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EMed Exam 2 > Environmental > Flashcards

Environmental Flashcards

1
Q

Risk factors for cold injuries

A 
 Lack of protective head/hand or footwear/wet
clothing
 Dehydration
 Alcohol consumption and smoking history
 Prolonged stationary posture
 Protective ointments on head/face
 Previous cold related injuries
 History of PVD, Raynaud’s, diabetes
 State of homelessness
 Use of vasoconstrictive medications
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2
Q

What causes tissue death

A

rewarming
 Arachidonic acid forms promoting vasoconstriction
 Platelets aggregate = erythrostasis resulting in venule and arteriole thrombosis
 Subsequent ischemia, necrosis and gangrene

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3
Q

Typical location of frostbite

A

face, nose, ears, fingers, toes

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4
Q

Sx of frostbite

A

prior to rewarming: pale, waxy, hard, cold

numbness, tingling

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5
Q

Dx of frostbite

A

clinical

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6
Q

1st degree frostbite

A

Numbness, central pallor with surrounding erythema and edema, desquamation, dysesthesia

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7
Q

Second degree frostbite

A

blisters w/ surrounding edema/erythema

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8
Q

Third degree frostbite

A

tissue loss involving entire thickness of skin;

hemorrhagic blisters

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9
Q

4th degree frostbite

A

tissue loss involving entire thickness, including deep structures, resulting in LOSS OF THE PART

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10
Q

Management of frostbite

A
  • emerse in warm water until erythematous and pliable (give IV opiods for pain)
  • anticoagulation (if present within 24 hrs and high risk for amputation)
  • cyanosis proximal to ITP: CTA or bone scan to assess circulation/tissue viability
  • aloe vera cream q 6 hours, non-occlusive dressing
  • monitor for infection (abx if you suspect)
  • Td immunization
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11
Q

Disposition for frostbite

A

Superficial: d/c home (ibuprofen, aloe vera, no smoking)

Admit deep tissue - ortho or hand surgeon

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12
Q

Causes of hypothermia

A

primary (cold exposure-)

Secondary: normal environment but they do (medical conditions, meds, newborns)

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13
Q

Medical conditions causing hypothermia

A

sepsis/shock
hypothyrodisim
burns

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14
Q

Meds causing hypothermia

A

antihyperglycemics

beta-blockers

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15
Q

What is hypothermia?

A

core below 35 celcius

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16
Q

Mild hypothermia

A

32-35 degrees

Confusion, tachy, increased shivering

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17
Q

Mod hypothermia

A

28-32
Lethary, bradycardia, arrhythmia, loss of pupillary reflex
decreased shivering

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18
Q

Severe hypothermia

A 
<28
coma
hypotension
arrhythmia
pulmonary edema
rigidity
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19
Q

Measuring temp

A

low-reading thermometer
rectal/bladder temps in conscious
severe: esophageal temp prob w/ ET intubation

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20
Q

Dx of hypothermia

A 
fingerstick glucose
ECG/CXR
BMP
CBC w/ diff (Hct increases 2% w/ each 1 degree drop)
Coagulation studies
O2 sat (ears/forehead)
ABG
TSH?
Tox screen if ams?
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21
Q

Management of hypothermia

A 
ABC's
ET intubation if needed
treat hypotension w/ warmed crystalloid (42 degree), DA prn
Avoid rough movement, may induce v. fib
Treat arrhythmias
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22
Q

When don’t you defibrillate in hypothermia

A

core <30

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23
Q

Mild hypothermia tx

A

passive external rewarming
remove wet clothes
cover w/ warm blankets

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24
Q

Mod hypothermia tx

A

EXTERNAL & INTERNAL REWARMING:
 Warmed, humidified oxygen, forced air warming systems
 Beware of initial paradoxical drop in core temp due to return of cold blood from extremities to core
 Rewarm trunk first to minimize risk of core temperature after-drop

