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Disciplines (Emergency) > Environmental Emergency > Flashcards

Environmental Emergency Flashcards

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Royal College: Emergency Medicine 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
Q

Treatment for heat rash

A

antihistamine

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26
Q

Dizziness, weak, malaise, N/V, headache, myalgias, Syncope, orthostatis, sinus tachycardia

A

Heat exhaustion

Tx: rest, volume and electrolyte replacement

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27
Q

Heat stroke triad

A
  1. Hyperthermia (>105 F)
  2. CNS dysfunction
  3. Anhydrosis
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28
Q

Difference between Heat stroke and Heat Exhaustion

A

Heat exhaustion will have normal mental status

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29
Q

What blood test is important to have in Heat stroke?

A

Markedly elevated transaminase levels (LFTs)

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30
Q

Heat stroke: treatment

A
  1. IV fluids
  2. Reduce temperature rapidly to 104
  3. Remove clothing and apply ice [axilla, neck, groin]
  4. Diazepam to inhibit shivering
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31
Q

Jellyfish treatment to remove nematocysts

A

vinegar or isopropyl alcohol

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32
Q

Sting ray treatment

A
  • Immerse in hot water
  • Irrigation, removal of foreign debris
  • Antibiotics (if dirty water)
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33
Q

Most common cause of allergic reaction secondary to insect stings

A

Yellow jacket (vespids - sting multiple times)

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34
Q

Most common cause of death from envenomation

A

upper airway obstruction

35
Q

Which insect nest is in the ground

A

yellow jacket

36
Q

Which insect nest is under leaves or windowsill

A

wasp

37
Q

Which insect nests in bushes, low-lying limbs

A

hornets

38
Q

Hymenoptera treatment

A
  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
Q

Which spider bite has a bluish blister followed by necrosis. Umbilicated lesion.

A

Brown Recluse Spider Bite

  • Midwestern and Southern US
  • Woodpiles, sheds, garages, closets
  • Loxosceles family
40
Q

This venom releases acetylcholine and norepinephrine at neurosynaptic junction–>muscle contractions and fatigue

A

black widow

  • Latrodectus family
  • Red hourglass on abdomen
41
Q

What spider venom (alpha-latrotoxin) has hallmark of muscular cramping (abdomen, chest, back)

A

Black widow

42
Q

Treatment for black widow spider bite?

A

Benzodiazepines (ex. Valium)
and
Narcotics

43
Q

When is antivenom for black widow indicated?

A 
Life-threatening HTN and HR
Respiratory diffiuclty
Refractory pain
Pediatric
Pregnant
Elderly
44
Q

Lice treatment

A
  1. Lindane (not for children and pregnant ladies)

2. Fine metal comb

45
Q

Intensly pruritic serpinginous in between the digits. White zigzag threadlike pattern

A

Scabies

46
Q

When is the most common time for snake bites?

A

August to October

47
Q

Most common location for snake bites

A

adult: upper extremity
child: lower extremity

48
Q

Snake bite clinical features

A

Erythema that moves proximally

-parethesias of the mouth and tongue (metallic taste)

49
Q

Snake bite Tx

A
  1. Elevate extremity
  2. Observe for at least 8 hours, then d/c if asymptomatic
  3. Admit all children with bites
50
Q

When are antivenins indicated?

A
  • 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
Q

Venom is neurotoxin activates sodium channels which causes immediate parethesias, tachycardia, increased temperature, SLUDGE, ***roving eye movements, fasciculations of the tongue

A

Scorpion venom

52
Q

Scorpion envenomation: grade 1

A

Local pain and/or paresthesias

53
Q

Scorpion envenomation: grade 2

A

Pain and/or parethesia remote from site of sting

54
Q

Scorpion envenomation: grade 3

A

CNS autonomic somatic dysfunction (blurred vision, roving eye movements, hypersalivation, tongue fasciculations, dysphagia, dysponia. Restlessness, involuntary shaking or jerking

55
Q

Scorpion envenomation: grade 4

A

CN/autonomic somatic nerve dysfunction

56
Q

Scorpion treatment

A

midazolam continuous infusion

Anascorp - Centruroides Immune Fab Equine Injection $$$$$$

57
Q

Most common causes of death in children 1-18 years old is unintentional injuries (2)

A
  1. MVC

2. Drowning

58
Q

What should be anticipated/expected with a drowning with ingestion of water?

A

vomiting (most victims ingest water)

59
Q

Drowning Treatment

A
  1. Oxygen (if <92%)

2. Admit for at least 24 hours

60
Q

Second most common cause of accidental death in US

A

Thermal burns

61
Q

Rule of 9s

A

% of body surface

62
Q

first Degree burn

A

epidermis only -painful, red, no blisters

63
Q

2nd Degree Burn

A

partly thru dermis, blisters, painful (hot liquids)

64
Q

Third Degree burn

A

skin fat - charred, pale, painless, leathery feel

65
Q

Who needs to go to a burn center (major burn crteria)?

A

Partial thickness >25% in 10-50 year old, >20% in under 10, over 50

  1. Full thickness >10% in anyone
  2. Burns to hands, face, feet, perineum
  3. Burn across major joint
  4. Circumferential limb burn
  5. Burn with fracture
  6. Burn in infant or elderly
66
Q

What prophylaxis is given for thermal burns?

A

tetanus

67
Q

Most common cause of death from lightening injury

A

cardiac arrest (asystole)

68
Q

Most common neurological event

A

temporary lost of consciousness

69
Q

Pathognomonic skin finding for lightening injury

A

fernlike pattern

70
Q

75% of fire related deaths are due to what

A

smoke inhalation

71
Q

What are two compounds that are lethal in smoke inhalation?

A
  1. Cyanide

2. Carbon monoxide (headache)

72
Q

Cherry red skin is pathognemonic for?

A

CO poisoning

73
Q

What lab test is strongly suggestive of cyanide poisoning (in the appropriate clinical setting)?

A

Lactate >8

74
Q

What is the most severe symptom of cyanide poisoning?

A

cardiovascular collapse

75
Q

Will cyanide poisoning have metabolic acidosis or respiratory acidosis?

A

Severe metabolic acidosis

76
Q

Cyanide treatment?

A

Hydroxycobalamin (Vitamin B12) binds to cyanide and is exreted in urine

-side effect of blue urine

77
Q

What type of necrosis do acids cause?

A

coagulation necrosis

78
Q

What type of necrosis do bases (ex. Lye) cause?

A

liquiefaction necrosis

79
Q

Is AC or DC more dangerous at the same amplitude?

A

AC

80
Q

What does AC voltage injury precipitate?

A

V fib

81
Q

What does DC voltage injury precipitate?

A

asystole

82
Q

What is a common urinary finding in electrical injuries?

A

myoglobinuria

renal failure from rhabdomyolysis

83
Q

What is the most common neurological event in lightening injury?

A

temporary loss of consciousness

Disciplines (Emergency) (5 decks)

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