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RRPA Clinical Decision Making I > Ross Enviro 2nd Part > Flashcards

Ross Enviro 2nd Part Flashcards

1
Q

T/F: Pernio and chilblains are freezing injuries

A

False - NON-freezing injuries caused by long term intermittent exposure to damp

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2
Q

How will a pt with pernio or chilblains most likely present?

A
  • Pain remains
  • Paresthesias, pain with any pressure on foot
  • Shoes are intolerable
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3
Q

Does chilblain or pernio result in long term sequelae?

A

Only Pernio - chronic pain, inability to walk

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4
Q

How do you treat chilblain or pernio?

A
  1. Warm
  2. Dry
  3. NO massage
  4. Nicardipine and occassionally steroids
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5
Q

What is trench foot due to?

A

Prolonged immersion in cold water leading

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6
Q

In trench foot the affected parts are first cold and anesthetic then what occurs?

A

Hyperemia with burning pain

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7
Q

What are key PE findings in trench foot?

A

The foot is pale and mottled and ulcers often form

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8
Q

Does Pernio or trench foot have a worse pathology?

A

Trench foot - can progress to localized cellulitis –> sepsis

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9
Q

Who is at risk for getting trench foot?

A

Military (majority)

Snowmakers

Raft operators

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10
Q

What are symptoms of trench foot?

A
  • Hyperhidrosis
  • Intolerance to cold
  • Pain - especially with the rewarming phase
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11
Q

What are sequelae of trench foot?

A
  • dysfunction of extremity
  • cold sensitivity
  • hyperhidrosis - leading to chronic fungal infx
  • Raynaud’s
  • swelling, chronic pain
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12
Q

What condition can lead to cryoglobulins forming, leading to hives and rashes?

A

Trench foot

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13
Q

T/F: frostbite is a freezing injury where tissue actually freezes

A

True

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14
Q

What is the histopathology of frost bite?

A

Endothelial damage -> arachidonic acid -> tissue ischemia

  1. Neurons damaged 1st
  2. Muscle then
  3. Endothelial cells
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15
Q

What are the 3 stages of frost bite?

A
  1. Pre-freeze
  2. Freeze-thaw
  3. Progressive microvascular collapse
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16
Q

In what stage of frostbite is there superficial tissue cooling, increased viscosity, and endothelium damage?

A

Pre-freeze

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17
Q

In what stage of frostbite is there extracellular fluid ice crystal formation, water diapedisis, and cell-membrane rupture?

A

Freeze-thaw phase

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18
Q

In what stage of frostbite is there sludge, microthrombi, and tissues are denied nutrients?

A

Progressive microvascular collapse

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19
Q

Acral skin structures, fingers, toes, ears and nose contain many ___ ___ they are able to constrict to facilitate shunting of blood

A

arteriovenous anastomoses

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20
Q

What are the 3 zones of cold injury?

A
  1. Zone of coagulation
  2. Zone of stasis
  3. Zone of hyperemia
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21
Q

In what zone of cold injury is damage irreversible?

A

Zone of coagulation

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22
Q

In what zones of cold injury is damage reversible?

A
  • Zone of stasis
  • Zone of hyperemia
23
Q

In what degree of frostbite will you see partial skin freezing, mild edema, no blister, and some stinging with rewarming?

A

First degree (frostnip)

24
Q

In what degree of frostbite will you see full thickness skin freezing and blisters that extend to the end of the digit forming black eschars?

A

Second degree

25
Q

In what degree of frostbite is there injury to subdermal tissues, skin necrosis, and the extremity feels like a “block of wood”?

A

Third degree

26
Q

In what degree of frostbite is there extension to subcutaneous tissue, muscle, bone, and tendons, mottled skin, and deep dry black mummified escar?

A

Fourth degree

27
Q

What is the treatment for frostbite?

A
  1. Avoid thaw and refreeze
  2. Remove wet, constrictive clothing
  3. Avoid slow defrost
  4. Rapid thaw with circulating water at 104 degrees
28
Q

Your friend was staying overnight in a tent, drinking a lot of alcohol of course, and his hand wasn’t in his sleeping bag and in the snow all night. You see his hand has blisters forming. What do you remember to do with your friend?

