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DipPEC 2025 > Enviro > Flashcards

Enviro Flashcards

1
Q

Datura stramonium (malpitte)
Datura brugmansia (moonflower)

A

Anticholinergic
Activated charcoal
If severe - physostigmine

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2
Q

Philodendron (elephant ear)
Monstera deliciosa (delicious monster)
Dieffenbachia (dumb cane)
Zantedechia (arum Lilly)

A

Calcium oxalate crystals and proteolytic enzymes

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3
Q

Nerium oleander

A

Presentation similar to digoxin
Contains Cardiac glycosides
Hyperkalaemia indication of severity
Digoxin-specific fab fragments

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4
Q

Ricinus communis (castor oil plant)

A

Ricin is cardio/renal/hepatotoxic
Vomiting then bloody diarrhea
Supportive Mx

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5
Q

Melia azedarah (syringa tree)

A

Yellow berries
Vomiting, respiratory distress, dilated pupils and seizures
Supportive Mx

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6
Q

Traditional herbs
Callilepis laureola (impila)

A
  • liver failure
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7
Q

Ceroctis capensis (blister beetle)

A

Used for aphrodisiac and induce abortion
Renal failure/ haematuria

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8
Q

Urginea sanguinea (sekanama or slangkop)

A

Large onion like bulbous plant
Used for tiredness, erectile dysfunction, venereal disease and “cleansing”
Cardiac glycosides !
Digoxin fab fragments

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9
Q

Amanita phalloides ( death cap )

Similar: galerina and gyromitra

A

Sx 6-18hrs later
GIT then apparent recovery
Hepatic and renal failure
Mx:
1. MDAC charcoal
2. NAC
3. Pen G (receptor competitor )
4. Antidote - Silibinin
5. Dialysis or liver transplant

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10
Q

Psilocybe (magic mushrooms)

A

Contain psilocybin - LSD like toxin
Supportive Mx

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11
Q

Amanita muscaria (Mario brothers)
Amanita panterina

A

Sx after 1-3hrs
Anti-muscarinic and psychoactive Sx
If severe anticholinergic Sx - physostigmine

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12
Q

Clitocybe and Inocybe

A

Organophosphate like Sx
30 min -2hrs onset
Can use single dose atropine

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13
Q

Oleander
Foxglove
Lilly of the valley

A

Digoxin like toxicity

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14
Q

Bella Donna (deadly nightshade)
Brugmansia (angels trumpet)
Mandrake
Jimson weed (malpitte)

A

Anticholinergic toxidrome

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15
Q

Cat bite

A

Pasturella multocida
Bartonella henselae
Rx:
augmentin
Or ciprofloxacin (penicillin allergy)
Tetanus

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16
Q

Dog bite

A

Capnocytophagia caninorsus
Rhabdovirus (rabies)
Rx
Augmentin
Tetanus

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17
Q

Human bite

A

Eikenella corrodens
Mx:
Augmentin
Tetanus

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18
Q

Snakebites covered by PVA polyvalent antivenom

A

One: rinkals
Two: adders (Puff and Gaboon)
Three: mambas (Black, Green, Jamesons)
Four: Cobras (Mozambique, Snouted/Egyptian, Forest, Cape)

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19
Q

Monovalent antivenom snake ?

A

Boomslang

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20
Q

Snakes according to toxidrome

A

Cytotoxic:
- Adders
- spitting cobras (rinkhals, Mozambique)
-stilleto

Neurotoxic:
- mambas
- nonspitting cobras (black mamba and cape cobra)

Haemotoxic:
- Boomslang

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21
Q

Poisonous snakes without antivenom

A

Vine snake
Stilletto snake
Rhombic snake
Berg adder

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22
Q

Risk of anaphylaxis to antivenom

A

Subcutaneous adrenaline 0.25ml (1:1000)

23
Q

Thick tail Scorpion - parabuthus spp

A

Neurotoxic - excitability
Bulbar paralysis
Autonomic instability

Mx: scorpion antivenom
NOT with prophylactic adrenaline due to autonomic instability
Ca for muscle crampsn

Monitor for dysrrhythmias and pancreatitis

24
Q

Anaphylaxis treatment?

