13 Environmental Flashcards
what is chillblains
aka Pernio
red/blue plaques on skin with itchy, burning pain
difference btwn frostnip and frostbite
retrospective dx: after rewarming, if no tissue loss, it is frostnip not frostbite
frostbite grading
1-2 degree: superficial, dermis only, good prognosis
3-4 degree: deep, SQ to bone. poor prog
Debride blisters in frostbite?
per hippo:
generally ok to debride clear blisters, leave hemorrhagic ones alone
hypothermia stages by temp
what are the signs/sxs
mild 32-35: shivering etc
mod 30-32: NO shivering. AMS, ataxia, osbourne J waves
severe <30: dysrhtyhmias,
when does shivering stop in hypothermia
when <32: going fromild to mod hypothermia
hypothremic arrest pt
shock?
can try 1 shock for Vfib
hypothermia rewarming goal in arrest
goal of 30C from severe to mod) in arrest. If still arrest likely not hypothermia the cause
X
X
High altitude emergencies:
acute mountain sickness, HAPE, HACE
Diving pathology/emergencies:
how to think about them
2 classes:
- Barotrauma–localized, POPS-AGE
- Dissolved gas problems–O2 tox, nitrogen narcosis, DCS
What is POPS-AGE
Pulmonary over pressurization syndrome,
Acute gas embolism (severe POPS)
When you ascend during diving but don’t breathe out-> alveoli rupture. you can get PTX, pneumomediastinum,
AGE is severe POPS. Can get arrest/AMS/sz/stroke. THIKN THIS IF SXS OCCUR WITHIN 10 MIN of surfacing
Diver surfaces, then upon arriving at surface becomes unconscious
think what
Think AGE- acute gas embolism (severe POPS)
as opposed to DCS which is usu more gradual like hours
nitrogen narcosis
- what is it
- when does this happen
- ‘drunk’ bx
- occurs when >100 ft below surface, tx to ascend
02 toxicity in diving
-what is it, sxs
Too deep->too much O2 breathed in, causes seizures, vision change, muscle twitch
- occurs in industrial divers going very deep, think >300ft deep). Or in divers increasing O2 % in tank
Seizure in diver at depth, think what
Think O2 toxicity
Decompression sickness
type 1 vs 2
1: ‘bends’ MSK sxs, arthralgias
2. neuro, pulm:
Cord dysfunction sxs,
‘staggers’ - ataxia from cerebellum bubbles
‘chokes’ - SOB/CP from bubbles in lungs (not same as acute gas embolism AGE)
Diver surfaces. After arriving at shore and walking, notices tingling and weakness in less, think what
Think DCS, type 2. bubbles in spinal cord
Heat stroke: Cooling temp target
stop cooling at 39 (102)
don’t overshoot
burn unit referral criteria
- > 10% 2nd degree
- hands, face, feet, genitals, major joints
- electrical, chemical burns
- inhalation injuries
- circumferential
- comorbidities
Low voltage injury vs High voltage injury management:
Low: if mild sxs, check ekg, urine/CK for rhabdo->normal can go home
High: must monitor 12-24h
- check ekg, CK/urine, other labs
pediatric lip commissure burn
-tell what to parnets
- around day 5 can bleed of labial artery
- hold pressure, if several min no help come to ed
keraunoparalysis
what is this
in lightning injury
current goes up one leg, down other, causes vasospasm and temporary paralysis, pulselessness
resolves in 6h usu
what lab test shows prognosis in radiation exposure
absolute Lymph count
