CLINICAL CARE FOR EMERGENCIES

Question 1

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

Answer 1

Anaphylaxis

Question 2

What is a systemic hypersensitivity reaction with multisystem involvement?

Answer 2

Anaphylaxis

Question 3

These are some classic signs of presentation and progression of what?

1. Pruritis
2. Flushing
3. Urticaria
4. Throat fullness (lump sensation)
5. Anxiety
6. Chest tightness, SOB, Lightheadedness

Answer 3

Anaphylaxis

Question 4

This is the severe reaction associated with what?

1. Loss of consciousness
2. Cardiopulmonary arrest

Answer 4

Anaphylaxis

Question 5

Symptoms of anaphylaxis usually begin within ___ mins of exposure?

Answer 5

60 minutes

Question 6

Anaphylaxis

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

Answer 6

21%

Question 7

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

Answer 7

Epinephrine

Question 8

What are some 2nd line therapies for anaphylaxis?

Answer 8

1. Corticosteroids : Methlyprednisone (Solumedrol) 125mg IM/IV daily x 2 days
2. Antihistamines

Question 9

Anaphylaxis

What helps control the allergic bronchospasm?

Answer 9

Nebulized albuterol 5mg nebulized or via inhaler q 15-30 minutes as needed for bronchospasm

Question 10

Drug allergies usually appear within what time frame?

Answer 10

first or second week

Question 11

What is a nonspecific group of injuries that describes injury to the respiratory tract including upper airway, tracheobronchial tree and pulmonary parenchyma?

Answer 11

Smoke Inhalation Injury

Question 12

Smoke inhalation injuries can be caused by what?

Answer 12

heat, smoke, or chemicals

Question 13

What is the leading cause of smoke inhalation injuries?

Answer 13

Fire

Question 14

Smoke Inhalation

Injury to the upper airway is usually caused by what and produces the following?

1. Leads to erythema, ulcers, and edema
2. Injury can cause impaired ciliary function as well
3. Can lead to airway compromise

Answer 14

Thermal injury

Question 15

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)?

Answer 15

Chemicals in the smoke

Question 16

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?

Answer 16

Parenchymal injury

Question 17

What is caused by breathing toxic substances?

Answer 17

Systemic Toxicity

Question 18

What are the two most relevant gases with systemic toxicity?

Answer 18

1. Carbon Monoxide

2. Hydrogen Cyanide

Question 19

What is a frequent cause of death which is the most common complication after inhalation injury of what?

Answer 19

Carbon Monoxide

Question 20

The affinity for what for hemoglobin is 260 times greater than oxygen?

Answer 20

Carbon Monoxide

Question 21

A patient presents with the following, what would your primary suspicion be?

1. Soot around the nares
2. Carbonaceous sputum
3. Obvious burns to the neck and face
4. Stridor
5. Drooling
6. Dysphonia

Answer 21

Smoke inhalation

Question 22

Clinical findings of what include the following?

1. Tachypnea
2. Decreased breath sounds
3. Adventitious lung sounds
4. Accessory muscle use

Answer 22

Smoke inhalation

Question 23

An EKG is useful in any patient being evaluated for toxicological purposes with ___ poisoning leading to myocardial ischemia

Answer 23

CO

Question 24

What is the first step in the treatment of smoke inhalation injuries?

Answer 24

Rescue from source and limit exposure time

Question 25

If there are signs of thermal injury to the airway what is indicated?

Answer 25

Intubation

Question 26

Significant burns (>40%) even with an airway that seems intact may require ______ if capability exists due to impending edema and airway compromise

Answer 26

Prophylactic intubation

Question 27

Smoke inhalation What should be used for bronchospasms?

Answer 27

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

Question 28

What should be used in the therapy of CO poisoning?

Answer 28

Hyperbaric oxygen

Question 29

What is a sarcomere?

Answer 29

Muscle fiber

Question 30

What are the intracellular components of Rhabdomyolysis?

Answer 30

1. Potassium 2. Creatine Kinase (CK) 3. Myoglobin

Question 31

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?

Answer 31

Rhabdomyolysis

Question 32

Rhabdomyolysis Leakage of extracellular calcium ions into the intracellular space, this interaction leads to the interaction of ____ and ___ that ends in muscle destruction

Answer 32

1. Actin | 2. Myosin

Question 33

Large quantities of potassium, myoglobin and CK leak into circulation and leads to complications in what?

Answer 33

Rhabdomyolysis

Question 34

If large amounts of muscle is damaged the ____ released can precipitate in the kidneys and cause renal damage and obstruction

Answer 34

myoglobin

Question 35

These are causes if what? 1. Trauma or muscle compression (consider in patients found down for prolonged periods) 2. Crush injury 3. Prolonged restraints or immobilization 4. Compartment syndrome 5. Electrical injuries

Answer 35

Rhabdomyolysis

Question 36

What kind of rhabdomyolysis is marked physical exertion particularly when: 1. Individual is not conditioned 2. Hot humid conditions 3. Impaired sweating (heat stroke) 4. Seizures and delirium tremens 5. Meth and cocaine use

Answer 36

Exertional Rhabdomyolysis

Question 37

What kind of rhabdomyolysis is caused by the following? 1. Coma induced by drugs (opioids, alcohol (prolonged down period)) 2. Medications (statins can lead to rhabdo) 3. Toxins (snake venom and CO)

Answer 37

Non-exertional Rhabdomyolysis

Question 38

These are symptoms associated with what? 1. Muscle tenderness 2. Weakness 3. Edema 4. Dark urine (*coke) 5. Altered mental status may occur from underlying etiology

Answer 38

Rhabdomyolysis

Question 39

What is the lab hallmark in Rhabdomyolysis?

Answer 39

Elevated CK, typically five fold increase from normal

Question 40

These labs will be noted in what? 1. Urinalysis dipstick positive for blood however no red blood cells on microscopic exam. (test does not differentiate between myoglobin and hemoglobin) 2. Electrolyte abnormalities (*Hyperkalemia*) 3. EKG to evaluate electrolyte abnormalities (Hyperkalemia (causes peaked T waves))

Answer 40

Rhabdomyolysis

Question 41

What is the treatment for Rhabdomyolysis?

Answer 41

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

Question 42

When should you MEDEVAC a patient with Rhabdo?

Answer 42

1. Altered mental status 2. Temp >105 3. Unresponsive to IV fluids

Question 43

What are some complications of Rhabdomyolysis?

Answer 43

1. Acute renal failure, acute kidney injury 2. Compartment syndrome 3. Electrolyte abnormalities 4. Cardiac arrhythmias 5. Death