Environmental

Question 1

Early symptoms: tingling/numbness

Exam: Pale, mottled, anesthetic, pulseless, immobile –does not improve quickly with rewarming.

Answer 1

trench foot

Question 2

Caused by long-term intermittent exposure to damp, nonfreezing ambient temperatures
Mild but uncomfortable inflammatory lesions typically affecting hands, feet, ears and lower legs

Answer 2

Chilblains (pernio)

Question 3

Mild degrees of necrosis of the subcutaneous fat tissue

Develops during prolonged exposure to temperatures just above freezing

Answer 3

paniculitis

Question 4

Immediately after freezing and thawing, an arachidonic acid cascade forms and promotes vasoconstriction, platelet aggregation, leukocyte sluding, and erythrostasis, which results in venule and arterial thrombosis and subsequent ischemia, necrosis and dry gangrene

Answer 4

frostbite patho

Question 5

superficial and is characterized by a central area of pallor and anesthesia of the skin surrounded by edema – excellent prognosis

Answer 5

1st degree frostbite

Question 6

Full thickness skin freezing, large blisters containing clear fluid surrounded by edema and erythema developing within 24 hours and extending to or nearly to the tips of digits. The blisters may form an eschar, but this later sloughs off, revealing healthy granulation tissue (no tissue loss) – good prognosis

Answer 6

2nd degree frostbite

Question 7

extends into the subdermal plexus; injury is deeper than second, blisters are smaller, hemorrhagic and more proximal. Forms a black eschar in one to several weeks – poor prognosis

Answer 7

3rd degree frostbite

Question 8

extends to muscle and bone, little edema, involves complete tissue necrosis mummification occurs in 4-10 days – extremely poor prognosis

Answer 8

4th degree frostbitezaq

Question 9

how to dx and tx frostbite

Answer 9

clinical
rapid rewarming – place the injured extremity in gently circulating water heated to a temperature of 37 – 39 C (98.6 – 102.2 F) for 20 – 30 minutes, when tissue is pliable and erythematous, opioids

Question 10

how to get temp for suspected hypothermia

Answer 10

NEED a CORE TEMPERATURE MEASUREMENT – from where? If intubated – lower third of the esophagus, if not – rectal temperature – depth 15 cm, or bladder probe

Question 11

hypothermia stages

Answer 11

Mild (HT I) – 
Conscious, shivering
T: 32 – 35 C
Moderate (HT II) –
Impaired consciousness (may or may not be shivering)
T: 28 – 32 C
Severe (HT III) – 
Unconscious, vital signs present
T: < 28 C
HT IV –
No vital signs

Question 12

how to tx heat edema

Answer 12

Diuretics are of no use – but elevation and support stockings help

Question 13

temps up to ( ) may be normal with heat stress

Answer 13

104

Question 14

Core Temperature Is > 104 F, 40 C and AMS

Answer 14

heat stroke

Cool to 102.2 F (39 C) & stop to avoid overshoot hypothermia

Question 15

Missouri, Ohio, South, South & Mid West

Warm, Dry Areas like Woodpiles & Cellars

Answer 15

brown recluse
Give Tetanus
Daily Wound Care
Antibiotics?

Question 16

Orange & Red Hourglass on the Abdomen

Wood-piles, Basements, Garages, Sheds

Answer 16

black widow
Supportive care
Analgesics and benzodiazepines for cramping
Lactrodectus anti-venom, derived from horse serum is rapidly effective
observe

Question 17

Clusters of 3 pruritic papules, urticaria, wheals, and bulla

Answer 17

bed bugs

Question 18

“Red on yellow kill a fellow; red on black venom lack!”

Answer 18

snake bites

Question 19

3 indigenous NY snakes

Answer 19

Timber Rattler(endangered)

Pygmy Rattler (massasauga)

*Copperhead- *Found in City limits

Question 20

give antivenom for pit vipers for grades

Answer 20

2, 3, 4

Question 21

HYDROZOANS include fire

Answer 21

coral and Portugese man-of-war (causes linear erythematous eruption and rarely can cause respiratory arrest

Question 22

CUBOZOANS (box jellyfish) may cause

Answer 22

death after stinging

Question 23

Bristle and fire worms embed bristles

Answer 23

annelida

Question 24

include gastropods and octopuses. Indo pacific cone shell and the blue ringed octopus can deliver paralytic venom

Answer 24

mollusca

Question 25

most common diving-related affliction

Answer 25

barotrauma

Question 26

signs of a bad outcome for drowning

Answer 26

Asystole, is a near-universal sign of poor prognosis
Submersion greater than 7 minutes
Time to effective basic life support >10 minutes
Resuscitation duration >30 minutes
Glasgow coma scale <5 (ie, comatose)
Persistent apnea and requirement of cardiopulmonary resuscitation in the emergency department
Arterial blood pH <7.1 upon presentation

Question 27

most important thing to do for drowning pts

Answer 27

Ventilation is the most important initial treatment for victims of submersion injury and rescue breathing should begin as soon as the rescuer reaches shallow water or a stable surface.

Question 28

lighting injuries are MC in

Answer 28

fisherman

Question 29

pathognomnic sign of lighting strike

Answer 29

Lichtenberg figures are considered pathognomonic for lightning strike

Question 30

hypoxia typically occurs at heights >

Answer 30

2440 M (8000 ft)

Question 31

Dry cough and impaired exercise capacity to resting dyspnea, productive cough, cyanosis, tachypnea, rales,
RAD, Right ventricular strain

Answer 31

high altitude pulmonary edema

Treat: immediate descent, oxygen, rest, hyperbaric therapy nifedipine, sildenafil, albuterol

Question 32

Ataxia, irritability, confusion, drowsiness ,stupor, and finally coma

Answer 32

high altitude cerebral edema
Treat: oxygen, immediate descent, hyperbaric, dexamethasone, intubate, monitor ABG, monitor ICP
Acetazolamide to prevent AMS