Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Typical location of frostbite

A

face, nose, ears, fingers, toes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Sx of frostbite

A

prior to rewarming: pale, waxy, hard, cold

numbness, tingling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Dx of frostbite

A

clinical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

1st degree frostbite

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Second degree frostbite

A

blisters w/ surrounding edema/erythema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Third degree frostbite

A

tissue loss involving entire thickness of skin;

hemorrhagic blisters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

4th degree frostbite

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Disposition for frostbite

A

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

Admit deep tissue - ortho or hand surgeon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Causes of hypothermia

A

primary (cold exposure-)

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Medical conditions causing hypothermia

A

sepsis/shock
hypothyrodisim
burns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Meds causing hypothermia

A

antihyperglycemics

beta-blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is hypothermia?

A

core below 35 celcius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Mild hypothermia

A

32-35 degrees

Confusion, tachy, increased shivering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Mod hypothermia

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Severe hypothermia

A 
<28
coma
hypotension
arrhythmia
pulmonary edema
rigidity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Measuring temp

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When don’t you defibrillate in hypothermia

A

core <30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Mild hypothermia tx

A

passive external rewarming
remove wet clothes
cover w/ warm blankets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Severe hypothermia tx

A

everything in moderate PLUS:
 Pleural and peritoneal irrigation with warm saline (400C-420C)
 Extracorporeal options: hemodialysis, cardiopulmonary bypass, continuous arteriovenous rewarming

26
Q

leading cause of deaths in athletes

A

heat emergencies

27
Q

Risk factors for heat emergencies

A

 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
Q

Heat cramps

A

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
Q

At risk for heat cramp

A
  • “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
Q

Management for heat cramp

A

hydrate, replace Na
relax/stretch mm
education/prevention

31
Q

Heat stress (exhaution)

A

due to water and sodium depletion

32
Q

Sx of heat exhaution

A 
h/a
n/v
dizziness
diffuse muscle cramps
orthostatic hypotension, +/- syncope
33
Q

PE for heat stress

A

temp normal or elevated (not higher than 104F)

No signs of CNS impairment

34
Q

Dx for heat stress

A

BMP

CBC (hemoconcentration common)

35
Q

Tx for heat stress

A

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
Q

Heat stroke sx

A 
hyperthermia (>104) PLUS AMS:
 Irritability
 Confusion
 Irrational behavior
 Decorticate and decerebrate posturing 
 Seizures
 Coma
37
Q

Dx of heat stroke

A 
 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
Q

Management of heat stroke

A

IVF resuscitation

cool quick w/o hypothermia induction (102.2 F)

39
Q

Mechanisms of cooling

A

evaporative (spray water w/ fan)
Ice packs
Immersion cooling
Invasive cooling (cardiopulmonary bypass)

40
Q

Con of evaporative cooling

A

hard to keep cardiac electrodes on skin

41
Q

Immersion cooling con

A

Electrodes cannot be on patient, poorly tolerated, cannot defibrillate if needed

42
Q

Disposition of heat stroke

A

admit

43
Q

black widow spider (L. mactans, L. hesperus)

A

males harmless
like to live OUTDOORS
enjoy warm weather/arizona

44
Q

Brown recluse spider (loxosceles reclusa)

A

6 eyes (instead of 8)
like to live INDOORS
not so common in AZ

45
Q

dx of spider bite

A

spier observed

skin lesion typical

46
Q

Tx for spider bite

A

wound cleansing
tetanus prn
treat secondary infection prn

47
Q

Presentation of mild black widow

A

local wound, +/- spasm to site

48
Q

Moderate sx for black widow

A

spasms, muscle pain in bitten extremitiy, back, chest, abdomen
adjacent diaphoresis

49
Q

Severe envenomation from black widow

A

evere pain and spasm and systemic features - n/v,

headache, tachycardia, hypertension

50
Q

Tx for mild/mod envenomation for black wiow

A 
self-limiting 24-48 hrs
analgesic (opiods in mod/severe)
muscle relaxant prn
Antivenom (bad risk)
monitor for 2nd infection
51
Q

Presentation of reclus lesion

A

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
Q

Management of brown recluse

A

 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
Q

Result of scorpion sting

A

minimal swelling
regional LAD
increased skin temp/tenderness around wound

54
Q

Presentation of bark scorpion

A

 Initial symptoms are pain and paresthesia over involved area
 Swelling usually absent, few skin changes
 Tachycardia
 Hypertension
 Tachypnea
 Weakness
 Muscle spasms and fasciculations

55
Q

Tx of bark scorpion

A

 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
Q

Features of rattlesnake bites (“pit vipers”)

A 
 Fang marks
 Local tissue injury 
 Fibrinolysis (anticoagulation)
 Thrombocytopenia 
 Systemic effects
57
Q

Tx for rattlesnake bites

A

ANTIVENOM! (IV or intraosseous)

ICU (due to anaphylaxis)

58
Q

Progression of rattlesnake bite

A

worsening of local injury (pain, ecchymosis, swelling)
abnormal labs (Coag, platelets)
Systemic (Unstable VS, AMS)

59
Q

Coral snake

A

bright colored (red/black/yellow rings.. red and yellow kill a fellow)

60
Q

Tx for coral snake

A 
admit
start antivenom (venom effects may take a while, give anyhow)
monitor respiratory function
61
Q

Gila monster: what is it?

A

slow moving in SW US, venom as potent in rattlesnake
NO FANTS
short, grooved teeth so difficult to envenomate

62
Q

Tx for gila monster

A

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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions