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X Emergency Med Exam 2 > Environmental Emergencies > Flashcards

Environmental Emergencies Flashcards

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1
Q

Risk factors for frostbite

A 
Lack of protective head/hand or footwear/wet clothing
Dehydration
Alcohol and smoking
Prolonged stationary posture
Protective ointments on head or face
Previous cold injuries
History of PVD or raynauds
Homeless
Vasoconstrictive meds
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2
Q

How to classify frostbite

A

Depth of injury and amt of tissue damage on appearance after rewarming

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3
Q

What happens with frostbite?

A

Thawing process starts a cascade (freezing alone doesn’t cause tissue death)
Ischemia, necrosis and gangrene

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4
Q

Presentation of frostbite

A

Can occur anywhere but mostly distal extremities (face, nose, ears, fingers or toes)
Before rewarming it looks pale and feels hard and cold
Numbness and tingling

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5
Q

Classification of frostbite

A

Done after rewarming process

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6
Q

First degree frostbite

A

Numbness, central pallor with surrounding erythema and edema, desquamation and dysesthesia

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7
Q

Second degree frostbite

A

Blisters of skin with surrounding edema and erythema

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8
Q

Third degree frostbite

A

Tissue loss involving entire thickness of skin, hemorrhagic blisters

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9
Q

Fourth degree frostbite

A

Tissue loss involving entire thickness of the part, including deep structures resulting in losing that part

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10
Q

Management of frostbite

A

Immersion in water 37-39C until erythematous and pliable (20-30 min)
IV opioids for pain
Maybe anticoagulation (if present in 24 hrs of injury and have high risk of amputation)
No blister or soft tissue debridement acutely
Maybe prophylactic abx
Td immunization PRN

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11
Q

Treatment of choice for frostbite

A

Aloe vera cream q 6 hrs with non-occlusive dressing

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12
Q

When can you discharge pts with frostbite home>

A

If can have appropritate f/u
Ibuprofen PO
Aloe vera cream
Discourage tobacco

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13
Q

Causes of hypothermia

A

Primary (cold exposure)
Secondary (become hypothermic in a temp that wouldnt normally cause it)
*bbs can cause this and also think with anti-hyperglycemics

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14
Q

Definition of hypothermia

A

Core temp below 35C

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15
Q

Classifications of hypothermia

A

Mild: core temp 32-35 F (89.6-95F ) and have confusion, tachycardia, increased shivering
Moderate: core temp 28-32 (82.4-89.6 F) and have lethargy, bradycardia, arrhytmia, loss or pupillary reflex, decreased shivering
Severe: temp below 28 C (82.4 F) and have coma, hypotension, arrhythmia, pulm edema and rigidity

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16
Q

How to get temp with severe hypothermia

A

Esophageal temp probe can be introduced with ET intubation

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17
Q

Labs for mod to severe hypothermia

A 
Fingerstick glucose
ECG/CXR
BMP and CBC with diff
Coag studies
O2 saturation (probably put probe on ears or forehead)
ABG
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18
Q

Initial management for hypothermia

A

ABCs
Endotracheal intubation maybe
Treat hypotension with warmed crystalloid 42C and dopamine PRN
Treat any arrhythmias (but defib not great ,<30C)

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19
Q

Rewarming for mild hypothermia

A

Passive external rewarming, remove wet clothes and cover with warm blankets

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20
Q

Rewarming for moderate hypothermia

A

Warmed humidified oxygen, forced air warming systems
Beware of intial paradoxical drop in core temp due to return of cold blood from extrems to core
SO rewarm the trunk first to minimize risk of core temp after drop

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21
Q

Rewarming for severe hypothermia

A 
Active internal and external rewarming like moderate AND
Pleural and peritoneal irrigation with warm saline (40-42C)
Extracorporeal options (hemodialysis, cardiopulm bypass, continuous arteriovenous rewarming)
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22
Q

One of leading causes of death in young athletes

A

Heat emergencies

23
Q

Risk factors of heat emergencies

A 
Strenuous exercise in high ambient temps and/or humidity
Lack of acclimatization
Poor fitness
Obesity
Dehydration
Acute illness
External loads
24
Q

Presentation of heat cramps

A

Intense muscle pain and spasm with no other signs of exertional heat stroke
“salty sweaters” so sweat with high salt conc
Heavy sweating with fluid replacement via water or other hypotonic solutions (K, Na or Mg deficiency)
Cramping in limited area, short and no risk for rhabdo

25
Q

Management for heat cramps

A

Hydrate and replace sodium losses (encourage oral POs)

Relax and stretch muscles

26
Q

Presentation of heat stress

A

Same with heat cramps PLUS
HA, n/v, dizzy, more diffuse muscle cramps, orthostatic hypotension and maybe near syncope
PE: temp is normal or elevated BUT not higher than 40 C (104F) and no CNS impairment

