Environmental Flashcards
Drowning disposition
within 10m surfacing from SCUBA sudden dramatic focal neurologic symptoms, AMS, seizure
TX
nitrogen narcosis-occurs at surface or at depth?
TX
Good oxygenation for 6 hours (but still RALS) ok for dc; o/w admit
arterial gas embolism
decompression chamber
nitrogen-at depth
gradual ascent
Etiology of decompression sickness (DCS)
symptom onset and classic symptoms (2)
TX
doing this can exacerbate symptoms of DCS
Formation of nitrogen bubbles in the vascular system during ascent
symptoms develop gradually, AMS, periarticular pain (sx can vary widely and affect many different systems)
decompression chamber - have a low threshold to initiate as symptoms often worsen
flying - no flying for one week to one month following treatment also
Blast injury types (4)
top four organs for type I
- Type I: Pulse of pressure (barotrauma)
- Type II: Flying debris (penetrating trauma)
- Type III: Flying humans (deceleration impact)
- Type IV: Toxic gases, radiation, burns
type I: CNS, eardrum, lung, G.I. tract
Pathophysiology underlying HACE and HAPE
physical fitness, women and age > 50 higher risk?
Noncardiogenic pulmonary edema, cause categories (4)
HAPE tx (3-4)
Hypoxia -> over perfusion of organs -> increased hydrostatic pressure -> capillary leak/edema
higher risk? No
environmental: HAPE, thermal, drowning
toxins: aspirin, carbon monoxide, opiates, phenobarbital
strangulation
fat or amniotic fluid emboli
tx: may try oxygenation for five minutes, descent, nifedipine, albuterol for wheezing
Hyperthermia
paradoxical core after drop?
Hunter’s response?
Shivering thermogenesis is lost at ?
Paradoxical drop in core temperature with rewarming as lactate rich cold blood returns from the periphery
paradoxical cold -induced vasodilation (the reason hypothermic’s sometimes take off their clothes)
last at 26°
EKG finding and underlying condition
renal and vascular effects of condition
cardiac arrest treatment modifications during this condition
Osborne J wave from hypothermia
renal: diuresis leading to volume loss
vascular: hyper viscosity, thrombosis, DIC
arrest: consider rewarming only early on, shocks only when warmed 1 to 2°, drugs may not work
Indications for active core rewarming and techniques (4)
frost nip vs bite definitions
frostbite degrees (4)
Temperature less than 30°C
warm, humidified O2, form IV fluids, gastric, bladder, chest, peritoneal lavage, dialysis or ECMO
nip: transient incompletely reversible
bite: freezing with irreversible damage
1: superficial erythema, no blisters
2: full thickness with edema, erythema and clear blisters
3: hemorrhagic blisters, skin necrosis
4: extension to bone, tissue loss
Frostbite treatment, avoid at all costs ?
ED treatment
blister management
trench foot is:
chillblains is: and tx
Avoid refreezing, much better to wait for more definitive treatment
40 deg water bath
debribe clear blister, leave hemorrhagic
trench: cold, wet but non-freezing feet
chillblains is: from chronic, non-freezing exposure -> painful inflammatory lesions of hands, ears, legs, feet
tx: rewarming, nifedipine, steroids
Minor heat illness types - see chart
Heat exhaustion-definition
heat stroke, key features (3)
Heat exhaustion - mild moderate symptoms with core temp <40°C Celsius
heatstroke: hyperthermia > 40°C, SIRS and AMS
Heatstroke categories (2)
abnormal labs (2)
cooling categories
adjunctive medication
Exertional and classic
labs: elevated LFTs (most sensitive), elevated CK
cooling categories: conduction (temperature difference between objects), evaporation, convection (increased air velocity), radiation (remove clothes)
medication: chlorpromazine to inhibit shivering
•Exertional
–Isolated
–Exertional
–Healthy, active
–Profuse sweating
–DIC
–Rhabdo is common
–Diarrhea
•Classic
–Epidemic (with heat wave)
–Nonexertional
–Elderly with chronic disease
–Anhidrosis
