Clinical care for Emergencies

Question 1

Defined by airway compromise or hypotension, is obviously a true medical emergency and must be rapidly assessed and treated

Answer 1

Anaphylaxis

Question 2

Systemic hypersensitivity reaction with multisystem involvement of cardiovascular & respiratory

Answer 2

Anaphylaxis

Question 3

Triggers for anaphylaxis

Answer 3

• Drugs (Antibiotics, NSAIDs, ANY DRUG)
• Food (nuts, shellfish, soy, eggs)
• Additives (sulfites)
• Toxins (insect stings, venom)
• Chemicals (contrast dye, latex)

Question 4

Pruritis, flushing, urticaria

Throat fullness, anxiety, chest tightness, SOB, lightheadedness

Answer 4

Anaphylaxis

Question 5

Anaphylaxis

Signs and symptoms begin within ____ mins of exposure

Answer 5

60 minutes

Question 6

Anaphylaxis

____% will have a reoccurrence within 12 hours after resolution of the first episode

Answer 6

21%

Question 7

With suspected anaphylaxis, the single most important step in treatment is the rapid administration of:

Answer 7

Epinephrine

Question 8

2nd line therapies for anaphylaxis

Answer 8

Corticosteroids

Antihistamines

Question 9

Allergic bronchospasm is treated with:

Answer 9

Albuterol

Question 10

Drug allergy usually occurs within:

Answer 10

First or second week

Question 11

Smoke inhalation can be caused by:

Answer 11

Heat

Smoke

Chemicals

Question 12

Leading cause of smoke inhalation injuries

Answer 12

Fire

Question 13

Smoke inhalation

Upper airway is usually due to:

Answer 13

Thermal injury

Question 14

Smoke inhalation

Tracheobronchial tree is usually caused by:

Answer 14

Chemicals in the smoke

Question 15

Smoke inhalation

Injury to the lung tissue, usually a delayed process.

• Results in alveolar collapse and impaired oxygenation.
• Risk for pneumonia

Answer 15

Parenchymal injury

Question 16

Caused by breathing toxic substances

Answer 16

Systemic toxicity

Question 17

Two most relevant gases for systemic toxicity are:

Answer 17

Carbon monoxide

Hydrogen cyanide

Question 18

Frequent cause of death and most common complication after inhalation injury

Colorless and odorless gas

Affinity for hemoglobin 260 times greater than oxygen

Answer 18

Carbon Monoxide (CO)

Question 19

Gaseous form of cyanide, colorless and odor of bitter almonds

Difficult to screen for and treatment should be considered in all inhalation injuries

Treatment should be initiated patients who are at risk and who display altered mental status, cardiac arrest or signs of heart failure

Answer 19

Hydrogen cyanide

Question 20

Gas that can lead to myocardial ischemia

Answer 20

CO poisoning

Question 21

First step in the treatment of smoke inhalation

Answer 21

Rescue from the source and limit exposure time

Question 22

Significant burns (>40%) even with an airway that seems intact might require ________ if capability exist due to impending edema and airway compromise

Answer 22

Prophylactic intubation

Question 23

Therapy used for significant CO toxicity

Answer 23

Hyperbaric oxygen

Question 24

Sarcomere

Answer 24

Muscle fiber

Question 25

Rhabdo

Intracellular components

Answer 25

Potassium

Creatine Kinase (CK)

Myoglobin

Question 26

Striated muscle breakdown

Occurs with injury/necrosis to the muscle fiber

Answer 26

Rhabdomyolysis

Question 27

Rhabdo

Leakage of extracellular calcium ions into the intracellular space leads to:

Answer 27

Interaction of actin and myosin that ends in muscle destruction

Question 28

Rhabdo

If large amount of muscle is damaged the myoglobin released can precipitate in:

Answer 28

Kidneys, cause renal damage and obstruction

Question 29

Causes of rhabdomyolysis

Answer 29

Trauma or muscle compression

Exertional rhabdomyolysis

Non-exertional rhabdomyolysis

Question 30

Rhabdo caused by:

Trauma, crush injury, prolonged restraints or immobilization, compartment syndrome, electrical injuries

Answer 30

Trauma or muscle compression

Question 31

Rhabdo caused by:

Individual is not conditioned, hot humid conditions, impaired sweating, seizures and delirium tremens, methamphetamine and cocaine use

Answer 31

Exertional rhabdomyolysis

Question 32

Rhabdo caused by:

Coma induced by drugs
Medications (statins)
Toxins (snake venom & CO)

Answer 32

Non-exertional rhabdomyolysis

Question 33

• Muscle tenderness
• Edema
• Muscle weakness
• Dark urine (*Coca Cola urine)
• Altered mental status may occur from underlying etiology

Answer 33

Rhabdomyolysis

Question 34

Lab hallmark in rhabdomyolysis

Answer 34

Elevation in CK (typically fivefold increase)

Question 35

Elevation in CK (Hallmark) typically fivefold increase from normal

Urinalysis dipstick positive for blood however no red blood cells on microscopic exam

Electrolyte abnormalities (*Hyperkalemia)

EKG to evaluate electrolyte abnormalities (Hyperkalemia (causes peaked T waves))

Answer 35

Rhabdomyolysis

Question 36

Treatment for rhabdomyolysis

Answer 36

Large volume IV fluid resuscitation (1.5L/hr)

2ml/kg/hr urine output

Question 37

When to MEDEVAC a rhabdomyolysis patient?

Answer 37

Altered mental status, temp > 105, or unresponsive to IV fluids

Question 38

Complications of rhabdomyolysis

Answer 38

Acute renal failure, acute kidney injury
Compartment syndrome
Electrolyte abnormalities
Cardiac arrhythmias
Death