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disciplines exam 3 > environmental emergencies > Flashcards

environmental emergencies Flashcards

1
Q

define hypothermia

A

core temperature 95 or less

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2
Q

classify hypothermia based on mild-mod-sev

A

mild: 89.6-95
mod: 96.98.5
severe: less than 86

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3
Q

define conduction

A

transfer of heat by direct contact (water immersion)

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4
Q

define convection

A

transfer of heat by movement of heated material (wind disrupting heat around body)

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5
Q

define radiation

A

uses electromagnetic transmission

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6
Q

define evaporation

A

conversion of liquid to vapor (10-15% body heat loss)

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7
Q

what is the MCC of hypothermia

A

ethanol

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8
Q

which clothing makes you colder more, wet clothing or not wet?

A

wet clothing

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9
Q

what medical illnesses are related to hypothermia

A

DM, PVD, ASVD, neuropathy, and psychiatric illness

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10
Q

which group is the MC affected by hypothermia?

A

males 30-49 y/o and extremities

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11
Q

what is the pathophysiology of hypothermia?

A

decreased HR
hypoventilation with CO2 retention leading to hypoxia and respiratory acidosis
Decreased mucocillary clearance
Slowed mentation, motor function, and speed of reasoning
Decreased platelet function
Decreased activity of coagulation factors
Cold diuresis
Impaired insulin release
After-drop occurs

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12
Q

when does shivering cease?

A

90F

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13
Q

what occurs at 86F or less (hypothermia)

A

increased arrhythmias (osborn J waves)

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14
Q

when should you withhold cardiac meds and defibrillation

A

until temp 82.4F or greater

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15
Q

how do you treat hypothermia?

A

warmed oxygen and IV fluids (NS)
active external warming (blankets)
gently circulating water
active core warming

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16
Q

what is the pathophysiology of frost bite

A 
cold exposure
formation of extracellular ice crystals which damage cell membranes and their osmotic gradient
intracellular dehydration
intracellular ice crystal formation
cell death
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17
Q

anesthetic central white plaque with peripheral erythema

A

first degree frostbite

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18
Q

clear or milky-filled blisters surrounded by erythema and edema

A

second degree frostbite

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19
Q

hemorrhagic blisters that progress to a hard black eschar

A

third degree frostbite

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20
Q

complete necrosis and tissue loss

A

fourth degree frostbite

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21
Q

how to treat frostbite?

A 
elevate and splint extremity
wrap extremity in dry sterile gauze
debride white or clear blisters
cover with aloe vera every 6 hours
tetanus as indicated
analgesics (ASA/NSAIDS, narcotics)
antibiotics have no role
no smoking
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22
Q

ultraviolet keratitis can develop within ____ hour of exposure

A

1 hour

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23
Q

how does UV keratitis present?

A

does not become symptomatic until 6-12 hours later

severe pain, FB sensation, tearing, conjunctival injection

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24
Q

how do you treat UV keratitis

A

self-limited
analgesics, cold compress
polarized sunglasses

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25
Q

which pts are at risk of heat injuries?

A 
age extremes
confusional states
limited water access
alcoholics
mental illness
chronic disease
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26
Q

define radiation in regards to heat injuries

A

occurs when air temp is less than body temp

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27
Q

define hyperthermia

A

rise in body temperature when heat production exceeds heat loss - fever is rise of core body temp in response to circulating cytokines

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28
Q

what is the pathophysiology of heat injuries?

A

increased endogenous heat production
decreased heat dispersion
thirst is poor gauge of hydration status
exercise increases metabolic rate 20-25 times above baseline

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29
Q

which meds increase heat production?

A 
neuroleptics
hallucinogens
amphetamines
anesthetics
LSD
cocaine
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30
Q

which meds inhibit sweating?

A 
antihistamines
neuroleptics
TCAs
atropine
antispasmodics
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31
Q

what is the duration of acclimatization of heat injuries for adults/children?

A

7-10 days for adults

14 days for children

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32
Q

define prickly heat aka heat rash

A

acute inflammation of sweat ducts caused by blockage of pores
pruritic, maculopapular erythematous rash found over clothed areas of body

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33
Q

how do you treat prickly heat aka heat rash

A

antihistamines

supportive care

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34
Q

define heat cramps

A

painful involuntary spasmodic contractions

usually sweat profusely but replace with water only

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35
Q

how do you treat heat cramps

A

rest in cool environment

replacement of fluids and electrolytes

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36
Q

what is the presentation of heat exhaustion

A

dizzy, weak, malaise, N/V, headache, myalgias
syncope, orthostasis, sinus tach, tachpnea
normal mental status

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37
Q

how do you treat heat exhaustion?

