burns, paresthesias (immediate or delayed)

82
Q

What are the sx of an electrical burn?

A

CNS injury (CNS, spinal cord, PNS), cutaneous burns, orthopedic injuries (due to muscle contractions/falls), vascular and muscle injury (risk of compartment syndrome)

83
Q

What is the tx for pt that has sustained a high voltage (≤600 VAC) electrical injury?

A

TX as trauma -> ABCs, fast exam, labs, EKG, CT head/spine, XR spine, XR injured extremities

ADMIT (even if no apparent injury/asx)

84
Q

What is the tx for pt that has sustained a low voltage (<240 V AC) electrical injury?

A

ECG, thorough exam, no labs or imaging required unless pt is symptomatic or w/ abn finding

D/C home if normal ECG and physical exam

85
Q

What spider bite will result in pain w/in 3 hrs of bite and systemic effect w/in 4-6 hrs?

A

Black widow

86
Q

Is this a mild moderate or sever envenomation by a black widow?

Local wound, +/- spasm adjacent to site?

A

Mild

87
Q

Is this a mild moderate or sever envenomation by a black widow?

Spasm and muscle pain in bitten extremity, back, chest, and abd w/ adjacent diaphoresis?

A

Moderate

88
Q

Is this a mild moderate or sever envenomation by a black widow?

Severe pain and spam and systemic features (N/V, HA, tachycardia, HTN)

A

Severe

89
Q

What spider bite will result in mild to intense pain and itching 2-8 hrs following bite w/ ulcer and necrosis 1+ wk later?

A

Brown recluse

90
Q

Pt presents following the bite of a spider. On exam you note, depressed grey macule, pale grey color w/ eroded center and halo of inflammation and hemorrhage. What do you suspect?

A

Brown recluse bite

91
Q

T or F: A Brown recluse bite will frequently result in a systemic sx?

A

FALSE

Infrequent systemic sx (mailse, n/v, fever) and rarely severe systemic sx (rhabdo, DIC, hemolytic anemia)

92
Q

Are systemic sx of a brown recluse bite more common in children or adults?

A

Children

93
Q

What is needed for the dx of spider bite?

A
  1. Spider observed inflicting the bite/collected/identified

2. Skin lesion/systemic finding typically associated w/ type of spider bite present

94
Q

What is the general tx for a spider bite?

A

Wound cleaning, tetanus PRN, tx secondary skin infection PRN

95
Q

What is the tx for black widow bite?

A

Self limited, duration of sx typically 24-48 hrs

Supportive care: analgesics/opioid, muscle relaxants, anti-venom if severe (must consult toxicologist)

Monitor for secondary infection

96
Q

What is the tx for a brown recluse bite?

A

Self limited, wound improves w/in 5-10 days
Monitor for secondary infection

Debridement no proven beneficial, no anti-venom in US

97
Q

What venomous scorpion is common to AZ, NM, and CA?

A

Bark spider

98
Q

When treating scorpion sting, what precaution should you take?

A

Treat all as potentially dangerous until lack of signs/sx indicate otherwise

99
Q

What are the sx of a bark scorpion bite?

A

Initial sx = pain and paresthesia to involved area, swelling usually absent, few skin changes

100
Q

What are the sx of an adult bit by bark scorpion?

A

Tachycardia, HTN, tachypnea, weakness, muscle spasm/fasciculations and respiratory difficulty is rare

101
Q

What are the sx of a child bit by a bark scorpion?

A

Restlessness, anxiety, agitation, muscle spasm, abnormal, random head, neck, eye movements, weakness, diaphoresis, excessive drooling/salivation, respiratory difficult is rare.

Death has resulted in children < 6

102
Q

What is the tx for a bark scorpion bite?

A

Supportive care, monitor for 8-12 hrs after sting, antivenom available for severe sx that are unresponsive to supportive care, tetanus prophylaxis

103
Q

What snake has a triangular shaped head, cat like pupils and foldable fangs?

A

Rattlesnake

104
Q

What is the prehospital tx for a rattlesnake bite?

A

Keep pt relaxed/limit movements, remove tight clothing/jewelry from bitten limb, seek emergency care ASAP

105
Q

What are the clinical features of rattle snake bite?

A

Fang marks, local tissue injury, fibrinolysis, thrombocytopenia, systemic effects (unstable vs AMS)

106
Q

We treat all pts w/ rattlesnake bites that develop progressive signs and sx ASAP. What are the progressing sx?

A

Worsening of local injury, abnormal lab results (decreasing platelet count, prolonged PPT, decreased fibrinogen), systemic manifestations

107
Q

What is the initial control of a rattlesnake bite at hospital?

