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Emergency Medicine > Environmental Emergencies > Flashcards

Environmental Emergencies Flashcards

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1
Q

Distribution of Electrical Injuries

A

Young children

Adults

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2
Q

Severity of Electrical Injuries

A 
Voltage
Duration
Type (AC, DC)
Current path through body
Environmental factors
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3
Q

Greatest Damage in the Body from Electrical Injuries

A

Nerves
Blood vessels
Muscle

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4
Q

Which wound site is often larger than the other in electrical injuries?

A

Exit wound site

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5
Q

Low Voltage AC Current Effects

A

Muscular tetany

Continuous grasping of source

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6
Q

High Voltage AC and DC Current Effects

A

Single violent muscular contraction
Throw victim from source
Increased risk of blunt/blast injury

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7
Q

Electrical Cardiac Changes in Low Voltage AC Current

A

V-fib

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8
Q

Electrical Cardiac Changes in High Voltage AC and DC Current

A

Asystole

Respiratory arrest

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9
Q

Physical Exam in Electrical Injuries

A 
Primary survey
Secondary survey
ABC's
C-spine immobilization
2 large bore IVs
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10
Q

CNS Physical Exam Findings

A

Transient LOC
Agitation, confusion
Coma
Visual disturbances: pupils fixed and dilated or asymmetric

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11
Q

Spinal Cord Injuries from Electrical Injuries

A

Fractures
Ascending paralysis
Spinal cord syndromes

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12
Q

Peripheral Nerve Injuries from Electrical Injuries

A

Involve hand touching a power source

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13
Q

Cutaneous Wounds in Electrical Injuries

A

Entry/exit points

Degree of burns of entry/exit points

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14
Q

Treatment of Burns from Electrical Injuries

A

Cleansed and dressed with silver sulfadizine

Careful neuromuscular compromise and compartment syndrome

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15
Q

Oral Injuries with Electrical Injuries

A

Kids

Vascular injury to labial artery

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16
Q

What section of the body generates the greatest amount of heat when exposed to electrical current?

A

Long bones

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17
Q

Which areas have the greatest destruction in electrical injuries?

A

Deep tissue surrounding long bones

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18
Q

Treatment of Electrical Burns

A 
ABCs
C-spine
Dysrhythmias
Aggressive fluid replacement
Labs
EKG
Watch electrolytes closely
Wound care
Myoglobinuria
Tetanus prophylaxis
Treat seizures
General surgeon consult
ENT consult (kids)
OB consult
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19
Q

Labs in Electrical Burns

A 
Electrolytes
BUN/Creatinine
Creatine kinase
Serum and urine myoglobin (rhabdo)
CBC
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20
Q

Monitoring in Electrical Burns

A 
CV monitoring
Development of compartment syndrome
I&O: 100+ mL/h
Rhabdomyolysis
Renal Failure
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21
Q

Types of Lightening Strikes

A

Direct strike
Side flash
Ground current
Step potential

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22
Q

What kind of current is lightening?

A

DC current

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23
Q

Effects of Lightening Strikes

A

Immediate cardiac arrest (sustained asystole)

Respiratory arrest

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24
Q

Minor Injuries Associated with Lightening Strikes

A 
Stunned patient
Confusion, amnesia
Short term memory problems
Headache
Muscle pain
Parasthesias
Temporary visual or auditory problems
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25
Q

Other Signs or Symptoms of a Lightening Strike

A

Pupil dilation
Anisocoria
Ruptured TM
Fern-like erythematous skin marking

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26
Q

Treatment of Lightening Strikes

A 
Aggressive resuscitation
ACLS and CPR
Cardiac monitoring, SAO2, BP
2 large bore IVs
High flow O2
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27
Q

Secondary Survey for Occult Injuries with Lightening Strikes

A

Cutaneous burns
Ocular involvement
Auditory involvement
Musculoskeletal fractures

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28
Q

Labs for Lightening Strikes

A 
Electrolytes
BUN/Creatinine
Creatine kinase
Serum and urine myoglobin (rhabdo)
CBC
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29
Q

Treatment for Lightening Strikes

A

Labs
Tetanus prophylaxis
Moderate to severe: CCU
Mild: admit, monitor cardiac and neuro status

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30
Q

What is the 3rd most common cause of accidental death in the US?

A

Drowning

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31
Q

Near Drowning Risk Factors

A 
Inability to swim
Overestimation of swimming capabilities
Risk-taking behaviors
ETOH or drugs
Inadequate supervision
Hypothermia
Concomitant trauma, CV, MI
Hyperventilation
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32
Q

Pathophysiology of Drowning

A 
Period of panic
Loss of normal breathing pattern
Reflex inspiratory efforts
Aspiration
Reflex laryngospasm
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33
Q

Pathophysiology of Dry Drowning

A

Laryngospasm
Hypoxia
LOC

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34
Q

Pathophysiology of Wet Drowning

A 
Aspiration of water
Dilution and washout of surfactant
Diminished gas transfer
Atelectasis
V/Q mismatch
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35
Q