A

rest and volume/electrolyte replacement (Do Mg first before fixing K)

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38
Q

what is the triad of heat stroke

A

hyperthermia (105F or more)
CNS dysfunction
anhydrosis (not sweating)

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39
Q

UV keratitis causes

A

sun reflecting on water/snow

welding

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40
Q

how does heat stroke present?

A

seizure, decreased BP, increased HR, increased RR
increased Na and BUN
Decreased K, Ca, Phos, Mg
Elevated Transaminate levels
5% develop renal failure (rhabdomyolysis)
25% develop ARDS

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41
Q

how to treat Heat stroke?

A

IV fluids at 250cc/hr with foley to monitor UO
Diagnostics
Reduce temp rapidly to 104F
Remove clothing apply “strategic ice packs”
TOC = evaporative cooling
Diazepam 0.1-0.3 mg/kg to inhibit shivering

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42
Q

What are poor heat stroke prognostic factors?

A 
delayed rapid cooling
AST 1000 or greater
DIC
prolonged coma
hypotension
renal failure in first 48 hours
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43
Q

How does jellyfish envenomation present?

A

pruritic pain, wheals, urticaria

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44
Q

how do you treat jellyfish envenomations?

A

vinegar to remove nematocyst (isopropyl alcohol)
topical anesthetics
oral analgesics
no ABX

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45
Q

how do stingray/catfish envenomations present?

A

pain, bleeding

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46
Q

how do you treat stingray envenomation?

A

irrigation, removal of foreign debris
hot water immersion
ABX controversial

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47
Q

what are vespids

A

yellow jackets, hornets, wasps that sting multiple times

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48
Q

what are apids

A

honey and bumblebees that are barbed stingers

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49
Q

what is the MCCC of allergic reaction secondary to insect stings

A

yellow jacket

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50
Q

what is the MCC of death from envenomation?

A

hymenoptera stings usually from upper airway obstruction

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51
Q

where are the nest locations of yellow jackets?

A

ground

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52
Q

where are the nest locations of wasps?

A

under leaves or window sills

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53
Q

where are the nest locations of hornets?

A

bushes, low-lying limbs

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54
Q

how does a local reaction of hymenoptera sting present?

A

pain, erythema, edema, pruritis, and swelling

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55
Q

how do systemic/anaphylactic reactions of hymenoptera stings present?

A

occur within 15 minutes
itchy eyes, facial flushing, urticaria, dry cough, dyspnea, wheezing, abdominal cramps, N/V/D, fever, arthralgias
IgE mediated histamine release

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56
Q

how to treat hymenoptera stings?

A 
clean with soap and water, remove stinger
apply ice pack and elevate extremity
antihistamines - benadryl
epinephrine
steroids
beta agonists
D/C with auto-injector of epinephrine
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57
Q

brown recluse spider bites are MC where

A

midwestern and southern us

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58
Q

where are brown recluse spiders hiding

A

woodpiles
sheds
garages
closets

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59
Q

what is the most active enzyme of brown recluse spider

A

sphingomyelinase D

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60
Q

how do brown recluse spider bites progress

A

mildly erythematous lesion that becomes firm and dry over days to weeks and becomes bluish blister then necrosis

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61
Q

what are symptoms of brown recluse spider bites?

A 
F/C
N/V
myalgias
petechia
seizure
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62
Q

what tests do you order for brown recluse spider bites

A

CBC
BMP
Coags
UA

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63
Q

how to treat brown recluse spider bites?

A

supportive
no antivenin available
surgery once clearly demarcated
no proven benefit for steroids, ABX, dapsone, early excision, hyperbaric oxygen, topical NTG

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64
Q

what is another name for brown recluse spider

A

loxosceles

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65
Q

what is another name for black widow spider

A

latrodectus

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66
Q

where are black widow spiders located?

A

North America except Alaska

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67
Q

where do black widow spiders hide?

A

attics, barns, sheds, garage, firewood, and hay bales

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68
Q

what do black widow spiders look like?

A

shiny black with red hourglass on abdomen

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69
Q

what do brown recluse spider look like?

A

light brown to tan in color with dark violin-shaped mark on dorsal cephalothorax

70
Q

what is the pathophysiology of black widow spider bites?

A

alpha-latratoxin
venom releases acetylcholine and NE at neurosynaptic junction
inhibits their reuptake
muscle contractions and fatigue

71
Q

what is the hallmark of envenomation in black widow spider bites

A

muscular cramping (abdomen > chest, back); onset 30-90 minutes post-bite and peaks in 3-12 hours

72
Q

what are other symptoms of black widow spider bites?

