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F24 > Environment > Flashcards

Environment Flashcards

1
Q

What does box jelly fish skin look like

A

Extensive linear erythematous marks

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2
Q

Cardiovascular effect of box jelly fish sting

A

Hr up or down
Bp down.
Crepitations
Jvp elevated

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3
Q

Treatment of box jellyfish sting

A

Vinegar
Remove tentacles
Antivenom

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4
Q

4 indications for antivenom for box jelly fish

A

Cardiac arrest/ instability
Severe pain
Unconscious
Hypoventilation

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5
Q

Lake Louise criteria for acute mountain sickness

A

Ascent >2500 in unacclimatised person
3/4
1. Headache
2. GI symptoms
3. Fatigue and weakness
4. Dizziness/ lightheaded

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6
Q

Tx of AMS

A

Oxygen
descent >300m
Hydration
Acetazolomide 250mg po bd

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7
Q

What causes most high altitude deaths

A

High altitude pulmonary oedema

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8
Q

Physiology of HAPE
And sx

A

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

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9
Q

Tx HAPE

A

Oxygen
Keep warm
Avoid exertion
Descent 500-1000m
Sublingual nifedipine 30mg po bd/ tds

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10
Q

HACE

A

High altitude cerebral oedema due
Progression neuro symptoms

Ataxia first
Reduced LOC — coma

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11
Q

Tx HACE

A

Dex 8mg stat 4mg QID
Oxygen >90%
Decent >1000m
Hyperbaric oxygen with Gamow bag

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12
Q

What organism is cause of cat scratch disease

A

Bartonella Henselae

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13
Q

Complications of cat bite

A

Abscess
Osteomyelitis
Tenosybovitis
Septic arthritis
Cellulitis

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14
Q

Microbiology of cat bite

A

Polymicrobial

Moraxella cattarrhalis
Pasteurella multicida
Strep
Staph
Anaerobes

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15
Q

Management of cat bite

A

Debride irrigate
Monitor for infection
Nil primary closure
Augmentin duo forte
ADT
Rule out FB

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16
Q

What is air embolism diving caused by
Symptoms

A

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

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17
Q

Treatment of arterial air embolism

A

Supine position, oxygen
Hyperbaric chamber decompression

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18
Q

What two types of bad jelly fish

A

Box jelly fish

Irakundji

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19
Q

What on jelly fish release venom

A

Nematocytes

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20
Q

What stops nematocytes releasing venom

A

Hot water
Box jellyfish: acetic acid / vinegar

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21
Q

What is most common cause of death in lightening strike

A

Asystole

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22
Q

What symptoms physical can lightening strike cause

What is Lichtenberg signs
What is keraunparalysis

A

Lichtenberg: pathognomic - ferning pattern

keraunparalysis: temporary lower limb paralysis

Cataracts
Tympanic membrane rupture

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23
Q

What is different mass casualty with lightening compared to normal

A

Attend those with no signs of life first - CPR prolonged

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24
Q

Treatment of Lyme disease

A

Doxycycline 200mg po stat for prophylaxis
100’g po bd for 14-21 days

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25
Q

What is Lyme disease caused by?

A

Ixodes scapularis tick
Borrelia burgdorferi

Most common vector borne disease
Doxycycline in prophylaxis within 72 hours

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26
Q

Symptoms of Lyme disease

A

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

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27
Q

What symptoms from diving to ear

A

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

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28
Q

Symptoms of diving issues

A

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

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29
Q

What c spine injury caused by axial loading

A

Jefferson’s

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30
Q

What is decompression sickness

A

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

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31
Q

Risk factors for decompression sickness

A

Age
Rapid ascent
Obesity
Depth of dive
Multiple dives per day
Increased exertion
Air travel within 24 hours

32
Q

3 types of decompression sickness

A

1: pain only msk and derm

2: serious pulmonary, cns, vestibular

3: combination of decompression and arterial air embolism

33
Q

Treatment decompression sickness

A

Decompression

34
Q

What risk factors for decompression sickness

A

Increasing depth of dive
Rapid ascent
Multiple dives in a day
Air flight soon after flight
Obesity
Alcohol

35
Q

Symptoms of decompression illness

A

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

36
Q

Treatment of HAPE

A

Immediate descent
Oxygen
Nifedipine
Portable hyperbaric chamber

37
Q

Symptoms of HAPE

A

Initial 2-4 days: subtle non productive cough soboe

Progression: sob, clear pink sputum, tachycardia, tachypnea, fever

38
Q

Order of mountain sickness with heights

A

Acute mountain sickness >2000m

High altitude cerebral oedema > 3000m

High altitude pulmonary oedema >4500m

39
Q

Conditions associated increase risk HAPE

A

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

40
Q

Treatment of barotitis

A

Middle ear trauma
Ear pain hearing loss nystagmus seventh nerve palsy

ABX if TM rupture
Rest
Nadal decongestants
Analgesia
Ent referral

41
Q

Cold water immersion syndrome
Times

A

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

42
Q

What environmental toxic exposures are indications for hyperbaric oxygen

A

Carbon monoxide and cyanide

43
Q

When should prophylactic abx be given dog bite

A

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

44
Q

Patient allergic to what abx risk allergy to acetazolmide

A

Sulfa

45
Q

Which snackes causes coagulpathy

A

Brown
Tiger
Taipan
Roughscale
Red bellied
Black mulga

46
Q

What pathological effect does antivenom work against in snackes

A

Established post synaptic paralysis- taipan
Pre synaptic paralysis- death adder
Anticoagulant coagulopathy
Rhadbo
Thrombotic micro angiopathy

