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EM - Exam 3 > Environmental Emergencies > Flashcards

Environmental Emergencies Flashcards

1
Q

Define hyperthermia

A
  • Heat production (exercise) or exogenous (environmental) heat load exceeds heat loss capacity
  • Results in some degree of symptoms/effects
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2
Q

Define heat exhaustion

A

Clinical syndrome of dehydration related to excess body heat

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3
Q

Define heat stroke

A
  • Excess heat buildup results in protein denaturation

- This causes thermoregulatory mechanism failure

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4
Q

Heat stroke consequences on the body

A
  • Core temp over 104.9
  • AMS
  • Possible end organ damage
  • Coagulation abnormalities
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5
Q

Treatment of hyperthermia

A
  • Immediate cooling
  • Avoid shivering by paralysis (produces heat)
  • Antipyretics
  • IVF
  • Replace K and/or gluc if needed
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6
Q

Methods of immediate cooling treatment of hyperthermia

A
  • Ice packs to groin/axillae

- Evaporative cooling (by dampening skin and using fans)

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7
Q

When to admit patients with hyperthermia?

A
  • Heat stroke (exhaustion can go home)

- Elderly, children, obese, multiple comorbidities

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8
Q

Define hypothermia

A

Core temp under 95 degrees F

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9
Q

Define primary hypothermia

A

Environmental exposure

homeless, alcoholic, wilderness, burns

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10
Q

Define secondary hypothermia

A 
Medical etiology
(sepsis, trauma, hypoendocrine, hypothalmic)
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11
Q

Define iatrogenic hypothermia

A 
Provider neglect
(cool IVR or prolonged ED/post-op exposure)
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12
Q

Define frost nip

A
  • Mild form of frostbite
  • Skin pales or turns red, feels very cold
  • Continued exposure leads to prickling and numbness
  • NO permanent damage
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13
Q

When does pain and tingling occur with frost nip?

A

As skin rewarms (prickling and numbness prior)

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14
Q

Define frostbite

A

Dermis and/or SC tissue damage 2/2 cold

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15
Q

Progression of frostbite

A
  • Begins as frost nip
  • Progresses to blistering w/clear fluid
  • Hemorrhagic blisters w/some tissue necrosis
  • Blue or black discoloration
  • Substantial edema
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16
Q

How are reflexes affected by hypothermia?

A

Reflexes decline as temperature becomes lower

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17
Q

Possible EKG findings of hypothermia

A
  • Prolonged PR, QRS, QT
  • Osborne (J) waves
  • T inversions
  • Bradycardia, AF, blocks
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18
Q

Treatment of hypothermia

A
  • Gradual rewarming to avoid VF (bear hug, NS warmed to 40-42 F)
  • Peritoneal lavage, dialysis or cardiac bypass if severe
  • Never dead until “warm and dead”
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19
Q

Treatment of frostbite

A
  • Rapid rewarming w/warm water bath
  • Avoid re-freezing
  • Avoid wt bearing until thawed
  • Update Td
  • tPA may be necessary
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20
Q

Define 1st degree burn

A
  • Epidermal injury only
  • Erythema w/o blisters
  • Generally heal within 3-5 days and w/o scars
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21
Q

Describe 2nd degree burn

A
  • Superficial partial thickness

- Deep partial thickness

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22
Q

Define superficial partial thickness burn

A
  • Type of 2nd degree burn
  • Injury extends into dermis
  • Pink, moist, blanchable, blisters/bullae
  • Healing time 2-3 wks w/minimal scarring
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23
Q

Define deep partial thickness burn

A
  • Type of 2nd degree burn
  • Injury extends TO SC tissue but NOT into
  • Waxy white, mottled pink/cherry red, nonblanchable, impaired sensation
  • 3 or more wks healing WITH scars
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24
Q

Define 3rd degree burn

A
  • Full thickness
  • Injury extends into SC tissue
  • White, charred, dry, insensate
  • Requires grafting to heal
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25
Q

Define 4th degree burn

A
  • Muscle and bone involved

- Requires grafting to heal

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26
Q

What type of burns require grafting to heal?

A

3rd and 4th degree

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27
Q

What may mask the depth of a burn injury?

A

Early presentation

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28
Q

How can blanchability and sensation be tested in burn victims?

A

Sterile cotton swab

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29
Q

What is important in order to determine fluid resuscitation of a burn victim?

