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EM/Surg > Environmental Emergencies (Exam #1) > Flashcards

Environmental Emergencies (Exam #1) Flashcards

1
Q

How does the rethawing process in a cold injury cause tissue damage (3 steps)?

A
  1. Arachidonic acid = vasoconstrict

2. Platelets aggregate = clots 3. Ischemia, necrosis, gangrene

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2
Q

What two symptoms may be seen prior to rethawing in a cold injury?

A
  • Pale, waxy, hard/cold skin

- Paresthesias

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3
Q

What are the four degrees of cold injury?

A
  • 1st Degree: numbness, central pallor with surrounding erythema/edema, desquamation, NO blisters
  • 2nd Degree: blisters with surrounding erythema/edema
  • 3rd Degree: tissue loss of entire thickness of skin; hemorrhagic blisters (deeper)
  • 4th Degree: tissue loss of entire thickness of skin + deeper structures = amputation
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4
Q

Treatment of heat injury (4)?

A
  • Immerse in water (101.5/102.2 F, 20-30 min.)
    +/- IV opioids for pain
  • Apply aloe vera
  • Give Ibuprofen
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5
Q

What indicates a poor prognosis with cold injury? What two diagnostic tests should be ordered?

A

Cyanosis proximal to ITP joints

  • CT angiography
  • DEXA scan
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6
Q

What are six causes of secondary Hypothermia (HT)?

A
  • Alcoholism
  • DKA
  • Meds (antihyperglycemics, BB, opioids)
  • Newborns
  • Malnutrition
  • Infusions/transfusions
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7
Q

With a hypothermic patient, what is the preferred method to check temperature (2)? Which is used on an unconscious patient?

A
  • Rectal/bladder thermometer (conscious)

- Esophageal temp probe (unconscious)

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8
Q

What are the four clinical stages of Hypothermia (HT), and what is the body temperature range for each?

A
  • Mild (HT I) = 89.6-95 F
  • Moderate (HT II) = 82.4-89.6 F
  • Severe (HT III) = <82.4 F
  • HT IV = 82.4-89.6 F
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9
Q

Which clinical stage of Hypothermia (HT) involves conscious, confused, tachy, inc. shivering? What is the temperature range for this stage?

A

Mild (HT I) = 89.6-95 F

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10
Q

Which clinical stage of Hypothermia (HT) involves lethargic, brady/arrhythmias, loss of pup. reflexes, dec. shivering? What is the temperature range for this stage?

A

Moderate (HT II) = 82.4-89.6 F

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11
Q

Which clinical stage of Hypothermia (HT) involves VS present, unconscious, hypotension, arrhythmias, pulm. edema? What is the temperature range for this stage?

A

Severe (HT III) = <82.4 F

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12
Q

Which clinical stage of Hypothermia (HT) involves absent VS, cardiac arrest? What is the temperature range for this stage?

A

HT IV = 82.4-89.6 F

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13
Q

What two clinical signs/changes may be seen before and after rewarming with Hypothermia (HT)?

A
  • Hyperglycemia → normal/hypoglycemia

- Normal → hyperkalemia

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14
Q

What is the treatment for Mild (HT I)?

A
  • Rewarm using blankets, fluids
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15
Q

What is the treatment for Moderate (HT II) (2)?

A
  • ABCs +/- intubation

- Internal AND external rewarming (trunk first)

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16
Q

If a patient is Hypothermic and you are treating them, what movements should be avoided, and why?

A

Avoid rough movements

- Can cause arrhythmias

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17
Q

What is the treatment for Severe (HT III) (3)?

A

Same as Moderate + pleural/peritoneal irrigation with warm saline

  • ABCs +/- intubation
  • Internal AND external rewarming (trunk first)
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18
Q

What is the treatment for Severe (HT III) (3)?

A
  • Start CPR
  • ACLS protocol
  • Thoracic lavage with NS
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19
Q

What two general treatments are always recommended with a Hypothermic patient?

A
  • Remove wet clothes

- Rewarm

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20
Q

What are four important complications associated with rewarming a Hypothermic patient?

A
  • Hypotension
  • Electrolyte abnormalities
  • Rhabdomyolysis
  • Late pulm/renal/neuro complications
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21
Q

What heat emergency is more common in “salty sweaters” and those who are not heat acclimated?

A

Heat Cramps

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22
Q

What condition involves muscle pain/spasm, low Na+/K+/Mg? What is the recommended treatment?

A

Heat Cramps

- Tx: rehydrate, rest

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23
Q

How can you differentiate Heat Stress/Exhaustion from Heat Stroke (2)?

A
  • Heat Stress/Exhaustion = <104 F, NO CNS impairment

- Heat Stroke = 104+ F, AMS

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24
Q

What condition involves normal/slightly elevated temp. (<104 F); NO CNS impairment?

A

Heat Stress/Exhaustion

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25
Q

What condition involves heat cramps + HA, N/V, dizziness?

