Environmental Emergencies

Question 1

Who is at risk of frostbite

Answer 1

anyone with increased/prolonged exposure to cold environments
(military, winter sports, outside workers, elderly/young patinets, homelessness, etc)

Question 2

What factors increase your risk of frostbite

Answer 2

temp < 20C of <-4F
hight winds
cold, wet, environments
prolonged exposure
high altitude
pre-existing neurovascular susceptibility

Question 3

what is the progression of frostbite stages

Answer 3

frostnip
frostbite (graded 1-4)
- 1st and 2nd degree = superficial
- 3rd and 4th degree = deep (frostbite)

Question 4

what is superficial frostbite

Answer 4

involves epidermis and dermis
white or yellowish skin
skin numbness
edema
blisters with clear or milky fluid

Question 5

what is frostbite

Answer 5

deeper into the dermis
hemorrhagic blisters
tissue necrosis (eschar)
4th degree = involvement of tissues beyond dermis

Question 6

how is frostbite diagnosed

Answer 6

usually clinical
imaging and labs not typically needed

Question 7

what is the treatment of frostbite

Answer 7

prevent further injury
dont add heat (graudal rewarming over 20-30 min)
give analgesia
dont rub area
apply topical ointment to blisters
apply loose dressings
elevate and immobilize
assess need for tetanus
consider abx

Question 8

what are complications of frostbite

Answer 8

persistent pain - CRPS
cold hypersensitivity
persistent numbness
raynauds
loss of limb/digit/appendage
increased susceptibility to frostbite in future

Question 9

what is Iloprost

Answer 9

vasodilator used in condition such as Raynauds

Question 10

what is the definition of hypothermia

Answer 10

drop of core body tep to 35C (95F) degrees of less
- primary: direct exposure to cold
- secondary - coplication of systemic illness/injury

Question 11

How is hypothermia treated

Answer 11

passive external re-warming (cover head, cover and insulate body)
Active rewarming

Question 12

what is active rewarming

Answer 12

external and core
external: foreced hot hair, heated blankets, radiant heat, hot packs
Core: heated IV fluids, heated/humidified O2, Heated HI irrigation, thoracic lavage (last resort)

Question 13

what are Osborne waves

Answer 13

“j waves” - seen best in inferior and precordial leads
slow, positive deflection at end of QRS

Question 14

what medications are considered with hypothermia cardiac arrest

Answer 14

epinepherine ( medications may be ineffective at low temps)

Question 15

What is heat exhaustion

Answer 15

core temp at or below 40.5C (105F)
usually accompany dehydration or Na+ depletion/dilution
may progress to heat stroke

Question 16

how does heat exhaustion differentiate from heat stroke

Answer 16

preservation of thermoregulation and NO CNS distrubances

Question 16

What is the treatment of heat exhaustion

Answer 16

remove from heat, hydrate +/- electrolyte correcton
evaporative cooling

Question 17

what is heat stroke

Answer 17

medical emergency
types:
- classic: prolonged exposure, older and co-morbidities
- exertional: increased activity/exercise, often higher temps, younger and otherwise health

Question 18

what is heat stroke

Answer 18

loss of thermoregulatory mechanisms
vasoconstriction to maintain MAP

Question 19

what is the diagnostic triad for heat stroke

Answer 19

heat exposure
CNS dysfunction
temp > 40.5 degrees C

Question 20

What is the treatment of heat stroke

Answer 20

ABC/IV/O2/monitor (core temp)
remove from exposure
correct electorolytes

Question 21

what are the three mechanisms of electrical injuries

Answer 21

direct tissue damage from current
direct tissue injury from thermal burns
mechanical trauma from fall, throws, muscle contraction

Question 22

how are electrical injuries diagnosed

Answer 22

report from pt /witness

Question 23

what are Arc burns

Answer 23

thermal burn from indirect electrical current - radiatn heat

Question 25

what are flash burns

Answer 25

thermal injury caused by combustion of material on contact wtih current

Question 26

How are electrical injuries treated

Answer 26

ABCS
address associated injuries (expose everything)
admit for observation and workup

Question 27

how do lightning injuries travel

Answer 27

skin surface, but magnetic field/pressure penetrates throughout

Question 28

what are associated injuries with lightning injuries

Answer 28

cardiac - asystole
ventricular arrhythmias
CNS disruption
intracranial hemorrhage
peripheral nerve damage
blunt trauma

Question 29

what are radiation injuries

Answer 29

exposure through transport, storage, occupational exosure, errors in therapeutic dose
high doses - cell death
low dose - interrupt mitosis - CA

Question 30

what are the radiation safety considerations

Answer 30

time
distance
shielding

Question 31

what is the presentation of acute whole body exposure to radiation

Answer 31

prodrome: N/V/D, anorexia, hypotension, fever, sweating, HA, fatigue
latent phase: symptom free
Manifests: Hematopoetic, GI, Neurovascular collapse

Question 32

what is the general treatment of radiation injuries

Answer 32

treat life threatning injuries first
minimize your own exposure
decontamination

Question 33

at what elevation does altitude sickness occur

Answer 33

elevations higher than 4,800ft within first 24 hours
- usually > 8,000ft and rapid ascent

Question 34

what is the treatment of altitude sickness

Answer 34

self-limited illness
mild cases - pause ascent and supportive tx (acetazolamide and dexamethasone)

Question 35

what is HAPE

Answer 35

High Altitude Pulmonary Edema
pink frothy sputum
usually, day 2-4 after ascent
add O2, positive pressure vent, nifedipine

Question 36

what is HACE

Answer 36

High Altitude Cerebral Edema
HA, ataxia, pailledema, encephalopathy
add O2, and dexamethasone

Question 37

What is HAFE

Answer 37

High Altitude Flatus Expulsion
increase in both volume and frequency of flatus
not as much an emergency as HAPE and HACE

Question 38

What occurs with viperidae

Answer 38

hemolytic changes

Question 39

What is Hymenoptera

Answer 39

bees, wasps, yellow-jackets, fire ants
most symptoms for IgE mediated reactions

Question 40

what is the initial treatment of hymenoptera

Answer 40

remove stinger
disinfect bite site
apply ice
elevation
analgesics, benadryl, calamine lotion
epinepherine
monitor 4 hours in ER

Question 41

what is the advanced anaphylaxis treatment

Answer 41

IV, O2 monitor and fluids
albuterol
IV epi
vasopressors for shock (norepi)

Question 42

what is brown recluse bites

Answer 42

provoking bite
mostly minor injury -edema/erythema in about 3 days

Question 43

what is the treatment of brown recluse bites

Answer 43

RICE
analgesics and antihistamines
abx and tetanus ppx
consider corticosteroids
debridement of large ulcerations and secondary closure

Question 44

what is the progression of black widow bites

Answer 44

within 60 min: cramps at bite site - extremity - trunk
later: abdominal rididity, abd pain
even later: excess salivation, lacrimation, urination, defication, emesis
late stages: respiratory arrest, cerebral hemorrhage, cardiac failure

Question 45

what is the treatment of black window bites

Answer 45

RICE
Mostly supportive, ABC
tetanus
?antivenom

Question 46

what is the definition of near drowning

Answer 46

suffocation wtih submersion and survival (immediate)
can occur with or without aspiration
results in ventilation-perfusion mistmatch

Question 47

what is the presentation of near drowning

Answer 47

rales on aucultation, cardiac arrhythmias, AMS
hypoxia, hypercabia, metabolic acidosis

Question 48

what is the treatment of near drowning

Answer 48

rescue breathing ASAP
CPR as necessary
secure airway
administer O2
monitor BP
correct electrolyte abnormalities