CLINICAL CARE FOR EMERGENCIES Flashcards
What is defined by airway compromise or hypotension, is obviously a true medical emergency and must be rapidly assessed and treated?
Anaphylaxis
What is a systemic hypersensitivity reaction with multisystem involvement?
Anaphylaxis
These are some classic signs of presentation and progression of what?
- Pruritis
- Flushing
- Urticaria
- Throat fullness (lump sensation)
- Anxiety
- Chest tightness, SOB, Lightheadedness
Anaphylaxis
This is the severe reaction associated with what?
- Loss of consciousness
- Cardiopulmonary arrest
Anaphylaxis
Symptoms of anaphylaxis usually begin within ___ mins of exposure?
60 minutes
Anaphylaxis
___% will have a reoccurrence within 12 hours after resolution of first episode
21%
With suspected anaphylaxis, the single most important step in treatment is the rapid administration of what?
Epinephrine
What are some 2nd line therapies for anaphylaxis?
- Corticosteroids : Methlyprednisone (Solumedrol) 125mg IM/IV daily x 2 days
- Antihistamines
Anaphylaxis
What helps control the allergic bronchospasm?
Nebulized albuterol 5mg nebulized or via inhaler q 15-30 minutes as needed for bronchospasm
Drug allergies usually appear within what time frame?
first or second week
What is a nonspecific group of injuries that describes injury to the respiratory tract including upper airway, tracheobronchial tree and pulmonary parenchyma?
Smoke Inhalation Injury
Smoke inhalation injuries can be caused by what?
heat, smoke, or chemicals
What is the leading cause of smoke inhalation injuries?
Fire
Smoke Inhalation
Injury to the upper airway is usually caused by what and produces the following?
- Leads to erythema, ulcers, and edema
- Injury can cause impaired ciliary function as well
- Can lead to airway compromise
Thermal injury
Smoke Inhalation
Injuries to the tracheobronchial tree is usually caused by what and leads to pulmonary edema and subsequent mismatches in ventilation and perfusion within the lungs (causes hypoxemia)?
Chemicals in the smoke
What is an injury to the lung tissue from smoke inhalation, usually a delayed process that results in alveolar collapse and impaired oxygenation, producing an increased risk for pneumonia?
Parenchymal injury
What is caused by breathing toxic substances?
Systemic Toxicity
What are the two most relevant gases with systemic toxicity?
- Carbon Monoxide
2. Hydrogen Cyanide
What is a frequent cause of death which is the most common complication after inhalation injury of what?
Carbon Monoxide
The affinity for what for hemoglobin is 260 times greater than oxygen?
Carbon Monoxide
A patient presents with the following, what would your primary suspicion be?
- Soot around the nares
- Carbonaceous sputum
- Obvious burns to the neck and face
- Stridor
- Drooling
- Dysphonia
Smoke inhalation
Clinical findings of what include the following?
- Tachypnea
- Decreased breath sounds
- Adventitious lung sounds
- Accessory muscle use
Smoke inhalation
An EKG is useful in any patient being evaluated for toxicological purposes with ___ poisoning leading to myocardial ischemia
CO
What is the first step in the treatment of smoke inhalation injuries?
Rescue from source and limit exposure time
If there are signs of thermal injury to the airway what is indicated?
Intubation
Significant burns (>40%) even with an airway that seems intact may require ______ if capability exists due to impending edema and airway compromise
Prophylactic intubation
Smoke inhalation
What should be used for bronchospasms?
Inhaled bronchodilators: Albuterol 1 to 2 inhalations every 2 hours for the first 4 hours; additional inhalations may be necessary every 4 to 6 hours as needed if inadequate relief
What should be used in the therapy of CO poisoning?
Hyperbaric oxygen
What is a sarcomere?
Muscle fiber
What are the intracellular components of Rhabdomyolysis?
- Potassium
- Creatine Kinase (CK)
- Myoglobin
What is striated muscle breakdown that occurs with injury/necrosis to the muscle fiber, the contents of muscle fiber (CK/myoglobin) leak into circulation and results in the complications of this process?
Rhabdomyolysis
Rhabdomyolysis
Leakage of extracellular calcium ions into the intracellular space, this interaction leads to the interaction of ____ and ___ that ends in muscle destruction
- Actin
2. Myosin
Large quantities of potassium, myoglobin and CK leak into circulation and leads to complications in what?
Rhabdomyolysis
If large amounts of muscle is damaged the ____ released can precipitate in the kidneys and cause renal damage and obstruction
myoglobin
These are causes if what?
- Trauma or muscle compression (consider in patients found down for prolonged periods)
- Crush injury
- Prolonged restraints or immobilization
- Compartment syndrome
- Electrical injuries
Rhabdomyolysis
What kind of rhabdomyolysis is marked physical exertion particularly when:
- Individual is not conditioned
- Hot humid conditions
- Impaired sweating (heat stroke)
- Seizures and delirium tremens
- Meth and cocaine use
Exertional Rhabdomyolysis
What kind of rhabdomyolysis is caused by the following?
- Coma induced by drugs (opioids, alcohol (prolonged down period))
- Medications (statins can lead to rhabdo)
- Toxins (snake venom and CO)
Non-exertional Rhabdomyolysis
These are symptoms associated with what?
- Muscle tenderness
- Weakness
- Edema
- Dark urine (*coke)
- Altered mental status may occur from underlying etiology
Rhabdomyolysis
What is the lab hallmark in Rhabdomyolysis?
Elevated CK, typically five fold increase from normal
These labs will be noted in what?
- Urinalysis dipstick positive for blood however no red blood cells on microscopic exam. (test does not differentiate between myoglobin and hemoglobin)
- Electrolyte abnormalities (Hyperkalemia)
- EKG to evaluate electrolyte abnormalities (Hyperkalemia (causes peaked T waves))
Rhabdomyolysis
What is the treatment for Rhabdomyolysis?
Large volume IV fluid resuscitation (1.5L/hr) to maintain 2ml/kg/hr urine output
**If there is no altered mental status and they are maintaining the 2ml/kg/hr urine output then it is reasonable to keep them on your platform and monitor
When should you MEDEVAC a patient with Rhabdo?
- Altered mental status
- Temp >105
- Unresponsive to IV fluids
What are some complications of Rhabdomyolysis?
- Acute renal failure, acute kidney injury
- Compartment syndrome
- Electrolyte abnormalities
- Cardiac arrhythmias
- Death