A

Heat Stress/Exhaustion

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26
Q

When treating a patient with heat emergency, what is the goal body temperature?

A

102.2 F

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27
Q

What is the recommended treatment for Heat Stress/Exhaustion (BE SPECIFIC)?

A

IV fluids

- 1-2 L NS short-term + 1.5x increase for maintenance

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28
Q

What condition involves 104+ F AND AMS? What symptoms may present?

A

Heat Stroke

  • Irritability
  • Confusion
  • Irrational behavior
  • Decorticate/decerebrate posture
  • Seizures
  • Coma
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29
Q

For Heat Stroke tx, which cooling method involves remove clothing, spray water on patient’s skin, direct a fan over the patient?

What is the con associated with this method?

A

Evaporative cooling

- Con: hard to keep cardiac electrodes on skin for monitoring

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30
Q

For Heat Stroke tx, if using the ice pack cooling method, what three specific body parts should they be applied to?

What is the con associated with this method?

A
  • Axillae
  • Neck
  • Groin
  • Con: poorly tolerated
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31
Q

For Heat Stroke tx, which cooling method involves patient placed partially in tub of ice water?

What are the three cons associated with this method?

A

Immersion cooling

Cons:

  • Electrodes cannot be on patient
  • Poorly tolerated
  • Cannot defibrillate if needed
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32
Q

For Heat Stroke tx, which cooling method involves cardiopulmonary bypass?

What are the two cons associated with this method?

A

Invasive cooling

Cons:

  • Invasive
  • Not readily available
33
Q

How can you differentiate AC from DC electrical injuries symptomatically (2)?

A
  • AC = repetitive muscle contraction, entrance wound ONLY

- DC = single muscle spasm (shorter duration), exit AND entrance wound

34
Q

What condition involves repetitive muscle contraction, entrance wound ONLY?

A

AC Electrical Injury

35
Q

What condition involves single muscle spasm (shorter duration), exit AND entrance wound?

A

DC Electrical Injury

36
Q

What are the four types of Electrical Injuries? Describe each…

A
  • Classic: body part of circuit
  • Flash/arc: strikes skin, but doesn’t enter body
  • Flame: clothing catches fire
  • Lightning: DC = shock wave through body; “Lichtenburg figures”
37
Q

What specific finding is seen with a Lightning Electrical Injury?

A

“Lichtenburg figures”

38
Q

What two systems are often affected with a High Voltage Electrical Injury?

A
  • Neuro

- Vascular

39
Q

With Electrical Injuries, what is the duration of contact for each type (Lightning vs. High Voltage vs. Low Voltage)?

A

Duration of Contact

  • Lightning: instant
  • High: brief
  • Low: prolonged
40
Q

With Electrical Injuries, what is the type of current for each type (Lightning vs. High Voltage vs. Low Voltage)?

A

Type of Current

  • Lightning: DC
  • High: DC or AC
  • Low: mostly AC
41
Q

With Electrical Injuries, what cardiac arrest dysrhythmia is seen with each type (Lightning vs. High Voltage vs. Low Voltage)?

A

Cardiac Arrest

  • Lightning: Asystole
  • High: V Fib
  • Low: V Fib
42
Q

With Electrical Injuries, what muscle contraction is seen with each type (Lightning vs. High Voltage vs. Low Voltage)?

A

Muscle Contraction

  • Lightning: single
  • High: single if DC; tetany if AC
  • Low: tetany
43
Q

With Electrical Injuries, what type of burn is seen with each type (Lightning vs. High Voltage vs. Low Voltage)?

A

Burn

  • Lightning: superficial = rare
  • High: deep = common
  • Low: usually superficial
44
Q

With Electrical Injuries, what blunt injury is seen with each type (Lightning vs. High Voltage vs. Low Voltage)?

A

Blunt Injury

  • Lightning: blast effect
  • High: fall (muscle contraction)
  • Low: fall = uncommon
45
Q

With Electrical Injuries, how common is acute mortality seen with each type (Lightning vs. High Voltage vs. Low Voltage)?

A

Acute Mortality

  • Lightning: very high
  • High: moderate
  • Low: low
46
Q

With High Voltage Electrical Injuries, what is the recommended diagnostic criteria (4)?

A

TRAUMA protocol…

  • FAST
  • CT scans
  • XR
  • Labs (CBC, CMP, etc)
47
Q

With Low Voltage Electrical Injuries, what is the recommended diagnostic criteria (2)?

A

Perform PE and EKG

- NO labs or imaging unless sxs/abnormal findings

48
Q

What is the recommended disposition for High Voltage Electrical Injuries? Low Voltage Electrical Injuries?

A
  • High: ADMIT ALWAYS (even if asxs or no apparent injury)

- Low: home if norma PE/EKG

49
Q

What type of bite involves pain within 3 hours of bite → systemic sxs 4-6 hours post-bite?

A

Black Widow Spider Bite

50
Q

What type of bite involves mild-intense pain and itching 2-8 post-bite?

