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Emergency Medicine > Environmental emergencies > Flashcards

Environmental emergencies Flashcards

1
Q

what is Heat Illnesses?
At risk pts?

A
  • one is unable to adequately regulate body temperature
  • Young/elderly, Obese, Chronic physical/mental illness, Impaired by drugs/ETOH, Anyone denied access to hydration/nutrition
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2
Q

Mild swelling of dependent extremities due to heat exposure
Results from muscular and cutaneous vasodilation combined with venous stasis

dx?
mgmt?

A
  • heat edema
  • self-limiting with elevation, rest, cooling, oral rehydration
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3
Q
  • Syncope after exertion in the heat
  • results from vasodilation leading to intravascular volume redistribution
  • Core temp is normal, skin is cool and diaphoretic, weak pulse, transient hypotension

dx? mgmt?

A
  • Heat Syncope
  • R/o other causes of syncope (hypoglycemia, arrhythmias, and fixed myocardial or cerebrovascular lesions)
  • supine with legs elevated, remove from heat, (+/-) external cooling, IV/oral rehydration
  • DC after tx and pt ed
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4
Q

painful spasms of voluntary muscles of the abdomen and extremities resulting from salt depletion
core temp normal or slightly elevated, (+/-) muscle fasciculations, skin is moist or dry and cool or warm

dx?
w/u?
mgmt?

A
  • Heat Cramps
  • w/u rarely needed - possible hemoceoncetration, low-nml Na, +/- low K+ & Mg
  • Remove from heat and start external cooling, PO lyte (pedialyte or Gatorade) or IV NS, Replace K+ and Mg if needed
  • DC home, Rest x 1-3 d - avoid physical exertion and heat exposure
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5
Q

inability to maintain adequate CO d/t strenuous physical exercise and environmental heat stress
Rapidly evolves to heat stroke if no intervention

dx?

A

Heat Exhaustion

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6
Q

2 types of Heat Exhaustion

A

often a combination

  1. Hypernatremic (water loss): results from lack of water access
  2. Hyponatremic (sodium loss): fluid loss replaced with water only
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7
Q
  • Temperature often mildly elevated - usually will not exceed 40°C (104°F)
  • Diaphoresis, HA, N/V, malaise, weakness,
  • Muscle cramps, dizziness, (+/-) dark urine
  • Tachycardia, hypotension
  • No evidence of CNS dysfunction

dx?

A

heat exhaustion

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8
Q

difference between heat exhaustion vs heat stroke?

A

Heat exhaustion does NOT have evidence of CNS dysfunction

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9
Q

w/u and mgmt for heat exhaustion

A
  • BMP, UA, additional labs depending on presentation (CK, LFT, ABG, EKG)
  • Remove from heat, (+/-) external cooling, PO lytes if tolerable; Alt: IV NS or LR; hypertonic saline if marked hyponatremia d/t water intoxication
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10
Q

criteria to admit for heat exhaustion

A
  1. moderate-to-severe symptoms
  2. comorbid illnesses
  3. patients at extremes of age
  4. lab abnormalities - Elevated CPK, creatinine, LFTs, cardiac abnormalities, hyponatremia, persistent acidosis
  5. social concerns

Home: mild cases who don’t meet criteria below

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11
Q
  • dysfunction of the heat regulating mechanism with hyperthermia (core body temp >104°F) and end-organ damage
  • Cardiovascular collapse due to vascular volume loss

dx?

A

heat stroke

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12
Q

what structures are most senstive to heat stress? (4)

A
  1. Neural tissue
  2. hepatocytes
  3. nephrons
  4. vascular endothelium
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13
Q

2 types of heat stroke

A
  1. exertional (rapid onset)
  2. non-exertional (slow onset)
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14
Q

after a hot day a pt is now presenting with:

  • HA, dizziness, nausea, diarrhea, visual disturbances
  • Skin is hot, flushed, usually dry
  • CV: rapid, bounding pulse, hypotension indicates CV collapse
  • Neuro: confusion, seizure, delirium, ataxia, coma
  • hematuria, hematemesis, bruising, petechiae, and oozing at sites of venipuncture

dx?
hematuria, hematemesis, etc are signs of what?

