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Disciplines Exam 4 > Environmental Emergencies > Flashcards

Environmental Emergencies Flashcards

1
Q

Definition and classification of Hypothermia

A

Def: core temp = 95F

Mild: 89.6-95F (32-35C)
Mod: 86-89.6F (30-32C)
Severe: <86F(<30C)

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2
Q

Conduction

A

Transfer of heat by direct contact (water immersion)

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3
Q

Convection

A

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

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4
Q

Radiation

A

electromagnetic transmission

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5
Q

evaporation

A

conversion of liquid to vapor - usually accounts for 10-15% heat loss (sweat, resp processes)

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6
Q

Etiology of hypothermia

A

medical illness (DM, PVD, ASVD, Neuropathy, Psych)

Ethanol (MCC)

wind chill
clothing
smoking
homeless

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7
Q

High risk pt for hypothermia and MC

A

age extremes, altered sensorsium

MC: males 30-49 y.o; extremities

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8
Q

Pathophys of hypothermia

A

Initially have increased HR, vasoconstrict + incr O2 consumption but decrHR after 32C
Hypoventilation w/ CO2 retention (=hypoxia, rest acid)
Decreased mucocillaiary clearance (incr secretions, dear gag/cough = incr aspiration)
Slowed mentation, motor, speed of reasoning
dear plt fan 2/2 sequester in portal system (= incr blood viscos + thrombi)
Decr. colga factor activity
cold diuresis
imp. insulin release
shift Oxyhemo curve to Left (harder to unload)

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9
Q

Hypothermia: what happens after trx started

A

cold, acidotic peripheral blood returns to central circ = temp decr. further and incr. risk for arrhythmia

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10
Q

Hypothermia: 3 main priority organs

A

brain, heart, kidney

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11
Q

hypothermia: clinical abnormalities

A

shivering stops @ 90 (32.2C)
incr. arrhythmias @ <86(30): Osborn J wave
w/hold card meds and defib until temp >82.4F (28C)

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12
Q

Hypothermia: common EKG signs

A

Osborn J-wave; no bunnies in v1/v2, but +in v3

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13
Q

Hypothermia: trx

A

warms O2 vent + warmed IV fluids
Active external rewarm (blankets) 1 deg C/hr
Gently circulating water (104-107.6F, 40-42C)
Active core rewarm (incr 2 deg/hr) = 2 cutes tubes each side w/ warm fluid in top, out bottom; warm NGT/urinary catheter + IVF

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14
Q

Frostbite Pathophys

A
  1. Cold Exposure
  2. Formation of extra cell ice crystals damaging cell membranes and osmotic gradient
  3. Intracell dehydration
  4. intracell ice crystal formation
  5. Cell death
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15
Q

Frost bite classifications

A

first deg: anesthetic central white plaque w/ peripheral erythema

2nd deg: clear or milky-filled blisters surrounded by erythema and edema

3rd deg: hemorrhagic blisters that progress to hard black eschar

4th degree: complete necrosis and tissue loss

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16
Q

Frostbite Treatment

A
  • elevate and splint extremity
  • wrap in dry gauze
  • debride white/clear blisters
  • aloe vera q 6 hr
  • tetanus
  • analgesics (ASA, NSAIDS, narc)
  • Abx no role
  • no smoke
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17
Q

UV Keratitis

A

-snowstorm/flare on slit lamp
damage to anterior chamber of eye
-develop w/in 1 hr of exposure; no symp until 6-12hrs
-severe pain, foreign body sensation, tearing, conjunctival injections
-bad far vision

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18
Q

UV keratitis Trx

A
  • self-limited
  • analgesics, cold compress
  • cyclogel helps spasm
  • polarized sunglasses
  • patching not recommended
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19
Q

Heat Injuryies high risk pt

A

age extremes, confusional states, limited water access, ETOHics, Menta illness, chronic dz

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20
Q

Heat injury: when does radiation occur

A

when air temp < body temp

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21
Q

What is hyperthermia

A

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

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22
Q

Heat Injuries Pathophys

A

-incr endogen heat prod
-decr. heat dispersion
-thirst is poor gauge of hydration status
excerise incr. metabolic rate 20-25x

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23
Q

What meds incr. heat production?