A

Brown Recluse Spider Bite

51
Q

What condition involves depressed macule/pale grey with erosion in center and halo of inflammation/hemorrhage?

A

Brown Recluse Spider Bite

52
Q

Are systemic sxs more common with a Black Widow Spider Bite or Brown Recluse Spider Bite? What four symptoms may be seen?

A

Black Widow Spider Bite

  • N/V
  • HA
  • Tachycardiac
  • HTN
53
Q

What is the recommended treatment for Spider Bites (3)? Which type involves an antivenom?

A

Often self-limiting

  • Clean wound
  • Tetanus prophylaxis
  • Analgesics

Antivenom = Black Widow

54
Q

Scorpion Stings are often harmless, except which type? What symptoms may be seen with this Scorpion (6)?

How are sxs different for children (3)?

A

BARK Scorpion = venomous

  • Pain/paresthesias
  • Tachycardia
  • HTN
  • Tachypnea
  • Weakness
  • Muscle spasms

Children: restless, muscle spasm, random head movements

55
Q

What is the recommended treatment for Scorpion Stings (3)? What if severe?

A

Monitor for 8-12 hours
- Supportive (ice packs, NSAIDs, muscle relaxants)

  • Severe = antivenom
56
Q

What is the recommended treatment for both Rattlesnake Bites and Coral Snake Bites?

A

ADMIT to ICU

- Start antivenom

57
Q

What type of bite involves fang marks, local tissue injury, thrombocytopenia?

A

Rattlesnake Bites

58
Q

What are three signs of progressive sxs with a Rattlesnake Bite?

A
  • Worsening local injury
  • Abnormal labs
  • Systemic sxs
59
Q

With snake antivenom administration, what condition may develop and how do you treat it?

A

Serum sickness

- Treat with oral Prednisone (1mg/kg/d for 1-2 weeks)

60
Q

What is an important consideration in the presentation/treatment of Coral Snake Bites?

A

Neurotoxic venom can take hours to take effect BUT once effects present = irreversible

61
Q

What condition requires prolonged bite for envenomation? What diagnostic test should be ordered?

A

Gila Monster Bites

- Order XR

62
Q

What is the recommended treatment for Gila Monster Bites (4)?

A
  • Remove lizard
  • Clean wound/remove teeth
  • Admit
  • Begin abx
63
Q

What are the two types of Barotrauma, and which is more severe?

A
  • Descent

- Ascent = more severe

64
Q

What condition involves EAC occluded → cannot equalize pressure between TM and EAC during descent?

A

Barotitis (Ear Squeeze)

- Descent Barotrauma

65
Q

What condition involves pain/fullness vs. conductive hearing loss, hemotympanum → ruptured TM, vertigo?

A

Barotitis (Ear Squeeze)

- Descent Barotrauma

66
Q

What condition involves sinuses occluded → air cannot enter sinuses during descent to equalize?

A

Sinus Barotrauma

- Descent Barotrauma

67
Q

What condition involves sinus pain, possible epistaxis?

A

Sinus Barotrauma

- Descent Barotrauma

68
Q

What is the recommended treatment for both Barotitis and Sinus Barotrauma (2)? What additional consideration should be made for Sinus Barotrauma?

A
  • Decongestant
    +/- abx PRN

Also, ENT referral for Sinus Barotrauma

69
Q

What condition involves occluded Eustachian tube + attempted Valsalva to equalize pressure in middle ear → oval/round window ruptures?

A

Inner Ear Barotrauma

- Descent Barotrauma

70
Q

What are the three types of Descent Barotrauma, and which is most severe?

A
  • Barotitis
  • Sinus Barotrauma
  • Inner Ear Barotrauma = most severe
71
Q

What condition involves severe pain; sudden onset sensineural hearing loss, tinnitus, severe vertigo?

A

Inner Ear Barotrauma

- Descent Barotrauma

72
Q

What is the recommended treatment for Inner Ear Barotrauma?

A

URGENT ENT consult

  • Head of bed up
  • No nose blowing
  • Antivertigo meds
73
Q

What condition is also called “Burst Lung Syndrome”; involves lung overinflation?

A

Pulmonary Barotrauma

- Ascent Barotrauma

74
Q

What two symptoms are seen with Pulmonary Barotrauma? What other condition may present?

A
  • SOB
  • CP

Possible PTX

75
Q

What is the recommended treatment for Pulmonary Barotrauma (2)?

A

Supportive if only pneumomediastinum

- PTX = intervention

76
Q

What condition involves ANY neuro sxs in setting of documented pulmonary barotrauma?

A

Arterial Gas Embolism

- Ascent Barotrauma

77
Q

What condition involves neuro sxs immediately after rapid/uncontrolled ascent (air into arterial system)?

A

Arterial Gas Embolism

- Ascent Barotrauma

78
Q

What is the recommended treatment for Arterial Gas Embolism (5)?

A

URGENT neuro consult

  • ABCs
  • HBOT
  • High flow O2
  • IV hydration

EM/Surg (16 decks)

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