A
  • heat stroke
  • signs of DIC
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15
Q

ddx heat stroke

A
  • Infectious: sepsis, meningitis, encephalitis, malaria, typhoid, tetanus
  • Endocrine: DKA, thyroid storm
  • Neuro: CVA, status epilepticus
  • Other: toxin exposure, serotonin syndrome, neuroleptic malignant syndrome, and anticholinergic toxicity
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16
Q

w/u for heat stroke

A
  1. CBC, PT/PTT - evidence of hemoconcentration and DIC
  2. CMP - reassess electrolytes every hour
    - hyperkalemia is seen with ARF secondary to rhabdomyolysis
  3. Phosphate (hypophosphatemia)
  4. UA - concentrated, with protein, myoglobin and tubular casts
  5. CK
  6. EKG
  7. CXR
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17
Q

mgmt heat stroke

A
  1. Rapid cooling - Ice water submersion (preferred method)
  2. severe shivering - IV BZD
  3. Continuous temp (rectal) - DC when 101.5-102℉
  4. If unresponsive: internal lavage - peritoneal, gastric, bladder, and/or rectal
  5. CV support - IV fluids
    - 1-2 L bolus NS if hypotension or rhabdo
    - fluid rate high enough to maintain UO
  6. Goal UO: 50–100 mL/h
  7. O2 if needed
  8. Significant AMS - ventilate/intubate
  9. Admit to ICU if hemodynamic instability, severe LFT elevation or rhabdomyolysis; All others admit to general floor (med/surg)
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18
Q

frostbite - Initial clinical findings before re-warming

A
  • Mild: Paresthesias, pruritus of tissue involved; loss of sensation and fine motor control
  • Mod-Severe: decreased ROM, blister formation, edema, tissue appears white, firm/hard, cool to touch
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19
Q

frostbite - clinical findings after warming

A
  • Stinging, burning, aching, throbbing, tenderness
  • Tissue discoloration, loss of elasticity and mobility
  • Profound edema, hemorrhagic blisters, necrosis, gangrene
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20
Q

when to assess severity of frostbite?

A

after rewarming

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21
Q

Degrees of frostbite - describe each

A
  • 1st degree: erythema and edema without blister, skin peeling
  • 2nd degree: serous filled blister
  • 3rd degree: skin necrosis: hemorrhagic blister with subcutaneous involvement
  • 4th degree: full-thickness (includes bone), non-blanching cyanosis; dry, black mummified eschar formation; loss or deformity of body part
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22
Q

mgmt for frostbite

A

Tx as burn

  1. tx systemic hypothermia before frostbite
  2. Avoid partial rewarming/refreezing
  3. Rapid rewarming in circulating water at 98.6–102.2°F
    - 15-60 min; until red–purple color appears and skin becomes pliable - allow skin to air dry
    - can be painful - parenteral NSAID/opiates
  4. Warm oral/IV fluids if evidence of hypovolemia
  5. Extremity/Wound Care - aloe q6h, consult/refer for superficial dead tissue in a whirlpool BID x 3 wks
  6. splint + elevate limb
  7. tetanus
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23
Q

disposition for frostbite

A
  • Home: limited area with only 1st degree injury
  • Hospital: extensive area of 1st degree and all 2nd, 3rd, 4th degree
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24
Q

Long-term sequelaes from frostbite

A
  1. Cold sensitivity
  2. loss of sensation
  3. hyperhidrosis
  4. loss of digit/limb
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25
Q

Defined as a core body temp < 35°C (< 95°F)
By rectal, bladder or esophageal thermometer

dx?
causes?

