EM Envi 5: Pearls

Question 1

stages of hypothermia

Answer 1

Mild HT I
conscious, shivering

Moderate HT II
impaired consciousness (may or may not be shivering)

Severe HT III
Unconscious, vital signs present

Hypothermic cardiac arrests HT IV
vital signs absent

Question 2

classic ECG findings seen in a hypothermic patient

Answer 2

The classic Osborn J waves usually occur below 32 C

- can be misdiagnosed as ST elevation MI

Question 3

Models of heat injury in heat stroke

Answer 3

classic
exertional
confinement

Question 4

Classic heat stroke

Answer 4

occurs during periods of high environmental heat stress

INcrease in core temp seen is often slow over period of HOURS TO DAYS

Question 5

cardinal feature of heat stroke

Answer 5

altered sensorium

Question 6

considered as early metabolic complication of heat stroke

Answer 6

hypokalemia

Question 7

recommended first aid measures in snake bites

Answer 7

1. retreat
2. remain calm. movemen increases venom absorption
3. immobilize extremity in a neutral position below the heart
4. transport to a medical facility
5. constriction bands

Question 8

dosing of epinephrine

Answer 8

IM, 0.3-0.5 mg
(0.3 to 0.5 mL of 1:1000 conc’n)

pedia:
0.01 mg/kg
(up to 0.3 mg)

Question 9

some indications for referrral for HBOT

Answer 9

Carboxyhemoglobin level ≥25%
pregnancy carboxyhemoglobin level ≥15%
AMI
Hypotension
Severe metabolic acidosis

Question 10

which is used as prevention and treatment of hape?

Answer 10

High altitude pulmonary edema

Nifedipine

Question 11

pathognomonic pattern of lightning injury

Answer 11

lichtenburg

Question 12

most common chemical burns to the scalp in women

Answer 12

acetic acid
“The dilute (<40%) acetic acid solution found in hair-wave neutralizer solutions is perhaps the most common cause of chemical burns to the scalp in women

Question 13

describe alkali burns

Answer 13

produce soft, gelatinous, friable, brownish eschars

Question 14

treatment of acetic acid burn

Answer 14

initial treatment is copious water irrigation

oral antibiotics should be prescribed if the sdalp burn has created open skin lesions

Question 15

remarks on exposur to white phosphorus

Answer 15

wood’s lamp examination aids identification of remaining phosphorus

copper sulfate solution should NOT be used espite its ability to detoxify phosphorus because it causes HEMOLYSIS and INCRESES MORTALITY

Question 16

Most common sites of chemical burns

Answer 16

1. hands

2. eyes

Question 17

critical event in frostbite

Answer 17

endothelial damage, beginning at the point of thaw

Question 18

tissue most susceptible to frostbite

Answer 18

bone marrow

Question 19

tissue leaset susceptible to frostbite

Answer 19

cartilage

Question 20

first degree frostbite

Answer 20

numbness, central pallor with surrounding erythema and edema, desquamation, dysesthesia

“frostnip”

Question 21

second degree frostbite

Answer 21

blister of the skin with surrounding edema and erythema

full-thickness skin freezing
formation of clear blisters filled with fluid rich in thromboxane and prostaglandins

Question 22

third degree frostbites

Answer 22

tissue loss involving the entire thickness of the skin
extends into the subdermal plexus
hemorrhagic blisters form and are assoc’d with skin necrosis and a BLUE-GRAY discoloration of the skin

patient may complain that the involved extremity feels like a “block of wood”, which is followed later by burning, throbbing, and shooting pains

Question 23

fourth degree frostbites

Answer 23

extension into subcutaneous tissues, muscle, bone, and tenden

little edema

skin is mottled with nonblanching cyanosis

eventually forms a deep, dry, black, mummified eschar