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Emergency Medicine > Wilderness Med > Flashcards

Wilderness Med Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Our baseline metabolism raises our body heat ___ every hour

A

1.1 degrees celsius

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2
Q

Fortunately we transfer heat into the environment via

A
  1. Conduction: direct contact
  2. Convection: air currents
  3. Radiation: being in space that is cooler than our own body
  4. Evaporation (most effective way we lose heat)
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3
Q

Physiologic changes under heat stress

A
  1. HR increases
  2. peripheral vasodilation
  3. sweating
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4
Q

Risk factors for heat illness

A
  1. young and old
  2. Meds (anticholinergic, BB, lithium)
  3. alcohol
  4. Obesity
  5. CHF
  6. mental illness
  7. athletes, laborers, military
  8. low socioeconomic position
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5
Q

Tx of heat cramps

A

electrolyte repletion, NS IV

*often after exercise

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6
Q

Tx of heat syncope

A

Horizontal positioning

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7
Q

Tx of heat edema

A

leg elevation, compression hose, acclimatization

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8
Q

Tx of heat rash

A

chlorhexidine cream

*usually under clothed areas (macular-papular rash)

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9
Q

Definition

Volume depletion in the setting of heat stress

A

heat exhaustion

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10
Q

signs and sx of heat exhaustion

A
  1. Fatigue
  2. Nausea/vomiting, anorexia
  3. Heat cramps
  4. LOC: dizzy/syncope
  5. HR and RR increased
  6. Skin: pale, cool, clammy, flushed
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11
Q

heat illnesses

A
  1. minor heat illnesses
  2. heat exhaustion
  3. heat stroke
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12
Q

tx of heat exhaustion

A
  1. Rest
  2. Cool environment
  3. CBC and chemistry (Cr)
  4. IV fluids
  5. Consider admission for elderly patients or those with significant electrolyte abnormalities
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13
Q

Life-threatening rise in internal temperature

Classic and exertion

A

heat stroke

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14
Q

signs and sx of heat stroke

A
  1. LOC: Disoriented, irritable, combative, unresponsive
  2. Altered mental status*** (Helps differentiate from heat exhaustion), hallucinations, seizures
  3. Ataxia
  4. Increased HR and RR
  5. Skin: Hot, wet or dry, flushed
  6. Core temp > 104 degrees
  7. Elevated Transaminases in liver function and Cr
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15
Q

How does humidity effect our cooling mechansim

A

more difficult to cool off

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16
Q

Tx of heat stroke

A
  1. Aggressive cooling*** (evaporative or immersive)
  2. Ice packs, cooling blankets, lavage
  3. Airway monitoring and management
  4. Avoid antipyretics ie. NSAIDs (DONT HELP–> too hot)
  5. IV fluids if hypotensive after cooling
  6. Admission
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17
Q

what is drowning definition

A

Respiratory impairment from submersion in a liquid

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18
Q

Describe the physiology of drowning

A

Submersion - panic - breath holding - struggle - hypoxia - loss of consciousness - respiratory arrest - cardiac arrest

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19
Q

What factors affect drowning survivability (these factors lead to better outcomes)

A
  1. Shorter
  2. Colder (lowers metabolic needs)
  3. Cleaner
  4. Younger
  5. Calmer
  6. BLS sooner
20
Q

Management/work up of drowning

A
  1. ECG to evaluate heart rhythm
  2. Chest XR
  3. Pulse ox, capnography, ABG
  4. CBC and chemistry
  5. ABCs and rewarming
  6. Monitor for respiratory signs and symptoms
  7. watch for 4-6 hrs
21
Q

common bites and stings

A
  1. Venomous Snakes
  2. Spiders
  3. Bed Bugs
  4. Hymenoptera
22
Q

Signs and sx of crotalid envenomations

A
  1. Fang marks
  2. Swelling and pain
  3. Bruising, blistering, necrosis
  4. Weakness, sweating, chills
  5. Nausea, vomiting
  6. Numbness, lymph node swelling
23
Q

Signs and sx of Elapid envenomations

A
  1. Local swelling
  2. Nausea, vomiting
  3. Dizziness
  4. Respiratory difficulty
24
Q

Snake bite initial management

A

Do not need the snake, pictures preferred

  1. Keep patient calm
  2. Immobilize the limb (prevent if from dispersing in blood more)
  3. Monitor degree of symptoms
  4. Avoid tourniquets (can overly concentrate in 1 area), ice, electricity, suction
  5. Clean wounds
  6. Close monitor of ABCs– need cardiac monitoring
    Supportive care for pain, nausea
  7. Possibly use Antivenin
  • *reassess every 30 min for systemic sx
  • *use wound/skin pen to outline rednesses
25
Q

When do we consider Antivenin?

