SHOCK & Emergency Care Flashcards
Drugs that Inhibit Sweating & may cause Heat Cramps, Heat Syncope, Heat Exhaustion or Heat Stroke…
All the Antis: AntiCholinergics AntiHistamines AntiSpasmotics Anti-Depressants (TriCyclics) AntiEmetics Alcohol
1 All Time Bad Drug for Heat Stroke
Tricyclic Antidepressants!!!
Why use these AT ALL?
Tricyclic antidepressants are used to treat depression
anxiety
headaches
chronic pain and irritable bowel syndrome.
Nerve Pain (Diabetes II)
They’ve been around for fifty years. They’re not addicting at all. Side effects sometimes limit their use.
They have anticholinergic Hot as a hare, dry as a bone, constipation, urinary retention sorts of side effects and that makes them pretty dangerous in certain settings
Heat Cramp to Stroke Cascade
Heat Cramps
Heat Exhaustion
Heat Stroke
Heat Syncope doesn’t usually lead to Heat Stroke and is most often associated with the elderly and their medications.
Who gets heat syncope
Elderly Inactive folks on Meds:
They get dependent edema, then poor venous return, then reduced cardiac output, then reduced blood supply to brain, dizziness, altered mental status and syncope.
Treatment for heat syncope
COOL them down, wet towels, axillary cervical groin & head cold compresses
Trendelenberg position to preserve blood flow to brain and
Rehydrate with sports drinks, not water.
Also, give sugar, just in case.
Who gets heat cramps?
Active people exercising or who exercised in the heat:
They get really sweaty, lose their salt and water and skew their electrolytes then get cramps and shaking in their legs (usually)
Rx for Heat Cramps
COOL down
DRINK Sports drink
STRETCH out crampy muscles
If Severe, may need cooled IV saline
DON’T exercise in the heat of the day anymore. Get up early and do it.
What stage in the cascade are we at when the core temperature actually rises?
Heat Exhaustion or Heat Stroke
If your hot but still clammy with dilated pupils - exhaustion
If you’re hot and DRY - Stroke
Both pts go to the hospital for cooling therapies
Hot, clammy w/dilated pupils
Heat exhaustion
Rehydrate with cooled saline or ringers
No altered mental state (usually)
Hot DRY, pupils constricted w/altered mental state?
Heat Stroke
Big End Organ Damage in Heat Stoke
Rhabdo
Hyperventillation causes Resp Alkalosis, then dehydration causes acidosis, then coagulation dysfunctions follow and DIC
What happens if you only drink water when over heated?
You are not replacing lost salt and you may skew your electrolytes into Hyponatremia with its attendant : cramps arrythmias headache seizures N/V Deressed reflexes Coma
Labs for Heat Stroke Pt
CBC - what are those platelets up to?? You’ve lost so much water, your blood is too thick!
ABG - are we still in alkalosis or have we crossed the line into lactic acidosis?
BMP - How about those electrolytes? How are
Na+, K+, Mg+
AND how are the kidneys doing?
Classic Urine description in Heat Stroke
Machine Oil Urine
Contains casts and Myoglobin as Rhabdo &Dehydration have shut down the kidneys
Most common cause of death in heat stroke?
DIC
Body Temp in Heat Stroke
Over 40C
105F
Worst Headache of my life
SubArachnoid Hemorrhage
Get brain CT
Test of choice for endocarditis dx?
TEE
Trans esophageal Echo
Cocaine and alcohol use, female gender, smoking, HTN and African American heritage are risk factors asst with this neurologic disorder
Sub Arachnoid Hemorrhage
Arterial blood supply to the brain is located mainly in the subarachnoid space. Arterial bleeds occur here, if not traumatic then aneurysms.
Subdural vs Epidermal Hemorrhages
Epis are usually traumatic arterial bleeds and are typically symptomatic quickly as pressure increases quickly. Most likely to bleed? Middle Meningeal from side impact to the temple.