Pathophysiology of Fresh Water Drowning

A

Transient hemodilution

Blood cells swell and burst

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36
Q

Pathophysiology of Salt Water Drowning

A

Draws blood out of blood stream
Build up of sodium in alveoli
Decreased/stopping of oxygen from reaching blood

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37
Q

Pulmonary End Organ Effects of Drowning

A 
Fluid aspiration
Wash out of surfactant
Non-cardiogenic edema
Acute respiratory distress
S/S of ARDS
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38
Q

Neurologic End Organ Effects of Drowning

A

Neuronal damage
Cerebral edema
Elevated ICP

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39
Q

CV End Organ Effects of Drowning

A

Arrhythmias
Sinus bradycardia
Fibrillation

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40
Q

Acid-Base and Electrolyte Effects of Drowning

A

Metabolic and/or respiratory acidosis

No significant electrolyte imbalances

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41
Q

Prehospital Drowning Management

A

CPR
Neck in neutral position
Rescue breathing
Rewarming

42
Q

ER Management of Drowning

A

Prehospital efforts continued
Seek out head and spinal cord injuries
Re-warming initiated

43
Q

Re-warming Efforts in Drowning

A

Blankets
Bair hugger
Overhead warmers
Resuscitative efforts until 32-35C

44
Q

Drowning Victims with CGS 13+ Management

A

O2
Observation 4-6 hours
Possible discharge home with someone
Reassess/admit

45
Q

Drowning Victims with GCS Less than 13 Management

A

O2
CXR
Labs

46
Q

Labs in Drowning Victims

A 
ABGs
CBC
CMP
PT/PTT
UA
CK
Urine myoglobin
Urine drug screen
47
Q

Inpatient Management of Neurologic Issues in Drowning Victims

A

Duration of LOC
Neuro state at presentation
Prevent secondary injury

48
Q

Secondary Neurologic Injuries in Drowning Victims

A 
Cerebral edema
Hypoxemia
Fluid and electrolyte imbalances
Acidosis
Seizure activity
49
Q

Inpatient Management of Pulmonary Issues in Drowning Victims

A

Intubation for PEEP delivery
CXR when indicated
Bronchospasm: beta agonists

50
Q

Factors Associated with a Poor Prognosis in Drowning

A 
Duration of submersion (10+ minutes)
Time to effective BLS (10+ minutes)
Resuscitation duration (25+ minutes)
Hypothermia with core temp less than 33C
GCS of 5
Less than 3 years
Persistent apnea and CPR in ER
Arterial pH less than 7.1
Water temp 50+ F
51
Q

Define Hypothermia

A

Core temperature less than 35C or 95F

52
Q

Core Temperature of Mild Hypothermia

A

90-95F

53
Q

Core Temperature of Moderate Hypothermia

A

82-90F

54
Q

Core Temperature of Severe Hypothermia

A

Less than 82F

55
Q

Individuals at Risk for Hypothermia

A

Elderly
Neonates
Individuals with altered sensorium

56
Q

How is heat loss from the body?

A

Evaporation
Radiation
Conduction
Convection

57
Q

How is heat preserved by the body?

A

Peripheral vasoconstriction
Shivering
Increase in metabolic rate

58
Q

Presentation of Mild Hypothermia

A 
Tachypnea
Tachycardia
Hyperventilation
Ataxia
Dysarthria
Impaired judgement
Shivering
"Cold diuresis"
59
Q

Presentation of Moderate Hypothermia

A 
Reduction in pulse and CO
Hypoventilation
A-fib
CNS depression
Hyporeflexia
Decreased renal flow
Loss of shivering
Paradoxical undressing
60
Q

Presentation of Severe Hypothermia

A 
Pulmonary edema
Oliguria
Areflexia
Coma
Hypotension
Bradycardia
Ventricular arrhythmias
Asystole
61
Q

Diagnosing Hypothermia

A

Low-reading thermometer
Labs
EKG: Osborne or J waves

62
Q

Labs in Diagnosing Hypothermia

A

Electrolytes
Hematocrit
Coagulation studies
ABGs

63
Q

Management of Hypothermia

A 
ABCs
Passive external rewarming
Active external rewarming
Active internal rewarming
Treat arrhythmias
64
Q

Methods of Active External Rewarming

A 
Warm blankets
Radiant heat
Warm baths
Forced warm air
CORE FIRST
65
Q

Methods of Active Internal Rewarming

A 
Pleural and peritoneal irrigation
Hemodialysis
Cardiopulmonary bypass
Warm humidified oxygen
Warm IV fluids
Bladder or GI irrigation
66
Q

What arrhythmias occur with hypothermia?