A

Hypothermia

  • Primary causes: Environmental exposure (alc/drugs); Therapeutic: targeted temperature management
  • Secondary causes: Burns, hypoglycemia, hypothyroidism, hypoadrenalism, hypopituitarism, CNS dysfunction, sepsis, drugs, trauma; Impaired shivering
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26
Q

s/s mild hypothermia

A
  • Conscious, shivering, HR/RR increase
  • 35–32°C ( 95-89.6°F)
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27
Q

s/s moderate hypothermia

A
  • Mild alteration in consciousness, loss of shivering reflex, HR/RR drop
  • < 32–28°C (89.6-82.4°F)
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28
Q

s/s of severe hypothermia

A
  • Unconscious, VS present, areflexia, fixed dilated pupils, hypotension, pulmonary edema, cardiac arrhythmia and arrest, coma
  • < 28°C (82.4°F)
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29
Q

s/s of hypothermia (HT) IV?

A
  • Vital signs absent
  • < 24°C (75.2°F)
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30
Q

w/u for hypothermia

A

Do not delay tx for labs

  1. CBC
  2. CMP - hypokalemia with mild HT, hyperkalemia with severe HT results from cell death/ARF
  3. TSH - severe untreated hypothyroidism
  4. Cortisol - look for signs of adrenal insufficiency
  5. Coags - elevated if complicated by coagulopathy (DIC)
  6. Lactic acid - elevated with cell death
  7. Blood gas
  8. EKG
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31
Q

mgmt for all hypothermia pts

A
  1. Continuous VS monitoring including core body thermometer
  2. Ventilate if needed
  3. Remove wet clothing, dry and cover up
  4. Handle gently to avoid fatal dysrhythmia
  5. KEEP supine in ALL CASES
  6. Rewarm in warm (24 C)environment, warm IV fluids, heat blankets or 75 F
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32
Q

mgmt for mild hypothermia (HT I)

A
  1. Place in warm environment - room temp at or above 28°C (82°F)
  2. Encourage active movement
  3. Warm oral sugary drinks
  4. If significant trauma, comorbidities or suspected secondary hypothermia treat as Moderate( HT II)
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33
Q

mgmt for moderate (HT II) hypothermia

A
  • Rewarming: warm environment with chemical, electrical, or forced air heating packs or blankets
  • Start warm IV fluids
  • Full-body insulation, horizontal position, and immobilization
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34
Q

mgmt for severe hypothermia (HT III)

A
  1. Airway management likely needed
  2. Sinus bradycardia, afib and flutter will resolve with rewarming
  3. V fib will not respond until pt is rewarmed - one defibrillation before rewarming; do not repeat until core temperature is 30C (86 F)
  4. Rewarming - external heating device (as in HTII), warm IV fluids; rewarming via ECMO preferred, if available, d/t high risk of cardiac arrest
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35
Q

mgmt for hypothermia IV

A
  1. Initiate CPR and provide airway management
  2. Transport to ECMO if available
  3. Prevent further heat loss (insulation, warm environment)
  4. Continue resuscitation until core temperature reaches 32°C (90°F)
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36
Q

other tx considerations for hypothermia

A
  1. Coma cocktail - dextrose, thiamine, naloxone
  2. Treat underlying:
    - Hypothyroidism: levothyroxine 400 mcg IV + hydrocortisone 100 mg IV
    - Hypoadrenalism: hydrocortisone 200 mg IV
    - Sepsis - broad-spectrum abx
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37
Q

Admit all hypothermia pts unless all of criteria are met: (3)

A
  1. No comorbidities
  2. No AMS
  3. Presenting core temp >34°C (93.2°F)
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38
Q

Stinging results in envenomation, causing one of 3 presentations:

A
  1. localized reaction
  2. systemic reactions
  3. anaphylaxis
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39
Q

a small pruritic, painful, erythematous, edematous lesion at the sting site due to venomous injection
occasionally lesion will be > 5 cm

dx?