27
Q

Heat stress management

A

Remove from heat
Bolus infusion of mod amt of IVF with short term increase in maintenance (normal saline)
May need external cooling if not responding within 30 min of fluids etc

28
Q

Cardinal features of heat stroke

A

Temp >40C plus AMS (irritable, confusion, irrational behavior, decorticate and decerbrate posturing, seizures, coma)

29
Q

Management for heat stroke

A 
Start fluids and monitor core temp
Cool to 102.2 F (not too quick)
Evaporative cooling
Ice packs
Immersion cooling
Invasive cooling
Admit based on response and labs
30
Q

Evaporative cooling for heat stroke

A

Remove clothing, spray water on pts skin, direct fan over pt

Con is that its hard to keep electrodes on skin for monitoring

31
Q

Ice packs for heat stroke

A

In axilla, neck and groin

But poorly tolerate

32
Q

Immersion cooling for heat stroke

A

Pt placed partially in tub of ice water

Cons: can’t put electrodes on, poorly tolerated, can’t defibrillate

33
Q

Invasive cooling for heat stroke

A

Cardiopulmonary bypass

Cons: invasive and not available everywhere

34
Q

Black widows

A

Male are harmless
Live outdoors
Like warm weather

35
Q

Brown recluse spider

A

6 or 8 eyes

Indoors and not common to AZ

36
Q

How to diagnose a spider bite

A

Saw the spider

A skin lesion and or systemic findings associated with a bite

37
Q

Tx for spider envenomation

A

Wound cleansing
Tetanus PRN
Treat secondary skin infection PRN

38
Q

Presentation of mild black widow envenomation

A

Local wound and maybe spams adjacent to site

39
Q

Presentation of moderate black widow envenomation

A

Spasms and muscle pain in bitten extremity, back, chest and abdomen
Adjacent diaphoresis

40
Q

Presentation of severe black widow envenomation

A

Severe pain and spasm and systemic features

N/v, HA, tachycardia, HTN

41
Q

Management of black widow envenomation

A

Self limiting with sxs usually resolving 24-48 hrs
Analgesics (maybe opioids if bad)
Muscle relaxants
Maybe antivenom

42
Q

Presentation of brown recluse bite

A

Depressed macule, pale gray, eroded in center with halo of inflammation and hemorrhage
Lesion may be very tender and extend to muscle tissue
Necrosis someimtes
Infrequent systemic sxs (malaise, n/v, fever, myalgia)
Rare systemic rxn (rhabdo, DIC, acute hemolytic anemia-kids more)

43
Q

Management of brown recluse bite

A

Debridement not beneficial
Wound gets better in 5-10 days
No antivenom here

44
Q

What do scorpion stings usually look like?

A

Minimal swelling
Regional LAD
Increased skin temp and tenderness around wound
(bark scorpion is venemous and can cause serious illness)

45
Q

Presentation of bark scorpion sting

A

Pain and paresthesia over involved are
Swelling absent with few skin changes
Tachycardia, HTN, tachypnea, weakness, muscle spams and fasciculations

46
Q

Management of bark scorpion sting

A 
Ice pack on wound
Oral NSAIDs
Muscle relaxants
Pain control
Monitor for 8-12 hrs after sting
Poison control: 800-222-1222
47
Q

Clinical features of rattlesnake bite

A 
Fang marka
Local tissue injury
Fibrinolysis
Thrombocytopenia
Systemic effects
48
Q

Mainstay of therapy for rattlesnake bite

A

Antivenom (treat all pts with progressive signs and sxs ASAP)
*want to stop progression

49
Q

How to define worse progression of sxs with rattlesnake bite

A 
Worsening local injury (pain, ecchymosis, swelling)
Abnormal labs (decreasing platelets, prolonged PT, decreased fibrinogen)
Systemic manifestations (unstable, AMS)
50
Q

What do coral snakes look like?

A

Brightly colored, red/black/yellow rings (red and yellow rings touch in coral snakes)
-neurotoxin venom that does not cause marked localized injury

51
Q

Management of coral snake bites

A

Admit b/c can take hours for effects of venom
Start antivenom ASAP (irreversible if starts seeing effects of venom)
Closely monitor resp function

52
Q

Gila monster

A

Slow moving lizard ith venom
No fangs, just short grooved teeth
Prolonged bite to envenomate (can have fractures with the bite)

53
Q

Management for gila monster bite

A

Remove lizard, clean wound and remove remaining teeth if fall out
X-ray for fractures
Tx and abx PRN
Admit and monitor for envenomation sxs (weakness, light headed, paresthesis, diaphoresis, HTN)
no antivenom

X Emergency Med Exam 2 (6 decks)

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