Environmental

Question 1

What are the complications of heat stroke you look for in lab investigations?

Answer 1

1. Hyperkalaemia
2. Metabolic acidosis
3. Raised CK (Rhabdomyolysis)
4. Coagulopathy (DIC)
5. Raised liver transaminases / amylase
6. Hypoglycaemia (Secondary to liver failure)

Question 2

What are the complications of near drowning?

Answer 2

1. Pneumonia
2. Aspiration pneumonia
3. Pulmonary Oedema
4. ARDS

Question 3

What factors in near drowning will predict poor prognosis?

Answer 3

1. Extreme of age
2. Severe acidosis
3. Immersion > 5 minutes
4. Coma on admission

Question 4

List admission criteria for electrical / lightning injuries

Answer 4

• History of high voltage injury or lightning strike
• Altered mental status / neuro deficits
• Respiratory weakness / paralysis
• Cardiac injury / contusion / dysrhythmia / ischemia
• Hypotension
  
  • Third spacing
• Extensive thermal burns or circumferential burns
• Rhabdomyolysis
• Compartment syndrome
• Blunt traumatic injuries
• Extremity thrombosis or vasospasm
• Deep pediatric oral burns (for hydration)
• Pregnant patients

Crackcast episode covering Rosen’s chapter 142

Question 5

List 6 complications of high voltage injuries

Answer 5

• Neuro-psychiatric sequelae
• Blunt trauma (anywhere!)
• Cardio-pulmonary arrest
• Thermal burns (anywhere!)
• Tetanic muscle contractions (leading to fractures, compartment syndrome)
• Rhabdomyolysis

Question 6

List 6 mechanisms of lightning injuries

Answer 6

• Conduction injuries
  
  • Direct strike
  • Contact strike (hits something the person is holding on to or touching)
  • Side flash or splash injury
  • Streamer (hits the ground and then travels through the patient)
    
    • May cause the “stride voltage injury”
  • Flash / arc burns (current doesn’t enter the body)
  • Blast injury
    
    • Barotrauma
    • Shrapnel
    • Blunt trauma

Question 7

List the ECG changes seen with lightning strikes

Answer 7

• ST elevation
• QT interval prolongation
• Atrial fibrillation
• Inverted or flattened T waves
• Myocardial infarction pattern without cardiac sequelae

Question 8

What is keraunoparalysis?

Answer 8

This flaccid paralysis, which is usually accompanied by marked vasomotor changes that result in extremities that appear blue, mottled, and pulseless, may persist up to 24 hours. The lower extremities are more commonly involved, and the typical pattern is recovery over minutes to days.