A

A fib
A flutter
V fib
Asystole

67
Q

Define Frostbit

A

Freezing of tissue

68
Q

Pathophysiology of Frostbite

A

Immediate cold-induced cell death
Gradual development of localized inflammation and tissue ischemia
Worse in thawing and refreezing

69
Q

Describe 1st Degree Frostbite

A

Central area of pallor and anesthesia of skin surrounded by edema
Superficial

70
Q

Describe 2nd Degree Frostbite

A

Blister formation containing clear or milky fluid surrounded by edema/erythema within 24 hours
Superficial

71
Q

Describe 3rd Degree Frostbite

A

Injury deeper than 2nd degree
Hemorrhagic blisters
Progress to black eschar over several weeks
Deep

72
Q

Describe 4th Degree Frostbit

A

Extends to muscle and bone
Involves complete tissue necrosis
Deep

73
Q

Presentation of Frostbite

A 
Cold, numbness, and clumsiness of affected area
Insensate, white or grayish-yellow skin
Hard to waxy to touch
Possible bullae
Eschars or tissue necrosis
74
Q

Diagnosis

A

Clinically

Technetium-99 scintigraphy

75
Q

Prehospital Treatment of Frostbite

A 
Remove wet clothing
Avoid walking on frostbitten feet
Don't rewarm if possibility of refreezing
Do not rub frostbitten areas
Avoid stove or fires to rewarm
76
Q

Prognostic Factors in Frostbit

A 
Temperature and wind velocity?
How long extremity frozen?
Refreezing occur?
Self-treatment?
Recreational drugs or alcohol used?
Predisposing medical conditions
77
Q

Treatment of Frostbite in Hospital

A 
Water bath heated to 40-42 C
Dry heat difficult to regulate
Thawing (15-30 minutes usually)
Bulky dressing
Elevation
Splinting
Tetanus prophylaxis
Topical aloe and ibuprofen
Possible tPA use
Surgical consultation
78
Q

Managing Blisters in Frostbit

A

Drain, debride, and bandage non-hemorrhagic bullae that interfere with movement
Hemorrhagic bullae drained by aspiration
Minor bullae should be left alone

79
Q

Reasons for Surgical Consult in Frostbite

A 
Long term wound care
Daily hydrotherapy
Repeated debridement
Escharotomy
Possible delayed amputation
80
Q

Short Term Complications of Frostbite

A

Infection
Gangrene
Autoamputation

81
Q

Long Term Complications of Frostbite

A

Hypersensitivity to the cold
Increased risk of developing frostbite again
Chronic parasthesias to affected area
Decreased sensation to touch

82
Q

2 Types of Heat Exhaustion

A

Water depletion

Salt depletion

83
Q

Define Water Depletion Heat Exhaustion

A

Inadequate fluid replacement by individuals working in a hot environment

84
Q

Define Salt Depletion Heat Exhaustion

A

Large volumes of thermal sweat are replaced by water with too little salt

85
Q

Signs and Symptoms of Heat Exhaustion

A 
Weakness
Malaise
Fatigue
Headache
Lightheadedness
Dizziness
N/V
Hypotension
Tachycardia
Tachypnea
Diaphoresis
Syncope
86
Q

Treatment of Heat Exhaustion

A

Cool environment
Volume and electrolyte replacement
Mild: oral replacement
Moderate: 1-2 L saline, guided by electrolytes

87
Q

Define Heatstroke

A

Life-threatening emergency that occurs when homeostatic thermoregulatory mechanisms fail
Body temp 105+

88
Q

4 Factors Tissue Damage is Affected by

A

Body temp
Exposure time
Work load
Tissue perfusion

89
Q

Signs and Symptoms of Heatstroke

A 
CNS dysfunction
Cerebral edema
Ataxia
Irritability
Confusion
Bizarre behavior
Combativeness
90
Q

Pathophysiology of Heatstroke

A

Functional hypovolemia compensated by vasoconstriction of splanchnic and renal vasculature

91
Q

Severe Heat Stress Continues in Heatstroke

A

Splanchnic vasoconstriction will fail
Heated core blood increases ICP
Decreases mean arterial pressure

92
Q

Diagnosis of Heatstroke

A 
Exposure to heat stress
Signs of severe CNS dysfunction
Core temp 105+
Dry, hot skin
Sweating may persist
Marked elevation of liver transaminases
93
Q

3 Ways Heatstroke can Kill

A

Vascular shock
Irregular pulse to heart attack
Kidney failure

94
Q

Treatment of Heatstroke

A 
ABCs
Primary survey
Cooling
Airway control
Fluid administration
Foley
Labs
Benzodiazepines (seizures)
Admission
95
Q

Cooling Techniques in Heatstroke

A 
Evaporative cooling
Cold-water immersion
Ice packing
Cold gastric lavage
Cold peritoneal lavage
96
Q

Define Evaporative Cooling

A

Position fans close to undressed patient then spraying water on patient

97
Q

Disadvantages of Evaporative Cooling

A

Shivering

Loss of EKG patches

98
Q

Define Immersion Cooling

A

Place undressed patient in tub of ice water deep enough to cover trunk and extremities

99
Q

Where should ice packs be placed to cool a patient?

A

Neck
Groin
Axillae

100
Q

When should cooling efforts be discontinued in a patient with heatstroke?

A

40C or 104F

101
Q

Labs for Heatstroke

A 
ABGs
CBC
CMP
Liver enzymes
Lactate dehydronase
Creatinine phosphokinase
Uric and lactic acid
PT/PTT

Emergency Medicine (17 decks)

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