A

Localized bee sting - MC reaction

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40
Q
  • sterile pustule, evolves of 6-24 h
  • may result in necrosis and scarring

dx - sting?

A

Fire ant sting

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41
Q

s/s of Systemic/toxic (non-allergic) reaction from sting?

A
  • MC with > 50 stings
  • N/V/D with urticarial lesions distant from site of sting
  • subside within 48 h
  • complications - rhabdo, hepatorenal failure, hemolysis, thrombocytopenia, DIC
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42
Q

s/s Anaphylactic reaction: true allergic reaction from sting?

A
  • Occurs with in 6 h (most with in 15 min)
  • Itchy eyes, urticaria, cough, respiratory failure, CV collapse
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43
Q

w/u for Wasp, Bees and Stinging Ants

A
  • do not delay life-saving intervention
  • Indicated only for systemic and anaphylactic reactions
  • directed by complications: CBC, CMP, coags, CK
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44
Q

Anaphylaxis tx
for Wasp, Bees and Stinging Ants

A

Anaphylaxis treat as anaphylactic shock

  1. Intubation if needed
  2. EPI 1:1000
    - Adults: 0.3-0.5 ml SC/IM
    - Children: 0.01 mg/kg (max 0.5 mg)
  3. IV methylprednisolone (Solu-medrol) 2 mg/kg (max 125 mg)
  4. IV diphenhydramine (Benadryl) 1 mg/kg (max 50 mg)
  5. IV famotidine (Pepcid) 0.5 mg/kg IV (max 40 mg)
  6. NEB albuterol 2.5-5 mg for bronchospasm
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45
Q

mgmt for Localized reaction only stings?

A
  1. Oral diphenhydramine (Benadryl) 25-50 mg
  2. Oral pain control: NSAID, acetaminophen (Tylenol)
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46
Q

mgmt for Systemic reactions for stings

A

IV methylprednisolone, diphenhydramine, famotidine

47
Q

wound care for stings?

A
  • Do not delay tx of systemic reactions to care for wound
  • Remove stinger with scraping technique
  • Wash wound
  • Ice and elevation
  • Tetanus update
48
Q

disposition for local stings? systemic rxn?

A
  1. Local - DC
  2. Systemic
    - admit: children, elderly, comorbidities, >=50 stings, or prolonged rxn
    - otherwise healthy pts - observe x 6 hrs, if no rebound sx, repeat labs before DC, Rx EpiPen, f/u with allergist
49
Q

Most scorpions produce what type of reaction

A

localized reaction

50
Q

only systemically toxic scorpion in US
infants and children are at highest risk of systemic toxicity
southwestern US

A

bark scorpion

51
Q
  • Sting is painful w/o initial erythema/swelling
  • Exquisite pain with light percussion “tap sign”
  • Neuromuscular excitation - muscle spasms, CN dysfunction, roving eye movement, diplopia, difficulty swallowing, hypersalivation
  • CV toxicity - tachycardia, HTN, pulmonary edema, and cardiogenic shock

dx?
mgmt?

A
  • Scorpions
  • symptomatic tx - pain meds, benzo for motor control; severe - monitor, IV access, antivenom (Anascrop)
  • Anascorp - MC SE: N/V, pyrexia, rash, pruritus
  • Anaphylaxis is rare
52
Q

Large triangle shaped head with a heat sensitive depression “pit” between their eyes
Venom is cytotoxic

A

Pit Vipers - Rattlesnakes, copperheads, water moccasin

53
Q
  • fang marks with pain, edema, hemorrhage and necrosis around the bite and extending out from the bite if severe envenomation
  • Usually < 30 min but may be delayed up to 12h
  • Systemic: N/V, Hemolysis, thrombocytopenia, coagulopathy, rsp failure with CV instability and collapse

dx?
what if there are no sx after >12 hrs?
w/u?
mgmt?

