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CMT-uno > Physical Med > Flashcards

Physical Med Flashcards

1
Q

drowning

Nonfatal drowning –

A

someone gets immersed, has respiratory impairment, but doesn’t die

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2
Q

drowning

Water rescue –

A

someone gets immersed and then removed without evidence of respiratory impairment

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3
Q

drowning

Fatal drowning –

A

someone gets immersed, has respiratory impairment, and dies

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4
Q

Drowning

When to Discharge

A

if no increased work of breathing, no decreased sats, little-to-no rales

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5
Q

drowning

The mammalian dive reflex –

A

metabolism slows when immersed in cold water – more pronounced in children vs adults

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6
Q

Drowning

resuscitation

A

Aggressively resuscitate nonfatal/fatal drowning (<60 min immersed for adults, longer for kids)

Shock from water rescue or nonfatal drowning is not typical – look for other causes
Hemorrhagic
Neurogenic

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7
Q

Scuba- disorders of descent

Barotitis

A

Barotitis (pressure inflaming the ear)
Mild: pain
Mod/severe: TM rupture / vertigo / N&V / SN hearing loss

One of the squeeze syndromes – this can happen to sinuses, facemask, suit, lungs – gas in the area shrinks under pressure as you go down (Boyle’s Law)

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8
Q

Scuba- disorder of descent

Barotitis Tx

A

Treat with decongestants, pressure equalization (Valsalva), analgesics, vertigo medications (meclizine, benzodiazepines)
Inflamed, intact TM? Consider droppered lido 2% into EAC

Mod/severe: refer to ENT

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9
Q

Scuba- disorder of descent

Nitrogen narcosis

patho, Sx, Tx

A

Pathophys: neurotoxic levels of nitrogen in blood
Sx: AMS & poor coordination at depth
Tx: controlled ascent – decreases nitrogen in blood

~ at depth, partial pressure of nitrogen in lungs goes up, pushing more nitrogen from your lungs in to your bloodstream (vicious tag-team of Dalton’s Law & Henry’s Law)

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10
Q

disorder of ascent - Scuba

Decompression sickness

type 1 and 2, Tx

A

Dissolved nitrogen forms bubbles in blood, tissue during too-rapid ascent – delayed onset – 98% w/in 24h, 100% w/in 48h

Type I – skin, lymphatic, MSK
“the bends” or “caisson disease” – joint pain, rashes, itching

Type II – more serious – other organs than above (like CNS)
gradual neuro sx – paresthesias, numbness, weakness, AMS (not ALOC)

Prevention – follow dive table
Tx – hyperbaric chamber

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11
Q

ascent disorder

A

Decompression sickness
Type I – skin rash called “cutis marmorata”

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12
Q

scuba disorder of ascent

Pulmonary barotrauma

A

Rapid ascent with closed glottis
Pneumothorax, hemothorax, pneumomediastinum
Gas in the area expands as pressure
drops (Boyle’s Law strikes back!)

Prevention – exhale as you ascend

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13
Q

ascent disorder

Gastrointestinal barotrauma

A

Pathophys – diving after carbonated beverages, gas-generating foods
Rarely – intestinal perforation, diaphragm rupture
Usually – abdominal cramps, eructation, flatulence

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14
Q

Scuba- disorder of ascent

Arterial air/gas embolism

A

Sudden air in arterial circulation immediately upon surfacing or within 10 minutes
Altered LOC and not just AMS, seizures

Prevention – follow dive table
Tx – hyperbaric chamber

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15
Q

Altitude illness

general

A

Due to relative hypoxia / increased sympathetic activity / capillary leak (brain and lungs)
Can occur in anyone; being fit is not protective

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16
Q

Acute Mountain Sickness

general

A

Usually > 8k feet (Vail is 11k)
Starts early – often day 1 at altitude

HA, nausea, fatigue, insomnia
Worsened with sedatives, alcohol

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17
Q

Acute mountain sickness

Tx
Preventative

A

May be prevented by prophylactic acetazolamide
Causes a metabolic acidosis which generates a respiratory alkalosis – increased ventilation increases oxygenation
Usually self-limited (1-2 days); can treat with NSAIDs, steroids, oxygen, descent

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18
Q

HACE / HAPE

General

A

HACE = high altitude cerebral edema
Severe, life-threatening; increased ICP
Ataxia, vomiting, confusion, seizures, coma
**Descent ASAP **(+/- steroids, hyperbarics)

HAPE = high altitude pulmonary edema
Most lethal of the altitude illnesses
Usually second night at altitude
Shortness of breath, fever, rales, pink sputum, hypoxia; normal heart size on CXR
Descent ASAP

Usually have symptoms of Acute Mountain Sickness before HACE/HAPE

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19
Q

Hypothermia

general

A

Core temperature < 35oC (95F)
Can occur even in non-freezing temperatures
Only use accurate thermometers; rectal, bladder, esophageal
Risks include extremes of age, altered sensorium, burns, trauma; may also see in sepsis, hypoglycemia
Findings – altered mental status, bradycardia

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20
Q

Hypothermia

A

Bradycardia with an idioventricular or junctional escape rhythm
Prominent J waves in the anterior leads = Osbourne waves
(named after the fact that they occur on the “J” point of the EKG)

21
Q

Hypothermia

Tx

A

Rewarming should start ASAP
External rewarming
Passive – remove wet clothes, give warm blanket
Active – radiant heaters, hot water bottles, warming blankets
Watch for core temperature afterdrop with passive rewarming (cold blood from the periphery goes into the central circulation)
Active core rewarming
Warm humidified oxygen, warmed IV fluids, warm lavage (NG tube, foley)

22
Q

Frostbite

general

degrees, Tx

A

Think of it as burns caused by cold (local tissue freezing)

First degree – superficial
Second degree – full thickness, clear blisters
Third degree – hemorrhagic blisters (blood = deeper)
Fourth degree – to bone

Rapid rewarming with warm circulating water
Do not allow refreezing
Do not debride bloody blisters

23
Q

Types of Heat Illness

Heat edema
Do not treat with

A

swelling of feet/hands, transient, do not treat with diuretics

24
Q

Types of Heat Illness

Heat cramps

A

after exertion in hot climates / usually after cooling / resolves without treatment

25
Q

Types of Heat Illness

Heat syncope

A

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

26
Q

Types of heat illness

Heat exhaustion

A

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

27
Q

Heat Stroke

general

A

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

28
Q

Heat stroke

S/Sx

A

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

29
Q

Heat Stroke

Classic

A

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

30
Q

Heat Stroke

Exertional

A

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

31
Q

Heat stroke

Tx

A

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)

32
Q

Burns

1st degree

A

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

33
Q

burns

2nd degree

A

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

34
Q

Burns

3rd degree

A

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.

35
Q

burns

4th degree

A

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

36
Q

Burns

Body Surface Area

A

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

37
Q

Minor burns

Tx

A

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)

38
Q

Major burns

Tx

A

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

39
Q

electrical injuries

general

A

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

40
Q

electrical injuries

Tx

A

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

41
Q

mammalian bites

human, dog, cat

A

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

42
Q

animal bite

Tx

A

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

43
Q

Rabies

general

A

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

44
Q

rabies

Tx

A

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)

45
Q

Bites and stings

general, Sx, Tx

A

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

46
Q

black widow spider bite

general Sx, Tx

A

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

47
Q

brown recluse

general

A

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

48
Q

Rattlesnake bite

A

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

CMT-uno (54 decks)

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