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Disciplines (Emergency) > Environmental Emergency > Flashcards

Environmental Emergency Flashcards

1
Q

Hypothermia core temperature definition

A

less than or equal to 95 (farenheit)

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2
Q

Mild hypothermia

A

32-35 C

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3
Q

Moderate hypothermia

A

30-32 C

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4
Q

Severe hypothermia

A

<30 C

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5
Q

transfer of heat by direct contact (water immersion)

A

Conduction

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6
Q

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

A

Convection

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7
Q

conversion of liquid to vapor -

A

Evaporation (10-15% of body heat loss)

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8
Q

Which group is most commonly affected by hypothermia?

What is the most common cause of hypothermia in US?

A

Males, 30-49

**MCC is ethanol (alcohol)

-affects extremities

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9
Q

Physiologic consequences of hypothermia

A

-Initially, increased HR,
vasoconstriction, increased heart muscle oxygen consumption
-Slowed mentation and reasoning
-Slower breathing–>respiratory acidosis and hypoxia
-Blood viscosity increases and increased risk of clot formation
-Shift of oxyhemoglobin curve shift to the left (harder to release O2 in tissues
-“After-drop”, acidotic peripheral blood returns to central circulation (increases chance of arrhythmia

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10
Q

When does shivering stop?

A

90 F (32.2 C)

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11
Q

What is an osborn J wave

A

Associated with hypothermia. Increased chance of arrhythmias when less than 86 F (30 C)

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12
Q

What temperature is needed before administering medications and defibrillation?

A

> 82.4 (>28 C)

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13
Q

Treatment: Hypothermia

A
  1. Warmed oxygen and IV fluids
  2. Active external rewarming
  3. Gently circuating water (104-107 F, 40-42 C)
  4. Active core rewarming–> if arrhythmias, need to rewarm pleura
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14
Q

Frostbite: pathophysiology

A

Formation of extracellular ice crystals–> damage cell membranes and osmotic gradients–>intracellular dehydration, and ice crystal formation = cell death

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15
Q

Frost bite: central white plaque with peripheral erythema

A

First degree

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16
Q

Clear or milky-filled blisters surround by erythema and edema

A

Second degree

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17
Q

Hemorrhagic blisters that progress to a hard black eschar

A

Third degree

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18
Q

Complete necrosis and tissue loss

A

Fourth degree

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19
Q

Frostbite treatment

A
  • Elevate and split extremity
  • Wrap in dry gauze
  • Clear blisters can be debrided
  • ASA/NSAIDs, Narcotics
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20
Q

Keratitis

A

Inflammation of the anterior chamber of the eye

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21
Q

Ultraviolet Keratitis (sunburn of the eye): Tx

A
  • Self-limited
  • topical analgesic, cold compress
  • Polarized sunglasses
  • Cyclogel (dilates the eye, prevents spasm and pain - loss of far vision)
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22
Q

Name 5 medications that inhibit sweating

A
  1. Antihistamine
  2. Atropine
  3. Neuroleptics
  4. Antispasmodics
  5. Tricyclic Antidepressents
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23
Q

How long does it take for adults to acclimatize to hot environment?

A

7-10 days for adults (14 for children)

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24
Q

Acute inflammation of sweat ducts caused by blockage of pores. Pruritic. Found overclothed areas

A

Prickly Heat (aka heat rash)