A

pit vipers

  • If no S/S after 12 h = dry bite
  • CBC, CMP, coags, CK, urine myoglobin, type and crossmatch
  • monitor & IV access; Immobilize; Remove constriction proximal to bite; Serial (30 min) wound eval - edema, compartment syndrome
  • Antivenom (CroFab) - Compare severity of envenomation to SE of antivenom
  • Td update
54
Q

SE of CroFab

A
  • urticaria, rash, N, pruritus and back pain
  • hypersensitivity in 5-19% pts
  • recurrent coagulopathy occurred in 50 % (in clinical trials)
55
Q

disposition for pit viper bites?

A
  • Observe in ER for 8-12 hours - d/c home if no local progression and all labs are WNL
  • Admit (ICU) for severe reaction and those receiving antivenom
56
Q
  • A spectrum of diseases that results from traveling to high elevations
  • Effects are most often seen at elevations at or >1500 m (4800 ft)
  • Hypoxia is the underlying physiologic insult
A

High Altitude Sickness

57
Q

The body’s physiological response causing High Altitude Sickness

A
  1. increased RR
  2. renal excretion of HCO3
  3. vascular changes
  4. increasing the blood’s oxygen carrying capacity
58
Q
  • resembling a “hangover”
  • HA plus one of the following: anorexia, N/V, weakness, fatigue, dizziness, light-headed, fluid-retention, insomnia, oliguria, dyspnea, AMS
  • sx occur within 48 hours of rapid ascent
  • Complications such as HAPE and HACE
A

Acute Mountain Sickness

59
Q

mgmt for acute mountain sickness

A
  1. DC ascent until sx resolve completely
  2. Descent to lower elevation if no improvement - 300-1000 m
  3. sx tx: low-flow O2; acetaminophen/NSAID; ondansetron
  4. Mild - better in 12-36 hrs after descent
  5. Moderate - hyperbaric O2 therapy if available; acetazolamide + dexamethasone
    - acetazolamide for prevention too
  6. Gink biloba (low)
60
Q

disposition and pt ed for acute mountain sickness

A
  1. DC if responses to intervention
  2. avoid: rapid ascents, overexertion, alc and rsp depressants
  3. acetazolamide prophylatic - 1 d prior to ascent and continue for 2 d after reaching highest altitude
61
Q
  • Hypoxic vasoconstriction and elevated right heart pressures results in noncardiogenic pulmonary edema
  • a continuum of untreated Acute Mountain Sickness
  • MCC of death in high altitude sickness and can be fatal within hours of onset
  • can occur in as little as a 2400 m (8000 ft) ascension

dx?

A

High Altitude Pulmonary Edema (HAPE)

62
Q

s/s of High Altitude Pulmonary Edema (HAPE)?
w/u and findings?

A
  1. Onset: day 2-4 after ascent
  2. Decr exercise capacity - 1st sx noticed
  3. 2 of the following must be present: dyspnea at rest, cough, rales, tachypnea, weakness, decreased performance, chest tightness, tachycardia, signs of pulmonary HTN
  4. CXR - alveolar infiltrates, enlarged pulmonary arteries, normal cardiac size
63
Q

mgmt for High Altitude Pulmonary Edema (HAPE)

A
  1. O2 sat >90% - O2 x 72h after decent if severe
  2. TOC - Immediate descent
    - avoid excessive exertion during descent
  3. Hyperbaric tx if descent isn’t possible
  4. Pulm vasodilators if O2 or descent is unattainable - Sildenafil, tadalafil, nifedipine
    - can be prophylactic if h/o HAPE
64
Q

DC criteria in HAPE

A

all must be met

  1. O2 on room air is maintained > 90%
  2. sx resolve
  3. CXR has improved
65
Q

An end-stage manifestation of AMS or HAPE

A

High Altitude Cerebral Edema (HACE)

66
Q

s/s of High Altitude Cerebral Edema (HACE)?
w/u?
mgmt?

