Environmental med trigger Flashcards
presents with slightly elevated or normal core body temp and is primarily d/t salt depletion. skin can be dry, moist cool, or warm.
heat cramps!
what populations are at risk for heat illnesses
- young/elderly
- obese
- chronic physical/mental illness
- impaired by drugs/ETOH
- anyone denied hydration/nutrition
Inability to maintain adequate CO d/t physical exercise and environmental heat stress characterizes what diagnosis
heat exhaustion
this disease can be split into hypernatremic or hyponatremic types
heat exhaustion
pt presents w diaphoresis, NV, dizziness and weakness after a 10k in 100 degree weather. pt is hypotensive and tachycardic with core temp of 103. the rest of the exam is normal despite dark urine. what is the dx and tx? what labs will you order?
heat exhaustion (no CNS abnormalities)
tx: move out of heat, cool down, PO/IV fluids. If hyponatremic use hypertonic saline.
hella fluids if you test his urine and find rhabdo
labs: BMP, UA, CK, LFTs, ABG, EKG
what extra labs should you add on if youre suspecting heat STROKE over heat EXHAUSTION
add CBC, PT/PTT, CMP, phosphate and CXR
if your patient who is currently having a heat stroke is found to have rhabdomyolysis w hypotension, what is the treatment
1-2L bolus fluids
a pt presents after attempting the “Hotter’n Hell 100” cycling race in Texas. He is lethargic and confused and persistently vomiting. his skin is warm and dry and his core temp is 104.8, BP 90/60 and HR 142. what is your dx? what is your tx?
heat stroke
- rapid cooling (spray w water and fan preferred)
- BZD for shivering
- IV fluids bolus 1-2L (hypotension)
- consider intubation (significant AMS)
a pt presents after attempting the “Hotter’n Hell 100” cycling race in Texas. He is confused and lethargic with a BP of 90/60, HR of 148 and core temp of 105.8. You notice on PE that he has dark colored urine, petechiae and is oozing from his venipuncture sites when the nurses draw labs. What is likely occurring in this patient other than the primary diagnosis?
DIC secondary to heat stroke
dark urine could also indicate rhabdo, but in this case i was going for blood in urine!
S/S of DIC include:
- hematuria
- hematemesis
- bruising
- petechiae
- oozing at venipuncture site.
A patient presents with a history of working with dry ice. He was transporting a box of dry ice and was holding it in his lap for about 10 min, only to realize his pinky had been sitting on some of the ice (oops). as youre rewarming his pinky, little blisters begin to form. what level of frostbite would this be? what is the disposition for this patient?
2nd degree!
he HAS to be admitted even tho its just his pinky.
the only people who can be sent home w frost bite is 1st degree frost bite that is over a limited area
if a patients core temp is 31 degrees celsius, what level of hypothermia are they
moderate! HT 2
HT 1 = 32-35
HT 2 = 28-32
HT 3 = 24-28
HT 4 = <24
which hypothermia stage is treated with active movement and warm sugary drinks
HT 1 (32-35)
pt presents after falling in a freezing lake and being there for approx 3 hours. Miraculously, they got her out and she still had a pulse. She now presents to the ED in comatose with a BP of 50/28 and pupils that are fixed and dilated. EKG shows V. fib. What is stage of hypothermia and what is the treatment plan (work through it! lots of steps!)
severe HT 3
(HT4 would be no vital signs!)
- secure airway
- shock patient once prior to rewarming (because VFIB)
- preferred warming method is ECMO (if not available use warming blanket and warm IV fluids)
- consider comatose cocktail (dextrose, thiamine, naloxone).
A pt with frostbite that does not extend past the dermis presents to the ED. you treat her appropriately. she now asks if there will be any lingering problems after the frostbite resolves.
- what did you treat her with
- what level of frostbite is this
- will she have lingering problems? if so what are they?
- rewarm in 98.6-102.2 degree water. apply topical aloe vera. splint to prevent contracture. update tetanus.
- 2nd degree
- she may have long term sequelae including:
- cold sensitivity
- loss of sensation
- hyperhidrosis
- loss of digit(s)/limb
a unconscious patient presents to the ED with a core temp of 27 degrees celsius. She was found on the side of the road unconscious in her car so there is not hx available. On initial general inspection, you see no burns on the patient and seeing as it is 75 degrees outside, you doubt she was exposed to cold while sitting in her car.
what are possible causes of this patients hypothermia? what labs would you assess to explore these causes? How would you treat these?
(we only know how to treat some of them so dont stress just do your best babe)
- hypoglycemia, hypothyroidism, hypoadrenalism, hypopituitarism, CNS dysfunction, sepsis, DRUGS, trauma.
- hypoglycemia = POC glucose
- hypothyroid = TSH
hypoadrenalism = cortisol - Lactic acid = sepsis ( I think)
- hypoglycemia = dextrose (i assume)
- hypothyroid = levothyroxine + hydrocortisone
- hypoadrenalism = hydrocortisone
- sepsis = broad ABX
also consider coma cocktail! = dextrose, thiamine and naloxone!!
when would you use hydrocortisone as a treatment in hypothermia
for hypoadrenalism or hypothyroidism (add levothyroxin for hypothyroid)
a 6 year old girl presents with small pustules over the top sides of her feet and on her lower ankles. her mom is terrified that she has some terrible virus because she was at the park about 8 hours ago playing with a boy who had a cough. you assure the mom that if she was at the park, the likely etiology of these bites is __________. The mom asks “will they be there forever!!!” and you say _________
fire ant stings!!
they can lead to necrosis or scarring. so maybe, idk lady.
A pt presents after sticking his foot in a beehive for a dare. He has many bee stings and you assume there are about 70 but they are all located on the distal lower extremities. He is vomiting and nauseous. After you administer pain medications to the idiot, he tells you his back itches and you lift up his shirt to find widespread urticaria over his left shoulder. He starts to panic because his uncle is allergic to bees, which he conveniently left out of the history ten minutes ago.
what is the diagnosis and what is the treatment
hahha being tricky im sorry.
dx: systemic reaction of bee stings.
tx:
- IV methylprednisolone, diphenhydramine, famotidine
- remove stinger, wash wounds, ice and elevate.
- give tetanus update.
- ADMIT HIM!!!! (50+ stings = admit)
A 7 year old girl comes to the ED with a bee sting to her calf that occured 8 minutes ago. She is now experiencing a cough with itchy eyes and widespread urticaria over the torso. what is your dx and tx.
dx: anaphlyactic reaction
tx:
- intubate PRN
- EPI (children 0.01mg/kg)
- methylprednisolone
- benadryl
- famotidine
- nebulized albuterol
when do we use methylprednisolone, benadryl, and famotidine
systemic sting reactions
for anaphylaxis add epi and albuterol
parkland formula
decompression sickness is tx with what