A

N/V, diaphoresis, HTN, tachycardia, anxiety, agitation, irritability, weakness, H/A, periorbital edema
shock, coma, respiratory failure

73
Q

how do you treat black widow spider bites?

A

narcotics
benzodiazepines
antivenin (horse serum) - indicated for life-threatening HTN and increased HR, respiratory difficulty, refractory pain, pediatrics, pregnant, and elderly
Calcium gluconate

74
Q

how does lice present?

A

intensely pruritic wheals
waists, shoulders, axillae, neck
eggs not easily brushed off

75
Q

how to treat lice?

A

lindane (avoid in young children and pregnant females)
fine combing of hairs
sterilize clothing and bed liners

76
Q

how do scabies present?

A

hands and feet between digits

white zigzag threadlike pattern

77
Q

how do you treat scabies?

A

elemite or lindane
calamine lotion
oral antipruritic agents (atarax)
analgesics

78
Q

what are the snakes that make up 90-95% of bites

A

rattlesnakes
copperheads
moccasins

79
Q

what is the MC time for snake bites to occur?

A

August-October

80
Q

Who is the MC to have a snake bite and where?

A

Male in his UE

Kids would have in LE

81
Q

What are the cardinal features of snake vites?

A

one or more fang marks, localized pain
erythema
ecchymosis
progressive edema

82
Q

what are S&S of snake bites?

A

N/V, weakness, paresthesias of mouth and tongue (metallic taste), tender lymphadenopathy, increased HR, dizzy, hematuria, decreased platelets

83
Q

what tests do you order for snake bites?

A

CBC, CMP, Coags, UA, T/S

84
Q

How to treat snake bites?

A 
elevate extremity
constriction bands
ABX not indicated
Observe for at least 8 hours, if asymptomatic, D/C
admit all children with bites
Peds treated same as adults
85
Q

When are antivenins indicated for snake bites?

A

worsening swelling, coagulation abnormalities (decreased platelets, PT > 20 seconds), systemic effects (hypotension), all copperhead bites

86
Q

what are examples of antivenins

A

antivenin crotolidea polyvalent (ACP)

polyvalent immune fab (CroFab, FabAV) - 5.2 times more potent than ACP

87
Q

what is the name for scropions

A

centruroides excilicauda (bark scorpion)

88
Q

where do you find scorpions?

A

wood piles, crevices, shoes, clothing

89
Q

what is the pathophysiology of scorpions?

A

venom activates sodium channels which causes immediate paresthesias, tachycardia, increased secretions, increased temperature, diaphoresis, and SLUDGE

90
Q

how do scorpion stings present?

A

pathognomonic roving eye movements
fasciculations
difficulty swallowing

91
Q

scorpion envenomation grade 1

A

local pain and/or paresthesias

92
Q

scorpion envenomation grade 2

A

pain and/or paresthesias remote from site of sting

93
Q

scorpion envenomation grade 3

A

CN/automatic or somatic dysfunction
blurred vision, roving eye movements, hypersalivation, tongue fasiculations, dysphagia, dysponia
restlessness, involuntary shaking or jerking

94
Q

scorpion envenomation grade 4

A

CN/autonomic and somatic nerve dysfunction

95
Q

what is the treatment of choice for scorpions?

A

supportive
cool compress
+/- midazolam continuous infusion

96
Q

What is anascrop

A

centruroides immune Fab Equine injection for scorpion sting

97
Q

how does one present with cactus sting?

A

pain and potential for multiple foreign bodies

98
Q

how can you remove cactus FB?

A

Elmer’s glue

99
Q

how do you treat cactus sting?

A

all that is required is removal of spines and local wound care

100
Q

define drowning

A

process resulting in primary respiratory impairment from submersion/immersion in a liquid medium

101
Q

define submersion

A

entire body is covered in liquid medium

102
Q

define immersion

A

oral and nasal airways are covered in liquid medium

103
Q

which group of people is drowning the MCC of death?

A

children 1-18 y/o

104
Q

what are RF for drowning

A 
african americans
unsupervised bath/pool time
bath seat use
seizure
alcohol use
105
Q

what is the pathophysiology of drowning

A 
struggle
last inhalation effort
moment of submersion or immersion
tissue hypoxia, acidosis, hypercapnia
larygnospasm or aspiration
respiratory failure and death
106
Q

how much water per kg can compromise surfactant in the alveoli

A

1-3 mL/kg

107
Q

what is common during the drowning process?