A
  • hx consistent with Acute mountain sickness; AMS, ataxia, stupor, coma; incr ICP: retinal hemorrhage, papilledema
  • MRI - cerebral edema
  • O2 >90%, descent/hyperbaric therapy, dexamethasone, admit if symptomatic >2 after descent
67
Q

pathophys of near drownings/water aspiration

A

water washes out surfactant resulting in diminished gas exchange, VQ mismatch and hypoxia

68
Q

s/s near drowning
w/u?
mgmt?

A
  1. Minimal water aspiration can lead to pulmonary injury and ARDS - ARDS can occur up to 6-24 h after aspiration
  2. Prolonged hypoxia = multiorgan failure
  3. Hypothermia - can occur even in warm water submersions
  4. CPR; high flow O2 ASAP; Goal is SaO2 >95%
  5. all asx pts need 4-6 hrs observation
  6. CXR, CBC, CK, urine myoglobin
  7. acid-base status; Investigate why - urine drug screen, etoh level.
69
Q

Most fire-related deaths are due to ?

A

smoke inhalation

70
Q

MOI of inhalation injury

A
  1. Thermal injury - affects upper airway = acute airway compromise
  2. Inhalation of particulate matter - bronchospasm and edema
  3. Inhalation of toxic gases
    - CO - suspected in all fire inhalation injuries
    - hydrogen cyanide - burned wool, silk, polyurethane, vinyl
71
Q

s/s of inhalation injury
mgmt?

A
  • Facial burns
  • Singed nasal hair
  • Soot in nose or mouth
  • Hoarseness
  • Carbonaceous sputum
  • Wheezing
  • CO poisoning possible
  • Humidified O2 (100%) via facemask; ET intubation; Bronchodilators; Pulmonary toilet
72
Q

Exposure to gas heat or smoke inhalation
Need to identify source
Multiple pts with same presentation from same residence
Flu-like sx, HA, dizziness, N/V, DOE, irritability, fatigue, vision changes, tachycardia, confusion, lethargy, syncope, convulsions, coma

dx?
w/u?

A
  • CO Poisoning
  • CO-oximetry - most reliable; carboxyhemoglobin level - elevated; ABG

Pulse ox is not reliable

73
Q

mgmt for CO poisoning

A
  1. do not wait for confirmation test
  2. High flow O2 via non-rebreather or ET intubation
  3. Hyperbaric O2 therapy for severe poisoning
    - LOC, AMS, MI, focal neuro deficit, pregnancy
74
Q

disposition for CO poisoning

A
  1. asx - safe home environment and no suicide attempt - d/c home
  2. Moderate - HA, N/V
    - observe x 4 h with 100% O2 - assess home safety before DC - DC home if sx resolve
  3. Severe - CNS sx, CP, EKG changes
    - Admit and consult with hyperbaric specialist
75
Q

MCC thermal burns

A

scalding, direct thermal and flame burns

76
Q

descriptors used for burns on body surface area?

A
  • Rule of 9’s
  • Lund and Browder
  • Palmar method
77
Q

old vs new system for thermal burns?

A
  1. Old system: 1st, 2nd, 3rd, 4th degree
  2. New system
    - superficial partial-thickness
    - deep partial-thickness
    - full-thickness burns
78
Q

quick, easy
used for 2nd and 3rd degree burns

A

Rule of 9’s

79
Q

more accurate for infants and children
provides estimates of BSA based upon age

what system for burns?

A

Lund and Browder

80
Q

palmar method for burns?

A
  • back of patients hand is 1% of BSA
  • used for small burns
81
Q
  • Epidermis
  • red, painful, tender skin; no blister
  • Sunburn
  • 7 d; no scar

burn depth?

