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Flight Paramedic Certification > Environmental Emergencies & Toxicology > Flashcards

Environmental Emergencies & Toxicology Flashcards

1
Q

Shivering stops at what temperature?

A

32*C

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2
Q

Body’s response to cold

A

Increased CBG
Respiratory acidosis
Enzyme function drops dramatically

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3
Q

Mild hypothermia temperature

A

32C - 34C

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4
Q

Moderate hypothermia temperature

A

29C - 32C

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5
Q

Severe hypothermia temperature

A

<28*C

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6
Q

S/S of Mild hypothermia

A

Increased basil metabolic rate
Increased cardiac output
Decreased heart rate at 32*C

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7
Q

S/S of Moderate hypothermia

A

LOC and SVR decrease
Acidosis
Decreased cardiac output
Hyperglycemia

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8
Q

S/S of Severe hypothermia

A

PT and APTT increase by 50%
Platelets decrease by 40%
Prolonged PR, QRS, QT
Osborne waves

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9
Q

V Fib risk is highest at ____.

A

22*C

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10
Q

Defer medications until core temp is ____.

A

> 30*C

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11
Q

Enzymatic retardation occurs at _____.

A

<33*C

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12
Q

Examples of passive external rewarming

A

Patient is allowed to rewarm self
Blankets
Heater in truck

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13
Q

Examples of active external rewarming

A

Heat placed on body surfaces mainly neck, groin, and axilla

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14
Q

Examples of active internal rewarming

A

Heat directly to core using warm IV fluids (warmed to 39*C), hemodialysis, gastric lavage, rectal lavage, ECMO

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15
Q

Sweat evaporation can lead to fluid loss of _____.

A

1-3 L/HR

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16
Q

High output failure may lead to ____.

A

AMI

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17
Q

Body’s response to heat

A 
NA+ loss causing cerebral edema and seizures
Increased clotting times
ARDS/DIC
Hypokalemia
ATN
Rhabdomyolysis
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18
Q

Define heat cramps

A

Cramps of muscles in high heat caused by hyponatremia

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19
Q

Define heat exhaustion

A

Increase in core temperature without neurological impairment. Patient retains ability to sweat.

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20
Q

Define Heat stroke

A

Failure of body to dissipate heat effectively
Altered LOC
Core temp >42*C

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21
Q

Heat cramp treatment

A

Remove from heat, rehydrate with salt containing solution

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22
Q

Heat exhaustion treatment

A

remove from heat, cool patient, fluid replacement with electrolytes

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23
Q

Heat stroke treatment

A

Aggressive cooling and airway management
Iv fluids
Prevent shivering

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24
Q

Labs to monitor for heat emergencies

A

ABG for acidosis
Watch clotting factors for DIC
Monitor liver enzymes
Watch Sodium for hyponatremia

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25
Q

Define Rhabdomyolysis

A

Myoglobin release clogging kidneys

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26
Q

Rhabdomyolysis treatment

A

Increase urine output to 2 ml/kg/hr
Alkalinize urine with NaHCO3
Lasix/Mannitol

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27
Q

Hyponatremia treatment

A

Correct sodium with 3.3% saline SLOWLY

Central Pontine Myelinolysis

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28
Q

In heat emergencies, potassium levels are seen ___ due to renal wasting then ___ due to metabolic acidosis / Rhabdomyolysis.

A

Lower

Higher

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29
Q

Common Tricyclic Antidepressants

A

Tofranil, Elavil, Pamelor, Norpramin, Amitriptyline

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30
Q

TCA overdose

A

Blocks sodium channels
Inhibits NorEpi reuptake
Blocks Parasympathetic nervous system
Torsade’s, Widening QRS, tachycardia, VF, VT

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31
Q

TCA treatment

A

NaHCO3 (Ion trapping)
NorEpi is first choice of pressor
(Dialysis not helpful)

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32
Q

Two types of Beta-blocker overdoses (-lol drugs)

A

Type #1 - Cardioselective causes bradycardia with hypotension.
Type #2 - Non-Cardioselective causes resp distress and exacerbates reactive airway disease

33
Q

Treatment of beta-blocker overdose

A

Atropine
Transcutaneous Pacing
Glucagon 2-5mg IVP
Dopamine for hypotension

34
Q

Common calcium channel blockers

A

Verapamil, Cardizem, Nifedipine, Amlodipine, Nicardipine

35
Q

Two types of calcium channel blocker overdoses

A

Type #1 - Cardiospecific causes severe bradycardia and AV dissociation
Type #2 - Vasculomotor causing severe hypotension

36
Q

Treatment of calcium channel blocker overdose

A

Calcium chloride/gluconate

Maintain insulin euglycemia

37
Q

Common Digitalis agents

A

foxglove, oleander, digoxin, digitoxin

38
Q

Digitalis toxicity

A

Visual disturbances of yellow/green halos

Bradycardia, SVT, VT, AV blocks

39
Q

Treatment of Digitalis toxicity

A 
Digoxin immunefab (Digibind)
Lidocaine, Magnesium, Phenytoin for tachyarrhythmias
40
Q

Define Hyperkalemia

A

K+ > 5.0 caused by profound acidosis (DKA, Vent management) or potassium supplements.