A

Adrenaline 1mg/ml 0.01mg/kg
Max 0.5ml
IMI anterolateral thigh
Every 5-15mins

+ promethazine
+ hydrocortisone
+ cimetidine
+ nebulise
Or glucagon if not responding to adrenaline

25
Widow/ Button spiders (lactrodectus)
Calcium Antivenom Neurotoxic: Autonomic instability Muscle cramps eg confused for Acute abdomen
26
Cytotoxic spiders ? NO antivenom Dapsone chronic non healing infection
Loxosceles parrami (Violin spiders) Cheiracanthium (sac spiders) Sicarius (six eyed crab spider) - cyctotoxic and haemotoxic
27
Scombroid poisoning
Not well refrigerated Bacteria results in high levels of histamine Eg Tuna /Mackerel Sx peppery taste NV Diarrhea
28
Ciguatera poisoning
Temperature reversal Hot feels like cold
29
Marine stings
30
Altitude Sickness types
AMS (headaches + …) Rx: antiemetic ibuprofen Prevention: acetazolamide 125mg bd/ dexamethasone and acclimatization HAPE ( 2x Sx and signs) Rx: descend! and Nifedipine Prevention: acclimatization and Nifedipine/ sildenafil HACE (AMS + cerebral dysfunction) Rx: descend ! And acetazolamide and dexamethasone Prevention: acetazolamide 125mg bd/ dexamethasone and acclimatization
31
Decompression sickness Gas Laws
Pascal Law - pressure transmitted equally Boyles Law - decrease P and increased volume NB ascent associated trauma Exhale on ascent ! Charles Law - volume and temp correlate eg cooling tank to decrease P General Gas Law - P V T Daltons Law - nitrogen behaves as if the only gas Henry’s Law - high P results in increased solubility
32
Nitrogen narcosis ?
Drunk at depth Martini rule
33
Ear barotrauma vs decompression sickness ?
vertigo, hearing loss, tinnitus On descent vs ascent Hooyah tool
34
Decompression sickness
Type 1: cutaneous, lymph, MSK Type 2: cerebral, spinal, pulmonary, circulatory Risk factor: patent foramen ovale Mx: for both types -> hyperbaric O2
35
Type 1 DCS skin finding
cutis marmorata
36
DCS names Muscle Inner ear Pulmonary Neurological
Muscle - the bends (bedside test with BP cuff improving Sx) Inner ear - the staggers Pulmonary - the chokes Neurological - neurologic DCS
37
Arterial Gas Embolism
DDx: CNS DCS Same treatment
38
Drowning
Fatal and nonfatal Amount of fluid = prognostic Rescue breaths ABC/NIV/intubation and ventilation ECMO
39
Hypothermia <35 degrees Swiss staging ?
Sx correlates with temperature range
40
Hypothermia CPR
<30 degrees - one defib and no adrenaline If bradycardia - rewarm and not atropine >30 degrees - as usual
41
Contraindications to start CPR in hypothermia?
Obvious lethal injury Frozen body especially chest Hyperkalaemia 10-12 Avalanche: airway packed with snow >35mins
42
Rewarding methods
Passive: environment Active: Noninvasive- heating pads/ IV fluids/ warm O2 Invasive - ECMO / bladder and thoracic lavage
43
ECG changes hypothermia?
Osborn waves ( J waves) Bradycardia Quivering baseline
44
Declared dead at what temp ?
35 degrees
45
Freezing and non freezing injuries
Non freezing: chillblain/pernio, frostnip, cold urticaria Freezing: frostbite
46
Frostbite stages
Pre freeze Freeze Thaw Vascular stasis and ischaemia Avoid freeze to thaw back to freeze ! Worse outcomes
47
Frostbite classification
First degree (partial thickness) - numbness erythema swelling Second degree (full thickness) - clear blister with oedema Third degree (tissue loss- skin) - haemorrhagic blisters Fourth degree (tissue loss - extends to subcut and muscle etc) - gangrene, Eshar, cyanosis, mortling *Specific staging for hands and feet
48
Rewarming Mx
NB analgesia Warm circulating water 37-39 degrees
49
Trench foot
Cold and wet weather exposure (Nonfreezing cold injury) Increases skin and tissue breakdown Tingling/itching/numbness Risk of gangrene Mx: - rewarming - analgesia
50
Hyperthermia types and Mx
Minor: - Milia (prickly heat) - staph - heat cramp - Heat syncope Major: >40 degrees - heat exhaustion = tired weak syncope - Heatstroke = heat exhaustion plus neurological dysfunction , DRY skin , increased LFTS. Mx: immersive ice or evaporation to 38/39 degrees then stop
51
Electrical injuries types
AC worse than direct current 1. Entry and exit 2. Arc or kissing burns 3. Thermal burns 4. Flash burns Lighting - direct - indirect
52
High voltage or lightning injuries ?
CVS: arrhythmia/ asystole Resp: prolonged apnea (medulla) CNS: pupils fixed and dilated, haemorrhage, keraunoparalysis (temporary and looks like threatened limb) ENT: perf TM, eye injuries MSK: rhabdo, compartment syndrome
53
Lichtenberg figures
54
Radiation exposure ?
Wash down Lymphocyte count at 48hrs

DipPEC 2025 (21 decks)

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