A

Superficial
(first degree)

82
Q
  • Epidermis & superficial dermis
  • blister, exposed dermis is red and moist, very painful
  • Hot water scald
  • 14–21 d, no scar

burn depth?

A

Superficial partial-thickness (superficial 2nd°)

83
Q
  • Epidermis & deep dermis, sweat glands, and hair follicles
  • blister, exposed dermis is pale white to yellow in color; no blanching with pressure; absent pain sensation
  • Hot liquid, steam, grease, flame
  • 3–8 wk, permanent scar

burn depth?

A

Deep partial-thickness (deep 2nd°)

84
Q
  • Entire epidermis and dermis
  • skin is charred, pale, leathery; no pain
  • Flame
  • Months, severe scarring, skin grafts

burn depth?

A

Full-thickness (third degree)

85
Q
  • Entire epidermis and dermis, as well as bone, fat, and/or muscle
  • Flame
  • Months, multiple surgeries; Amputation or extensive reconstruction

burn depth?

A

Fourth degree

86
Q

general mgmt for thermal burns

A
  • O2 and early intubation if needed
  • Monitor VS - radial/femoral arterial cath if unable to use BP arm cuff
  • tx trauma, inhalation, CO poisoning
  • IV opiates
  • Urinary cath to measure I&O’s - UO at 0.5-1 mL/kg/h
  • IV LR via 2 large bore in unburned area
  • Labs - freq ABGs, CBC, CK, CMP, UA for myoglobin, carboxyhemoglobin level
  • imaging - CXR, EKG
87
Q

use what formula to determine fluid amounts

A

Parkland formula - LR 4 mL * wt (kg) * % BSA burned for first 24 h
half for first 8 hrs from time of burn
other half over next 16 hr

88
Q

wound care mgmt for minor burns

A
  • Cleaned with mild soap and water
  • Large bullae (>2 cm) or those over mobile joints - Drain or debride; topical 1% Silvadene
  • DC to home with PCP follow up
  • Update tetanus as indicated
89
Q

wound care mgmt for moderate and sevevere burns?

A
  1. Cover with dry sterile sheet
  2. Admit
    - moderate - hospital
    - severe - burn center
90
Q
  • results in a coagulation necrosis leading to eschar formation limiting extent of damage
  • partial-thickness with erythema & erosion

type of chemical burn?

A

acid

91
Q
  • results in a liquefaction necrosis resulting in deeper damage
  • full-thickness, appear pale, and feel leathery & slippery

type of chemical burn?

A

Alkali burns

92
Q

mgmt chemical burns

A
  1. Remove clothing (prevent self exposure)
  2. Copious irrigation with tap water
  3. Cover elemental metals (Na, lithium, Ca, Mg) with mineral oil - water will cause exothermic reaction worsening burn
  4. Contact poison control
  5. IV fluid, pain control; Assess for systemic toxicity; Td update if needed
  6. Consult surgeon/burn center to determine need for emergency excision
93
Q

classifications of electrical injuries

A
  1. High voltage (>1000 V) - Power lines; At risk population: adults
  2. Low voltage (< 1000 V) - House; At risk population: children
94
Q

3 types of MOI in electrical injuries

A
  1. Direct tissue damage (electrical energy) - Cardiac dysrhythmias and arrest, seizure, LOC
  2. Thermal damage (heat created)
    - Severe burns - Size of skin injury doesn’t correlate with internal injury
    - Rhabdomyolysis
  3. Mechanical (fall or tetanic muscle contraction)
95
Q

mgmt electrical injury

A
  1. Stabilize and maintain airway
  2. EKG
    - V Tach, Vfib and asystole - ACLS guidelines
    - all other are likely transient
  3. Assess as a general blunt force trauma - Stabilize neck/back; order imaging if needed
  4. IV fluids
    - Urinary cath - keep UO 2 ml/kg/h
  5. Labs - CBC, PT/PTT, CMP, CK, urine myoglobin, cardiac enzymes, type and crossmatch
  6. Once stable: full head to toe exam is needed
  7. treat appropriately - seizures, burns, fx
    - Large burn: cover with sterile dressing
    - Small burn: clean and dress
  8. Opiate pain control
  9. Td update
  10. Children: isolated oral or hand injury; consult ENT or plastics for follow up
96
Q

disposition for electrical injury

A

DC if: low voltage injury, asx, normal PE and EKG
Admit all others

97
Q

s/s electronic control devices?
mgmt?

