Environmental and Nutritional Disorders: Part III Flashcards
What three major symptoms does cocaine cause?
tachycardia, HTN, and peripheral vasoconstriction
how does cocaine use lead to myocardial ischemia?
coronary artery vasoconstriction + platelet aggregation+ thrombus formation leads to myocardial ischemia
what does cigarette smoking and cocaine use potentiate
cocaine induced coronary vasospasm
what can be said about the lethal arrhythmias that are associated with cocaine use?
they are not dose related; so this could be a first time use of cocaine and it could be a very small amount and still cause lethal arrhythmias
What effect does cocaine have on the placenta?
it decreases blood flow to the placenta, which causes fetal hypoxia and spontaneous abortion
what effect does cocaine have on the CNS?
hyperpyrexia (fever) and seizures
what are the major effects of opiate use?
profound respiratory depression, arrhythmia, cardiac arrest, and pulmonary edema
if a drug abuser injects opiates or heroin, what could happen?
they are injecting into a vein so there could be an infection leading to endocarditis of the right side of the heart (NOT THE LEFT)
what are the symptoms of methamphetamine use?
violent behavior, confusion, psychotic symptoms (paranoia and hallucinations)
what is MDMA?
ecstasy; often spiked with other drugs which can enhance its effects on the CNS
what are the effects of chronic use of ecstasy?
sleep disorders, depression, anxiety, and aggressive behavior
what are the effects of marijuana?
increased heart rate, changes to blood pressure (could cause angina in a patient with CAD), cognitive and psychomotor impairment with continued use; there are also large carcinogens in smoke
what are the effects of huffing/glue sniffing?
there is MRI detectable brain damage that ranges from mild to severe dementia
what are the effects of bath salts?
agitation, psychosis, MI, and suicide
if you open a body bag of a person that overdosed on opiates, what would you expect to find?
a foam cone centered over the nose and mouth–> bubble frothy fluid coming out of the lungs and out through the nose and mouth due to pulmonary edema
The clinical significance of burn injuries depends on 4 things, what are they?
depth of the burn, % of body surface covered by the burn, internal injuries, and fluid and electrolyte management and infection control
What classifies a burn as 1st degree?
superficial; epidermis only
what classifies a burn as 2nd degree?
partial thickness; epidermis and dermis
what classifies a burn as 3rd degree?
full thickness; extend into the subcutaneous tissue
what classifies a burn as 4th degree?
full thickness; involves the underlying muscle and the subcutaneous tissue
what percentage is the adult torso?
a: 18% p: 18%
what percentage is the adult arm?
a: 4.5% p: 4.5%
what percentage is the adult leg?
a: 9 p: 9%
what percentage is the adult head?
a:4.5% p: 4.5%
what percent is the male genitalia?
1%
when we are talking about internal injuries what are we talking about?
inhalation of toxic fumes and heat injuries especially considering the trachea (important to consider this because this could cause issues when trying to incubate)
when you have loss of skin, what issue arises?
maintenance of fluid and electrolyte balance–> must monitor
What should you expect to see if a patient has more than 20% of their body surface covered in burns?
there will be a rapid shift of body fluids into the interstitial compartment leading to shock–> this ultimately can lead to PULMONARY EDEMA
what happens if more than 40% of the body surface is burned?
the resting metabolic rate doubles
what are some of the colonizations that occur on burns?
pseudomonas aeruginosa (most common), MRSA, and candida species
what happens within 24-48 hours of being burned?
respiratory insufficiency–> direct heat effects on the upper airway (mouth, nose, trachea) and inhalation of noxious gases (Cl, sulfur dioxide, and ammonia)
what is the stance that is found when bodies are burned beyond recognition?
pugilistic stance
what is the effect of heat exhaustion?
sudden prostration and collapse; lack of cardiac compensation for hypovolemia caused by dehydration; if you rehydrate you should recover
what are the signs of heat stroke?
sweating ceases and core body temperature rises to more than 40 degrees C, leading to multiorgan dysfunction
what all occurs during heat stroke?
generalized vasodilation with peripheral pooling of blood and decreased effective circulating blood volume; hyperkalemia, tachycardia, arrhythmias
what does sustained contractions of skeletal muscle lead to?
muscle necrosis (rhabdomyolysis)
what regulates calcium release from the sarcoplasm (and the calcium leak stimulates the muscle contraction)?
the RYR1 gene
what is malignant hyperthermia?
“heat stroke-like” rise in core body temp and muscle contractures in response to common anesthetics
how do you treat malignant hyperthermia?
muscle relaxers
what is hypothermia defined as?
when body temperatures fall below 90 degrees
what can hypothermia lead to within the body?
loss of consciousness, bradycardia, then atrial fibrillation
what could worsen hypothermia?
high humidity, wet clothing, and it is exacerbated by EtOH
what are the direct effects of hypothermia?
frostbite (which is crystallization if the intra and extracellular water)
what are the indirect effects of hypothermia?
vasoconstriction and an increase in vascular permeability, which leads to edema and hypoxia, which leads to hypoxia and infarction of the extremities which causes GANGRENE
What is paradoxical undressing?
often times before a person dies from hypothermia, they experience a burst of extreme heat and it causes them to undress themselves
when discussing electrical injuries, there are two types of injuries. What are these?
1) burns 2) ventricular fibrillation or cardiac-respiratory failure
What does the extent of electrical injury depend on?
the strength (amps), duration, and path of current through body
What are low-voltage electrical injuries?
typically household injuries; burn sites at entry and exit if sustained
in low-voltage electrical injuries, the alternating currents induce what?
tetanic muscle spasms; irreversible grasp; spasm of the chest wall (asphyxia)
what are high-voltage electrical injuries?
lightening is a classic example; causes paralysis of the medullary centers and more extensive burns
what is the pattern that occurs on the skin if a patient has been struck by lightening?
lichtenberg figures (these are transient)
What is the morphology after someone undergoes ionizing radiation?
nuclear swelling, giant cells, pleomorphic nuclei, >1 nucleus, cytoplasmic swelling
what problem might a pathologist have when evaluating irradiated tissues for the possible persistence of tumor cells?
the histological constellation of cellular pleomorphism, giant-cell formation, conformational changes in nuclei, and abnormal mitotic figures creates a more than passing similarity between radiation-injured cells and cancer cells
What are secondary cancers?
individuals who received radiation therapy for cancers such as Hodgkin’s lymphoma may develop different cancers-secondary cancers- such as AML, myelodysplastic syndrome (MDS), and solid tumors
if someone has radiotherapy to the mediastinum, what might happen?
they could get extensive fibrosis in the area- so not just the lungs, but the pericardial sac can become very thick and fibrotic and this can have some interference with its functionality
