Environment & Tox Emergencies: Communicable Infections Flashcards
Measles
(3 C’s)
- high contagious
- incubation period 8-12 days
- conjunctivitis, coryza (stuffy nose), cough
- Koplik spots (near molars)
-maculopapular rash from head to toe
-treat s/s & immunizations
Mumps
- contagious 16-18 days
-swollen salivary glans leadt to puffy cheeks and swollen jaw
Rubella
- contagious up to a week prior to symptoms and a week after rash
- rash starts on face
-complications is birth defects and arthritis
Pertussis
(whooping cough)
- high contagious incubation 7-10 days
- attaches to the respiratory tract and limit the child’s ability to clear secretions
-coryza (sneezing), low grade fever
- paroxysmal bursts of coughing “whooping”
- petechial rash above nipple lien from broken blood vessels
- swab in nasopharynx
- tx with erythromycin, supportive care
Chickenpox
(Varicella)
- infectious 48 hr before rash appears
-contagious until all skin lesions crust over
-airborne precautions
- purulent vesicular rash starts on trunk with fever & urticaria (rash)
*No ASA
- varicella zoster vaccine
Shingles
- lesions follow path of nerve dermatomes
- pain develops first followed by lesions and do not cross body midline
- pain control and antivirals
- varicella zoster vaccine
Diphtheria
- incubation 1-8 days
- sore throat, low grad fever, *thick gray membranes covering tonsils (throat culture)
- tx with erythromycin
Mono
(epstein -barr virus)
- spread by body fuids
- fatigue, lymphs, myalgia(muscle aches)
- splenomegaly
-monospot blood test
cdiff
- antibiotic associated diarrhea
- gram +, anaerobic, bacillus
- standard & contact isolation
- treat with flagyl
active pulmonary tuberculosis (TB)
- chronic cough, night sweats, fever, chills, weight loss
- CXR, sputum culture
-negative pressure, standard & airborne
-tx with rifampin (stains body fluids bright orange) and isoniazid
Burns
-carbonaceous sputum & stridor indicates oral burns, intubate immediately
-perform escharotomy for circumferential chest burn and you cannot ventilate
Burn Formula
2 adult, 3 peds, 4 electrical
-LR at 2ml/kg x TBSA
-1st half of the total volume of fluid over the 1st eight hours from time of burn injury
*adult urine output 0.5-1.0 ml/kg/hour
*ped urine output 1-2 ml/kg/hour
Electrical burns
-risk of rhabodo
- ^ IVF
- ECG monitoring for 24 hrs
-risk of vfib
Lightening burns
-Lichtenberg feathering
- ruptured tympanic membrane
-cataracts long term
Chemical exposure to lime powder
brush off dry chemical first
Chemical exposure to asphalt
cool and apply emollient to loosen, must have physician order
Chemical exposure to phenol (carbolic acid)
copious irrigation with 50% MiraLAX and water
Chemical exposure to hydrofluoric acid (rust remover)
irrigate for at least 30mins, until pain relief then apply 2.5% calcium gluconate gel
Chemical exposure to lye, cement, or ammonia
large volumes of irrigation due to chemical causes liquefaction and destroys tissue
What causes carbon monoxide poisoning?
When you breathe Co in, it attaches to and replaces the oxygen on the hemoglobin molecule, resulting in carboxyhemoglobin and reducing the oxygen content of the blood known as the silent killer
What is the treatment for carbon monoxide poisoning?
-S/S: headache with n/v, seizures, & cherry red skin
- DX with carboxyhemoglobin (do not trust SpO2)
-TX with 100% high flow o2 with tight fitting mask until level is <10%
What causes cyanide poisoning?
-burning of plastics or carpets
-interferes with cellular respiration
What is the treatment for cyanide poisoning?
S/S: smell of bitter almonds on breath, headache, dizziness, and seizures
TX: Cyanide kit (inhaled amyl nitrite), IV sodium nitrite, IV sodium thiosulfate or VitB 12 (pink urine)
black widow spider bite
-appearance has a red hourglass on abdomen of female spider
-S/S: sting to dull ache of bite, abdominal cramping, muscle spasm, HT, tachycardia, N/V
-TX: ice, elevate, benzos for muscle spasms, anitvenin
brown recluse spider bite
(fiddle back violin shape)
S/S: painless bite, pruritus, redness, blister, bluish ring, fever, chills, N/V, necrotizing ulcer over time
TX: wound care, removal of necrotic tissue, hyperbaric oxygen therapy, antibiotics, steroids
pit viper snakes
-most snake bites are dry bites, does no require antivenin
-S/S progressive edema, blood filled vesicles
-TX: 2 large bore IVs, remove constructive clothing, immobilize limb in neutral position, antivnenom
-No ice!
coral snakes
(red on yellow, kill a fellow; red on black, venom lack)
-neurotoxic venom causing respiratory paralysis
-S/S: respiratory distress, local paresthesia, diplopia, ptosis, difficulty swallowing, > salivation
-TX: supportive care, possible antivenom
stingrays
-venom coated barbed stingers create severe pain and swelling
-immerse in warm water for up to 2hrs until relief of pain
jellyfish
-nematocysis are stinging darts that fire producing sever pain and reddened welts
-TX: rinse in normal saline and remove tentacles using forceps
-water stimulates venom
dog bites
-associated with underlying crush injury
-15% become infected
-leave open and consider rabies prophylaxis or watch dog closely for rabies
cat bites
-highest rate of infection of animal bites because of long fangs
-saliva contains pasteurella which leads to cellulitis
-leave wound open unless on face
human bites
-saliva carries 10 bacteria per milliliter and can transmit hepatitis B
-requires copious irrigation and debridement
-usually left open and bulky dressing is applied to decrease movement
submersion injury
-inadequate decompression after exposure
-increased pressure resulting in bubbles growing in tissues that cause local damage known as the “bends”
-body absorbs nitrogen during ascent
-S/S: sob, crepitus, numbness & tingling, petechial rash, seizures, joint discomfort
-TX: oxygen administration, fluids, analgesic, position patient on left side in Trendelenburg, hyperbaric oxygen therapy