A

KEEP them COLD until you can gurantee warming and STAYING warm

29
Q

What do you always want to remember to check on with a frostbite patient?

A

TETANUS!

*tetanus spores can live in freezing cold environments

30
Q

What are higher level of care treatments for frostbite?

A
  • Vasodilators: Iloprost, Nitroglycerin, Reserpine (decrease amputation)
  • local tPA
  • LMWD (dextrose) ONLY if the other two options are not available
31
Q

Over half of frostbite patients will have what sequelae?

A
  • hypersensitvity to cold
  • ongoing numbness
32
Q

T/F: Admit all but most minor frostbite patients

A

True

33
Q

A pt presents with strong muscle contractions that occur at rest and electrolyte deficiency. How would you treat this patient?

A

Pt has Heat Cramps

Tx: give electrolytes (salt)

34
Q

What is miliaria rubra?

A

Skin rash occurring in hot temperatures often found in small children (rupture of blocked sweat glands)

35
Q

What symptoms are characteristic of heat exhaustion?

A
  • Temp <40.5 (104)
  • fatigue, weakness
  • N/V
  • HA
  • muscle cramps, myalgia
  • irritability
36
Q

What is heat exhaustion due to?

A

Either dehydration (primary water loss) or sweating with hypotonic rehydration (primary sodium loss) depletion

37
Q

What is the treatment for heat exhaustion?

A
  1. Minor: check electrolytes, consider CPK check, orally hydrate, send home
  2. Several Symptoms: check electrolytes, calculate water deficit, replace deficit over 48 hrs, usually admit
38
Q

What is the hallmark sign of heat stroke?

A

CNS symptoms (bizarre behavior, hallucinations, AMS)

39
Q

In what condition is a patient’s temperature >104 degrees?

A

Heat stroke

40
Q

Who are at the greatest risk of heat stroke?

A
  1. Elderly (due to meds - BBs)
  2. Neonates (lack thermoregulatory systems)
  3. Psych pts
  4. Drug abuse
41
Q

How do you manage heat stroke?

A
  1. Must have core thermomter in place (rectal or foley)
  2. Cool down by conduction (blanket, ice packs)
  3. Dec Temp by evaporation - wet them down or water immersion
42
Q

Are antipyretics helpful in heat stroke?

A

NO

43
Q

What is the MCC of hyperthermia?

A

Neuroleptic Malignant Syndrome

44
Q

Neuroleptic Malignant Syndrome is characterized by what symptoms?

A

Extrapyramidal

  • catatonia - AMS
  • muscle rigidity (lead pipe)
  • parkinsonism, masked facies, tremors, akinesia
45
Q

What does autonomic dysfunction that occurs in Neuroleptic Malignant Syndrome cause?

A
  • Labile BP
  • diaphoresis
  • urinary incontinence
46
Q

What is the treatment for Neuroleptic Malignant Syndrome?

A
  1. Dantroline or Bromocriptine
  2. Benzodiazapines - for rigidity
47
Q

On PE how can you distinguish NMS from heat stroke?

A
  • diaphoresis
  • rigidity
  • liver function tests (abnl in heat stroke)
48
Q

Serotonin syndrome presents similarly to Neuroleptic Malginancy Syndrome. What symptoms are characteristic of serotonin syndrome?

A
  • mycoclonus, hyperreflexia
  • AMS
  • fever, N/V
49
Q

What is the treament for serotonin syndrome?

A

Cyproheptadine

50
Q

If a pt presents with lictenberg figures, dec respiratory rate, and cardiac asystole what injury have they sustained?

A

Lightning injury

51
Q

What can form 2-3 years after a lightning injury?

A

Delayed cataract

52
Q

What is keraunoparalysis and how do you treat it?

A

Vascular spasm usually in the lower legs, cold mottled skin, and look pulseless

Usually resolves spontaneously

53
Q

What is the work up for a lightning injury?

A
  1. CBC, BMP, CPK, UA, urine myoglobin, trop, look for DIC
  2. EKG
  3. look for blunt trauma, mental status changes, and cardiac arrhythmia

Dispo: asympto w/ nl EKG = d/c

54
Q

What could you see on an EKG if a patient sustained a lightning injury?

A

Prolonged QT or elevated ST

RRPA Clinical Decision Making I (17 decks)

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