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25
Severe hypothermia tx
everything in moderate PLUS:  Pleural and peritoneal irrigation with warm saline (400C-420C)  Extracorporeal options: hemodialysis, cardiopulmonary bypass, continuous arteriovenous rewarming
26
leading cause of deaths in athletes
heat emergencies
27
Risk factors for heat emergencies
 Strenuous exercise in high ambient temperature and/or humidity  Lack of acclimatization  Poor physical fitness  Obesity  Dehydration  Acute illness  External load, including clothing, equipment, and protective gear
28
Heat cramps
exertional heat illness - intense muscle pain/spasm w/ no other signs of exertional heat stroke - localized to one area, short in duration, no risk for rhabdo
29
At risk for heat cramp
- "salty sweaters" @ higher risk - heavy sweating w/ fluid replacement via water or other hypotonic solutions (sodium, K, Mg deficiency) - lack of heat acclimatization (vacation)
30
Management for heat cramp
hydrate, replace Na relax/stretch mm education/prevention
31
Heat stress (exhaution)
due to water and sodium depletion
32
Sx of heat exhaution
``` h/a n/v dizziness diffuse muscle cramps orthostatic hypotension, +/- syncope ```
33
PE for heat stress
temp normal or elevated (not higher than 104F) | No signs of CNS impairment
34
Dx for heat stress
BMP | CBC (hemoconcentration common)
35
Tx for heat stress
remove from hot environment bolus of IVF, w/ short term 1.5 increase in maintenance fluid (NS good while waiting for labs) CHF or significant electrolyte abnormalities may need admitted for longer or slower duration of fluid replacement should start to respond in 30 min
36
Heat stroke sx
``` hyperthermia (>104) PLUS AMS:  Irritability  Confusion  Irrational behavior  Decorticate and decerebrate posturing  Seizures  Coma ```
37
Dx of heat stroke
```  Fingerstick glucose  CBC plus diff  CMP  ABG  Coagulation studies  CPK and myoglobin  Urinalysis  ECG and CXR  Toxicology  CT of head and LP may be indicated to r/o other causes of AMS  Evaluating for end-organ damage ```
38
Management of heat stroke
IVF resuscitation | cool quick w/o hypothermia induction (102.2 F)
39
Mechanisms of cooling
evaporative (spray water w/ fan) Ice packs Immersion cooling Invasive cooling (cardiopulmonary bypass)
40
Con of evaporative cooling
hard to keep cardiac electrodes on skin
41
Immersion cooling con
Electrodes cannot be on patient, poorly tolerated, cannot defibrillate if needed
42
Disposition of heat stroke
admit
43
black widow spider (L. mactans, L. hesperus)
males harmless like to live OUTDOORS enjoy warm weather/arizona
44
Brown recluse spider (loxosceles reclusa)
6 eyes (instead of 8) like to live INDOORS not so common in AZ
45
dx of spider bite
spier observed | skin lesion typical
46
Tx for spider bite
wound cleansing tetanus prn treat secondary infection prn
47
Presentation of mild black widow
local wound, +/- spasm to site
48
Moderate sx for black widow
spasms, muscle pain in bitten extremitiy, back, chest, abdomen adjacent diaphoresis
49
Severe envenomation from black widow
evere pain and spasm and systemic features - n/v, | headache, tachycardia, hypertension
50
Tx for mild/mod envenomation for black wiow
``` self-limiting 24-48 hrs analgesic (opiods in mod/severe) muscle relaxant prn Antivenom (bad risk) monitor for 2nd infection ```
51
Presentation of reclus lesion
depressed macule, pale gray, eroded in center with halo of inflammation and hemorrhage; tender and may extend into muscle tissue may lead to necrosis fever/muscle pain/myalgia (rarely systemic sx) rare: rhabdo, DIC, acute hemolytic anemia (more common in children)
52
Management of brown recluse
 Debridement has not proven beneficial in most cases  Typically wound improves within 5-10 days  No antivenom available in US  Monitor for secondary infection
53
Result of scorpion sting
minimal swelling regional LAD increased skin temp/tenderness around wound
54
Presentation of bark scorpion
 Initial symptoms are pain and paresthesia over involved area  Swelling usually absent, few skin changes  Tachycardia  Hypertension  Tachypnea  Weakness  Muscle spasms and fasciculations
55
Tx of bark scorpion
 Supportive care:  Ice pack over wound  Oral NSAIDS  Muscle relaxants for spasms  Pain control  Patients should be monitored for 8-12 hrs after sting  Antivenom available in US, should be given to all patients with severe symptoms who are unresponsive to supportive care
56
Features of rattlesnake bites ("pit vipers")
```  Fang marks  Local tissue injury  Fibrinolysis (anticoagulation)  Thrombocytopenia  Systemic effects ```
57
Tx for rattlesnake bites
ANTIVENOM! (IV or intraosseous) | ICU (due to anaphylaxis)
58
Progression of rattlesnake bite
worsening of local injury (pain, ecchymosis, swelling) abnormal labs (Coag, platelets) Systemic (Unstable VS, AMS)
59
Coral snake
bright colored (red/black/yellow rings.. red and yellow kill a fellow)
60
Tx for coral snake
``` admit start antivenom (venom effects may take a while, give anyhow) monitor respiratory function ```
61
Gila monster: what is it?
slow moving in SW US, venom as potent in rattlesnake NO FANTS short, grooved teeth so difficult to envenomate
62
Tx for gila monster
remove lizard clean wound remove remaining teeth which may fall out Radiographs for fx Td & ABX! prn admit for sx of envenomation: (weakness, light h/a, paresthesia, diaphoresis, HTN no antivenom available

EMed Exam 2 (6 decks)

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