A

neuroleptics, hallucinogens, amphetamines, anesthetics, LSD, cocaine

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24
Q

What meds inhibit sweating?

A

Antihistamines, Neuroleptics, TCAs, Atropine, Antispasmodics

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25
Q

how long does acclimation take?

A

7-10 for adults, 14 for children

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26
Q

Prickly Heat (AKA heat rash)

A

Acute inflammation of sweat ducts caused by blockage of pores

Pruritic, emaculoppular erythematous rash found over CLOTHED areas of body

Trx: antihistamines, supportive care (cool compress)

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27
Q

Heat Cramps

A

Painful involuntary spasmodic contractions

usually sweat profusely but replace w/ water only (cramping 2/2 lyte deficit K, Mg)

Treated with rest in cool environment, replacement of fluids and lytes

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28
Q

Heat Exhaustion

A

Dizzy, weak, malaise, N/V, H/A, myalgias

Syncope orthostasis (drop in 20 from lying to standing), sinus tach (1st treat based on cause), tachypnea

Normal mental status

Treat: rest, volume, lyte replacement

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29
Q

What separates heat exhaustion from heat stroke?

A

Normal mental status in heat exhaustion; altered in heat stroke

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30
Q

Heat Stroke

A

MC in summer
TRIAD: hyperthermia (>105F), CNS dyxfxn, Anhydrosis

Seizure, decr. BP, incr HR + RR

Labs: incr. Na/BUN, decr. K, Ca, Phos, Mg

Markedly ELEVATED TRANSAMINASE LEVELS

5% renal failure + rhabdo)

25% ARDS

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31
Q

Heat Stroke treatment

A

aggressive hydration (IVF @ 250ml/hr w/ foley - monitor UO)

Diagnostics
Reduce temp rapidly to 104F
Remove clothes and apply strategic ice packs (Axilla, neck, groin)

TOC: EVAP COOLING

Diazepam to inhibit shivering

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32
Q

Heat Stroke Poor Prognostic Factors

A 
Delayed rapid cooling
AST > 1000
DIC
Prolonged coma
hypotension
Renal Failure in 1st 48 hours
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33
Q

Jellyfish sting

A

-Pruritic pain, wheals, urticaria

Vinegar used to remove nematocyst (tails); can also use isopropyl alcohol

Topical anesthetics

Oral analgesiscs

No ABX

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34
Q

Stingray or Catfish

A

Pain, bleed

Irrigation, removal of foreign debris

Hot water immersion (dissolves)

Abx controversial (consider if in dirty water)

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35
Q

Vespids

A

Yellow jackets, hornets, wasps

sting mx times

bad guys

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36
Q

Apids

A

honey and bumble bees

barbed stingers

37
Q

MC allergic rxn 2/2 insect stings

A

yellow jacket

38
Q

MCC death from envenomation

A

Upper airway obstructions

39
Q

Nest locations

A

ground = yellow jacket
under leaves/window: wasps

Brushes/lowlying limbs = hornets

40
Q

Hymenoptera Stings

A

Local rxn: pain, erythema, edema, pruritus, swelling

Systemic/anaphylactic: majority occur w/in 15 min
-itchy eyes, facial flush, urticaria, dry cough, dyspnea, wheeze, abdominal cramps, N/V/D, Fever, arthralgia
IgE mediated histamine release

Anaphylaxis happens from 2nd exposure

41
Q

Hymenoptera Stings: Trx

A 
clean wound w/ soap + H2O, remove stinger
apply ice pack + elevate
Antihistamins
epinephrine
Steroids
Beta Agonists
D/c w/ auto-injector of epi (eli-pen)
42
Q

