CLINICAL CARE FOR EMERGENCIES

Question 1

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

Answer 1

anaphylaxis.

Question 2

anaphylaxis: single most important step in treatment is the rapid administration of what?

Answer 2

EPI

Question 3

What is the preferred route for EPI

Answer 3

IM

Question 4

ANAPHYLAXIS
Management steps

Answer 4

(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

Question 4

2nd Line Therapies for anaphylaxis

Answer 4

(a) Corticosteroids
–1)Methylprednisolone (Solumedrol) 125mg IM/IV daily x 2 days
(b) Antihistamines

Question 5

Tx for Allergic Bronchospasm

Answer 5

Nebulized albuterol
-5mg q 15-30m prn

Question 6

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)

Answer 6

Drug Allergy
1) Stop the medication
2) Determine if actual allergy vs known drug reaction
3) Antihistamines
4) Corticosteroids
5) internal Medicine/Allergist referral

Question 7

What is the preferred antihistamine agent for anaphylaxis?

Answer 7

Diphenhydramine (Benadryl) - 25-50 mg IV

Question 8

________ is the leading cause of smoke inhalation injuries

Answer 8

Fire

Question 9

_______ 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)

Answer 9

Tracheobronchial tree

Question 10

_______: injury to the lung tissue, usually a delayed process.
(a) Results in alveolar collapse and impaired oxygenation.
(b) Risk for pneumonia

Answer 10

Parenchymal injury

Question 11

Systemic toxicity - caused by breathing toxic substances. Two most relevant gases are _____ and ______

Answer 11

carbon monoxide and hydrogen cyanide.

Question 12

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

Answer 12

CO

Question 13

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

Answer 13

Hydrogen cyanide

Question 14

Causes of rhabdo

Answer 14

(a) Trauma,
(b) Crush injury,
(c) Prolonged restraints or immobilization,
(d) Compartment syndrome,
(e) Electrical injuries.

Question 15

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

Answer 15

Rhabdomyolysis

Question 16

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

Answer 16

Exertional Rhabdomyolysis

Question 17

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)

Answer 17

Non exertional Rhabdomyolysis

Question 18

Labs for rhabdo

Answer 18

1. CK (elevated) hallmark
2. UA dipstick positive for blood
3. Electrolyte abnormalities (*Hyperkalemia)
4. EKG to evaluate electrolyte abnormalities (Hyperkalemia (causes peaked T waves))