A
  • High voltage, low-amperage electrical pulses - Electrical injury is unlikely
  • Involuntary muscle contraction, neuromuscular incapacitation and pain
  • Symptomatic: w/u as blunt trauma or ingestion; asx: DC
98
Q

Electrical injury is unlikely in electronic control devices except when?

A

psychosis, stimulant drug use, comorbid conditions

99
Q

whenis survival rate better in lightning injury?

A
  1. lightning flashes over skin (MC) - improves survival
  2. fatal if lightning travels through the body
100
Q

s/s of lightning injury? MCC od death? mgmt?

A
  • MC immediate cause of death is cardiac arrest
  • Feathering or fern-shaped burns: pathognomonic, but transient
  • Temporary LOC, confusion and/or amnesia
  • Rupture of TM
  • Deep tissue injury, myoglobinuria and renal failure with “through body” injury
  • Work-up and treatment same as electrical injury
101
Q

complications associated with changes in environmental ambient pressure and with breathing compressed gases
Barotrauma
Decompression Sickness
Underwater diving, aircraft cabin decompression, explosions or blasts

A

Dysbarism

102
Q

occurs when gas-filled cavities of the body contract or expand with pressure changes

A

Barotrauma

103
Q

Types of Barotrauma of Descent

A
  1. Middle ear barotrauma - “barotitis media” - pressure in middle ear leads to rupture or bleeding of TM
  2. Inner ear barotrauma - valsalva during equalization can rupture the round or oval window leading to tinnitus, sensorineural hearing loss, vertigo
  3. Sinus ostia occlusion during descent can lead to bleeding from the sinus cavity
104
Q

What is Barotrauma of Ascent

A
  • Leads to expansion of gas in the body cavities
  • Various presentations: Lung overinflation, pneumomediastinum, subcutaneous emphysema, pneumothorax, cerebral arterial gas embolism
105
Q
  • Results from a release of nitrogen gas bubbles from the plasma into tissues during ascent
  • Occurs in divers who exceed the dive limits for time & depth and in unpressurized flights
A

Decompression Sickness

106
Q

2 types of Decompression Sickness

A

Type 1: minor sx complex
Type 2: cardiorespiratory or neurologic sx

107
Q

Deep, aching pain in large joints and extremities - MC elbows and shoulders

what type of decompression sickness

A

Type 1: minor symptom complex

108
Q
  • Fatigue, ataxia, spinal paralysis, vertigo, visual or speech disturbance, cognitive deficits
  • Spinal cord embolism - scuba divers
  • High-altitude flight - cerebral gas embolism

which type of decompression sickness?

A

Type 2: cardiorespiratory or neurologic symptoms

109
Q

mgmt for middle ear barotrauma

A

decongestants and analgesics; refer to ENT if TM rupture occurs

110
Q

mgmt inner ear barotrauma

A

bed rest with head upright, ENT consult

111
Q

barotrauma - Pulmonary overinflation increases risk of ?
mgmt?

A

pneumothorax
needle decompression or tube thoracostomy if pneumothorax occurs

112
Q

mgmt decompression sickness

A
  • Oxygen, 100% by mask for at least 2 h
  • Crystalloid IV fluids to maintain hydration
  • Recompression - hyperbaric oxygen chamber
113
Q

mgmt for Frostbitten Raynauds Syndrome

A

Treat the same as stage 3 frostbite

Emergency Medicine (20 decks)

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