Physical Medicine

Question 1

Drowning

describe water rescue

Answer 1

someone gets immersed and then removed without evidence of respiratory impairment

Question 2

Drowning

describe non-fatal drowning

Answer 2

someone get simmersed, has respiratory impairment, but doesn’t die

Question 3

Drowning

describe fatal drowning

Answer 3

someone gets immersed, has respiratory impairment, and dies

Question 4

Drowning

when to discharge?

3

Answer 4

• no increased work of breathing
• no decreased sats
• little to no rales

Question 5

Drowning

generally describe the mammalian dive reflex

Answer 5

metabolism slows when immersed in cold water

Question 6

Drowning

who is the mammalian dive reflex more pronounced in?

Answer 6

children

Question 7

Drowning

describe shock related to drowning?

Answer 7

not common- look for other causes (hemorrhagic/neurogenic)

Question 8

Drowning

describe resuscitation in nonfatal/fatal drowning

Answer 8

• adults: aggressive resuscitation for < 60 min drowning
• children: aggressive resuscitation even if over 60 min

Question 9

Scuba- Barotitis

what is barotitis

Answer 9

pressure inflaming the ear

Question 10

Scuba- Barotitis

describe mild vs mod/severe sx

Answer 10

• mild: pain
• mod/severe: TM rupture, vertigo, n/v, sensorineural hearing loss

Question 11

Scuba- Barotitis

tx

Answer 11

• decongestants
• pressure equalization (pinched nose valsalva)
• vertigo meds (meclizine, benzos)
• analgesics

Question 12

Scuba- Barotitis

what to consider if TM is inflamed but intact?

Answer 12

2% lido

Question 13

Scuba- Barotitis

when to refer to ENT?

Answer 13

if mod/severe

Question 14

Scuba- Nitrogen Narcosis

cause

Answer 14

neurotoxic levels of nitrogen in the blood

Question 15

Scuba- Nitrogen Narcosis

sx

2

Answer 15

• AMS
• poor coordination at depth

Question 16

Scuba- Nitrogen Narcosis

tx

Answer 16

controlled ascent to decrease blood nitrogen

Question 17

Scuba- Decompression Sickness

how does this occur

Answer 17

• dissolved nitrogen forms bubbles in blood, tissue whend ascending too quickly
• 98% have sx w/in 24hrs, 100% have sx w/in 48 hrs

Question 18

Scuba- Decompression Sickness

describe Type I

Answer 18

• Systems: MSK, skin, Lymph
• Sx: joint pain, rash, itching

Question 19

Scuba- Decompression Sickness

describe Type II

Answer 19

• Systems: Neuro, CNS
• Sx: gradual neuro sx like paresthesia, numbness, weakness, AMS

Question 20

Scuba- Decompression Sickness

prevention/tx

Answer 20

• slow ascent to prevent
• hyperbaric chamber to prevent

Question 21

Scuba- Decompression Sickness

what is the rash called?

Answer 21

cutis marmorata

Question 22

Scuba- Pulmonary Barotrauma

describe

Answer 22

• gas expands as pressure drops
• occurs when you have rapid ascent w/ a closed glottis

Question 23

Scuba- Pulmonary Barotrauma

sx

Answer 23

• pneumothorax
• hemothorax
• pneumomediastinum

Question 24

Scuba- Pulmonary Barotrauma

prevention

Answer 24

exhale as you ascend

Question 25

# Scuba- GI Barotrauma pathophys

Answer 25

diving after carbonated beverages or gas-generating foods

Question 26

# Scuba- GI Barotrauma sx

Answer 26

* mild: abd cramps, eructation, flatulence * severe: intestinal perf, diaphragm rupture

Question 27

# Scuba- Arterial Air/Gas Embolism sx

Answer 27

* occur immediately upon surfacing (w/in 10 min) * Altered LOC * Seizures

Question 28

# Scuba- Arterial Air/Gas Embolism tx

Answer 28

hyperbaric chamber

Question 29

# Altitude Illness pathophys

Answer 29

due to relative hypoxia, increased sympathetic activity, capillary leak (brain and lungs)

Question 30

# Altitude Illness- Acute Mountain Sickness how high and how long?

Answer 30

* usually anywhere >8k feet * starts early (day 1)

Question 31

# Altitude Illness- Acute Mountain Sickness sx

Answer 31

* HA * nausea * fatigue * insomnia

Question 32

# Altitude Illness- Acute Mountain Sickness alleviating? aggravating?

Answer 32

* allev: prophylactic acetazolamide * aggra: sedatives, alcohol

Question 33

# Altitude Illness- Acute Mountain Sickness MOA of acetazolamide for altitude illness

Answer 33

causes a metabolic acidosis which generates a respiratory alkalosis leading to increased ventilation which increases oxygenation

Question 34

# Altitude Illness- Acute Mountain Sickness tx

Answer 34

* self limited (1-2d) * NSAIDs * steroids * oxygen * descent

Question 35

# Altitude Illness what is HACE? HAPE?

Answer 35

* High altitude cerebral edema * High altitude pulmonary edema

Question 36

# Altitude Illness HACE pathophys

Answer 36

increased ICP from altitude

Question 37

# Altitude Illness HACE sx | 5

Answer 37

* ataxia * vomiting * confusion * seizures * coma

Question 38

# Altitude Illness HACE tx

Answer 38

* immediate descent * steroids * hyperbarics

Question 39

# Altitude Illness HAPE general

Answer 39

* most lethal altitude illness * usually occurs the second night at altitude

Question 40

# Altitude Illness HAPE sx | 6

Answer 40

* SOB * fever * Rales * pink sputa * hypoxia * CXR: normal heart size

Question 41

# Altitude Illness tx

Answer 41

immediate descent

Question 42

# Altitude Illness what do people with HACE or HAPE have prior?

Answer 42

sx of acute mountain sickness

Question 43

# Hypothermia what core body temp?

Answer 43

< 35 deg C or 95 deg F

Question 44

# Hypothermia which thermometers to use?

Answer 44

rectal, bladder, esophageal

Question 45

# Hypothermia risk factors | 6

Answer 45

1. extreme ages (young/old) 2. altered sensorium 3. burns 4. trauma 5. sepsis 6. hypoglycemia

Question 46

# Hypothermia findings | 2

Answer 46

AMS, bradycardia

Question 47

# Hypothermia EKG findings | 3

Answer 47

* bradycardia * Idioventricular or junctional escape rhythm * prominent J waves in anterior leads (Osbourne waves)