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Hippos > Environmental > Flashcards

Environmental Flashcards

1
Q

What are chillblains (pernio), and how do you treat them?

A

Red/blue edematous plaques from prolonged cold exposure that resolve with supportive care

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2
Q

What is trench foot?

A

Pale, mottled foot from ischemia d/t prolonged cold exposure.

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3
Q

What is the treatment for trenchfoot?

A

Supportive

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4
Q

What is Hunter’s response?

A

Cycles of vasoconstriction and vasodilation when exposed to cold temperature

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5
Q

What is the difference between frostnip and frostbite?

A

Frostnip does not have crystal formation and is without tissue damage

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6
Q

What causes the damage with frostbite?

A

Crystal formation breaks down tissue

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7
Q

What is the temperature of the water that should be used to submerse tissue in for treating frostbite?

A

41-42 C

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8
Q

True or false: dry heat is appropriate for treating frostbite

A

False

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9
Q

Which type of blisters can be debrided with frostbite?

A

Clear blisters (maybe)

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10
Q

What is the definition of hypothermia?

A

Core temp of less than 35 C (95 F)

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11
Q

What is the temp and s/sx that define mild hypothermia?

A

32-35 C

Excitation phase of increased HR, BP, RR, shivering, confusion

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12
Q

What is the temp and s/sx that define moderate hypothermia?

A

30-32 C

shivering stops, worsening mental status

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13
Q

What is the goal temp for rewarming in cardiac arrest?

A

30 C

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14
Q

What is the temp and s/sx that define severe hypothermia?

A

Less than 30 C

arrhythmias

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15
Q

What are the two mechanisms that cause a cold diuresis?

A
  • Shift of fluid intravascularly

- Loss of enzymatic functions in kidneys

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16
Q

What causes the cold coagulopathy? Why won’t this show up on testing?

A
  • Loss of enzymatic function due to cold

- sampled warmed to standard temp when testing

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17
Q

Why is hyperglycemia common with hypothermia?

A

Insulin is less effective at lower temperatures

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18
Q

What is passive rewarming, and who is this good for?

A

Drying and wrapping patient

Good for mild hypothermia

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19
Q

What is active rewarming? What severity of hypothermia is this indicated for?

A
  • Application of exogenous heat (bair hugger)

- Hemodynamically stable pts

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20
Q

What is active invasive warming?

A

Application of exogenous heat through invasive means

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21
Q

What happens to brain veins with hypobarism?

A

Dilate

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22
Q

What is the MOA of acetazolamide? Why is this helpful for acute mountain sickness?

A

Causes HCO3 diuresis, causing you to hyperventilate

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23
Q

At what altitude does acute mountain sickness occur?

A

Over 2000 m

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24
Q

At what altitude does acute HAPE occur?

A

Over 3000 m

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25
Q

At what altitude does acute HACE occur?

A

Over 4500 m

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26
Q

What pharmacotherapy can be used to treat HAPE? (2)

A

Nifedipine and PDEIs

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27
Q

What pharmacotherapy can be used to treat HACE? (2)

A

Dexamethasone

Acetazolamide

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28
Q

Why do you never put in earplugs when diving?

A

Will cause a low pressure chamber, and cause vasogenic edema around that area

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29
Q

What causes barotitis interna? What are the symptoms?

A
  • Bleeding or rupture of the round window due to excessive attempts to equalize pressure
  • Vertigo, tinnitus, nystagmus
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30
Q

What causes barodontalgia?

A

If have crappy fillings with air trapped, when rising from diving causes expansion of gas and pain

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31
Q

What is alternobaric vertigo?

A

Unequal pressures in each ear causes vertigo

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32
Q

What causes ascent barotrauma?

A

Holding your breath while surfacing increases the volume in the lungs, and causes an alveoli to rupture

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33
Q

What is the mechanism by which an air gas embolism occurs?

A

Air bubbles forced into pulmonary veins and into arteries

34
Q

How fast will an air gas embolism present?

A

Within 10 minutes of surfacing

35
Q

Besides using a hyperbaric chamber, what two treatments can help with an air gas embolus?

A
  • Oxygen to minimize ischemia

- IVFs to maximize fluids status

36
Q

What causes nitrogen narcosis?

A

Nitrogen under pressure with enter CNS and act like an anesthetic

37
Q

What is the main problem with oxygen toxicity from diving too deep?

A

Seizures

38
Q

What is cutis marmorata?

A

Patchy rash from dissolution of nitrogen gas in lymphatic tissue from diving

39
Q

What causes pulmonary edema with heat stroke?

A

High output HF d/t severe dilitation

40
Q

At what core temperature should you stop cooling with heat stroke? Why?

