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FM4 Cramming > Chemical and Physical Injury > Flashcards

Chemical and Physical Injury Flashcards

1
Q

toxic products of ethylene glycol

A

Glycolic acid and glyxolic acid via aldehyde dehydrogenase

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2
Q

Secondary metabolites of ethylene glycol

A

Formate, oxalate

Oxalate is highly toxic in small amounts (nephrotoxicity)

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3
Q

Areas of brain damaged by CO inhalation

A

globus pallidus

Pars reticularis of substantia nigra

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4
Q

Biological half life of CO

A

4-6 hours on room air
40-80 minutes on 100% O2
15-30 minutes on hyperbaric O2

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5
Q

Effects of CO on hemoglobin curve

A

Left shift

hgb remains saturated with O2 even at low pO2 of tissues

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6
Q

CO effect on mitochondria

A

Binds to the hemeochromes in ETC –> impaired respiration

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7
Q

LD of CO

A

Varies.
Very low in children or patients with COPD
Higher in smokers (baseline levels reach 15%)

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8
Q

Mechanisms of CO damage to CNS

A
  1. Direct hypoxia
  2. Cell death mediated cerebral edema
  3. Direct binding to neurons of the SN and gobus pallidus –> parkinsonianism
  4. Myelinopathy
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9
Q

Relation of cyanide to CO poisoning

A

CO poisoning occurs primarily in house fires, which also release cyanide from building materials.
Cyanide inhalation can be just as dangerous.

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10
Q

Free basing

A

Extraction of cocaine salt and smoking it

Carries risk of ignition of remaining solvent

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11
Q

Crack

A

Cocaine purified with baking soda

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12
Q

Administration routes of cocaine and associated bioavailabilty

A

IV: 100%
Intranasal: 25-94%, cocaine constricts nasal vessels. People snorting cocaine will also swallow some.
Ingesition: LOW due to first pass metabolism from portal blood
Smoking: RAPID absorption, depends on smoking technique
Rectal: Unknown, but bypasses portal system metabolism

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13
Q

Cocaine metabolites that are stimulatory

A

Ethylcocaine
Norcocaine (p450)
Cocaine
Benzylcocaine is main metabolite and is not active

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14
Q

Cocaine metabiolites made by smoking or EtOH ingestion and p450 metabolism

A

EtOH: Ethylcocaine
Smoking: Methylecgonide
p450: norcocaine

Major metabolite is benzyloegonine

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15
Q

Importance of ethylcocaine

A

Formed with EtOH ingestion, stronger and has longer half live than cocaine

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16
Q

Mechanisms of Toxicity for cocaine

A
  1. Monoamine reuptake inhibition
  2. Reduced sodium channel conductance
  3. Long-term neruophysiological changes–> psychiatric Disease

DEATH IS NOT DOSE DEPENDENT

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17
Q

Abrasions concurring when force is perpendicular to the skin

A

Impact abrasion

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18
Q

Pattern abrasion

A

abrasions showing the pattern of the offending object

19
Q

Clinical used of “contusion”

A

May be internal or external bruising

Use of word must be accompanied by explanation as it implies blunt force trauma

20
Q

Tearing of tissue

A

Laceration

21
Q

Characteristics of laceration

A

Adjacent abrasions
Bridging of tissue, nerves or blood vessels in wound
Adjacent area of contusion
Irregular wound edges

22
Q

Characteristics of an incision

A

Linear wound edges without bridging

Abrasions or contusions may or may not be present

23
Q

Sharp force injury that is deeper than it is wide

A

Stab

24
Q

Sharp force injuries that also have characteristics of a blunt trauma, including potential for bone markings

A

Chop

25
Q

Three types of contact gunshot wounds

A

Tight
Loose
Near

26
Q

Differentiation of contact gunshot wounds

A

Tight: Radiating skin splitting, muzzle imprint (due to gaseous expansion against muzzle)

Loose: No splitting, muzzle imprint present

Near: Lacks splitting, muzzle, and signs of intermediate GSW (stippling)

27
Q

Characteristics of intermediate GSW

A 
Stippling from unburnt powder
No soot (See only in contact wounds)
28
Q

Characteristics of distant GSW

A

No signs seen in intermediate or near GSW (no stippling, soot, muzzle imprint, skin splitting)

29
Q

Characteristics of a first degree burn

A

Damage to epidermis only

30
Q

Characteristics of a second degree burn

A

Damage to upper skin layers
Blistering
Dues not penetrate epidermis

31
Q

Characteristics of a third degree burn

A

Deep damage extending through the dermis and skin structures into the dermis.
Requires skin grafts

32
Q

Characteristics of a fourth degree burn

A

Severe damage penetrating the epidermis and dermis to underlying structures.
Requires grafting, debridement, etc.

33
Q

Rule of 9’s

A 
Head 9%
Each arm 9%
Front of each leg 9%
back of each leg 9%
Front of torso 18%
back 18%
Genitals 1%

Does not apply to infants

34
Q

Determining variable in electrocution

A

Amperage

I= V/R

35
Q

Most damaging amperage

A

between 40-150Hz

(household wiring is 60Hz

36
Q

Characteristics of electrocution burns

A

Present only in 50% of all electrocutions
White, chalky appearance with raised border and central crater

Most typically seen on thick palmar or plantar skin

37
Q

Mechanism of death in most lightning strikes

A

Cardiac or pulmonary arrest

38
Q

Potential non-environmental causes of hyperthermia

A

MDMA + dancing
Anti-cholinergics (reduce vasodiation)
Malignant hyperthermia with anesthesia

39
Q

External signs of asphyxiation

A

Cyanosis

Conjuntival hemmorhage

40
Q

Pressure exerted outside the body –> impedance of inspiration

A

Mechanical asphixiation

41
Q

Internal asphyxiation

A

Suffocation from excess intra-abdominal pressure (seen in gut motility issues, opiate overdoses, CP)

42
Q

Characteristics of manual strangulation

A

Fracture of tracheo-laryngeal skeleton
Conjunctival petechiae
Abrasions or fingernail marks on neck

43
Q

Characterisitics of ligature strangulation

A

Ligature abrasions
Petechiae
Tracheolaryngeal skeleton fracture

Suffocation is VERY RAPID

44
Q

Unique characteristics of hanging asphyxiation

A

Ligature furrow

Absent ocular petechiae or tracheolarygeal fracture

FM4 Cramming (6 decks)

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