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Clinical Disciplines-ER > Environmental > Flashcards

Environmental Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Define Hypothermia

A

core temperature < 95°F

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2
Q

Define conduction heat loss

A

Transfer of heat by direct contact: Water immersion

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3
Q

Define convection heat loss

A

Transfer of heat by movement of heated material: wind disrupting heat around body

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4
Q

Define radiation heat loss

A

uses electromagnetic transmission

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5
Q

Define Evaporation heat loss

A

Conversion of liquid to vapor – usually accounts for 10-15% of body heat loss

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6
Q

At what temperature does shivering stop?

A

90°F (32.2°C)

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7
Q

At what temperature do you see increased arrhythmias? EKG changes?

A

86°F (30°C)

Osborn J wave

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8
Q

At what temperature should you withhold cardiac medications and defibrillation

A

> 82.4°F (>28°C)

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9
Q

Hypothermia treatment

A
  1. Warmed oxygen and IV fluids
  2. Active external rewarming
  3. Gently circulating water* (104-107.6 °F, 40-42°C)
  4. Active core rewarming
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10
Q

What is the triad of sx’s in heat stroke?

A
  1. Hyperthermia (> 105°F)
  2. CNS dysfunction
  3. Anhydrosis (no sweating)
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11
Q

List the vespids

A
  1. Yellow Jackets
  2. Hornets
  3. Wasps
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12
Q

List the Apids

A

Honey

Bumblebees

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13
Q

What is the MCC of allergic reaction secondary to insect stings

A

Yellow Jacket= Hymenoptera Sting

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14
Q

What is the MCC of death from envenomation

A

Upper airway obstruction

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15
Q

Hymenoptera Sting Treatment

A
  1. Remove stinger
  2. Apply ice pack and elevate extremity
  3. Antihistamines – Benadryl
  4. Epinephrine
  5. Steroids
  6. Beta agonists
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16
Q

Where are brown recluse spiders MC?

A

Midwestern and southern US

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17
Q

Brown recluse appearance

A

Light brown to tan in color with dark violin-shaped mark on dorsal cephalothorax

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18
Q

What is the most active enzyme in the brown recluse?

A

Sphingomyelinase D

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19
Q

Skin Appearance from brown recluse bite

A

Mildly erythematous lesion–>Firm and Dry–>Bluish blister–>Necrosis

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20
Q

Brown recluse bite treatment

A

Supportive
No antivenin available
Surgery once clearly demarcated

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21
Q

Another name for brown recluse?

A

Loxosceles

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22
Q

Another name for black widow spider

A

Latrodectus

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23
Q

Where are black widow spiders MC?

A

North America

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24
Q

Black widow appearance

A

Shiny black with red hourglass on abdomen

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25
Q

What is the venom/toxin the Black widow spider releases?

A

Alpha-latrotoxin

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26
Q

What it the hallmark clinical presentation with a black widow spider bite?

A

Muscular cramping

  • Abdomen!
  • Chest
  • Back
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27
Q

Complications of a black widow spider bite?

A

1 .Shock

  1. Respiratory Failure
  2. Coma
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28
Q

Black widow spider bite treatment

A
  1. Narcotics
  2. Benzodiazepines (Valium)
  3. Antivenin
  4. Ca Gluconate 10%
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29
Q

Lice treatment

A

Lindane

30
Q

Scabies treatment

A
  1. Elemite or Lindane
  2. Calamine lotion
  3. Oral antipruritic agents (atarax)
  4. Analgesics
31
Q

Effects of venom from snake bites?

A
  1. Local tissue injury
  2. Systemic vascular damage
  3. Hemolysis*
  4. Fibrinolysis
  5. Consumption of fibrinogen and platelets
32
Q

Cardinal features of snake bite

A
  1. One or more fang marks
  2. localized pain
  3. erythema
  4. ecchymosis
  5. progressive edema
33
Q

Sx’s of a snake bite

A
  1. N/V
  2. Paresthesias of mouth and tongue (metallic taste)
  3. Tacyhcardia
  4. Hematuria
  5. Low platelets
34
Q

Snake bite treatment

A
  1. Elevate extremity
  2. Constriction bands-2 inches wide, occludes venous outflow only
  3. Observe- If asymptomatic after 8 hrs, discharge
35
Q

Who do you always admit with a snake bite?

