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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
What is Lyme disease caused by?
Ixodes scapularis tick Borrelia burgdorferi Most common vector borne disease Doxycycline in prophylaxis within 72 hours
26
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
27
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
28
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
29
What c spine injury caused by axial loading
Jefferson’s
30
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
31
Risk factors for decompression sickness
Age Rapid ascent Obesity Depth of dive Multiple dives per day Increased exertion Air travel within 24 hours
32
3 types of decompression sickness
1: pain only msk and derm 2: serious pulmonary, cns, vestibular 3: combination of decompression and arterial air embolism
33
Treatment decompression sickness
Decompression
34
What risk factors for decompression sickness
Increasing depth of dive Rapid ascent Multiple dives in a day Air flight soon after flight Obesity Alcohol
35
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
36
Treatment of HAPE
Immediate descent Oxygen Nifedipine Portable hyperbaric chamber
37
Symptoms of HAPE
Initial 2-4 days: subtle non productive cough soboe Progression: sob, clear pink sputum, tachycardia, tachypnea, fever
38
Order of mountain sickness with heights
Acute mountain sickness >2000m High altitude cerebral oedema > 3000m High altitude pulmonary oedema >4500m
39
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
40
Treatment of barotitis
Middle ear trauma Ear pain hearing loss nystagmus seventh nerve palsy ABX if TM rupture Rest Nadal decongestants Analgesia Ent referral
41
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
42
What environmental toxic exposures are indications for hyperbaric oxygen
Carbon monoxide and cyanide
43
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
44
Patient allergic to what abx risk allergy to acetazolmide
Sulfa
45
Which snackes causes coagulpathy
Brown Tiger Taipan Roughscale Red bellied Black mulga
46
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
47
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
48
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
49
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
50
Treatment blue ringed octopus
No antivenom Intubation and ventilation Paralysis usually resolved 24 hours
51
What sea life causes collapse on Australia beach
Box jelly fish: collapse and sudden death: arrhythmia Sea snake: post synaptic neurotoxin descending flaccid paralysis
52
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
53
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
54
DDX hyperthermia
Heat stroke Sepsis CNS infection Toxidrome Drug withdrawal Neuro - iCH Endocrine thyroid storm
55
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
56
Hypothermia ALS
Resistance to DC shocks Aggressive rewarming No proven benefit of antiarrythmic drugs High suspicion of early treatment metabolic high k Prolonged resuscitation
57
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
58
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
59
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
60
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
61
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
62
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
63
Effect of hypothermia on CVS Resp Renal Metabolic
CVS; hypotension, afib Resp: depression hypoventilation Renal: duiresis Metabolic: hypoglycaemia
64
How long observe snakebite for
12 hours post Ensure no neurotoxicity Normal 12 hour coags and CK Parents have access back to hospital
65
2 blood tests in snake bite
Coags Ck
66
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
67
Lab results venom induced consumptive coagulopathy
Increase INR/ PT Increase D Dimer Low unrecordable fibrinogen
68
Role of venom detection kit Where test
Swab- best Urine Blood To assess for type of antivenom not confirmation of envenomatiob
69
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
70
Risk factors decompression illness
Increase dive duration Multiple dives Dehydration Strenuous exerezuze Cold Ascent to altitude Alcohol Obesity Smoking
71
Antivenom babies Pregnancy
Doesn’t change 1 vile Less volume for kids
72
Indications for ECG monitoring in patient with electrical injury
High voltage Loss of consciousness Seizures ECG changes arrhythmia Burns
73
Conn and model classification for neurological function
A: awake B: conscious but obtunded C comatose
74
Poor prognosis in drowning
Submersion >10 min GCS <5 cPR>25 mins VT/VF on Fixed dilated pupils
75
Resuscitation cease in drowning
1 hour post rescue cpr if not hypothermic Serum k>11

F24 (22 decks)

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