Brown Recluse Spider

A

Loxosceles
MC in midwest + south
Wood piles, sheds, garages, closets
Light brown to tan w/ dark violin-shaped mark

43
Q

Most active enzyme in Brown Recluse Spider Bite

A

Sphingomyelinase D

Starts dissolving things in skin. Later leads to necrosis

44
Q

Brown Recluse Spider Bite Si/sx

A

Mildly erythematous lesion that becomes firm and dry over days-weeks; blush blister then necrosis

F/C, N/V, myalgia, petechia, seizure

45
Q

Brown recluse spider test and trx

A

Test: CBC, BMP, Coags, UA; no specific is dx

Trx: supportive, sx once clearly demarcated - wait until wound defines itself

No antivenin available; no benefit for steroids, abs, dapsone, early excision, hyperbaric O2, topical NTG

46
Q

Black Widow

A

Lactrodectus

North America (not Alaska)

Attics, barns, sheds, garage, firewood, hay bales

Shiny black w/ red hourglass on abdomen

47
Q

Black Widow pathophys

A

Alpha-latrotoxin

Venom releases acetylcholine and norepinephrine @ neurosynaptic junction causes inhibition of reuptake leads to muscle contractions + fatigue

Severe and rigid abdominal pain

48
Q

Black Widow clinical effects

A

Hallmark: muscular cramping (abd > chest, back); onset 30-90 min, peaks 3-12 hrs

N/V, diaphoresis, HTN, tachycardia, anxiety, agitation, irritability, weakness, H/A, periorbital edema

Bad: Shock, coma, respiratory failure

49
Q

Black Widow Trx

A

No specific test
Narcotics, bentos
Antivenin: 2 vials + NS in 20-30 min (horse serum)
-inidcated for life-threatening HTN/incr HR, rest issues, refractory pain, meds, pregnant, elderly

Ca gluconate, valium as well

50
Q

Lice

A

intensely pruritic wheals

waists, shoulders, axillae, neck

Eggs no easily brushed off

Try: lindane (avoid in kids/preggo); fine combing, sterilize clothes + bed

51
Q

Scabies

A

Hands/feet between digits

white zigzag threadlike pattern

Trx: elevate/Lindane; calamine; oral antipruritic (ataraxic), analgesics

52
Q

Snakebites background

A

8000bites, 5-15death;
90-95% rattlesnakes, copperheads, moccasins

MC time: august - Oct

M>F 9:1

Adults = UE> LE
Kids = LE > UE

dry = no venom

53
Q

Snakes: Red, yellow, black

A

Red on yellow will kill a fellow; red on black you’ll be fine jack

54
Q

Snake bites clinical

A

venom causes local tissue injury, systemic vascular damage, HEMOLYSIS, fibrinolysis, DIC

cardinal features: one/more fang marks, localized pain, etythemia, ecchymoses, progressive edema

N/V, weakness, parenthesis mouth/tongue, METALLIC TASTE, tender lympadenopahty, incr. HR, dizzy, hematuria, Decr. platelets

55
Q

Snake Bites test + trx

A

test: CBC, CMP, Coag, UA, T/S

Try: elevate, constriction bands occluding venous outflow ONLY IF DELAY TO CARE, observe x 8 hrs

Admit ALL kids

Cut and suck NOT rec. Extractor devices unproven, Abx NOT rec.