A

Total body surface area (TBSA)

*NOT for 1st degree burns

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30
Q

How to determine total body surface area involvement of a burn injury?

A
  • Rule of 9s/palms
  • For adults, 1 palm is 1%
  • For kids, 1 hand is 1%
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31
Q

What needs to be updated for all burn victims?

A

Td

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32
Q

Treatment of minor burns

A

Bacitracin

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33
Q

Treatment of major burns

A

Silver sulfadiazine (Silvadine)

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34
Q

How should blisters/bullae be treated in burns?

A
  • Should be left intact if possible

- Debride ruptured ones

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35
Q

Treatment of burns (generally)

A
  • Update Td (tetanus/diptheria)
  • Leave blisters/bullae in tact (or debride ruptured ones)
  • Non-adherent bulky dressing changed daily
  • Pain management and recheck in 1-2 days
  • Fluid resuscitation based on pt specifics
36
Q

Guidlines for fluid resuscitation treatment for burn victims

A
  • Adults over 20% TBSA
  • Children over 15% TBSA
  • Infants over 10% TBSA
37
Q

What is the Parkland formula?

A

Estimates fluid replacement in first 24 hrs of burn pts

-IV lactated ringers 4 mL/kg/% TBSA for first 24 hrs (half of total volume over first 8 hrs, remainder over next 16 hrs)

38
Q

When should a burn pt be referred to burn center?

A
  • Partial thickness burns over 10% TBSA (or 5% if under 16 yo)
  • Chemical, electrical, or ionizing radiation burns
  • Major burns involving certain areas of body
  • Any full thickness burn
  • Concomitant injuries
39
Q

Voltages of various sources?

A 
Taser: 50,000 V (but low amperage)
Power lines: 7,620 V
3rd rails: 600 V
Entering house: 220 V
Household: 110 V
40
Q

How do electrical injuries affect the body?

A
  • Muscle contracture (resulting in fx, dislocation, rhabdo)
  • Secondary trauma from being “thrown”
  • Arrhythmias
  • Seizures, confusion, agitation
  • Burns (entry and exit sites, deep partial thickness or 3rd degree)
41
Q

Cardiac monitoring of electrical injuries?

A

NOT necessary if initial EKG is normal

42
Q

What electrical injuries require admission for monitoring?

A

Anything over 600 V

43
Q

How should pregnant women with electrical injuries be monitored?

A

If pregnant over 20 wks, minimum of 4 hr fetal monitoring and US

44
Q

Describe lightning injuries

A
  • 70-90% survive

- Typical voltage: 10 mil - 2 bil V, 20K-200K Amps

45
Q

How do lightning injuries affect the body?

A
  • Flashover phenomenon (current travels over body surface)
  • Cardiac arrest (myocardium depolarization)
  • Respiratory arrest (medullary depolarization)
  • Ocular flash burns (UV keratitis)
46
Q

How may a nearby lightning strike affect the body?

A

Shockwave effect - blunt internal injuries

47
Q

How do most lightning strike patients present?

A

Lower extremity paralysis (temporary)

48
Q

What are Lichtenberg figures?

A

Branching electrical discharges that appear on the body surface of someone struck by lightning

49
Q

What type of burns may lightning strike patients experience?

A

Punctate burns

50
Q

Possible EKG findings of lightning injuries

A
  • Asystole
  • ST elevation from vasospasm
  • Long QT
  • T inversions
51
Q

Cardiac monitoring of lightning injuries?

A

Required for most patients (due to delayed sequelae)

52
Q

Complications of lightning injuries

A
  • Delayed cataract formation
  • TM injury
  • Vasospasm
  • Compartment syndrome
53
Q

Potential sources of CO poisoning?

A
  • Vehicle or generator exhaust
  • Charcoal
  • Wood
  • Kerosene
54
Q

What patients will have mildly elevated levels of CO?