A
  • 39 C

- avoid overshoot hypothermia

41
Q

Why should you spray warm water on patient’s with heat stroke?

A

Cool water will cause inappropriate shivering

42
Q

What is the parkland formula?

A

4kg%burn

43
Q

True or false: you should decrease the amount of fluids given in a burn resuscitation if they also have an inhalational injury

A

False

44
Q

When is time 0 for fluid resuscitation in burn pts?

A

When the burn occurred, not when they arrive at the ED

45
Q

How do you get tar off of a tar burn?

A

Use neosporin and leave on for 24 hours. Will dissolve

46
Q

2nd degree burns over what body surface area need referral to a burn center

A

10%

47
Q

True or false: all 3rd degree burns need to be referred to a burn center

A

True

48
Q

Over what volatege is considered “high” voltage?

A

1000 volts, but over 600 v is when significant damage can occur

49
Q

Why are electrical burns always less severe superficially?

A

Skin has higher resistance than underlying tissue

50
Q

What is the equation for voltage?

A

I * R

51
Q

Which is more lethal AC or DC current?

A

AC

52
Q

True or false: asymptomatic low voltage shock pts go home without testing

A

True

53
Q

How long should high voltage shock pts be monitored for? Does it matter if they’re symptomatic?

A

12-24 hours, regardless of symptoms

54
Q

What causes ARDS in drowning?

A

Washed out surfactant causes alveolar inflammation and non-cardiogenic pulmonary edema

55
Q

What is the most common metabolic derangement with drowning?

A

Lactic acidosis

56
Q

True or false: you should abrade the skin when decontaminating for a radiation exposure

A

False

57
Q

An absolute lymphocyte count over what after a radiation exposure portends a good prognosis? An ALC below what is lethal?

A

1000 at 48 hours

300

58
Q

What bacteria is associated with human bites?

A

Eikenella corrodens

59
Q

What bacteria is found in cat and dog bites?

A

Pasteurella

60
Q

What are the s/sx of the delayed beasting rxn? When does this happen, and what causes this?

A

Serum sickness with nonspecific s/sx, 10-14 days after rxn

61
Q

What is the dose of epi for anaphylaxis?

A

0.3-0.5 mg 1:1000 IM

62
Q

What does the bite of a fire ant look like?

A

Many tiny pustules

63
Q

What is the latin name for brown recluse spider? Black widow?

A 
Loxosceles = brown recluse
Latrodectus = black widow
64
Q

Violin spider = ?

A

Brown recluse

65
Q

Which spider bites are typically painful, and which are painless: brown recluse vs black widow

A 
Painless = brown recluse
Painful = black widow
66
Q

What does the black widow toxin do physiologically? What are the s/sx?

A
  • Releases NE and ach.

- Causes painful muscle contractions, either systemically or locally as well as localized sweating

67
Q

What is the treatment for mild and severe cases of black widow spider bites?

A
  • Benzos and analgesics

- Antivenom

68
Q

What are three snakes make up the crotalid snakes?

A
  • Rattlesnakes
  • Copperheads
  • cottonmouths
69
Q

What type of venom do crotalids produce? S/sx?

A
  • Cytotoxic venom

- Local pain, swelling, hemorrhage/coagulopathy

70
Q

How do you dose crofab?

A

Treat based on s/sx

71
Q

How do you treat compartment syndrome from snake bites?

A

Antivenom is the treatment. Should not have to call surgeon for fasciotomy as the cause is based on toxin

72
Q

What are the coral snakes?

A

Red on black snakes

73
Q

What are the s/sx of coral snakes?

A

Neurotoxin–bulbar palsies, n/v, paralysis

74
Q

What is the treatment for jellyfish stings?

A

vinegar or isopropyl alcohol

75
Q

What is the treatment for the man of war jellyfish sting?

A

Saltwater

76
Q

True or false: freshwater can be used to deactivate jellyfish stings

A

False–will cause triggering of barbs

77
Q

Are abx recommended for stingray envenomation?

A

Yes

78
Q

What is the treatment for stingray envenomation?

A

Hot water immersion as toxin is heat labile

79
Q

What type of toxin do sea snakes have (cytotoxic or neurotoxic)?

A

Neurotoxic

80
Q

What is erysipelothrix? What is the treatment?

A

Fish handler’s cellulitis that looks like erysipelas

-Fluoroquinolones or beta lactams

81
Q

What is the bacteria that causes fish-tank granuloma? How does this present? Treatment?

A
  • Mycobacterium marinum
  • Delayed presentation of granulomas at site of abrasion
  • TB drugs
82
Q

What are the two presentations of vibrio vulnificus? Treatment?

A
  • Necrotizing fasciitis
  • Primary septicemia

-3rd gen cephalosporin and doxy

Hippos (23 decks)

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