A

Supportive care, antivenom (given in ICU), clean wound, prevent progression of sx

108
Q

What is rattlesnake antivenom administered in ICU?

A

Risk of anaphylaxis and/or develop serum sickness (fever, rash, arthralgia)

109
Q

What is the tx for pt that develops serum sickness to rattlesnake antivenom?

A

Oral prednisone 1 mg/kg/d x 1-2 wks

110
Q

How can you identify a coral snake?

A

Red, black, yellow rings. Red and yellow rings touch

111
Q

What is the tx for pt bitten by coral snake?

A

Admit pt and give antivenom ASAP
Supportive care
Tetanus prophylaxis

112
Q

What is the concern w/ coral snake venom?

A

Venom in a neurotoxin that does not cause marked local tissue injury and can take hours for effects to manifest

113
Q

What lizard requires a prolonged bite for envenomation and has a strong bite grip that can result in fractures and deep tissue injuries?

A

Gila monster

114
Q

What is the tx for a gila monster bite?

A

Remove lizard, clean wound, remove any remaining teeth, XR for fx, Td and ABX prophylaxis, admit

*No anti-venom available

115
Q

What are the sx of a gila monster envenomation?

A

Weakness, light-headedness, paresthesia, diaphoresis, HTN

116
Q

What injuries can result due to pressure changes during descent while diving?

A

Barotitis, sinus barotrauma, inner ear barotrauma

117
Q

What barotrauma is a result of the an occluded ear canal (either by cerumen or ear plugs) resulting in an inability to equalize pressure b/w TM and external canal during descent?

A

Barotitis, aka ear squeeze –> conductive hearing loss, vertigo, ruptured TM

118
Q

What are the sx of barotitis?

A

Range of sx

Pain/fullness in ear w/o otoscopic changes to hemorrhage w/in TM or middle ear (hemotympanum)

119
Q

What is the concern w/ barotitis is TM ruptures?

A

Water can flow into ear –> pain relief BUT can induce vertigo, panic, drowning/other injury

120
Q

What is the tx for barotitis?

A

Decongestant, +/- ABX if TM rupture, secondary infection

121
Q

What barotrauma is a results if the sinus ostia is occluded and air can’t enter sinuses during descent to equalize pressure?

A

Sinus barotrauma –> submucosal hemorrhage (blood bleeding into diving mask), stripping of sinus mucosa from bone

122
Q

What are the sx of sinus barotrauma?

A

pain over affected sinus, possible epistaxis

123
Q

What is the tx for sinus barotrauma?

A

Decongestant, +/- ABX

ENT consult based on severity

124
Q

What barotrauma is a result of a diver attempting a forceful valsalva maneuver to equalizer pressure in middle ear against an occluded eustachian tube?

A

Inner ear barotrauma –> rupture of oval window and tearing of vestibular membrane

125
Q

What are the sx of inner ear barotrauma?

A

sudden onset f sensorineural hearing loss, tinnitus, severe vertig

126
Q

What is the tx for inner ear barotrauma?

A

Stat ENT consult, elevated head of bed, no nose blowing, antivertigo meds

127
Q

Is barotrauma of descent of ascent for severe?

A

Ascent

128
Q

Barotrauma of ascent results in what injuries?

A

Pulmonary barotrauma, arterial gas embolism

129
Q

What is the pathophys for barotrauma of ascent?

A

Secondary to rapid or uncontrolled ascent while diving, w/ rapid ascent, over expansion of air injury can occur, pressure difference becomes so great the tissues rupture and air is introduced into tissues and spaces

130
Q

What are RF for barotrauma injuries of ascent?

A

Breath holding while ascending, hx of obstructive airway disease

131
Q

What barotrauma of ascent will result in pulmonary overinflation or burst lung syndrome?

A

Pulmonary barotrauma

132
Q

What are the sx of pulmonary barotrauma?

A

Dyspnea, chest pain, subQ air, PTX

133
Q

What is the pt for pulmonary barotrauma?

A

Pnuemomediastimun requires sx care, if PTX may require further interventions

134
Q

Any neurologic sx in the setting of documented pulmonary barotrauma must be treated as what?

A

Arterial gas embolism

135
Q

What are the sx of arterial gas embolism?

A

Neurologic sx occurring immediately after an uncontrolled, rapid ascent while diving

136
Q

What is the tx for arterial gas embolism?

A

ABCs, high flow O2, IV hydration, hyperbaric oxygen, stat neuro consul

3. E Med & Surgery (19 decks)

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