Chemical and physical injury

Question 1

Who is at risk of ethylene glycol poisoning?

Answer 1

children
suicide attempt
alcoholic

Question 2

What are the key toxic metabolites of ethylene glycol?

Answer 2

oxalate: generates calcium oxalate crystals that deposit in the kidney, can lead to renal failure
glycolate: contributes to anion gap metabolic acidosis

Question 3

Where in the brain does CO preferentially bind cytochrome enzymes?

Answer 3

globus pallidus, pars reticularis of substantia nigra

Question 4

Describe CO toxicity

Answer 4

• tissue hypoxia due to decreased available oxygen

- binding to cytochrome enzymes= impairment of cellular respiration

Question 5

_______ causes a bright red coloration to tissues

Answer 5

carboxyhemoglobin

Question 6

Describe the bioavailability of different forms of cocaine administration

Answer 6

IV> intranasal, smoking> swallowed

rectal insertion thought to be effective

Question 7

Describe the major metabolites of cocaine

Answer 7

Principle metabolite is benzoylecgonine.
Combination with ethanol → coca ethylene/ ethylcocaine
Norcocaine in people with activated hepatic P450s (ex chronic alcoholic)
Methylecgonidine is a metabolite unique to smoked form

Question 8

____ is a metabolite of cocaine that has a stronger biological activity and longer half life than parent cocaine

Answer 8

ethylcocaine/ cocaethylene

Question 9

Describe the biochemical mechanisms of cocaine toxicity

Answer 9

cellular reuptake blockage of norepinephrine, dopamine, serotonin, and blockage of sodium channel conductance

Question 10

Premature _______ is a key concern related to chronic cocaine use

Answer 10

coronary atherosclerosis

Question 11

Define abrasion

Answer 11

epidermal injury where the outer layers of skin are removed due to frictional forces.

types: linear, brush type (road rash), impact, pattern

Question 12

Define contusion

Answer 12

• area of localized tissue and vascular damage caused by blunt trauma
• confluence of non-epithelial microscopic tissue lacerations

Question 13

Define laceration

Answer 13

tearing of tissue caused by shearing or crushing injury

Question 14

What differentiates a laceration vs an incision

Answer 14

Lacerations: adjacent tissue abrasion, tissue bridging, adjacent contusion

Question 15

Define incision

Answer 15

tissue disruption due to contact with a sharp edged object

Question 16

Define stab

Answer 16

sharp force injury that is deeper than it is wide

Question 17

Describe three types of gunshot wounds in terms of range of fire

Answer 17

• contact: soot and powder within wound, abrasion collar, charring of wound edges
• intermediate: far enough away that there is no soot, may still have a small abrasion (stippling, tattooing)
• distant: no soot or powder, no stippling

Question 18

Describe the rule of 9s for body surface area affected by a burn

Answer 18

• head is 9%
• each upper extremity is 9%
• front of each leg is 9% the back of each leg is 9%
• top front of the torso is 9%, bottom front of torso is 9%
• top front of the back is 9%, bottom front of back is 9%

The genital region is 1%.

Question 19

_______ is the most important factor related to electrical injuries

Answer 19

amerage

Question 20

How do electrical injuries cause death?

Answer 20

paralysis of respiratory muscles
cardiac arrhythmia
internal charring

Question 21

Describe the appearance of electrical burns

Answer 21

white chalky appearance with raised border, central crater
microscopically- denaturation of collagen, elevation and blistering of epidermis, distortion and linear streaming of nuclei
usually palmar or plantar skin

Question 22

A fern-like pattern of skin burning is characteristic of injury from ______

Answer 22

lightning

Question 23

What groups are at increased risk of heat stroke?

Answer 23

elderly 
very young
cardiopulmonary disease
users of MDMA
use of anti-cholinergic drugs- decreased vasodilation/ inhibition of sweating

Question 24

What is malignant hyperthermia?

Answer 24

syndrome of hypermetabolism (tachycardia, tachypnea, and muscle spasms) usually triggered by the induction with halogenated anesthetics

Question 25

Hypothermia is body temperature below ____ degrees. Hyperthermia is body temperature above _____ degrees

Answer 25

95, 106

Question 26

A unique feature of hypothermia is paradoxical _______

Answer 26

undressing- due to burning paresthesias

also “hide and die syndrome”

Question 27

What are classic postmortem manifestations of asphyxia?

Answer 27

cyanosis, conjunctival petechiae

Question 28

Differentiate between the common types of suffocation

Answer 28

entrapment: deficiency of oxygen in the environment
smothering: mechanical occlusion of the external airway
choking: internal obstruction of airway
mechanical: pressure from outside the body that impedes inspiration, aka traumatic asphyxiation

Question 29

What gases can cause chemical asphyxiation

Answer 29

CO2, methane, high concentration inert gases

Question 30

_______ occurs when pressure is exerted on the neck with compression of the blood vessels and/ or airway

Answer 30

strangulation