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EM Exam #2 Retake > Lecture 7: Environmental Emergencies > Flashcards

Lecture 7: Environmental Emergencies Flashcards

1
Q

What is good samaritan law?

A

Not liable when providing emergency care.

Stay within your scope ideally

Must turn over to emergency personnel once they arrive.

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2
Q

What are the 3 stinger type insects with venom?

A
  • Bee
  • Hornet
  • Wasp

Can only differentiate via allergy testing

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3
Q

How long might it take for insect venom to cause anaphylaxis?

A

15-30 mins, maybe even more

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4
Q

What is the average epi dose for a child? Cutoff? Adult?

A
  • Child < 33 lbs: 0.1mg
  • For a child/person 33-66 lbs: 0.15 mg
  • For an adult: 0.3 mg

Anterolateral thigh is main site.

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5
Q

How much epi remains in an autoinjector after injection?

A

1.7 mL

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6
Q

How does carbon monoxide poisoning present?

A
  • HA
  • N/V
  • Weakness
  • Confusion
  • Syncope
  • Cherry red skin is pretty rare

Will affect multiple people simultaneously

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7
Q

How do you treat carbon monoxide poisoning?

A
  • 320 minutes of RA
  • 74 minutes of 100% O2
  • 23 minutes in hyperbaric chamber
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8
Q

What is the spectrum of heat illness?

A
  • Heat Edema
  • Heat Syncope
  • Heat Cramps
  • Heat Exhaustion
  • Heat Stroke
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9
Q

Demographics most at risk for heat illness

A
  1. Young/elderly
  2. Obese/thin
  3. Mental illness
  4. Drugs/ETOH
  5. Limited hydration/nutrition
  6. Depends on if its hypernatremic or hyponatremic
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10
Q

Management of Heat edema

A
  • Mild swelling d/t vasodilation and venous stasis
  • Elevate ext + rest
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11
Q

Management of heat syncope

A
  • Vasodilation + intravascular redistribution
  • Oftentimes normal Na or hypernatremic
  • Treat as heat edema, but consider IVF.
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12
Q

Management of heat cramps

A
  • Painful spasms d/t hyponatremia
  • Temp is normal or slightly elevated
  • Moist/dry skin
  • Cool them and give them 6% carb & electrolyte (gatorade)
  • Avoid heat/exertion for 1-3d
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13
Q

Features of heat exhaustion

A
  • Unable to maintain CO
  • Muscle cramps + tachy + hypotension + temp of around 104F
  • Could have dark urine
  • Either hypo or hypernatremic.

Most accurate core temp is via rectal.

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14
Q

What is required to treat heat exhaustion?

A

Water with electrolytes

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15
Q

What are the additional symptoms of heat stroke over heat exhaustion?

A
  • Dysfunction of heat regulation due to hyperthemia + end organ dmg
  • Neural dmg, hepatic dmg, and vascular dmg occur
  • CV collapse due to vascular volume loss
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16
Q

Characteristics of a thyroid storm

A
  • Zero TSH, but very higher T3/T4
  • Temp > 38C
  • N/V/D/Abd pain
  • Shaking of hands, anxious
  • Tachy, HTN, sweating

High mortality if untreated.

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17
Q

S/S of heat stroke

A
  • HA/dizziness/N/V/AMS
  • Hematuria, hematemesis, bruising/petechiae, oozing
  • Hot, flushed, Dry
  • Tachycardic with bounding pulse
  • Hypotensive
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18
Q

Management of Heat Stroke

A
  • Rapid cooling
  • Severe shivering = BZD after electrolyte check
  • Monitor core temp until safe zone of 101.5-102
  • If unresponsive…. internal lavage to cool the brain
  • IV NS bolus for hypotension and rhabdo
  • Goal Urine output: 50-100 mL/hr
  • Supplemental O2
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19
Q

What is ICU criteria for heat stroke?

A
  • Hemodynamic instability
  • Rhabdo
  • LFTs elevated/severe lyte abnormalities
  • Unknown etiology
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20
Q

What are the poor prognostic signs of heat stroke?

A
  • Extreme hyperpyrexia (107F+)
  • Hyperkalemia w/ rhabdo
  • Coma persists after cooling
  • Marked LFT elevation
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21
Q

MC RFs for trench foot

A
  • Military
  • Agriculture
  • Homeless
22
Q

What is trench foot?

A

Standing in cold water < 40F for long periods of time.

23
Q

How does frostbite initially present?

A
  • Paresthesias
  • Pruritis
  • Loss of sensation
  • Loss of fine motor control
24
Q

What are the 4 degrees of frostbite?

A
  1. Erythema and edema
  2. Blisters
  3. Skin necrosis, hemorrhagic blisters, SubQ
  4. Full thickness, non-blanching dry, black & mummified with eschar, loss of body parts
25
Q

How do you treat Frostbite Raynaud’s?

A

Treat as stage 3.

26
Q

How do you rewarm frostbite?

