CLINICAL CARE FOR EMERGENCIES Flashcards
What issue?
(1) Classic Presentation
-(a) Pruritis
-(b) Flushing
-(c) Urticaria
(2) Progression
-(a) Throat fullness (lump sensation)
-(b) Anxiety
-(c) Chest tightness, SOB, Lightheadedness
(3) Severe reaction
-(a) Loss of consciousness
-(b) Cardiorespiratory arrest
(4) Signs and symptoms begin within 60 mins of exposure
(5) The faster the onset, the more severe the reaction
anaphylaxis.
anaphylaxis: single most important step in treatment is the rapid administration of what?
EPI
What is the preferred route for EPI
IM
ANAPHYLAXIS
Management steps
(a) REMOVE AGENT
(b) Primary Survey
(c) IV/IO, O2, monitor, lines
(d) EPINEPHRINE 0.5 mg IM
(e)Bolus with NS or LR
(f) Secondary Survey
(g) MEDEVAC/MEDAVICE
2nd Line Therapies for anaphylaxis
(a) Corticosteroids
–1)Methylprednisolone (Solumedrol) 125mg IM/IV daily x 2 days
(b) Antihistamines
Tx for Allergic Bronchospasm
Nebulized albuterol
-5mg q 15-30m prn
What issue/Tx
Hx of new medication
(a) Usually within the first or second week
(b) Pruritus
(c) Urticaria
(d) Fever
(e) Erythema
(f) Angioedema
(g) Stevens-Johnson (SJS) or toxic epidermal necrolysis (TEN)
Drug Allergy
1) Stop the medication
2) Determine if actual allergy vs known drug reaction
3) Antihistamines
4) Corticosteroids
5) internal Medicine/Allergist referral
What is the preferred antihistamine agent for anaphylaxis?
Diphenhydramine (Benadryl) - 25-50 mg IV
________ is the leading cause of smoke inhalation injuries
Fire
_______ usually caused by chemicals in the smoke.
(a) These chemicals can lead to pulmonary edema and subsequent mismatches in ventilation and perfusion within the lungs (which causes hypoxemia)
Tracheobronchial tree
_______: injury to the lung tissue, usually a delayed process.
(a) Results in alveolar collapse and impaired oxygenation.
(b) Risk for pneumonia
Parenchymal injury
Systemic toxicity - caused by breathing toxic substances. Two most relevant gases are _____ and ______
carbon monoxide and hydrogen cyanide.
What gas?
1) Frequent cause of death and most common complication after inhalation injury
2) Colorless and odorless gas
3) Affinity for hemoglobin 260 times greater than oxygen
CO
What gas?
1) colorless and odor of bitter almonds
2) Difficult to screen for and treatment should be considered in all inhalation injuries
3) Treatment should be initiated patients who are at risk and who display altered mental status, cardiac arrest or signs of heart failure
Hydrogen cyanide
Causes of rhabdo
(a) Trauma,
(b) Crush injury,
(c) Prolonged restraints or immobilization,
(d) Compartment syndrome,
(e) Electrical injuries.
Symptoms and Exam for what issue?
(1) Muscle tenderness
(2) Edema
(3) Muscle weakness
(4) Dark urine (*Coca Cola urine)
(5) Altered mental status may occur from underlying etiology
Rhabdomyolysis
What issue?
Marked physical exertion particularly when:
(a) Individual is not conditioned (New recruits)
(b) Hot humid conditions
(c) Impaired sweating (heat stroke)
(d) Seizures and delirium tremens
(e) Methamphetamine and cocaine use
Exertional Rhabdomyolysis
What issue?
(a) Coma induced by drugs (opioids, alcohol that lead to a prolonged “down” period)
(b) Medications (statins though they more commonly cause myalgias. Can lead torhabdomyolysis)
(c) Toxins (snake venom & CO)
Non exertional Rhabdomyolysis
Labs for rhabdo
- CK (elevated) hallmark
- UA dipstick positive for blood
- Electrolyte abnormalities (*Hyperkalemia)
- EKG to evaluate electrolyte abnormalities (Hyperkalemia (causes peaked T waves))
