Environment Flashcards
What does box jelly fish skin look like
Extensive linear erythematous marks
Cardiovascular effect of box jelly fish sting
Hr up or down
Bp down.
Crepitations
Jvp elevated
Treatment of box jellyfish sting
Vinegar
Remove tentacles
Antivenom
4 indications for antivenom for box jelly fish
Cardiac arrest/ instability
Severe pain
Unconscious
Hypoventilation
Lake Louise criteria for acute mountain sickness
Ascent >2500 in unacclimatised person
3/4
1. Headache
2. GI symptoms
3. Fatigue and weakness
4. Dizziness/ lightheaded
Tx of AMS
Oxygen
descent >300m
Hydration
Acetazolomide 250mg po bd
What causes most high altitude deaths
High altitude pulmonary oedema
Physiology of HAPE
And sx
Non cardiogenic pulmonary oedema due to hypoxia leading to vasoconstriction and acute
pulmonary hypertension
Sx: non productive cough, pink frothy spurts develop sob, tachynea, cyanosis, crepitations and patchy opacities on cxr
Tx HAPE
Oxygen
Keep warm
Avoid exertion
Descent 500-1000m
Sublingual nifedipine 30mg po bd/ tds
HACE
High altitude cerebral oedema due
Progression neuro symptoms
Ataxia first
Reduced LOC — coma
Tx HACE
Dex 8mg stat 4mg QID
Oxygen >90%
Decent >1000m
Hyperbaric oxygen with Gamow bag
What organism is cause of cat scratch disease
Bartonella Henselae
Complications of cat bite
Abscess
Osteomyelitis
Tenosybovitis
Septic arthritis
Cellulitis
Microbiology of cat bite
Polymicrobial
Moraxella cattarrhalis
Pasteurella multicida
Strep
Staph
Anaerobes
Management of cat bite
Debride irrigate
Monitor for infection
Nil primary closure
Augmentin duo forte
ADT
Rule out FB
What is air embolism diving caused by
Symptoms
Rupture of air or nitrogen into pulmonary vein/ into left heart
Suspect in any diver LoC on ascent or within 10 mins or resurfacing
Pulmonary embolism like: sob, haemoptysis, chest pain
Stroke like: hemiplegia, dysarthria
AMI: chest pain, arrhythmia
Treatment of arterial air embolism
Supine position, oxygen
Hyperbaric chamber decompression
What two types of bad jelly fish
Box jelly fish
Irakundji
What on jelly fish release venom
Nematocytes
What stops nematocytes releasing venom
Hot water
Box jellyfish: acetic acid / vinegar
What is most common cause of death in lightening strike
Asystole
What symptoms physical can lightening strike cause
What is Lichtenberg signs
What is keraunparalysis
Lichtenberg: pathognomic - ferning pattern
keraunparalysis: temporary lower limb paralysis
Cataracts
Tympanic membrane rupture
What is different mass casualty with lightening compared to normal
Attend those with no signs of life first - CPR prolonged
Treatment of Lyme disease
Doxycycline 200mg po stat for prophylaxis
100’g po bd for 14-21 days
What is Lyme disease caused by?