41
Q

EKG changes with Hyperkalemia

A

Flattening / slurring of P waves with peaked T waves

42
Q

Treatment of Hyperkalemia

A 
Calcium Chloride
NaHCO3
Insulin/D50
Lasix
Kayexalate
B2 agonist
43
Q

Define Hypokalemia

A

K+ <3.5 caused by loop diuretic misuse, serum K+ and Ph levels important

44
Q

Treatment of Hypokalemia

A

Potassium Chloride / Potassium Phosphorus
Commonly 10-20 MEQ/HR
Never more than 0.5-1.0 MEQ/KG/HR

45
Q

Mild ASA poisioning

A

Tinnitus

Hyperventilation

46
Q

Severe ASA poisoning

A 
Seizures
Electrolytes disturbances (TCO2, HCO3)
47
Q

Treatment of ASA poisoning

A

Alkaline diuresis using HCO3
Hemodialysis
Charcoal / gastric emptying

48
Q

Stage 1 APAP Poisioning

A

30 min-24 hours “Flu like symptoms”

N/V, Malaise, Pallor, Diaphoresis

49
Q

Stage 2 APAP Poisioning

A

24-48 hours “Owe my liver”
Increased liver enzymes, serum bilirubin, PT
RUQ pain / tenderness, oliguria from ATN

50
Q

Stage 3 APAP Poisioning

A

48-72 hours “Gonna die now”

Jaundice, Hepatic encephalopathy, DIC, Death

51
Q

Stage 4 APAP Poisioning

A

4 days - 2 weeks “I’m not dead yet”

Liver functions return to normal, asymptomatic, resolution period

52
Q

Define APAP Poisioning

A

Ingestion of > 5G or 150 mg/kg. Measure serum levels after 4 hours.

53
Q

APAP Poisioning treatment

A

N-Acetylcysteine (Mucomyst)

70 mg/kg Q4 for 17 doses

54
Q

S/S Ethylene glycol / Methanol Poisioning

A

Profound anion gap, osmolar gap, nystagmus, blindness, coma, myoclonic jerks. Look for fluorescent skin / clothes

55
Q

Treatment of Ethylene glycol / Methanol Poisioning

A

IV Ethanol drip, Fomepizole (Antizol)

56
Q

Cocaine Overdose

A

Benzos for anxiety

Avoid Beta blockers, use Alpha blockers for HTN

57
Q

Benzo overdose

A

Flumazenil 0.1-0.2 mg IVP

Max 3-5 mg

58
Q

Carbon Monoxide Antidote

A

O2 / Hyperbarics

59
Q

Cyanide Antidote

A

Amyl / NA Nitrate, NA thiosulfate

60
Q

Organophosphate Antidote

A

Atropine

2-Pam

61
Q

Methemoglobinemia Antidote

A

Methylene Blue

62
Q

Anticholinergic Antidote

A

Physostigmine

63
Q

Coumadin Antidote

A

Vitamin K, FFP

64
Q

Heparin Antidote

A

Protamine Sulfate

65
Q

Cerebral flow decreases 6-7% for every 1*C decline until __?

66
Q

What are the symptoms of “after drop” in the hypothermic patient?

A

Cardiac dysrhythmias and hypotension.

67
Q

What is “after drop” in a hypothermic patient?

A

Acidotic blood returning from extremities to core after rewarming

68
Q

Mammalian diving reflex

A

Apnea
Bradycardia
Vasoconstriction

69
Q

Define Acute Mountain Sickness

A

Occurs in non-acclimatized patients with recent travel to altitude within the last 24 hours.
Usually occurs above 8000ft MSL

70
Q

Acute mountain Sickness symptoms

A

Headache, N/V, weakness

71
Q

Acute Mountain Sickness treatment

A 
Descend 1000 to 3000ft
Hydration
Zofran
Tyleno
Dexamethasone
72
Q

Define High Altitude Pulmonary Edema

A

Onset of symptoms occuring 2-4 days after rapid ascent >10,000 ft

73
Q

High Altitude Pulmonary Edema symptoms

A 
Rales
Tachycardia
Tachypnea
Cough
Dyspnea at rest
74
Q

Treatment of High Altitude Pulmonary Edema

A 
Descend 
Diamox
Dexamethasone 
Nifedipine
Oxygen
Hyperbaric therapy
75
Q

Define High Altitude Cerebral Edema (HACE)

A

Often at altitudes >12,000 ft MSL in climbers who ascend rapidly. Occurs after 5 days at sustained altitudes.

76
Q

High Altitude Cerebral Edema symptoms

A

Visual changes
Parasthesias (numbness)
AMS
Coma

77
Q

Treatment of High Altitude Cerebral Edema (HACE)

A 
Descend
Diamox
Dexamethasone 
Oxygen 
Hyperbaric therapy
78
Q

Iron overdose Antidote

A

Deferoxamine

Pink urine “Vin rose urine” indicates therapeutic level

Flight Paramedic Certification (15 decks)

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