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25
Treatment for heat rash
antihistamine
26
Dizziness, weak, malaise, N/V, headache, myalgias, Syncope, orthostatis, sinus tachycardia
Heat exhaustion Tx: rest, volume and electrolyte replacement
27
Heat stroke triad
1. Hyperthermia (>105 F) 2. CNS dysfunction 3. Anhydrosis
28
Difference between Heat stroke and Heat Exhaustion
Heat exhaustion will have normal mental status
29
What blood test is important to have in Heat stroke?
Markedly elevated transaminase levels (LFTs)
30
Heat stroke: treatment
1. IV fluids 2. Reduce temperature rapidly to 104 3. Remove clothing and apply ice [axilla, neck, groin] 4. Diazepam to inhibit shivering
31
Jellyfish treatment to remove nematocysts
vinegar or isopropyl alcohol
32
Sting ray treatment
- Immerse in hot water - Irrigation, removal of foreign debris - Antibiotics (if dirty water)
33
Most common cause of allergic reaction secondary to insect stings
Yellow jacket (vespids - sting multiple times)
34
Most common cause of death from envenomation
upper airway obstruction
35
Which insect nest is in the ground
yellow jacket
36
Which insect nest is under leaves or windowsill
wasp
37
Which insect nests in bushes, low-lying limbs
hornets
38
Hymenoptera treatment
1. Clean with soap and water, remove stinger 2. Apply ice pack and elevate extremity 3. Antihistamines 4. Epinephrine 5. Steroids 6. Beta agonists (ie Albuterol) 7. Rx Epi Pen
39
Which spider bite has a bluish blister followed by necrosis. Umbilicated lesion.
Brown Recluse Spider Bite - Midwestern and Southern US - Woodpiles, sheds, garages, closets - Loxosceles family
40
This venom releases acetylcholine and norepinephrine at neurosynaptic junction-->muscle contractions and fatigue
black widow - Latrodectus family - Red hourglass on abdomen
41
What spider venom (alpha-latrotoxin) has hallmark of muscular cramping (abdomen, chest, back)
Black widow
42
Treatment for black widow spider bite?
Benzodiazepines (ex. Valium) and Narcotics
43
When is antivenom for black widow indicated?
``` Life-threatening HTN and HR Respiratory diffiuclty Refractory pain Pediatric Pregnant Elderly ```
44
Lice treatment
1. Lindane (not for children and pregnant ladies) | 2. Fine metal comb
45
Intensly pruritic serpinginous in between the digits. White zigzag threadlike pattern
Scabies
46
When is the most common time for snake bites?
August to October
47
Most common location for snake bites
adult: upper extremity child: lower extremity
48
Snake bite clinical features
Erythema that moves proximally | -parethesias of the mouth and tongue (metallic taste)
49
Snake bite Tx
1. Elevate extremity 2. Observe for at least 8 hours, then d/c if asymptomatic 3. Admit all children with bites
50
When are antivenins indicated?
- worsening swelling - coagulation abnormalities (prolonged PT >20 seconds) * *all copperhead bites** 1. Antivenin crotolidea polyvalent 2. Polyvalent immune Fab (CroFab, FabAV)*** [this one is good for any snake in AZ]
51
Venom is neurotoxin activates sodium channels which causes immediate parethesias, tachycardia, increased temperature, SLUDGE, ***roving eye movements, fasciculations of the tongue
Scorpion venom
52
Scorpion envenomation: grade 1
Local pain and/or paresthesias
53
Scorpion envenomation: grade 2
Pain and/or parethesia remote from site of sting
54
Scorpion envenomation: grade 3
CNS autonomic somatic dysfunction (blurred vision, roving eye movements, hypersalivation, tongue fasciculations, dysphagia, dysponia. Restlessness, involuntary shaking or jerking
55
Scorpion envenomation: grade 4
CN/autonomic somatic nerve dysfunction
56
Scorpion treatment
midazolam continuous infusion Anascorp - Centruroides Immune Fab Equine Injection $$$$$$
57
Most common causes of death in children 1-18 years old is unintentional injuries (2)
1. MVC | 2. Drowning
58
What should be anticipated/expected with a drowning with ingestion of water?
vomiting (most victims ingest water)
59
Drowning Treatment
1. Oxygen (if <92%) | 2. Admit for at least 24 hours
60
Second most common cause of accidental death in US
Thermal burns
61
Rule of 9s
% of body surface
62
first Degree burn
epidermis only -painful, red, no blisters
63
2nd Degree Burn
partly thru dermis, blisters, painful (hot liquids)
64
Third Degree burn
skin fat - charred, pale, painless, leathery feel
65
Who needs to go to a burn center (major burn crteria)?
Partial thickness >25% in 10-50 year old, >20% in under 10, over 50 2. Full thickness >10% in anyone 3. Burns to hands, face, feet, perineum 4. Burn across major joint 5. Circumferential limb burn 6. Burn with fracture 7. Burn in infant or elderly
66
What prophylaxis is given for thermal burns?
tetanus
67
Most common cause of death from lightening injury
cardiac arrest (asystole)
68
Most common neurological event
temporary lost of consciousness
69
Pathognomonic skin finding for lightening injury
fernlike pattern
70
75% of fire related deaths are due to what
smoke inhalation
71
What are two compounds that are lethal in smoke inhalation?
1. Cyanide | 2. Carbon monoxide (headache)
72
Cherry red skin is pathognemonic for?
CO poisoning
73
What lab test is strongly suggestive of cyanide poisoning (in the appropriate clinical setting)?
Lactate >8
74
What is the most severe symptom of cyanide poisoning?
cardiovascular collapse
75
Will cyanide poisoning have metabolic acidosis or respiratory acidosis?
Severe metabolic acidosis
76
Cyanide treatment?
Hydroxycobalamin (Vitamin B12) binds to cyanide and is exreted in urine -side effect of blue urine
77
What type of necrosis do acids cause?
coagulation necrosis
78
What type of necrosis do bases (ex. Lye) cause?
liquiefaction necrosis
79
Is AC or DC more dangerous at the same amplitude?
AC
80
What does AC voltage injury precipitate?
V fib
81
What does DC voltage injury precipitate?
asystole
82
What is a common urinary finding in electrical injuries?
myoglobinuria | renal failure from rhabdomyolysis
83
What is the most common neurological event in lightening injury?
temporary loss of consciousness

Disciplines (Emergency) (5 decks)

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