Emergency Medicine

Question 1

What are the three causes of burns?

How should all burns be managed initially?

Answer 1

thermal, chemical, or electrical

management:

• ABCs
  
  • give 100% O2 in the setting of a fire until carboxyHg from CO is ruled out
• IV fluids (LR)
• removal of all clothing or smoldering items on the body
• copius irrigation of chemical burns

Question 2

What are the important sequelae of electrical burns?

What should you do in this setting?

Answer 2

with electrical burns, most of the tissue destruction is internal, resulting in

• muscle necrosis
• myoglobinuria
• acidosis
• renal failure

Use large amounts of IV hydration to prevent renal shutdown

Get ECG because the immediate life-threatening risk associated with electrical shock and burn (e.g., from lightning or household outlets) is cardiac arrhythmias

Question 3

How are chemical burns managed? Which is worse, acid or alkali burns?

Answer 3

copius irrigation

Alkali burns are worse because alkaline substances penetrate more deeply

Question 4

What is burned skin prone to develop?

what should you do in this case?

Answer 4

Infections, usually by Staphylococcus aureus or Pseudomonas aeruginosa

Prophylactic topical antibiotics + tetanus booster to all burn patients unless they have recently received one (within the past 5 years)

Question 5

How is burn severity classified?

Describe the management of each class.

Answer 5

Burn depth terminology no longer includes the use of first-, second-, and third-degree burns. Burn severity is now classified as:

• Superficial burns (previously 1˚) - erythematous w/o blister formation, involve only the epidermis, and pain is localized.
• Partial (previously 2˚)
  
  • superficial - burns are painful, warm, and moist with blister formation and involve the epidermis and superficial papillary dermis.
  • deep - burns reveal skin that is mottled, waxy, and white in appearance with ruptured blisters. Pain sensation is absent, but pressure sensation is intact.
• Full thickness (previously 3˚) - burns involve both the epidermis and dermis, have a white to gray leathery appearance, and do not blanch with pressure

Question 6

Define hypothermia. How is it managed? What are the complications and management?

Answer 6

<95°F (35°C)

complications:

• mental status changes
• generalized neurologic deficits
• sinua bradycardia (+ J wave) and arrhythmias

management:

• if conscious: rewarm patient slowly with blankets
• if unconscious: gastric + bladder lavage with warm water, give warm IV fluids
• montior ECG

Question 7

Distinguish between frostnip and frostbite. How are they managed?

Answer 7

frostnip - mild form of cold injury, the affected skin is cold and painful

frostbite - more severe form of cold injury, the skin is cold and numb

Treat both with warming of the affected areas, using warm water (not scalding hot), and generalized warming (e.g., blankets).

Question 8

True or false: You should not give up resuscitation efforts until the patient is fully warmed in the setting of hypothermic cardiac arrest.

Answer 8

True

Hypothermia can slow body function to a remarkable degree, and there are case reports of resuscitation hours after initial attempts in the field once the body was warmed.

Question 9

Define hyperthermia. What causes it? How is it managed?

What should you be most concerned about and how should these be managed?

Answer 9

>104˚F

3 primary causes: infections, medications, heat stroke

treatment: immediate cooling (e.g., wet blankets, ice, cold water), rule out infection and medications (especially those with anticholinergic activity such as antihistamines, antipsychotics, and antidepressants) as the cause.

immediate threats: convulsions (treat with diazepam) and cardiovascular collapse

Question 10

What are the two classic examples of hyperthermia caused by medication?

Answer 10

Malignant hyperthermia - genetically related reaction to general anesthesia, usually caused by succinylcholine or halothane exposure.

• Treat with dantrolene.

Neuroleptic malignant syndrome - genetically related reaction to an antipsychotic: rigidity, myoglobinuria, autonomic instability, hyperpyrexia.

• Stop offending medication, treat with IVF to prevent AKI secondary to rhabdomyolysis, and give dantrolene, D2 agonists (e.g., bromocriptine).

Question 11

How are patients managed after a near-drowning episode?

Answer 11

if unconscious -> intubate

if conscious -> get ABG

Question 12

What are toxidromes?

Describe the toxidromes associated with cholinergic crisis, anticholinergic crisis, sympathomimetics, and opiates.

Answer 12

Toxidromes are syndromes caused by dangerously high levels of toxic substances in the body.

• Cholinergic crisis classically develops with SLUDG (excessive Salivation, Lacrimation, Urination, Defecation, and Gastrointestinal activity). Also look for pinpoint pupils and decreased heart rate.
• Anticholinergic crisis develops with a patient who is blind as a bat (eye muscles unable to focus), hot as a hare (temperature dysregulation), mad as a hatter (CNS disturbances), dry as a bone (decreased secretion of bodily fluids), and red as a beet (flushing). Also look for dilated pupils and increased heart rate.
• Sympathomimetics can cause hypertension, tachycardia, increased activity, anxiety, dilated pupils, diaphoresis, and possibly altered mental status.
• Opiates cause coma, pinpoint pupils, and respiratory depression. Also look for bradycardia and hypotension.

Question 13

Name the antidote for each of the poisonings or overdoses listed

Answer 13