56
Q

Snake Antivenins

A

Indicated for worsening swelling, coat abnormalities, systemic effects (hypotensive), all copperhead bites

ACP: 0-5mild, 10-15 mod, 15-20 severe

Polyvalent Immune: 5.2x more potent than ACP; 4-6 initial then repeated 2vials @ 6,12,18hrs

No diff between peds/adults

57
Q

Scorpions background

A

found in wood piles, crevices, shoes, clothes

venom activates Na channels = immediate paresthesias, tachycardia, incr. secretions, incr. temp, diaphoresis, SLUDGE (cholinergic)

EYE ROVING
TONGUE FASICULATIONS/DIFF SWALLOW

58
Q

Scorpion Graes

A
  1. local pain +/- paresthesias
  2. pain remote from site of sting
  3. CN/Auonomic/somatic dysfxn: blurred vision, roving eye, hyper salivation, tongue fasciculation’s, dysphagia, dystonia; restlessness, involuntary shaking or jerking
  4. CN/autonomic and somatic nerve dyxfunction
59
Q

Scorpion Trx

A

TOC: supportive (cool compress, +/- midazolam)

Anascopr: anitvenom. Supper expensive

60
Q

Cactus

A

Pain
Mx foreign bodies

TOC: removal of spines and local wound care

Elmers glue works super well!

61
Q

Drowning def

A

process resulting in primary resp impairment from submission/immersion in a liquid medium

Submersion = entire body; immersion = part

62
Q

Drowning risk factors

A

Age: 0-4; 15-19

AA, unsupervised bath/pool, bath seat, seizure, ETOH

63
Q

Drowning Pathophys

A
  1. Perceived risk (struggle)
  2. Last inhalation effort
  3. Moment of submersion/immersion
  4. Tissue hypoxia, acidosis, hypercapnia
    - Loss of consciousness; involuntary rest. drive
  5. Laryngospasm/aspiration
  6. Resp failure + death
64
Q

Water on Sufactant/alveoli

A

alveolar collapse, shunting, V/Q mismatch

Most victims ingest water during drowning. Vomiting is common and Expected!

65
Q

Prognostic Factors

A

Largest: DURATION of submersion and interval time between drowning + ventilation

Good: Age < 14, CPR, CPR < 25min, Detectable pulse on arrivale

Poor: submersion > 5min, no resus > 10, fixed/dilated pupils, GCS < 5, pH < 7.1

66
Q

Drowning Trx

A

All victims who require resuscitation should be evaluated in hospital

Asympt observed x 4-6 hrs

Spinal precautions not recommended
O2 if O2 < 92%
Admit x 24 hrs if survive to ER

67
Q

Thermal burns

A

2nd MCC accidental death
More freq in <4 or >65

Rule of 9s

Zone of coag = loss
Zone of stasis = salvageable
Zone of hyperemia: hurts

68
Q

Thermal Burn Degrees

A

1st: epidermis only; painful, red, no blisters (Sunburn)
2nd part: partially thru dermis, blisters, painful (Hot liquids)
2nd deep: thru hair follicles and sweat glands (steam/oil)
3rd: skin to fat, charred, able, painless, leathery feel

Skin graft: 2nd deep and more

69
Q

Major Burn criteria

A 
Partial thick > 25% 10-50; >20 outside range
full thick > 10;
any burn hand/face/feet/perineum
any burn crossing amor joint
circumferential limb burn
inhalational/electrical
burn+fractures
Burns in infants/elderly
70
Q

Minor Burn Criteria

A

<15% 10-50, < 10 outside area

Full thickness < 2%

71
Q

Thermal Burn Treatment

A

All get tetanus prophy
NGT
LR x 2 large bore periph IVs

Parkland formula: 4cc/kg/% - 1/2 given in 1st 8 hours, remaining 1/2 over next 18

2-4 in 24, 1/2 in 8 the rest can wait

UrineOP: 0.5-1ml/kg/hr
IV narco
debride OPEN blisters
cover w/ sterile moist dressings w/o abx ointment
24hr f/u after d/c
72
Q

Thermal Burns Admit criteria

A 
Partial thick >15 or full >5 in 10-50
Part thick >10, full >3 outside range
all w/ burn to face, hands, get, perineum, major joint, circumferential
electrical, chemical, inhalation burn
immunocompromised
burns + trauma
73
Q

Smoke inhalation

A

3/4 of all fire-related deaths

Suspect: facial/intraoral/pharyngeal burns, singed nasal hairs, soot in mouth/nose, hoarseness, carbonaceous sputum, wheeze

74
Q

CO pathophys

A

Binds to hg to form carboxyhemoglobin

affinity for hg 200. > O2 (leftward shift of dissociation curve)

75
Q

When should you suspect CO poisoning?