A

vomiting

108
Q

what are good prognostic factors of drowning

A

age < 14 y/o
CPR in the filed
CPR < 25 minutes
detectable pulses on arrival

109
Q

what are poor prognostic factors of drowning

A 
submersion > 5 minutes
no resuscitation for > 10 minutes
fixed and dilated pupils
GCS < 5
pH < 7.1
110
Q

which type of drowning victims should go to hospital?

A

all victims of drowning who required any form of resuscitation

111
Q

how long should asymptomatic drowning victims be in hospital?

A

observed 4-6 hours post event

112
Q

how to treat drowning?

A

Oxygen if SaO2 < 92%

if survive to ER, then admit for at least 24 hours

113
Q

what is the second MCC of accidental death in US

A

thermal burns

114
Q

what are the zones of thermal burns?

A

zone of coagulation
zone of stasis
zone of hyperemia or inflammation

115
Q

what are the rule of nines for thermal burns

A 
Head/neck - 9
Each UE - 9 (9x2)
Each thigh - 9 (9x2)
Each lower leg/foot - 9 (9x2)
Clavicle to pubis - 18
Root of neck thru buttocks - 18
Perineum - 1
ROT = back of hand = 1% BSA
116
Q

how does a first degree thermal burn present

A

epidermis only - painful, red, no blisters - sunburn

117
Q

how does a second, degree, partial thermal burn present

A

partly through dermis - blisters, painful - hot liquids

118
Q

how does a second degree, deep thermal burn present?

A

thru hair follicles and sweat glands - hot steam or oil

119
Q

how does a third degree thermal burn present?

A

skin to fat - charred, pale, painless, leatherly feel

120
Q

what are the major burn criteria

A 
partial thickness 25% or more, BSA in 10-50 y/o, 20% or more if 10 year olds or less or 50 year olds or more
full thickness 10% or more in anyone
any burn to hands, face, feet, perineum
any burn crossing major point
circumferential limb burn
inhalational or electrical injury
burn with fractures
burns in infants and elderly
121
Q

what is minor burn criteria

A

<15% or less BSA in 10-50 y/o
<10% 10 y/o or less or 50 y/o or older
full thickness 2% or less BSA

122
Q

how to treat thermal burns?

A

all get tetanus prophylaxis regardless of current status
NG tube
LR via 2 large bore peripheral IV’s
Keep UO 0.5-1.0cc/kg/hr for adult and 1.0cc/kg/hr for children
IV narcotics
sharply debride open blisters
cover with sterile moist dressings without ABX ointment if pt to be transferred
If D/C’ed, need 24 hour follow up

123
Q

what is the parkland formula?

A

4cc/kg/%BSA
1/2 given in first 8 hours postburn
remaining 1/2 over next 18 hours

124
Q

what is thermal burn admission criteria?

A

partial thickness 15% or more and full thickness 5% or more in 10-50 y/o
partial thickness 10% or more and full thickness 3% or more in 10 y/o or less and 50 y/o or greater
anyone with partial or full thickness burn to face, hands, feet, perineum, across major joint, circumferential limb burn
any electrical, chemical, inhalational burn
immunocompromised
burns with trauma (fractures)

125
Q

3/4 of all fire related deaths are due to this

A

smoke inhalation (CO and/or cyanide poisoning)

126
Q

suspect smoke inhalation if

A 
facial, intraoral, or pharyngeal burns
singed nasal hairs
soot in mouth or nose
hoarseness
carbonaceous sputum
wheezing
127
Q

what is smoke inhalation pathophysiology

A

CO binds to Hgb to form carboxyhemoglobin
CO has affinity for Hgb that is 200x that of oxygen
Causes leftward shift of the Hgb oxygen dissociation curve

128
Q

when should you suspect CO poisoning

A

if you have multiple family members with nonspecific symptoms, which resolve in the ED

129
Q

what are normal CO-Hgb values

A

normal 2-5%

130
Q

what are CO-Hgb values for msokers

A

higher 5-13%

131
Q

Based on CO-Hgb levels, what are the symptoms

A 
<10% = asymptomatic
10-30% = H/A, N/V, loss of dexterity
30-40% = confusion, lethargy, ST segment depression
40-60% = coma
>60% = death
132
Q

when is hyperbaric treatment indicated?

