PHYSICAL AND ENVIRONMENTAL AGENTS, BURNS, AND SMOKE INHALATION Flashcards
A woman comes into clinic on a chilly winter day in downtown Portland. She has red lesions on her extremities that became swollen and blistered after she rewarmed. What is this, how do you treat it?
Chilblains. Passively rewarm
You are in a rain forest and your buddy complains that his feet are losing sensation. He takes off wet boots and you see pale, macerated, blistering feet. What is this and how do you treat it?
immersion foot. Dry, warm, treat infection.
You go for a jog while visiting a friend who lives in the Swiss alps. Your nose and cheek become cold and very pale. What is this? TX?
Frost bite, first degree in epidermis, passive rewarm
It’s winter and you get into a big snowball fight without gloves. Your hands become blue so you go inside and start to develop clear blisters. What is this? TX?
2nd degree frost bite, dermis, rewarm w/ warm fluid
A man passes out from drinking and is found in a snow bank. When he starts to rewarm you notice hemorrhagic blisters. What is this?
3rd degree frost bite, subQ, rewarm w/ warm fluid
A refugee had to walk through snow for 5 days in tennis shoes, his toes are swollen, black and necrotic. What is this? TX?
4th degree frost bite. Full thickness. splint, rewarm in warm fluid, lytics, inf. Control
Define mild hypothermia by sx and temp. How do you treat it?
mild: 90-95.
confusion, tachycardic, shivering.
passive rewarm.
Define moderate hypothermia by sx and temp. How do you treat it?
82-90
lethargy, brady/arrhyth, less shivering, no pupil reflx.
TX: ABC, active rewarm trunk first.
Define severe hypothermia by sx and temp. How do you treat it?
<82
coma, hypotension, arrhyth, pulm ed, rigid
TX: ABC, warm IV (No LR), lavage, Extra corp. ABX, Glucose, fluids, look out for hyperK, rhabdo.
Steve just got done with an Insanity workout video and his leg muscle is contracting uncontrollably. What now?
Heat cramp.
Sports drink/ NS
stretch and relax
Betty is an older woman who shows up in the ER on a hot day. She was working in her garden when she passed out. She has a core temp of 103, is tachycardic, diaphoretic, hypotensive and has a headache. What now?
Heat exhaustion
Cool and treat shock by elevating legs and giving fluids
Wayne was throwing hay bales onto his truck in the middle of August in Texas. His co-worker said he started acting strange, couldn’t walk straight, threw up and passed out. You find him in clinic hypotensive and with a core temp of >104 degrees. What now?
Heat stroke
rapid cooling w/ immersion or evaporation
expect rhabdo, electrolyte abnormalities and end organ damage
A teenager was knocked unconscious after taking a spill while tubing behind a speed boat. Her friends found her apneic and performed CPR. She started breathing again and was taken to the ED. What now?
be suspicious for end organ dysfunction from hypoxemia, ARDS, Brain damage, Arrythmias, etc.
- Admit and give 02 by PPV per need
- keep PT until symptoms resolve
- if asymptomatic watch for 8 hours then release.
Phil was repairing his HAM radio antenna in a lightning storm and was struck by lightning. What sort of injuries do you suspect?
burns that may not be evident from the surface, compartment syndrome, arrhythmias, vascular coagulation, rhabdo…
Diver Dave sees a great white shark and shoots to the surface. Less than an hour later he feels localized joint pain in his elbow and shoulder and his chest is itchy and mottled looking. What is this?
DCS type 1 Musc/skel complaints
Fluids, O2 and Hyperbaric chamber
Scuba Steve decides to try to ride a whale shark and it takes him to the surface abruptly. He is taken aboard his dive boat and he immediately loses control of his bladder, starts complaining of tingling in his legs, difficulty breathing and is behaving strangely. What is this?
DCS type 2 Neuro/pulm complaints
Fluids, O2 and hyperbaric chamber
Jim decides to hike to the top of a local mountain that is about 6500 ft. He gets a severe headache with malaise. What is this and how do you treat it?
Acute mountain sickness
avoid abrupt ascents above 6500 ft. TX: Analgesia, antiemetic, 02, acetazolamide, dex, descent
Ed and his climbing party just reached a mountain pass at 9500 feet. Ed notices his friend starts walking and behaving almost as though he’s drunk. What is this?
HACE
Descent, Dex, O2
Gena is back country skiing in a range that sits at about 8000 feet. It’s been 4 days since she started her trip and she has developed a cough, sob and feels fatigued. What is going on?
HAPE
O2, descent.
what’s a first degree burn?
epidermal (red, blanches), touch/air causes pain, heals in 3-6d. Not counted in burn eval
what’s a second degree burn?
partial/dermal (blisters, blanches)/ deep partial (blisters, non blanch), touch/air causes pain, heals in 7-21d/>+surg.
what’s a third degree burn?
full/subQ (waxy white, grey, black, non blanch), deep pressure can be felt , full healing is rare, needs surg.
what’s a fourth degree burn?
(fascia, muscle inv.), can feel deep pressure, never heals, need surg.
When evaluating burn size what percentage is….
- an arm
- a leg
- the anterior trunk
- the posterior trunk
- the head
- genitals
- an arm=9
- a leg=18
- the anterior trunk=18
- the posterior trunk=18
- the head=9
- genitals=1
John a 35 year old man who was playing with a flame thrower and sustained 2nd burns to one arm. Is this considered major or minor?
Minor: <2% full thickness
What is the general treatment plan for minor burns?
Cool (H2O + gauze),
Pain (Tylenol/NSAID/Opioid),
Remove clothes/debris,
Clean (Soap + H2O),
debride (leave small, blisters if intact),
Prophylaxis (topical ABX if skin broke),
Dress (non-adherent, then dry, then elastic),
Itching (H1 blocker)
What constitutes a moderate burn?
Moderate >10<20%
B/t 2-5% full
What constitutes a major burn? What are some specific burn sites that need special attention?
Severe (>20 2nd / >10 3rd )
inhalation, face, hands, feet, genitals, joints, circumferential
What is the general treatment plan for major burns?
Stop burn (cool with H2O) ABC O2 IV Tx hypothermia, Pain mgt. Tetanus Fluid (LR) Wound mgt. Check for CO poisoning
A pregnant woman comes into the ED with burns near her eyes. She has a sulfa allergy what burn cream should you use for wound management: bacitracin, silver sulfadiazine or mafenide?
- Bacitracin
- Silver sulfadiazine is contraindicated in pregnancy, infants, breastfeeding and sulfa allergies
- mafenide is contraindicated for sulfa allergy
How long do sunburns generally last and how are they treated?
72 hours
TX: cool compress, calamine, aloe, NSAID, fluids.
How what is the main treatment of chemical burns and when is it contraindicated?
30 minutes of irrigation or until pH is physiologic
contraindicated w/ Dry Lyme, elemental metals, phenol
When should you consider intubation with burn patients?
stridor, access muscle use, dysp, hypoxemia, deep burns to face/neck. Edema/blisters in mouth
Name a few of the major complications of burn injuries
Infection(Pneumonia/cellulitis/UTI), resp failure, MODs, SIRS, rhabdo, compartment syndrome, gastroparesis, GI ulcers, keloids, Depression, PTSD
Justin is an 8 year old patient in your practice. He lives at home with his single mother. He comes in today for immunizations required for school and you notice burns on both of his arms that look like the outline of some sort of object. What is going on?
Abusive burns:
single parent, burns to both hands/legs, Brands (clear outline of object), Cig. burns(face, back of hands/feet), immersion (butt, legs, stocking/glove).