Ixodes scapularis tick
Borrelia burgdorferi
Most common vector borne disease
Doxycycline in prophylaxis within 72 hours
Symptoms of Lyme disease
Stage 1: erythema migrans pathognomonic, viral like fever, fatigue, malaise, myalgia
Stage 2: myocarditis, bilateral facial nerve palsy- pathognomonic
Stage 3: chronic arthritis chronic encephalopathy
Sx/ slightly raised red lesion with central clearing - bulls eyes erythema migrans rash
What symptoms from diving to ear
Barotrauma barotitis
Descent -/ increase in pressure - ear pain and hearing loss- middle ear most common
Sx: severe ear pain, ear fullness, hearing loss, vertigo, nystagmus
Possible perforation
Symptoms of diving issues
Middle ear: barotrauma, Eustachian tube dysfunction: pain, haematola, TM rupture, vertigo
Inner ear; rupture of round window
Sinus squeeze: maxillary sinus most commonly effected, oedema, haemorrhage and pain
Dental pain: trapped air in cavity pain
Pulmonary: arterial gas embolism
Haemoptysis pneumothorax
What c spine injury caused by axial loading
Jefferson’s
What is decompression sickness
Dissolved nitrogen reforming gas bubbles in different tissues
Symptoms within 6 hours
Or post air travel
Pulmonary: sob, chest pain, cough the chokes
Msk: the bends/ arthralgis, myalgia
The staggers: vestibular: vertigo, tinnitus, nausea
Neuro: headache and ascending paralysis
Derm; pruritis, burning mottling
Risk factors for decompression sickness
Age
Rapid ascent
Obesity
Depth of dive
Multiple dives per day
Increased exertion
Air travel within 24 hours
3 types of decompression sickness
1: pain only msk and derm
2: serious pulmonary, cns, vestibular
3: combination of decompression and arterial air embolism
Treatment decompression sickness
Decompression
What risk factors for decompression sickness
Increasing depth of dive
Rapid ascent
Multiple dives in a day
Air flight soon after flight
Obesity
Alcohol
Symptoms of decompression illness
Occur within 6 hours
Dissolved nitrogen reforming into gas bubbles in different tissues
Msk: the bends: pain athralgia, myalgia
Pulmonary: the chokes: haemoptysis, chest pain sob cough
Neurological: vertigo, tinnitus, nausea: the staggers
Spinal cord: parenthesis, paralysis
Dermatological: pruritis, burning, skin bends
Skin mottling rash
Treatment of HAPE
Immediate descent
Oxygen
Nifedipine
Portable hyperbaric chamber
Symptoms of HAPE
Initial 2-4 days: subtle non productive cough soboe
Progression: sob, clear pink sputum, tachycardia, tachypnea, fever
Order of mountain sickness with heights
Acute mountain sickness >2000m
High altitude cerebral oedema > 3000m
High altitude pulmonary oedema >4500m
Conditions associated increase risk HAPE
Environment >2500m ascent rapid >1000m/day, cold exposure
Cardiac: anomalies increased pulmonary blood flow or increase pulmonary artery pressure,VSD, coarction aorta, CCF
Pulmonary: Chronic lung disease, hypoplastic lung, pulmonary htn, sleep apnea,
Infection: urti, pneumonia is, bronchitis, otitis medial
Pharmacological: alcohol, sympathomimetics
Systemic: Down’s syndrome premature birth : low birth weight
Treatment of barotitis
Middle ear trauma
Ear pain hearing loss nystagmus seventh nerve palsy
ABX if TM rupture
Rest
Nadal decongestants
Analgesia
Ent referral
Cold water immersion syndrome
Times
Stages
1: initial immersion: 3 mins: skin cooling
Cold shock during immersion thought to be cause of most feather
2: short term immersion: superficial neuro muscle cooling: muscle fatigue and swim failure
3: long term immersion >30 mins deep tissue cooling, hypothermia
4: post immersion collapse: during or after rescue
What environmental toxic exposures are indications for hyperbaric oxygen
Carbon monoxide and cyanide
When should prophylactic abx be given dog bite
Deep puncture wounds or lacerations
Associated crush injury
Involving hands/ feet/ genitalium
Delayed presentation >6hr
Wound close to bone
Wounds closed primarily
Immunocompromised: or no spleen
Patient allergic to what abx risk allergy to acetazolmide
Sulfa
Which snackes causes coagulpathy
Brown
Tiger
Taipan
Roughscale
Red bellied
Black mulga
What pathological effect does antivenom work against in snackes
Established post synaptic paralysis- taipan
Pre synaptic paralysis- death adder
Anticoagulant coagulopathy
Rhadbo
Thrombotic micro angiopathy
What pathological effect does antivenom work against in snackes
Established post synaptic paralysis- taipan
Pre synaptic paralysis- death adder
Anticoagulant coagulopathy
Rhadbo
Thrombotic micro angiopathy
Methods of cooking in hypothermia
Evaporation: tepid water spray and fan: easy accessible, can do in combination, nil pain/ invasive, negative: equipment water - electricity