A
  • Rapid rewarming via water @ 98.6-102.2F for 15-60
  • Do not partially rewarm
  • If severe, treat as a burn! (Wound care and infection management)
27
Q

Hypothermia stages

A

Under 32C, you cannot rewarm yourself!

You can only recover alone in stage 1

28
Q

Outpatient tx of hypothermia

A
  • Insulate from ground
  • Dry
  • Keep Supine!
  • Warm liquids, keep environment > 82F
  • O2 is main concern
29
Q

Hypothermia management

A
  • Rewarm in 24C or higher environment
  • Horizontal/supine
  • If in VFIB, you get 1 shot to defib until core temp is 30C
30
Q

Overview of acute mountain sickness

A
  • Primarily occurs above 9k feet unless ill
  • Decreases in PO2
  • HA w/ anorexia, weakness, dizziness, imsomnia, etc
  • Untreated => HAPE => HACE

By the time youre at 15k, arterial blood = venous blood at seas level.

Everest PO2 is even lower than fetal umbilical PO2

31
Q

How does your body attempt to compensate high altitude sickness?

A
  • Tachypnea
  • Renal excretion of HCO3
  • Edema
  • Hypoxic pulmonary vascoconstriction
  • EPO, hgb, and o2 affinity increase
32
Q

How do you help treat acute altitude sickness?

A
  • Hike up slow
  • Gingko biloba & acetazolamide
  • Steroids delay
  • Amphetamines can help
  • Sleeping lower is ideal!
  • Cure: Descent off the mountain

Alternatives to descent: hyperbaric O2 bags

33
Q

Why does HAPE occur?

A
  • Hypoxic vasoconstriction increases right sided pressures
  • Decreased exercise capacity
  • Cough, rales, tachypnea, pulmonary HTN
34
Q

What is indicative of HACE? Tx?

A
  • Acute mountain sickness
  • Retinal hemmorhages
  • Papilledema
  • Tx: Descent
  • Tx: dexamethasone to help
35
Q

When should you admit for HACE?

A

If still symptomatic > 2 hrs post tx.

36
Q

What snakes does CroFab cover?

A
  • Copperhead (pit viper)
  • Rattle (Pit viper)
  • Cottonmouth
37
Q

Management of a pit viper bite

A
  • Do not restrict
  • Watch for compartment syndrome
  • Only considered a dry bite if nothing occurring after 12 hrs.
  • N/V/hemolysis/coagulopathy
  • Poison control: 1-800-222-1222
38
Q

How do you remember snake venom?

A
  • Red touch yellow, kills a fellow.
  • Red touch black, venom lack

Coral snake

39
Q

Empiric tx for tick bite

A

Doxycycline 100mg BID

Alpha gal cannot be treated.

40
Q

What is the concern with doxycycline in children?

A

Staining of teeth/weakening of enaml

41
Q

What is the MC culture of black widow bites?

A

MRSA

aka treat it with vanco

Presents like a cellulitis

42
Q

Where are brown recluses endemic to?

A
  • Georgia
  • Illinois
  • Missouri
  • Arkansas

Causes an acid like effect

43
Q

What injuries occur with lightning?

A
  • Electrical asystole responsive to CPR
  • Treat burn entrance and exit as major burns
  • Bunt force trauma can cause pneumomediastinum or hemorrhage
  • Eye injuries (cataracts)
  • Ear ringing/tinnitus (TM perf)
44
Q

What is the mainstays of treatment for drowning?

A
  • CPR asap
  • Oxygen is main priority
  • Obs 4-6 hrs after symptoms resolve
45
Q

Tx of inhalation burns

A
  • ACLS
  • 100% O2 w/ humidity
  • LR at KVO rate
46
Q

What might suggest inhalation burns?

A
  • Facial burns, singed nasal hairs
  • Soot
  • Hoarseness, carbonaceous sputum, wheezing
  • Hypoxemia
47
Q

How do we manage external burns?

A
  • Extract
  • Remove burned clothing & jewelry
  • Pour cool water over burns (way longer if its chemical)
  • Keep warm and transport

Body temp regulation is impaired

48
Q

What formulas help calcuate LR rate for external burns?

A
  • Parkland
  • Modified Brooke
  • Depends on Total BSA of burn
49
Q

Rule of 9s for burns

A
  • H&N: 9%
  • Each full arm: 9%
  • Entire trunk: 38%
  • Groin: 1%
  • Each leg: 18%

> 9% is Burn unit

50
Q

How do acidic and alkaline burns and heavy metal burns differ?

A
  • Acid burns, causing scabbing which limits depth.
  • Alkaline combined with lipids and saponify
  • Metal burns need water to dilute
  • Treat all chemical burns as full thickness
51
Q

What can occur from ascending too fast in scuba diving?

A
  • Lung burst, due to rapid expansion of lungs
  • Air embolism, due to nitrogen dissolving and expanding
  • Mediastinal emphysema

EM Exam #2 Retake (7 decks)

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