A
  1. rapid swelling
  2. hypotension
  3. coagulopathy

25% of snake bites are dry w/o venom

Reassess wound every 30 minutes– look for systemic sx (SOB, increased INR, fever)–> systemic symptoms then administer antivenin

26
Q

Snake bite lab management

A
  1. CBC (platelets),
  2. Chemistry,
  3. Coagulation studies,
  4. LFTs,
  5. D-dimer,
  6. CPK
27
Q

late management of snake bite management

A
  1. Updated tetanus
  2. Contact CDC/toxicology
  3. Extended monitoring (8-12 hours)
  4. Disposition depending on severity
28
Q

signs and sx of widow spider bite

A
  1. Initially red, itchy, painless
  2. Progressive pain and anxiety
  3. Target lesion
  4. Muscular cramping in the back and abdomen
  5. Burning, numbness in the feet
  6. Headache, dizziness
  7. N/V
29
Q

Tx of widow spider bite

A
  1. Wound care
  2. Opioids and Benzos
  3. IV fluids
  4. Tetanus
  5. Antivenin
  6. Monitor for respiratory symptoms and hypotension
30
Q

Signs and sx of Recluse spider bite

A
  1. Red blister with painless bite
  2. Progression to a non-healing wound
  3. Chills, fever, generalized rash, weakness
    * *more localized
    * *Not found in CO
31
Q

Lab studies for Recluse spider bite

A
  1. CBC,
  2. Chemistry,
  3. Coagulation studies
32
Q

Management of Recluse spider bite

A
  1. labs
  2. Update teatnus
  3. wound care and monitoring
  4. Infection management with antibiotics
  5. Outpatient follow up, may need surgical debridement
33
Q

Bed bugs are about the size of ____ and are usually found ___

A
  • About the size of an apple seed

- Hide on mattresses, clothing, along baseboards, under light switches

34
Q

Signs and sx of bed bugs

A
  1. Red bite, darker in the center
  2. Itchy
  3. Linear or clustered appearance
    - “breakfast, lunch and dinner bit– 3 bites in a row”
  4. Face, neck, arms, hands, back
  5. Severity varies, with systemic allergic symptoms of urticaria and itching possible
35
Q

Tx of bed bugs

A
  1. Topical steroid cream and antihistamine cream
  2. Diphenhydramine for systemic symptoms
  3. Monitor for infection, antibiotics as needed (secondary infection from scratch)
  4. need to wash and dry everything on HIGH heat
36
Q

What electrolyte abnormality might you expect with heat stroke?

A

Hypovolemic hypoatremic–> risk for cerebral pontine myelinolysis w/ rapid IV fluids

37
Q

Signs and sx of Hymenoptera (stings)

A
  1. Immediate pain**
  2. Swelling and redness
  3. Itching
  4. Localized urticaria
  5. Anaphylaxis
38
Q

Tx of Hymenoptera (stings)

A
  1. Remove the stinger**
  2. Wound care
  3. Supportive care (itch and pain)
  4. Antihistamines
39
Q

Signs and sx of anaphylaxis

A
  1. Urticarial rash
  2. Swelling of lips, tongue, hands, feet
  3. Dysphagia
  4. Dyspnea
40
Q

Tx of anaphylaxis

A
  1. Epinephrine
  2. Diphenydramine
  3. Famotadine
  4. Prednisone
  5. 6 hours of monitoring
41
Q
  • Swelling of deeper tissues

- May be seen with allergic reactions

A

Angioedema

*due to bradykinin

42
Q

Tx of angioedema

A
  1. epi
  2. antihistamines
  3. steroids
    * * might have to support the airway
  4. Icatiband (new med that helps with angioedema complications)
  5. +/- FFP

*4 and 5 are for ACEI angioedema

43
Q

Coral snakes:
Snake colors: “red on yellow, ____”
“red touches black, __”

A
  • red on yellow, kill a fellow

- red touches back, safe for jack”

44
Q

What are side effects of antivenin

A

Monitor for anaphylaxis and serum sickness (can be days after)

45
Q

In general for spider bites management includes

A

-most the time its wound care and have pt monitor for systemic sx and reassurance

46
Q

Describe the organ system involvement with anaphylaxis

A

4 organ systems involved:

  1. Skin: urticaria, flushing
  2. Resp.: stridor, wheezing, tachypnea
  3. CV: decreased BP, syncope,
  4. GI: N/V, diarrhea

*If they have 2 or more of these sx (from diff. symptoms) they are having anaphylaxis and use epi!

47
Q

Angioedema is a SE of what medication

A

ACEI

Emergency Medicine (22 decks)

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