Day 3 - EM1 Accidents/Injury

Question 1

Burn -painful, erythema, no blisters, capillary refill intact

Answer 1

1st degree burn: Superficial (only epidermis) or superficial partial thickness (epidermis & partial thickness of dermis)

Question 2

Burn - painful, erythema, blisters, capillary refill intact

Answer 2

1st degree burn: Superficial partial thickness (epidermis & partial thickness of dermis)

Question 3

Types of 1st degree burn

Answer 3

1st degree burn: Superficial (only epidermis) or superficial partial thickness (epidermis & partial thickness of dermis)

Question 4

Burn - painful, erythema, blisters, no blanching with pressure

Answer 4

2nd degree burn: deep partial thickness (epidermis, deeper dermis)

Question 5

Burn - painless, white or charred, no blanching with pressure

Answer 5

3rd degree burn: entire epidermis & dermis with possibly deeper tissue

Question 6

Type of burns assoc. w/ electric shock injuries

Answer 6

4th degree burn: entire epidermis & dermis with muscle &/or bone involvement

Question 7

Complications may arise from electrical burns

Answer 7

Internal damage may be worse than external damage, Cardiac dysrhythmias, Compartment syndrome (muscle tissue swelling in muscle compartment, blocking blood entry), Myoglobinuria, Acidosis, Rhabdomylosis & renal failure, Various neuro. disturbances

Question 8

Unique mgt. of electrical burns

Answer 8

Aggressive IV fluids (prevent myoglobinuira, renal failure, acidosis); HIgh suspicion for compartment syndrome; EKG & monitor for dysrhythmias

Question 9

When to transfer pt to burn service

Answer 9

Full-thickness burn > 5%, Partial-thickness burn > 10% need inpatient care; Burn to face, genitals, perineum, circumferential (risk of compartment syndrome), electrical/lighting injury, inhalation injury, fracture/trauma assoc, prior med/psych issues

Question 10

Common life-threatening complications in pt w/ substantial burns

Answer 10

Inhalation injury, hypovolemia, sepsis/pseudomonal wound infx, renal failure, cardiac dysrhythmias

Question 11

Near drowning mgt

Answer 11

ABC, eval. for head/spine injuries and illicit drug use, hypothermia - remove clothing & rewarm (patient not dead until warm & dead), NGT placement, monitor hospital for at least 8 hrs - electrolytes, diuresis/bronchodilators PRN, seizures - phenytoin

Question 12

Tx heat stroke

Answer 12

ABC, confirm temp (rectal if possible), O2, cool patient (ice packs neck, groin, axilla), continuous fanning & spraying of skin w/ lukewarm water (evaporation most effective), cool gastric lavage or cold IV fluids; IVF - 2 L NS bolus w/ goal of MAP of at least 60; Seizures - phenytoin; Acetaminophen and NSAIDs ineffective (hypothalamus set up is not underlying problem)

Question 13

Black widow spider bite tx (mild-moderate)

Answer 13

Mild skin rxn: resolve in 2cm: 5-7 days of corticosteroids; Ulceration: wound care, debridement; S/sx of infx or abscess: antibx (usually oral arithromycin); Consider dapsone (to reduce extent of necrosis due to leukocyte inhibitory properties, rule out G6PD def first)

Question 14

Lactrodectism - s/sx & tx

Answer 14

Systemic sx assoc. w/ severe bite from black widown spider - muscle spasms, stiffness, autonomic dysfunction; Tx Calcium gluconate for muscle pain, Benzos for mental status change, Steroids, Nitrates for HTN, Methocarbamol for muscle spasm, Analgesics for pain, Antivenom within 30 min of bite

Question 15

Tx dog or cat bites

Answer 15

Clean (may use iodine), copious pressure irigation (normal saline), plain film bite (no foreign materials such as bone fragments); NOT close w/ sutures if hand, facial wounds should be sutured (due to low rate of infx - well perfused); Tetanus toxoid; Rabies ppx if animal cannot be observed for next 10 days; Antibx 10-14 days, especially if hand bites/deep puncture wounds/cat or human bites (clindamycin w/ fluoroquinolones, clindamycin w/ TMP-SMX, etc.); Photos; If child, f/u for psych assessment of PTSD (more likely in child that have bites)

Question 16

When to leave bite wound open

Answer 16

Infx more likely in cat than dogs, wet food rather than dry food, presentation more than 64 hrs after bite to legs or arms, more than 12-24 hrs after bite to face, host immunocompromised (DM, on steroids, etc.)

Question 17

Mgt of infected cat/dog bite

Answer 17

Wound culture both anaerobic and aerobin; F/u 24 h & daily for progressing resolution (to make sure no surgical debridement necessary); Antibx; Hand surgery consult if hand wound; If severe systemic sx or cellulitis - hospitalize for IV Antibx;

Question 18

Indications for tetanus booster in adults

Answer 18

Every adult every 10 years; Tdap (acellular pertussis) booster 1x in nplace of Td (ages 19-64); Burn wounds, trauma injuries, bites, stings - Td; Non-tetanus prone wound, Tetanus status unknown or Less than 3 prior Td immunizations - Td booster & complete series; Non-tenaus prone wound, More than 3 prior boosters & more than 10 years since last dose - Td booster; Tetanus prone wound (Dirt, contamination, puncture wound, crushed component), status uncertain or less than 3 prior - Tetanus toxin & immunoglobin; Tetanus prone wound only, lower criteria to 5 years since last dose - Tetanus toxin