A

Mx family members w/ nonspecific symptoms that resolve in ED

76
Q

Can pulse ox distinguish hg/carboxyhg, methemoglobin?

A

no, but pulse CO-OXIMETRY can

77
Q

CO-Hgb Levels + symptoms

A 
<10% asymptomatic
10-30 = h/a, n/a, loss of dexterity
30-40 = confusion, lethargy, ST seg depress
40-60 = coma
>60 = death
78
Q

Hyperbaric trx indicated?

A 
CO-Hgb > 25-30
cardiac involvement
severe acidosis
transient or prolonged unconsciousness
neuro impriment
>36 y.o
preggos
79
Q

cyanide poisoning

A

MCC = smoke inhalation (house fire)
also in: wool, nylon, acrylics, silk, foam, rubber, plastics; fruits (apricots, bitter almonds, cherries, peaches), cassava root, jewelry/textile industries, Na nitropresside

80
Q

Cyanide pathophys

A

Disrupts mitochondrial production of ATP by binding to and inhibiting cytochrome oxidase

Causes cessation or aerobic cellular metabolism

  • cellular asphyxiant
  • ATP priced via ANAEROBIC pathway which lead to lactate production (>8 strongly suggestive of cyanide poisoning)
81
Q

Cyanide Symptoms

A

Mild: H/A, N, vertigo, tachypnea, HTN, AMS

Severe: dyspnea, bradycardia, hypotensive, arrhythmia, unconsciousness, convulsions, CV collapse

82
Q

Cyanide poison findings

A

SEVERE metabolic acidosis (2/2 lactate), usually not cyanotic, bitter almond smell

83
Q

Cyanide Trx

A

O2
3 parts: Amyl nitrite (oxidizes hero to methe which combos with cyanide to form cyanomethemoglobin)
Sodium nitrite
Sodium thiosulfate

or

Vit B12 (binds with cyanide to for cyanocobalamin - excreted in urine). may cause HTN, chromaturia

84
Q

Chemical Burns

A

Acids: Coag, NeCrosis, limits penetration of chem

Alkalis = liquefAction (keeps moving through)

therapy: gentlefolk hydrotherapy

Acetic acid (hair dyes) = local

Overall: Acid > Alkaline

85
Q

Electrical background

A

5th leading cause of fatal occupational injury; 2nd leading COD in construction

Most involve low volts

kids < 6 MC w/ cords/sockets

AC more dangerous than DC

AC = lock, DC = thrown back

86
Q

Order of Resistance to Electricity

A 
Most: bone
fat
tendon
skin
muscle
blood
nerves (least!)
87
Q

Electrical injuries patho

A

Cell membrane disruption, edema, coag nec, ischemia, release of myoglobin (renal fail 2/2 rhabdo)

Extent of skin damage no correlate w/ extend of below skin (burn center!)

AC may precipitate V Fib, DC causes systole

Thoracic muscle tetany, direct coronary artery spasm, and myocardial ischemia

88
Q

Associated injuries with electricity

A

CP arrest is MC COD (immediate): defib if in V fib

LOC< seizure, amnesia, H/A, weakness

compartment syndrome

89
Q

Electrical Trx

A

CBC, CMP, CK, myoglobin

IVF, keep UP >1cc/kg/hr

Myoglobinuria: 1/2amp Na Hco3 to each liter of NS: UO > 1.5 - 2cc/kg/hr

Tetanus prophylaxis

D/c if no evidence of electrothermal injury, normal exam, and EKG; no heme in urine

Disciplines Exam 4 (4 decks)

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