Physical Med Flashcards

Question

# Types of Heat Illness Heat syncope

Answer 1

– pooling of blood in extremities / treat by lying patient down in cool place

Answer 2

– “summer flu” / nausea, vomiting, due to salt and water depletion / treat by moving to cooler environment, PO hydration with fluids with electrolytes/sugar

Answer 3

A true emergency – must cool ASAP Multiorgan failure / brain, liver and endothelium at highest risk, but all systems affected Core temperature usually ≥ 40oC (104F) Two types, classic and exertional

Answer 4

**Altered mental status,** tachycardia, tachypnea, may be hypotensive May see acidosis, rhabdomyolysis, ARDS, renal failure, hyperkalemia

Answer 5

Epidemic (with heat wave) **Non-exertional** Elderly with chronic disease, very young, chronic illnesses Dry skin Rare to see acute tubular necrosis (ATN), rhabdomyolysis

Answer 6

Isolated Exertional Healthy, active Profuse sweating May have diarrhea DIC, ATN, rhabdomyolysis common

Answer 7

Cooling is crucial – change “ABCs” to “C-ABCs” Resuscitate as usual, but cool simultaneously Methods of cooling External -- strip patient / tepid mist plus fans / wet sheets plus fans; *ice packs to groin, axillae, neck* Internal -- iced water gastric lavage / iced water bladder lavage May need chlorpromazine to control shivering Goal is to decrease temperature by 0.1-0.2oC per minute to 38.5oC (101.3F), then stop; watch for overshoot (hypothermia)

Answer 8

(superficial) -- epidermis only, painful, red and dry, hypersensitive. Heals in 3-7 days.

Answer 9

Superficial partial thickness --to dermis, painful, red and wet, thin-walled blisters, hypersensitive. Heals in 7-14 days without scarring (called “second degree”)

Answer 10

Deep partial thickness: To dermis, painful, red and white (mottled), thick-walled blisters, slight decrease in sensation. Heals in weeks-months with scarring and pigment changes.

Answer 11

Full thickness: To deeper tissues, painless, white and brown and dry. No sensation. Needs grafting.

Answer 12

Body surface area (BSA) Patient’s palm = 1% of patient’s BSA Adults – rule of 9’s Children – Lund/Browder chart

Answer 13

Minor burns Cool ASAP Treat pain with NSAIDs, opiates Leave blisters intact if unruptured and not tense Debride if blisters broken, tense, across joints Update tetanus Can manage ”open” (topical antimicrobials) or “closed” (occlusive dressings)

Answer 14

Major burns Cool > watch for hypothermia Assess airway > look for singed nasal hairs, oral burns; intubate early for respiratory distress, concern for airway edema Enclosed space? Think carbon monoxide, cyanide toxicity. **Fluid resuscitation crucial** – Parkland formula 4 mL x kg x %BSA per day of Ringers lactate Half of volume given over first 8 hours Watch urine output – goal is > 1ml/kg/hr

Answer 15

Tissue damage caused by electrical current Injuries common (falls) AC 3X worse than DC at same voltage Degree of injury determined by Type of current Duration of contact Tissue in path of current Biggest risk of death is either trauma or cardiac arrhythmia – treat them as a trauma patient Mouth burns in children usually from biting electric cord; risk of arterial bleeding at 7-10 days after burn

Answer 16

Examine carefully – look for entrance and exit sites Resuscitation and ABCs Household current exposure generally requires no specific treatment, testing or monitoring If more than minor electric shock, consider labs – CMP, CBC, CK (risk of rhabdomyolysis), coag studies if seriously injured Monitor urine output / admit to monitored bed

Answer 17

Human bite is the worst “mammal” bite “Fight bite” – wound over MCP joint High risk; may need to go to OR Dog bites < infection rate, > crush injury rate Cat bites Puncture wounds > risk of infection

Answer 18

1st line: amoxicillin/clavulanate 2nd line: doxycycline OR TMP/SMX PLUS clindamycin OR metronidazole

Answer 19

Rare in US; most cases imported in developing countries (often dog bites) Bites at risk -- fox, skunk, raccoon, bats (most common risk animal) / rodents, rabbits and squirrels do not pose risk A bat in an occupied room – assume bite

Answer 20

Early post-exposure prophylaxis is key Passive human rabies immune globulin (HRIG); give as much as possible around and into wound, remainder give IM Active human diploid cell vaccine (HDCV) – 4 doses (days 0-3-7-14)

Answer 21

Bees, wasps and ants Usually only cause local symptoms – burning, pain, swelling Treatment usually ice to area, OTC meds (NSAIDs, acetaminophen, nonsedating antihistamine) About 10-15% of those stung will have unusually large areas of swelling lasting up to a week with a sting

Answer 22

Black with red hourglass, aggressive Immediate pain N/V, cramps, rigid abdomen (appy mimic) Treat with ice, opioids/benzos, antivenom (?)

Answer 23

Brown with “violin,” reclusive Delayed pain, “volcano” lesion Systemic symptoms including hemolysis, necrosis Treat with analgesics, debridement if needed

Answer 24

Envenomation – amount of venom in bite / up to one quarter are “dry bites” Local effects – swelling, ecchymosis, pain Systemic effect – DIC, capillary leak Males, teens-twenties, intoxicated – highest risk Ooze at site of bite suggests envenomation Do not I&D, tourniquet or try to extract venom If ecchymosis, blisters, systemic effects – treat with antivenom – look up doses, side effects