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Physical Medicine Flashcards

1
Q

Drowning

describe water rescue

A

someone gets immersed and then removed without evidence of respiratory impairment

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2
Q

Drowning

describe non-fatal drowning

A

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

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3
Q

Drowning

describe fatal drowning

A

someone gets immersed, has respiratory impairment, and dies

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4
Q

Drowning

when to discharge?

3

A
  • no increased work of breathing
  • no decreased sats
  • little to no rales
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5
Q

Drowning

generally describe the mammalian dive reflex

A

metabolism slows when immersed in cold water

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6
Q

Drowning

who is the mammalian dive reflex more pronounced in?

A

children

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7
Q

Drowning

describe shock related to drowning?

A

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

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8
Q

Drowning

describe resuscitation in nonfatal/fatal drowning

A
  • adults: aggressive resuscitation for < 60 min drowning
  • children: aggressive resuscitation even if over 60 min
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9
Q

Scuba- Barotitis

what is barotitis

A

pressure inflaming the ear

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10
Q

Scuba- Barotitis

describe mild vs mod/severe sx

A
  • mild: pain
  • mod/severe: TM rupture, vertigo, n/v, sensorineural hearing loss
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11
Q

Scuba- Barotitis

tx

A
  • decongestants
  • pressure equalization (pinched nose valsalva)
  • vertigo meds (meclizine, benzos)
  • analgesics
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12
Q

Scuba- Barotitis

what to consider if TM is inflamed but intact?

A

2% lido

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13
Q

Scuba- Barotitis

when to refer to ENT?

A

if mod/severe

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14
Q

Scuba- Nitrogen Narcosis

cause

A

neurotoxic levels of nitrogen in the blood

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15
Q

Scuba- Nitrogen Narcosis

sx

2

A
  • AMS
  • poor coordination at depth
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16
Q

Scuba- Nitrogen Narcosis

tx

A

controlled ascent to decrease blood nitrogen

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17
Q

Scuba- Decompression Sickness

how does this occur

A
  • dissolved nitrogen forms bubbles in blood, tissue whend ascending too quickly
  • 98% have sx w/in 24hrs, 100% have sx w/in 48 hrs
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18
Q

Scuba- Decompression Sickness

describe Type I

A
  • Systems: MSK, skin, Lymph
  • Sx: joint pain, rash, itching
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19
Q

Scuba- Decompression Sickness

describe Type II

A
  • Systems: Neuro, CNS
  • Sx: gradual neuro sx like paresthesia, numbness, weakness, AMS
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20
Q

Scuba- Decompression Sickness

prevention/tx

A
  • slow ascent to prevent
  • hyperbaric chamber to prevent
21
Q

Scuba- Decompression Sickness

what is the rash called?

A

cutis marmorata

22
Q

Scuba- Pulmonary Barotrauma

describe

A
  • gas expands as pressure drops
  • occurs when you have rapid ascent w/ a closed glottis
23
Q

Scuba- Pulmonary Barotrauma

sx

A
  • pneumothorax
  • hemothorax
  • pneumomediastinum
24
Q

Scuba- Pulmonary Barotrauma

prevention

A

exhale as you ascend

25
Q

Scuba- GI Barotrauma

pathophys

A

diving after carbonated beverages or gas-generating foods

26
Q

Scuba- GI Barotrauma

sx

A
  • mild: abd cramps, eructation, flatulence
  • severe: intestinal perf, diaphragm rupture
27
Q

Scuba- Arterial Air/Gas Embolism

sx

A
  • occur immediately upon surfacing (w/in 10 min)
  • Altered LOC
  • Seizures
28
Q

Scuba- Arterial Air/Gas Embolism

tx

A

hyperbaric chamber

29
Q

Altitude Illness

pathophys

A

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

30
Q

Altitude Illness- Acute Mountain Sickness

how high and how long?

A
  • usually anywhere >8k feet
  • starts early (day 1)
31
Q

Altitude Illness- Acute Mountain Sickness

sx

A
  • HA
  • nausea
  • fatigue
  • insomnia
32
Q

Altitude Illness- Acute Mountain Sickness

alleviating? aggravating?

A
  • allev: prophylactic acetazolamide
  • aggra: sedatives, alcohol
33
Q

Altitude Illness- Acute Mountain Sickness

MOA of acetazolamide for altitude illness

A

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

34
Q

Altitude Illness- Acute Mountain Sickness

tx

A
  • self limited (1-2d)
  • NSAIDs
  • steroids
  • oxygen
  • descent
35
Q

Altitude Illness

what is HACE? HAPE?

A
  • High altitude cerebral edema
  • High altitude pulmonary edema
36
Q

Altitude Illness

HACE pathophys

A

increased ICP from altitude

37
Q

Altitude Illness

HACE sx

5

A
  • ataxia
  • vomiting
  • confusion
  • seizures
  • coma
38
Q

Altitude Illness

HACE tx

A
  • immediate descent
  • steroids
  • hyperbarics
39
Q

Altitude Illness

HAPE general

A
  • most lethal altitude illness
  • usually occurs the second night at altitude
40
Q

Altitude Illness

HAPE sx

6

A
  • SOB
  • fever
  • Rales
  • pink sputa
  • hypoxia
  • CXR: normal heart size
41
Q

Altitude Illness

tx

A

immediate descent

42
Q

Altitude Illness

what do people with HACE or HAPE have prior?

A

sx of acute mountain sickness

43
Q

Hypothermia

what core body temp?

A

< 35 deg C or 95 deg F

44
Q

Hypothermia

which thermometers to use?

A

rectal, bladder, esophageal

45
Q

Hypothermia

risk factors

6

A
  1. extreme ages (young/old)
  2. altered sensorium
  3. burns
  4. trauma
  5. sepsis
  6. hypoglycemia
46
Q

Hypothermia

findings

2

A

AMS, bradycardia

47
Q

Hypothermia

EKG findings

3

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

CMT (78 decks)

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