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Clin Med IV: Emergency Medicine > Environmental Emergencies > Flashcards

Environmental Emergencies Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Who is at risk of frostbite

A

anyone with increased/prolonged exposure to cold environments
(military, winter sports, outside workers, elderly/young patinets, homelessness, etc)

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2
Q

What factors increase your risk of frostbite

A

temp < 20C of <-4F
hight winds
cold, wet, environments
prolonged exposure
high altitude
pre-existing neurovascular susceptibility

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3
Q

what is the progression of frostbite stages

A

frostnip
frostbite (graded 1-4)
- 1st and 2nd degree = superficial
- 3rd and 4th degree = deep (frostbite)

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4
Q

what is superficial frostbite

A

involves epidermis and dermis
white or yellowish skin
skin numbness
edema
blisters with clear or milky fluid

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5
Q

what is frostbite

A

deeper into the dermis
hemorrhagic blisters
tissue necrosis (eschar)
4th degree = involvement of tissues beyond dermis

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6
Q

how is frostbite diagnosed

A

usually clinical
imaging and labs not typically needed

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7
Q

what is the treatment of frostbite

A

prevent further injury
dont add heat (graudal rewarming over 20-30 min)
give analgesia
dont rub area
apply topical ointment to blisters
apply loose dressings
elevate and immobilize
assess need for tetanus
consider abx

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8
Q

what are complications of frostbite

A

persistent pain - CRPS
cold hypersensitivity
persistent numbness
raynauds
loss of limb/digit/appendage
increased susceptibility to frostbite in future

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9
Q

what is Iloprost

A

vasodilator used in condition such as Raynauds

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10
Q

what is the definition of hypothermia

A

drop of core body tep to 35C (95F) degrees of less
- primary: direct exposure to cold
- secondary - coplication of systemic illness/injury

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11
Q

How is hypothermia treated

A

passive external re-warming (cover head, cover and insulate body)
Active rewarming

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12
Q

what is active rewarming

A

external and core
external: foreced hot hair, heated blankets, radiant heat, hot packs
Core: heated IV fluids, heated/humidified O2, Heated HI irrigation, thoracic lavage (last resort)

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13
Q

what are Osborne waves

A

“j waves” - seen best in inferior and precordial leads
slow, positive deflection at end of QRS

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14
Q

what medications are considered with hypothermia cardiac arrest

A

epinepherine ( medications may be ineffective at low temps)

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15
Q

What is heat exhaustion

A

core temp at or below 40.5C (105F)
usually accompany dehydration or Na+ depletion/dilution
may progress to heat stroke

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16
Q

how does heat exhaustion differentiate from heat stroke

A

preservation of thermoregulation and NO CNS distrubances

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16
Q

What is the treatment of heat exhaustion

A

remove from heat, hydrate +/- electrolyte correcton
evaporative cooling

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17
Q

what is heat stroke

A

medical emergency
types:
- classic: prolonged exposure, older and co-morbidities
- exertional: increased activity/exercise, often higher temps, younger and otherwise health

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18
Q

what is heat stroke

A

loss of thermoregulatory mechanisms
vasoconstriction to maintain MAP

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19
Q

what is the diagnostic triad for heat stroke

A

heat exposure
CNS dysfunction
temp > 40.5 degrees C

20
Q

What is the treatment of heat stroke

A

ABC/IV/O2/monitor (core temp)
remove from exposure
correct electorolytes

21
Q

what are the three mechanisms of electrical injuries

A

direct tissue damage from current
direct tissue injury from thermal burns
mechanical trauma from fall, throws, muscle contraction

22
Q

how are electrical injuries diagnosed

A

report from pt /witness

23
Q

what are Arc burns

A

thermal burn from indirect electrical current - radiatn heat

24
Q
A
25
Q

what are flash burns

A

thermal injury caused by combustion of material on contact wtih current

26
Q

How are electrical injuries treated

A

ABCS
address associated injuries (expose everything)
admit for observation and workup

27
Q

how do lightning injuries travel

A

skin surface, but magnetic field/pressure penetrates throughout

28
Q

what are associated injuries with lightning injuries

A

cardiac - asystole
ventricular arrhythmias
CNS disruption
intracranial hemorrhage
peripheral nerve damage
blunt trauma

29
Q

what are radiation injuries

A

exposure through transport, storage, occupational exosure, errors in therapeutic dose
high doses - cell death
low dose - interrupt mitosis - CA

30
Q

what are the radiation safety considerations

A

time
distance
shielding

31
Q

what is the presentation of acute whole body exposure to radiation

A

prodrome: N/V/D, anorexia, hypotension, fever, sweating, HA, fatigue
latent phase: symptom free
Manifests: Hematopoetic, GI, Neurovascular collapse

32
Q

what is the general treatment of radiation injuries

A

treat life threatning injuries first
minimize your own exposure
decontamination

33
Q

at what elevation does altitude sickness occur

A

elevations higher than 4,800ft within first 24 hours
- usually > 8,000ft and rapid ascent

34
Q

what is the treatment of altitude sickness

A

self-limited illness
mild cases - pause ascent and supportive tx (acetazolamide and dexamethasone)

35
Q

what is HAPE

A

High Altitude Pulmonary Edema
pink frothy sputum
usually, day 2-4 after ascent
add O2, positive pressure vent, nifedipine

36
Q

what is HACE

A

High Altitude Cerebral Edema
HA, ataxia, pailledema, encephalopathy
add O2, and dexamethasone

37
Q

What is HAFE

A

High Altitude Flatus Expulsion
increase in both volume and frequency of flatus
not as much an emergency as HAPE and HACE

38
Q

What occurs with viperidae

A

hemolytic changes

39
Q

What is Hymenoptera

A

bees, wasps, yellow-jackets, fire ants
most symptoms for IgE mediated reactions

40
Q

what is the initial treatment of hymenoptera

A

remove stinger
disinfect bite site
apply ice
elevation
analgesics, benadryl, calamine lotion
epinepherine
monitor 4 hours in ER

41
Q

what is the advanced anaphylaxis treatment

A

IV, O2 monitor and fluids
albuterol
IV epi
vasopressors for shock (norepi)

42
Q

what is brown recluse bites

A

provoking bite
mostly minor injury -edema/erythema in about 3 days

43
Q

what is the treatment of brown recluse bites

A

RICE
analgesics and antihistamines
abx and tetanus ppx
consider corticosteroids
debridement of large ulcerations and secondary closure

44
Q

what is the progression of black widow bites

A

within 60 min: cramps at bite site - extremity - trunk
later: abdominal rididity, abd pain
even later: excess salivation, lacrimation, urination, defication, emesis
late stages: respiratory arrest, cerebral hemorrhage, cardiac failure

45
Q

what is the treatment of black window bites

A

RICE
Mostly supportive, ABC
tetanus
?antivenom

46
Q

what is the definition of near drowning

A

suffocation wtih submersion and survival (immediate)
can occur with or without aspiration
results in ventilation-perfusion mistmatch

47
Q

what is the presentation of near drowning

A

rales on aucultation, cardiac arrhythmias, AMS
hypoxia, hypercabia, metabolic acidosis

48
Q

what is the treatment of near drowning

A

rescue breathing ASAP
CPR as necessary
secure airway
administer O2
monitor BP
correct electrolyte abnormalities

Clin Med IV: Emergency Medicine (18 decks)

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