Ice packs: non invasive, easy -ve shivering discomfort
Gastric lavage: effective and rapid, invasive
What type of toxic has blue ring octopus and how does it work
Teratotoxin
Rapids progressive ascending flaccid paralysis
Early: oral parasethesia, ptosis, diplopia, blurred visual
Late: descending flaccid paralysis
Resp failure
Treatment blue ringed octopus
No antivenom
Intubation and ventilation
Paralysis usually resolved 24 hours
What sea life causes collapse on Australia beach
Box jelly fish: collapse and sudden death: arrhythmia
Sea snake: post synaptic neurotoxin descending flaccid paralysis
What complications of hyperthermia
Muscular: shivering
Neurological: loc, confusion, seizures
Cardiac: arrythmia
Resp: ards,
Renal: aki rhabdo
GIT: hepatitis
Metabolic: high K, high Na, low Ca,
Haem: dic
Methods of cooling
Evaporation: simple effective, non invasive and readily available
Ice packs: readily viable non invasive, need to be replaced
Immersion: effective but not practical
Cooled fluids readily available not effective
Cold gastric lavage effective but impractical intubated
Cold peritoneal lavage
ECMO
DDX hyperthermia
Heat stroke
Sepsis
CNS infection
Toxidrome
Drug withdrawal
Neuro - iCH
Endocrine thyroid storm
Complications of hypothermia
Resp: depression, suppressed gag/ cough reflex
Cardiac: bradycardia: hypotension
CNS: reduced LoC, seizure
Renal: aki/ rhabdo
Metabolic met and resp acidosis
Pancreatitis
Hypothermia ALS
Resistance to DC shocks
Aggressive rewarming
No proven benefit of antiarrythmic drugs
High suspicion of early treatment metabolic high k
Prolonged resuscitation
Definition of heat wave
3 days of more of sustained high max and high min temps that unusual for location
Lead to adverse events on health
drugs that interfere with heat stroke make worse
Interfere sweating: BB, anticholinergics, antihistamines
Interfere thermoregulation: sSRIs, stimulants, thyroxine
Reduce thirst: ACEi, haloperidol
Dehydration: diuretics, alcohol
Reduce renal function: nsaids
Reduced Loc; alcohol benzodiazepines
4 risk factors for classic non exertions heat stroke
1 environment: prolonged heat exposure
Situational: lack of aclimitisarion, red oral intake
Pt related: elderly, young, poor health alcohol
Meds: serotenergics
Medical: sepsis comorbidities
Swiss staging hypothermia
Stage 1: conscious and shivering
Stage 2: impaired consciousness and not shivering 28-32
Stage 3: unconscious and not shivering 24-28
Stage 4: cardiac arrest <24
3 ways to transport decompression illness and pro/ con
Road ambulance: no change in pressure, slower
Helicopter: unpresurised cabin, can land near hospital
Fixed wing: pressurised cabin but slower/ park further away
3 modification in ALS hypothermic
Defib- withold until >30
Drugs >withhold until > 30 then double dosing interval
Duration: good survival >2 hours prolong d cpr
Heroic measures: early ECMO
Effect of hypothermia on
CVS
Resp
Renal
Metabolic
CVS; hypotension, afib
Resp: depression hypoventilation
Renal: duiresis
Metabolic: hypoglycaemia
How long observe snakebite for
12 hours post
Ensure no neurotoxicity
Normal 12 hour coags and CK
Parents have access back to hospital
2 blood tests in snake bite
Coags
Ck
Signs of snake envenomation
Neurotoxicity: paralysis, progressive descending paralysis, ptosis, resp muscle
Mytoxicity: muscle pain, tenderness CK myoglobinuria
CVS: sudden collapse, cardiac arrest, dizziness, hypotension
Coagulopathy; local site bruising/ bleeding, ICH, GI, genitourinary
Other: renal failure local pain swelling
Lab results venom induced consumptive coagulopathy
Increase INR/ PT
Increase D Dimer
Low unrecordable fibrinogen
Role of venom detection kit
Where test
Swab- best
Urine
Blood
To assess for type of antivenom not confirmation of envenomatiob
Absolute indication for anti venom
Relative
Hx sudden collapse
Abnormal INR
Evidence of paralysis with ptosis and or ophthalmolegia
Systemic symptoms
Abnormal aptt
CK>1000
Leucocytosis
Risk factors decompression illness
Increase dive duration
Multiple dives
Dehydration
Strenuous exerezuze
Cold
Ascent to altitude
Alcohol
Obesity
Smoking
Antivenom babies
Pregnancy
Doesn’t change 1 vile
Less volume for kids
Indications for ECG monitoring in patient with electrical injury
High voltage
Loss of consciousness
Seizures
ECG changes arrhythmia
Burns
Conn and model classification for neurological function
A: awake
B: conscious but obtunded
C comatose
Poor prognosis in drowning
Submersion >10 min
GCS <5
cPR>25 mins
VT/VF on
Fixed dilated pupils
Resuscitation cease in drowning
1 hour post rescue cpr if not hypothermic
Serum k>11