A 
CO-Hgb > 25-30%
Cardiac involvement
severe acidosis
transient or prolonged unconsciousness
neurological impairment
age > 36 y/o
pregnancy
133
Q

what is the MCC of cyanide poisoning

A

smoke inhalation

134
Q

what products would have cyanide released after burning

A 
wool
nylon
acrylics foam rubber
silk
plastics
cassava root
jewelry and textile industries
sodium nitroprusside
135
Q

which fruit pits containing amygdalin related to cyanide

A

apricots
bitter almonds
cherries
peaches

136
Q

what is cyanide pathophysiology

A

cyanide disrupts mitochondrial production of ATP by binding to and inhibiting cytochrome oxidase
causes cessation of aerobic cellular metabolism
cellular asphyxiant
ATP produced via anerobic pathway which leads to lactate production

137
Q

what lab suggests cyanide poisoning

A

lactate > 8

138
Q

what are mild cyanide symptoms

A 
H/A
nausea
vertigo
tachypnea
HTN
AMS
139
Q

what are severe cyanide symptoms

A 
dyspnea
bradycardia
hypotension
arrhythmia
unconsciousness
convulsions
CV collapse
140
Q

what are cyanide poisoning findings

A

severe metabolic acidosis
usually are not cyanotic
smells like bitter almonds

141
Q

how do you treat cyanide poisoning?

A 
oxygen
amyl nitrite
sodium nitrite
sodium thiosulfate
hydroxycobalamin (vitamin B12) - causes transient HTN, chromaturia
142
Q

define chemical burns

A

acids cause coagulation necrosis which limits penetration of chemical
alkalis causes liquefaction necrosis

143
Q

what is the cornerstone of therapy for chemical burns?

A

hydrotherapy (gentle flow not high pressure)

144
Q

what chemical is found in hair dyes?

A

acetic acid

145
Q

what is the 5th leading cause of fatal occupational injury and 2nd leading cause of death in construction industry?

A

electrocution

146
Q

what group of people are most commonly injured with electrical cords and sockets?

A

children < 6y/o

147
Q

which parts of body are most resistant to least resistant to electrical injuries?

A 
bone
fat
tendon
skin
muscle
blood vessels
nerves
148
Q

what is the pathophysiology of electrical injuries?

A

cell membrane disruption, edema, coagulation necrosis, ischemia, release of myoglobin (renal failure from rhabdomyolysis)
extent of skin damage does not correlate with extend of damage below skin
AC may precipitate V fib
Thoracic muscle tetany, direct coronary artery spasm, and myocardial ischemia

149
Q

what is the primary cause of immediate death with electrical injuries

A

cardiopulmonary arrest

150
Q

what are the symptoms of electrical injuries

A

LOC, seizure, amnesia, H/A, weakness, compartment syndrome

151
Q

what labs to obtain for electrical injuries

A

CBC, CMP, CK, myoglobins

152
Q

how to treat electrical injuries

A

IV fluids to keep UO 1 cc/kg/hr or greater
myoglobinuria - amp NaHCO3 to each liter of NS to keep UO 1.5-2cc/kg/hr
tetanus prophylaxis as indicated

153
Q

how to know when to discharge for electrical injuries?

A

may d/c if no evidence of electrothermal injury, normal exam and EKG, no heme in urine, if otherwise, admit

154
Q

where do direct strike lightning occur?

A

open areas

155
Q

which lightning strike is the most deadly?

A

direct strike because person becomes part of the main lightning discharge tunnel

156
Q

occurs when lightning strikes a taller object near the victim, then a portion of the current jumps from the taller object to the victim; can injure several people at once

A

side flash

157
Q

the lightning strike that is most common cause of lightning injuries and deaths to persons/animals

A

ground current

158
Q

how does a conduction lightning strike occur

A

when person is touching an object through which the current is transversing (i.e. wires or other metal surfaces, indoor lighting injuries, electrical outlets, plumbing, water faucets/shower, corded phone, windows, doors)

159
Q

how do streamers develop?

A

downward moving leader approaches the ground and is met by an upward moving current

160
Q

what is the MCC of death with lightening injuries?

A

cardiac arrest (asytole)

161
Q

what are symptoms of lightening injuries?

A

stunned, headache, myalgias, paresthesias, vision and hearing loss (usually gradually resolves)

162
Q

what is the MC neurological event of lightening injuries?

A

temporary LOC

163
Q

pathognomonic fernlike pattern

A

lightening injuries

164
Q

what may you develop later in life with lightening injuries?

A

cataracts

165
Q

what labs do you check with lightening injuries?

A

CBC, CMP, CK, EGK, +/- spine or CT brain

166
Q

how do you treat lightening injuries?

A

supportive
if survive to ER, admit
do not need aggressive fluids

167
Q

what is the treatment of choice for any anaphylactic reaction to a bee sting?

A

epinephrine

168
Q

what is the pathognomonic physical exam finding in scorpion sting?

A

roving eye movements

169
Q

what bite is associated with muscle cramps?

A

black widow spider

170
Q

what is the most lethal form of acute mountain illness?

A

HAPE

disciplines exam 3 (1 decks)

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