Environmental/Toxicology Flashcards
A 26-year-old police cadet suddenly collapsed while running in July at the police training camp. You learn that this is only their second day of training and they have been training all day including running, sit-ups, and push-ups. The diagnosis was determined to be acute renal failure. What is the most likely classification for this renal failure?
Intra-renal – vascular
Pre-renal failure
Post-renal failure
Intra-renal – tubular
Intar renal tubular
Pre-renal failure would be caused by decreased renal perfusion from a source above the level of the kidneys. Post-renal failure occurs secondary to an obstruction below the level of the kidneys. This patient is suffering from rhabdomyolysis secondary to the intense exertion during high-temperature times. This is an example of a tubular etiology. As myoglobin is released from the breakdown of muscle, it can precipitate in the kidneys leading to renal tubular obstruction and tubular injury. Vascular causes of intra-renal failure would include situations associated with artery obstruction, malignant hypertension, DIC, transplant rejection, etc.
What acid-base imbalances would you anticipate in salicylate toxicity?
Respiratory acidosis and metabolic alkalosis
Respiratory alkalosis and metabolic alkalosis
Respiratory acidosis and metabolic acidosis
Respiratory alkalosis and metabolic acidosis
Respiratory alkalosis and metabolic acidosis
A patient in severe hypothermia has an esophageal temperature that reads 28°C. You know that you should withhold cardiac medications until the core temperature reaches what?
28°C
30°C
34°C
32°C
30c
You have responded to a fire with five victims. The patients are exhibiting increased signs of respiratory distress and coughing after high-flow oxygen administration. What may be causing these signs and symptoms?
Hydrocarbons
Carbon dioxide
Ammonia
Cyanide
Cyanide
Identify the inaccurate statement regarding heatstroke?
Oxygen supply exceeds demand
Level of consciousness is decreased
Core temperature can exceed 104°F
Respiratory alkalosis is a common finding in heatstroke
All of the answers are correct except for “oxygen supply exceeds demand.” In the hyperthermic patient, there will be a high demand and low supply. We need to optimize oxygenation through all means necessary.
The electrical activity becomes abnormal when the body core temperature becomes < ______
33 degree Celcius
The core temperature starts to show asystole when body core temp is ________
19-20 degree
Describe mild hypothermia.
Temp between 32-32 (89.6-95)
Shivering
altered judgment
increased RR
increased HH
cold diuresis
Describe moderate hypothermia.
28-32 degrees (82.4-98.6)
decreased o2 consumption
stupor
LOSS OF SHIVER!!!!!!!!!!!!!!!
paradoxical undressing
arrhythmia risk
describe severe hypothermia.
<28 degree Celsius <82.4 F
V fib
pulmonary edema.
hypotension
no activity on EKG
Thermoregulation
Controlled by balance between heat production between heart and liver, and heat dissipation from skin and lungs
Where does temperature regulation occur?
Anterior hypothalamus
Describe this 12 lead for a patient that had a long exposure to the cold?
The ECG findings of hypothermia include An “Osborne wave” characterized by a notch in the downward portion of the R wave in the QRS complex. Low voltage. Bradycardia: This can be sinus bradycardia, junctional bradycardia, atrial fibrillation with a slow ventricular response, or higher-grade AV blocks
In hydrofluoric acid exposure, you would expect the QT interval to be___________ and the CA++( calcium and MG++ to be _________ due to the hydrofluoric acid rendering them __________. EKG then goes into __________.
QT interval > 460 normal QT interval is < 440-460.
Low due to tendering them neutral.
EKG goes into torsades and K+ will be elevated.
Treatment for hydrofluoric?
MgSO4 1-2 g
Calcium 500-1000
What type of chemical ingestion is described?
Cell death from disruption of cell membranes, liquefaction necrosis,
injuries occurs immediately
granulation tissue replaces necrotic tissue.
scar tissue can form over 2-4 weeks then form strictures.
Alkaline ingestion,
cell death from liquefaction
What type of chemical ingestion is this? Cell death from coagulation formation of escar, >4 inches should be evaluated in the ER. usually involves the stomach.
Acid ingestion
cell death from coagulation
Think liquefaction for Alkaline ingestion and coagulation from Acid
The PH of a product ____________ increases damage
<2 or >12
What is contraindicated in a caustic ingestion?
What is the treatment for a caustic ingestion?
No emetics
No gastric lavage
No activated charcoal
Treatment: control airway, pain management, proton pump inhibitor
In Acetaminophen ingestion your patient starts to complain of right upper quadrant pain and tenderness with nausea vomiting tachycardia and hypotension with an increase in AST/ALT levels.
Stage 2 toxicity ( 24-72 hours)
In Acetaminophen ingestion your patient starts to N/V abdominal pain tender hepatic edge Jaundice,DIC hypoglycemia death of the patient occurs in this stage.
Stage 3 (72-96 hours )toxicity
In Acetaminophen ingestion your patient has completed resolution of symption and complete resolution of organ failure.
Stage 4 (4days-3 weeks )
Treatment for Acetaminophen
Acetylcysteine (NAC mucomyst ) Acetadote
In salicylate ( aspirin ) ingestion your patient begins to hyperventilate what phase is this patient in?
Phase 1 remember hyperventilation