Subdurals are usually venous bleeds from broken bridge veins and symptoms come on slowly, over days even a week. Slowly increasing pressure alters mental status and balance as more blood bleeds into the space
Smoking, advanced age and anticoagulant use are risk factors for this acute neurologic disorder in which pt’s present with altered level of consciousness
Intracranial Hemorrhage
Smoking damages the endothelium of arteries, Age weakens the vessels and anticoagulants prevent clotting. A deadly combo
Name the 5 Fs of gallbladder dz
Fat Forty Fertile Female Flatulent
1 Cholinergic Antidote?
Atropine
Use for severe Brady and Sludgy things like organophospate toxicity or Sarin gas
DON’T regimen for 911 comas of unknown origen
D dextrose IV
O oxygen -high flow
N naloxone
T thiamine
Benzo Toxicity Antidote
Flumanazil (Romazicon)
Meningitis post exposure Rx
Rifampin + Cipro
TIMI score over 6
High risk of MI subsequent mortality from Acute Coronary Syndrome (NSTEMI and/or Unstable Angina)
IgE activation, Degranualtion of Basophils and Histamine release:
Anaphlaxis
No spleen and in sepsis, guess which pathogen…
Strep pneumo
Aslpenic Pts should always be vaccinated against Neisseria Meningitis, Strep Pneumo and HFlu
Think the NHS proticol
HASECK organisms have a predilection for causing:
Endocarditis
Haemophilis-es and various other bad guys but none that are familiar by name. They all get lumped under HASECK as their favorite spot seems to be the endocardium.
Staph Aureaus and Strep Viridians also favor endocardium which is how IV drug users and dental patients end up being classed together as endocarditis risks.
Streptococcus Bovis
(S. Bovis) is associated with which two life threatening infections?
Endocarditis (with the HASECK and S.Aureau and Strep Viridans)
Colon Cancer (with Strep Gallolyticus)
Stupor
Neurological State in which VIGOROUS STIMULI are required to elicit response (loud verbal + sternal rub)
Symetrically reactive but DILATED pupils suggests what sorts of drug use?
Amphetamines + Hallucinogens
Cocaine
Anticholinergics
Anticholinergics like Belladonna and Datura may be ingested in error OR…. some brainiac may aspire to experience ANTICHOLINERGIC DELIRIUM - an effect of Solanaceae toxicity (usually atropine and scopolamine from belladonna/datura)
OR… note these drugs are used for bradycardia, motion sickness (scopolamine patches) and for overactive bowel syndromes as they essentially shut down the bowel
Antidote is Physostigmine
Causes Tachycardia, Hyperthermia, Mydriasis/photosensitivity, Delirium, Memory loss, coma and death
Describe the effect of Increased Intracranial Pressure on Bp, Hr and Respiratory rate:
Bp will rise, possibly very high
Hr + Respirations will fall, possibly
very low as the cardiac + respiratory centers on the Medulla are squashed
Which kind of cranial bleed occurs as a result of head trauma, causes a brief loss of consciousness after which Pt returns to conscious but thereafter develops headache Nausea + Vomiting …. coma death…
Epidural (arterial) Bleed
These are often caught before its too late as the sxs don’t wait to appear like a subdural bleed (venous) will.
The #1 culprit in these is the Middle Menangial Artery from temporal trauma (Side Impact MVA)
Worst HA you’ve ever had AND photophobia
Think SubArachnoid bleed aka brain aneurysm
Intracerebral bleeds usually present more like a stroke, not the sudden onset though an aneurysm outside the subarachnoid space is often the cause of ICH
Empiric Abx for suspected Meningitis:
Rocephin (Cephtriaxone)
Family/Dorm Mates get RiFampin and Cipro as preventative but actual pt gets Rocephin until lumbar puncture gives us the actual pathogen.
What are Janeway Lesions
Nontender palmar/solar nodules or macules are Hallmark for Endocarditis
Likewise Splinter Lesions at the edge of the nailbed
and
Osler Nodes - painful raised red nodules on the fingers + toes.