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emergency Medicine > environmental emergencies > Flashcards

environmental emergencies Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

How fast does cold water decrease body temperature

A

4 times faster than cold air

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2
Q

What stage of frosbite do thrombi form

A

vascular stasis

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3
Q

What will superficial frostbite look like

A

White or yellow skin
Numbness
edema
blisters w/ clear/ milky fluid

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4
Q

What layer of skin will 4th degree frostbite effect

A

tissue beyond the dermis

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5
Q

When and how do you treat someone with frostbite

A

gradual rewarming over 2-3 minutes only when there is NO risk of refreezing
**No dry heat

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6
Q

What are some complications associated with frostbite

A

Complex regional pain syndrome
Cold hypersensitivity
Persistent numbness
Raynaud’s
Loss of limb etc
increased susceptibility of future frostbite

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7
Q

What is iloprost and when is it used

A

a vasodilator used in conditions such as Raynaud’s

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8
Q

What is hypothermia

What are the types

A

Drop in core body temperature to 35C (95F) or less

Primary (direct exposure) & secondary (complications of systemic illness

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9
Q

Which populations are at higher risk of hypothermia

A

Extremes of age
dehydration & malnutrition

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10
Q

What exam findings are there with hypothermia

A

CNS: AMS progressing to coma
CV: Tachy–> brady & eventually asystole
Resp: tachypnea–> hypoventilation
Renal: Increased metabolic activity
Neuromuscular: Shivering –> hyporeflexia

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11
Q

What are some external active rewarming startegies

A

Bair hugger
heated blankets
heated water circulation pad
hot packs

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12
Q

What are some core active rewarming techniques

A

Heated IV fluids
Heated/humidified O2
Heated GI irrigation
Thoracic lavage (last resot)

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13
Q

What are Osborne waves and when are they seen

What do you need to be careful with when these waves are present

A
  • J waves seen best in the inferior and precordial leads
  • Positive deflection at the end of QRS
  • Seen in hypothermia

Positioning/moving the patient

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14
Q

What will be seen on labs in those with hypothermia indicating high mortality

A
  • K+ >10-12 (massive cell lysis)
  • core temp <10-12 degrees
  • pH <6.5
  • Fibrinogen <.5 (intravascular thrombosis present)
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15
Q

What defines heat exhaustion

What accompanies it

A

Core temp at or above 105F

Dehydration / Na+ depletion

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16
Q

How does heat exhaustion differ from heat stroke

A

Heat exhaustion preserves thermoregulation and there will be NO CNS disturbances

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17
Q

Over what time frame should people with heat exhaustion be rehydrated

Why

A

over 24-48 hours

Prevents further Na dilution

18
Q

What are the 2 primary types of heat stroke

A

Classic –> older patients
Exertional –> Younger/healthy

19
Q

What sxs will someone have with heat stroke

A

Tachycardia, tachypnea, hypotension, widened pulse pressure

20
Q

What is the diagnostic triad for heat stroke

A

Heat exposure
CNS dysfunction
Temp >40.5 degrees

21
Q

At what temperature is someone at risk for irreversible damage

What will be seen

A

Temp of 107.6F

Hepatic failure, renal failure, DIC. multisystem organ failure

22
Q

What shoud vasopressors never be given to someone in heat stroke even if they are hypotensive

A

It causes vasoconstriction leading to even less heat loss from the patient

23
Q

What population are electrical injuries mostly seen in

A

Kiddos < 6 and adults with occupational exposure

24
Q

What are the mechanisms for electrical injuries

A

Direct tissue damage from current
Direct tissue injury from thermal burn
Mechanical trauma from fall/ spasms etc

25
Q

What are the types of thermal burns seen with electrical injuries

A

Arc burns: Burns from indirect electrical current
Flash burns: Thermal injury caused by combustion of material on contact w/ current

26
Q

What tissues are better conductions and more prone to injury

A

Nerve> blood> muscle> skin> tendon> fat> bone

27
Q

What is the prodrome for radiation injuries

How about the latent phase

A

n/v, anorexia, diarrhea, hypotension, fever, sweating, H/A, fatigue

Symptom free interval

28
Q

Where does altitude sickness occur

A

Elevations > 4800ft within the first 24 hours
*generally >8000ft & rapid ascent

29
Q

What can altitude sickness lead to if ignored

A

Cerebral/pulmonary edema
GI distress

30
Q

Which patients CANNOT take acetazolamide

A

Athletes

31
Q

What is HAPE

What are the sxs

When does it occur

A

High altitude pulmonary edema
*think flash pulmonary edema

pink frothy sputum

2-4 days after ascent

32
Q

How can you treat HAPE

A

add O2, positive pressure ventilation, nifedipine (reduces PA pressure)

33
Q

What is HACE

SXS?

treatment?

A

High altitude cerebral edema

ataxia, H/A, Papilledema, Encephalopathy

immediate descent, O2, dexamethason

34
Q

What is HAFE

A

High altitude flatus expulsion
*increases both in volume and frequency of flatus

35
Q

What is the difference between poison and venom

A

Poison= secreted toxin (you bite it)
Venom= injected toxin (it bites you)

36
Q

What is the mechanism of drowning for kiddos <1y/o

A

bathrubs or buckets of water

37
Q

What is the drowning mechanism for kiddos 1-4y/o

A

pools

38
Q

What is the drowning mechanism for school aged kids and older

A

large bodies of water

39
Q

What is near drowning

A

Suffocation with submersion WITH survival

*can occur w/ and w/o water aspiration

Will get a VQ mismatch

40
Q

What are primary injuries assocaited with drowning

A

Anoxic brain injury (hypoxia)
ARDS (inhalation)

41
Q

How will someone with near drowning present

A

rales on auscultation
AMS
secondary arrhythmias

42
Q

How do you treat near drowning

A

rescue breathing ASAP

emergency Medicine (5 decks)

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