47
Q

What pathological effect does antivenom work against in snackes

A

Established post synaptic paralysis- taipan
Pre synaptic paralysis- death adder
Anticoagulant coagulopathy
Rhadbo
Thrombotic micro angiopathy

48
Q

Methods of cooking in hypothermia

A

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

49
Q

What type of toxic has blue ring octopus and how does it work

A

Teratotoxin
Rapids progressive ascending flaccid paralysis
Early: oral parasethesia, ptosis, diplopia, blurred visual
Late: descending flaccid paralysis
Resp failure

50
Q

Treatment blue ringed octopus

A

No antivenom
Intubation and ventilation
Paralysis usually resolved 24 hours

51
Q

What sea life causes collapse on Australia beach

A

Box jelly fish: collapse and sudden death: arrhythmia
Sea snake: post synaptic neurotoxin descending flaccid paralysis

52
Q

What complications of hyperthermia

A

Muscular: shivering
Neurological: loc, confusion, seizures
Cardiac: arrythmia
Resp: ards,
Renal: aki rhabdo
GIT: hepatitis
Metabolic: high K, high Na, low Ca,
Haem: dic

53
Q

Methods of cooling

A

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

54
Q

DDX hyperthermia

A

Heat stroke
Sepsis
CNS infection
Toxidrome
Drug withdrawal
Neuro - iCH
Endocrine thyroid storm

55
Q

Complications of hypothermia

A

Resp: depression, suppressed gag/ cough reflex
Cardiac: bradycardia: hypotension
CNS: reduced LoC, seizure
Renal: aki/ rhabdo
Metabolic met and resp acidosis
Pancreatitis

56
Q

Hypothermia ALS

A

Resistance to DC shocks
Aggressive rewarming
No proven benefit of antiarrythmic drugs
High suspicion of early treatment metabolic high k
Prolonged resuscitation

57
Q

Definition of heat wave

A

3 days of more of sustained high max and high min temps that unusual for location
Lead to adverse events on health

58
Q

drugs that interfere with heat stroke make worse

A

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

59
Q

4 risk factors for classic non exertions heat stroke

A

1 environment: prolonged heat exposure
Situational: lack of aclimitisarion, red oral intake
Pt related: elderly, young, poor health alcohol
Meds: serotenergics
Medical: sepsis comorbidities

60
Q

Swiss staging hypothermia

A

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

61
Q

3 ways to transport decompression illness and pro/ con

A

Road ambulance: no change in pressure, slower
Helicopter: unpresurised cabin, can land near hospital
Fixed wing: pressurised cabin but slower/ park further away

62
Q

3 modification in ALS hypothermic

A

Defib- withold until >30
Drugs >withhold until > 30 then double dosing interval

Duration: good survival >2 hours prolong d cpr

Heroic measures: early ECMO

63
Q

Effect of hypothermia on
CVS
Resp
Renal
Metabolic

A

CVS; hypotension, afib
Resp: depression hypoventilation
Renal: duiresis
Metabolic: hypoglycaemia

64
Q

How long observe snakebite for

A

12 hours post
Ensure no neurotoxicity
Normal 12 hour coags and CK
Parents have access back to hospital

65
Q

2 blood tests in snake bite

A

Coags
Ck

66
Q

Signs of snake envenomation

A

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

67
Q

Lab results venom induced consumptive coagulopathy

A

Increase INR/ PT
Increase D Dimer
Low unrecordable fibrinogen

68
Q

Role of venom detection kit
Where test

A

Swab- best
Urine
Blood
To assess for type of antivenom not confirmation of envenomatiob

69
Q

Absolute indication for anti venom
Relative

A

Hx sudden collapse
Abnormal INR
Evidence of paralysis with ptosis and or ophthalmolegia

Systemic symptoms
Abnormal aptt
CK>1000
Leucocytosis

70
Q

Risk factors decompression illness

A

Increase dive duration
Multiple dives
Dehydration
Strenuous exerezuze
Cold
Ascent to altitude
Alcohol
Obesity
Smoking

71
Q

Antivenom babies
Pregnancy

A

Doesn’t change 1 vile

Less volume for kids

72
Q

Indications for ECG monitoring in patient with electrical injury

A

High voltage
Loss of consciousness
Seizures
ECG changes arrhythmia
Burns

73
Q

Conn and model classification for neurological function

A

A: awake
B: conscious but obtunded
C comatose

74
Q

Poor prognosis in drowning

A

Submersion >10 min
GCS <5
cPR>25 mins
VT/VF on
Fixed dilated pupils

75
Q

Resuscitation cease in drowning

A

1 hour post rescue cpr if not hypothermic
Serum k>11

F24 (22 decks)

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