A

Children

36
Q

Antivenin indications in snake bites

A
  1. Worsening swelling
  2. Coagulation abnormalities: low platelets, PT>20 sec
  3. Systemic effects: Hypotension
  4. ALL Copperhead bites
37
Q

List the types of antivenins used in snake bites

A
  1. Antivenin Crotolidea Polyvalent (ACP)

2. Polyvalent Immune Fab (CroFab, FabAV)= 5x more potent

38
Q

What scorpion is ONLY found in AZ?

A

Centruroides exilicauda (bark scorpion)

39
Q

Sx’s in a scorpion sting?

A
  1. Immediate paresthesia
  2. Tachcardia
  3. Increased secretion
  4. Increased temperature
  5. Diaphoresis
40
Q

Pathognomonic findings in a scorpion sting?

A
  1. Roving eye movements

2. Tongue Fasciculations

41
Q

Scorpion sting treatment

A
  1. Cool compress
  2. +/- midazolam continuous infusion
  3. Anascorp
42
Q

How do you remove cactus

A

Elmers glue

43
Q

What is the one of the MCC of death in children 1-18 y.o?

A

Drowning

44
Q

Risk factors for drowning

A
  1. African Americans-Except for 0-4 year olds
  2. Unsupervised bath/pool time
  3. Bath seat use
  4. Seizure
  5. Alcohol use
45
Q

What are good prognostic factors in drowning?

A
  1. Age < 14 years of age
  2. CPR in the field
  3. CPR < 25 minutes
  4. Detectable pulses on arrival
46
Q

What are poor prognostic factors in drowning?

A
  1. Submersion > 5 minutes
  2. No resuscitation for > 10 minutes
  3. Fixed and dilated pupils
  4. GCS < 5
  5. pH < 7.1
47
Q

Drowning treatment

A
  1. Oxygen if SaO2 < 92%

2. If survive to ER, admit for at least 24 hours

48
Q

What is the second MCC of accidental death in US?

A

Thermal burns

49
Q

What age population has the highest death rates from thermal burns?

A
  1. 65+

2. <4 y.o,

50
Q

First degree burn definition

A
  1. Epidermis only
  2. Painful and red
  3. No blisters
51
Q

Give an example of a first degree burn

A

Sunburn

52
Q

Second degree burn definition

A
  1. Through Dermis=partial thickness
  2. Blisters
  3. Painful
53
Q

Third degree burn definition

A
  1. Skin-to-fat=Full thickness
  2. Charred, pale
  3. PAINLESS
54
Q

Burn treatment

A
  1. Tetanus prophylaxis

2. IV LR (isotonic saline)

55
Q

What is the Parkland formula?

A

Fluid (LR) Administration:
1/2 given in first 8 hours
Remaining ½ over next 18 hours

56
Q

Burn admission criteria

A
  1. 10-50 y.o: Partial thickness > 15% and full thickness > 5%
  2. < 10yo and > 50yo:
    Partial thickness > 10% and full thickness > 3% in
57
Q

Hyperbaric Tx Indications in CO poisoning

A
  1. CO-Hgb >25-30%
  2. Cardiac involvement
  3. Severe acidosis
  4. Transient or prolonged unconsciousness
  5. Neurological impairment
  6. Age >36 years old
  7. Pregnancy
58
Q

What skin sx would you expect to see in CO poisoning?

A

Cherry red skin

59
Q

What is the MCC of cyanide poisoning?

A

Smoke inhalation

Cyanide is a byproduct of burning

60
Q

What lab finding is strongly suggestive of cyanide poisoning?

A

Lactate >8

61
Q

Clinical/exam findings in cyanide poisoning?

A
  1. Severe metabolic acidosis*
  2. Smells like bitter almonds
  3. Usually are not cyanotic
62
Q

Cyanide treatment

A
  1. Oxygen
  2. Hydroxycobalamin=Vitamin B 12
  3. Amyl nitrite
  4. Sodium nitrite
  5. Sodium thiosulfate
63
Q

What is the cornerstone of therapy in chemical burns?

A

Hydrotherapy

64
Q

Are 60-70% of electrocutions high or low voltage sources?

A

Low voltage

65
Q

What kind of current is the most dangerous?

A

Alternating current

66
Q

What is the most resistant to electrical injuries?

A

Bone

67
Q

What is the least resistant to electrical injuries?

A

Nerves

68
Q

What is the primary cause of immediate death in electrical injuries?

A

Cardiopulmonary arrest

69
Q

What is the MCC of death in direct current lightening injuries?

A

Cardiac arrest

70
Q

What is the MC neurological even in lightening injuries?

A

Temporary LOC

71
Q

What is Pathognomonic in lightening injuries?

A

Fernlike pattern rash

Clinical Disciplines-ER (4 decks)

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