–Rarely ATN, rhabdomyolysis
Burns, Parkland formula
best measure of adequacy of resuscitation
Rule of 9s review
4 mL x wgt (kg) x % BSA per day of LR, 1/2 of volume over 1st 8 hours
measure: urine output 1mL/kg/hr
Burns, admission criteria highlights
2nd° > ?BSA
3rd° > ?BSA
other review
burn infection agents (2)
2nd° > 10 BSA
3rd° - ANY
other review: evidence of inhalation injury, has medically sensitive areas, joints, circumfrential, infants
agents: Pseudomonas, gram-negative
Electrical injuries, relative severity AC versus DC
tissue property affecting severity
cardiac monitoring duration after electrical injury
AC three times worse than DC
higher resistance = worse (more heat) - –Tissue resistance: nerve < blood < muscle < skin < tendon < fat < bone
high-voltage (> 1000V) - 24 to 48 hours
low-voltage household - no monitoring needed of EKG normal asymptomatic and no cardiac disease
Cardiac arrest after lightning injury - management differences
radiation injuries exposure types (3)
median lethal dose
prognostic rules of thumb
CPR alone recommended - most common rhythm is asystole but often recovers on its own
assisted ventilation-diaphragm paralysis often prolonged
Types: external, internal, contact (skin/clothes)
- 5 Gy
prognosis: earlier symptoms, worse
48-hour ANC > 1200 good, < 300 lethal, in between intermediate
Radiation decontamination
internal (2+)
anthrax chest x-ray (2+)
TX (3)
needs isolation?
Cutaneous form causes
internal: activated charcoal, WBI;
potassium iodide if I-131, chelating agents for radioactive heavy-metal
CXR: •Mediastinal widening, paratracheal & hilar fullness, pleural effusions, infiltrates
Tx: Cipro, doxycycline, vaccine
needs isolation? No
Cutaneous form causes ulcer/escar
Plague, infection types (3)
smallpox a.k.a.
classic rash feature
Types: pneumonic (respiratory isolation, doxycycline), bubonic (from bite, no person-to-person spread), septicemic (complication of above)
smallpox a.k.a. variola virus
feature: all lesions in the same stage (unlike varicela)
Botulism toxin mechanism
chemical weapons, categories (4)
human, dog, cat bite antibiotic
Botulism: weakness from binding to the preganglionic membrane of cholinergic synapses and inhibits acetylcholine release
categories: vessicants (mustard, skin blisters), nerve agents (cholinergics like Sarin, VX), cyanide, lung damaging agents
abx: Augmentin
Cat scratch fever
agent
classic symptoms
treatment
agent: Bartonella henselae
classic symptoms: enlarging macule at scratch site and LAD in drainage
treatment: none, usually self-limiting
Classic animals with (4) and without rabies (3)
postexposure prophylaxis
with: bat, fox, raccoon, skunk
without: squirrels, rodents, rabbit
HDCV days 0,3,7,14
one dose HRIG: 20 IU/kg
Snakebite injury categories (3)
indications for rattlesnake antivenom (3)
antivenom side effect categories (3)
Direct cell injury, coagulation system systemic injury (capillary leak and myocardial depression)
local injury progression, evidence of coagulopathy, systemic effects
side effects: anaphylactic/toid, delayed allergic (serum sickness), febrile response
Coral snake bite sx category and treatment
Black widow tx (3)
Brown recluse (2-3)
Neurologic, supportive (antivenom often not available)
Black: benzodiazepine, Ca Gluconate, antivenom
Brown: dapsone, HBO, surgery; no antivenom available
Anaphylaxis from bee sting (or other) mediated by
tick illness associations
- Q Fever:
- Tularemia:
- Babesiosis:
- Borreliosis:
- Ehrlichiosis:
by IgE
- Q Fever: flu like illness
- Tularemia: rabbits
- Babesiosis: Hemolytic anemia
- Borreliosis: Relapsing fever
- Ehrlichiosis: Monocytic, granulocytic
Coral cut treatment (4)
stingray injury treatment
tx: soap and water, freshwater flush, vinegar, ABX if indicated, steroids/antihistamine if itching
stingray: soak in water is hot as possible, toxin is heat sensitive
