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1-KWPEM > Environmental > Flashcards

Environmental Flashcards

1
Q

GI syndrome (side effect of radiation)

A

side effect of radiation

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2
Q

What’s the disposition of an asymptomatic lightning strike?

A

Admit for observation 12-24hrs!
late cardiac injuries may present
(rhabdomyolysis and myoglobinuria also possible)

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3
Q

How to treat shivering once cooling has started for hyperthermia?

A

Benzodiazepines

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4
Q

What’s the first aid care for a snake bite?

A

keep affected limb in a dependent position
minimize movement
rapid transport to hospital

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5
Q

What are illnesses associated with high altitude? Why?

A

As PIO2 decreases with ascent, the normal driving pressure of PO2 down the oxygen cascade diminishes, resulting in progressive hypoxemia and tissue hypoxia.
Acute Mountain sickness (AMS): headache and malaise, anorexia
can progress to High Altitude Cerebral Edema (HACE): encephalopathic signs and symptoms
HIgh Altitude Pulmonary Edema (HAPE)

All respond to oxygen but definitive treatment is with descent

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6
Q

What are the clinical manifestations of a scorpion bite? How to manage?

A

Symptoms occur within minutes, peak at 1-2hrs
excitatory neurotoxin with restlessness, hyperactivity, rotatory eye movements, swelling and local pain most common
Treat supportively, antivenom available

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7
Q

What laboratory finding is suggestive of cyanide poisoning?

How to treat?

A

lactate >10

hydroxycobalamin IV

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8
Q

In a household minor socket injury, how to manage?

A

If asymptomatic, no need to investigate

consider CBC, troponins, serum electrolytes, myoglobin and ECG

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9
Q

What is an early poor prognostic sign for radiation exposure?

A

Prodromal phase – 0 to 2 days after exposure
Latent phase – 2 to 20 days after exposure
Manifest illness – 21 to 60 days after exposure
The earlier the development of symptoms, the worse the exposure, the shorter the latent phase.
follow lymphocyte counts within the first 48hrs, if lymphopenia <100 it is lethal
lymphopenia <1000 it is severe but chance of survival
they will also develop GI syndrome, CNS syndrome

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10
Q

What’s that rhyme for which snakes are nice and which ones aren’t??

A

RED ON YELLOW, KILL A FELLOW

RED ON BLACK, A FRIEND OF JACK

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11
Q

How to manage a potentially dangerous snake bite presenting to the ED?

A

Admit for a minimum of 24hrs

Watch for the development of neurotoxic symptoms with paralysis, respiratory failure/insufficiency

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12
Q

What are features of scuba diving decompression sickness?

A

air bubble precipitating into the joints, skin, lymphatics (pulmonary and neurologic in certain cases)
treat with hyperbaric O2

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13
Q

When should you provide prophylactic antibiotics to animal bites?

A

moderate to severe bites
all deep puncture bites
bites to the hands, feet of genitals
significant or deep bites to the face

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14
Q

What are symptoms of a black widow bite?

A

the venom is a neurotoxin which creates systemic sympathomimetic efffects
treat with supportive care: benzos, opioids

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15
Q

What are examples of the crotalus snake family? What are the effects of envenomation?

“Think of rats…..”

A 
rattle, copperhead, cottonmouth
local edema, ecchymosis, hemorrhage
(low platelets, low fibrinogen)
Observe 12-24hrs
Rx CroFab if unwell and repeat labs in 1hr
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16
Q

What kind of sea venoms are heat labile?

A

stingray, jellyfish, Portuguese man of war, lionfish, scorpion fish, cat fish, sea urchin

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17
Q

How do you treat cold related injuries

A

ABCS
Passive rewarm if >32
Active if less than 32 (radiant heat and heat packs)

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18
Q

2 methods methods of rewarming (active)

A

Noninvasive: heated humid O2 and warmed IVF 40-44C, invasive warm fluid lavage

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19
Q

Having HAPE at >4000 what needs to happen?

A

Come down now!

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20
Q

Having HAPE t < 3000 what needs to happen?

A

Oxygen and re-eval after two hours

21
Q

Poor prognosis in frostbite lack of symptom?

A

Loss of sensation

22
Q

highest survival rate in which temp of water?

A

Cold water < 10 deg (20-30%)

23
Q

treatment for lacs from fire coral

A

leave wound open and rx tetracyline if > 8, if < 8 bactrim, keflex

bugs are: vibrio and Mycobac marinum

24
Q

Which coelenterate has the most venous stuff?

