Environmental Flashcards by Kenshata Watkins

GI syndrome (side effect of radiation)

side effect of radiation

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What’s the disposition of an asymptomatic lightning strike?

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

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How to treat shivering once cooling has started for hyperthermia?

Benzodiazepines

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

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

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What are illnesses associated with high altitude? Why?

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

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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What laboratory finding is suggestive of cyanide poisoning?

How to treat?

lactate >10

hydroxycobalamin IV

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In a household minor socket injury, how to manage?

If asymptomatic, no need to investigate

consider CBC, troponins, serum electrolytes, myoglobin and ECG

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What is an early poor prognostic sign for radiation exposure?

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

RED ON YELLOW, KILL A FELLOW

RED ON BLACK, A FRIEND OF JACK

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

Admit for a minimum of 24hrs

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

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What are features of scuba diving decompression sickness?

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

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When should you provide prophylactic antibiotics to animal bites?

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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What are symptoms of a black widow bite?

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

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

“Think of rats…..”

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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What kind of sea venoms are heat labile?

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

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How do you treat cold related injuries

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

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2 methods methods of rewarming (active)

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

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Having HAPE at >4000 what needs to happen?

Come down now!

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Having HAPE t < 3000 what needs to happen?

Oxygen and re-eval after two hours

Poor prognosis in frostbite lack of symptom?

Loss of sensation

highest survival rate in which temp of water?

Cold water < 10 deg (20-30%)

treatment for lacs from fire coral

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

bugs are: vibrio and Mycobac marinum

Which coelenterate has the most venous stuff?

Box Jellyfix

Ciguatera fish poisoning TRT

Supportive, Mannitol

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

sea snake venom causes these sx

What are deadliest snames?

sea snakes venom is neuro/myo/nephrotoxic

What is the impact of the coelenterate venom?

Dermatonecrotic, myotoxic, cardiotoxic, neurotoxic, hemolytic

Scombroid fish poisoning toxin and treatment?

Histamine from conversion of histidine by bacterial growth Rx: Antihistamine, epinephrine, steroid

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

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

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

Supportive (respiratory)

Echinoderms: starfish, sea urchins management

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

Voltage amount associated with greater morbidity

>1000

Ligthening strike sx

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

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

Labial artery hemorrhage

Most common dysrythmias seen after drowning are _______ and _____

Sinus brady, AF –most common

Drowning and Submersion injury trt:

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

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

2 12

What gel is used for Hydrofluoric acid chemical burn?

Calcium gluconate gel applied topically

Superficial or 1st degree

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

* Partial Thickness or 2nd degree

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

Full thickness or 3rd degree

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

* 4thdegree burn –

life threatening, into deeper tissue

Thermal Burn Treatment

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

Burn center admission criteria

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

HF acid burn causes what cardiac finding

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

How long should you watch an immersion injury?

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

INdications for cardiac monitoring after a burn

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.

Drowning/submersion duration with best outcomes

<6 min