A

Chronic cigarette smokers

55
Q

Properties of CO

A
  • Odorless, colorless gas
  • 250x higher binding affinity w/hemoglobin than O2
  • Half life is 3-4 hrs on room air, 60 mins on O2, 15-30 mins on hyperbaric O2
56
Q

Neuro effects of CO

A

HA, confusion, dizzy, difficulty concentrating, nausea, lethargy

57
Q

CV effects of CO

A

Ischemia, palpitations, mottled skin, poor cap refill, hypotension, cardiac arrest

58
Q

Labs for CO workup

A
  • Carboxyhemoglobin (COHb) via blood gas
  • CBC
  • Cardiac enzymes
59
Q

Possible EKG findings of CO poisoning

A

Ischemia

Arrhythmia

60
Q

Pulse ox evaluation of CO poisoning

A

NOT a useful indicator of oxygenation

61
Q

Treatment of mild CO poisoning

A

Nothing - will resolve with time

62
Q

Treatment of moderate CO poisoning

A

4 hrs of O2 therapy

63
Q

Treatment of severe CO poisoning

A

Hyperbaric oxygen therapy

64
Q

How is the need for hyperbaric oxygen therapy determined for CO poisoning patients?

A

Based on symptoms NOT COHb levels

65
Q

When should a CO poisoning patient be admitted?

A
  • LOC
  • Amnesia
  • MI
  • Seizures
  • Comorbidities
66
Q

How many Americans will be bitten by a dog in their lifetime?

A

50% (mostly kids)

67
Q

What pathogens are MC a/w dog bites?

A

Pasteurella mixed w/strep and staph

68
Q

Treatment of dog bites

A
  • Irrigation is important
  • Loosely close only large wounds or those of cosmetic concern
  • Abx for deep wounds or if closing (Augmentin or Clinda+Cipro, 5 days if proph, 10 days if infected)
69
Q

Describe cat bites

A
  • 60-80% infection rate

- MC Pasteurella multocida

70
Q

Treatment of cat bites

A
  • Irrigation is difficult d/t small puncture wound
  • Abx for all (except most superficial wounds)
  • Augmentin or Doxy or Cefuroxime for 7 days (10 days if infected)
71
Q

MC pathogen of cat bites?

A

Pasteurella multocida

72
Q

Describe cat scratch disease

A
  • Regional lymphadenopathy 7-12 days after bite or scratch
  • Caused by Bartonella henselae
  • Treated with Azythromycin
73
Q

MC pathogen of human bites?

A

Streptococcus

74
Q

Who needs rabies prophylaxis?

A

Those bit by:

  • Domestic animal that can’t be observed for 10 days
  • Bats (possible bite or significant feces exposure)
  • Wild animals (specific guidelines depending on animal)
75
Q

What does rabies prophylaxis consist of?

A
  • Immune globulin 20U/kg or 250 units

- Vaccine 1 mL IM days 0, 3, 7, 14

76
Q

Describe brown recluse spiders

A
  • Spider has violin shape on dorsal surface

- Commonly found in/around wood piles (mostly S, W US)

77
Q

Describe brown recluse bites

A
  • Bluish discoloration w/vesicles progressing to necrotic wound
  • Systemic effects are rare (hemolysis, thrombocytopenia, fever)
78
Q

Treatment of brown recluse bites

A
  • Supportive care
  • Abx if infected
  • Dapsone (?)
79
Q

Describe black widow spiders

A
  • Orange red hourglass shape on body

- Found in basements, garages, wood piles

80
Q

Describe black widow bites

A
  • Venom causes significant pain and erythema w/in 60 mins
  • Site can turn into target lesion
  • Usually a/w muscle cramping, abd pain, HTN
81
Q

Treatment of black widow bites

A

MAP

  • Muscle relaxant
  • Antivenom (if available)
  • Pain control
82
Q

Describe jellyfish stings

A
  • Most result in localized erythema or wheal formations
  • Moderate pain
  • Anaphylactic reaction is possible
83
Q

Treatment of jellyfish stings

A

CLAP

  • Careful removal of tentacles
  • Local application of vinegar (or rubbing alcohol)
  • Apply HEAT rather than ice
  • Pain management
84
Q

Treatment of snake bites

A
  • Antivenom ASAP (CroFab for diamondback, Mojave, or cottonmouth snakes)
  • Constriction band may be helpful
  • NO longer recommended to incise and suction OR tourniquets
85
Q

Constriction band treatment of snake bites

A
  • Apply with enough tension to restrict superficial venous flow
  • BUT maintain distal pulses and capillary refill
  • Reduces systemic toxicity of venom
86
Q

How should snake bites be monitored?

A

Minimum 8 hr observation, low threshold for admission

EM - Exam 3 (6 decks)

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