A

Box Jellyfix

25
Q

Ciguatera fish poisoning TRT

A

Supportive, Mannitol

26
Q

muscle spasms, trismus which can proceed to muscular and respiratory paralysis

A

sea snake venom causes these sx

27
Q

What are deadliest snames?

A

sea snakes
venom is neuro/myo/nephrotoxic

28
Q

What is the impact of the coelenterate venom?

A

Dermatonecrotic, myotoxic, cardiotoxic, neurotoxic, hemolytic

29
Q

Scombroid fish poisoning toxin and treatment?

A

Histamine from conversion of histidine by bacterial growth

Rx: Antihistamine, epinephrine, steroid

30
Q

What fish toxin causes this—Facial flushing/sweating, peppery taste sensations, tachycardia, headache

A

Scombroid fish poisoning –often seen with improperly stored tuna, amberjack, mahi mahi

31
Q

Tetrodotoxin poisoning (Fugu): Pufferfish, Blue-ringed octopus TREATMENT

A

Supportive (respiratory)

32
Q

Echinoderms: starfish, sea urchins management

A

hot water immersion for pain and removal of spines, c/s tetanus and abx

33
Q

Voltage amount associated with greater morbidity

A

> 1000

34
Q

Ligthening strike sx

A

*
Altered mental status
*
CPR at site of injury
*
Dysrhythmia
*
Hypotension
*
Transthoracic current pathway

35
Q

________ hemorrhage –seen up to 2 weeks after eschar falls off

A

Labial artery hemorrhage

36
Q

Most common dysrythmias seen after drowning are _______ and _____

A

Sinus brady, AF –most common

37
Q

Drowning and Submersion injury trt:

A

Treatment
*
Remove wet clothing and rewarm, if hypothermic
*
ABCs
*
Consider 10 cc/kg bolus for patient with pulmonary edema
*
Support respiration
*
BiPAP, CPAP, high humidified nasal cannula may be appropriate in conscious patients
*
ECMO for refractory hypoxemia, witnessed cardiac arrest

38
Q

For acid, < ___ causes more severe burns (liquefactive) and for alkaline, ph > ___, causes more severe burns

A

2
12

39
Q

What gel is used for Hydrofluoric acid chemical burn?

A

Calcium gluconate gel applied topically

40
Q

Superficial or 1st degree

A

*
Epidermis only, red and painful, blanches
*
Not included in TBSA estimation for major burns

41
Q

*
Partial Thickness or 2nd degree

A

*
Superficial –epidermis/superficial dermis, red and painful, weeping, blisters, blanches
*
Deep –epidermis/deep dermis, less painful, blisters, white to red, nonblanching

42
Q

Full thickness or 3rd degree

A

Destroyed epidermis and dermis, white/grey to charred black, dry and inelastic, nonblanching
*
Insensate

43
Q

*
4thdegree burn –

A

life threatening, into deeper tissue

44
Q

Thermal Burn Treatment

A

Treatment
*ABCs –anticipate difficulty airway
*Fluid resuscitation in major burns (1st24h)
*Parkland: 4 mL/kg per % TBSA plus normal maintenance fluid
*Administer ½ the mount over the 1st8 hours, other half over 16 hr
*LR fluid of choice –include dextrose for children <20 kg
*Adequate pain control
*Monitor fluid status
*House fire burns –consider CO and CN poisoning
*Clean and dress burns –leave blisters intact unless large, painful or rupture is imminent
Silvadene and topical antibiotics

45
Q

Burn center admission criteria

A

Burn Center Admission Criteria
*
Partial thickness burns > 20% TBSA at any age or >10% TBSA in those <10
*
Full thickness burns >5% TBSA
*
Any significant burn to the face, hands, feet, joints or genitalia/perineum
*
Inhalation injury
*
Significant chemical or electrical injury
*
Significant associated injuries
*
If patient has unstable VS and/or need for mechanical vent: ICU

46
Q

HF acid burn causes what cardiac finding

A

QT prolongation b/c of chelation wiht Ca, development of hypocalcemia

47
Q

How long should you watch an immersion injury?

A

monitor for 6-8 hours (need to be asymp with a normal cxr)

48
Q

INdications for cardiac monitoring after a burn

A

Cardiac arrest, documented loss of consciousness, abnormal ECG, observed dysrhythmia, history of cardiac disease, presence of significant cardiac disease risk factors, chest pain or hypoxia.

49
Q

Drowning/submersion duration with best outcomes

A

<6 min

1-KWPEM (20 decks)

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