ENVIROMENTAL NON-TRAUMA Flashcards
(183 cards)
1
Q
What is a common pathogen found in wound infections from dog bites
A
Pasteurella multocida
2
Q
When would you consider prophylactic antibiotics in field conditions
A
Signs of infection
Bite on face < 24 hour or extremity < 8 hrs without irrigation
Immunocompromised state for the victim
Crush injury or significant contamination of would
Bite wounds of the hands or feet
3
Q
What antibiotics would you use for prophylactic treatment of dog or cat bite
A
Amoxicillin/clavulanate (augmentin) 875/125 BID or 500/125 TID
PCN allergy = Clindamycin + Fluoroquinolone 300mg PO q6 hours for 7 days
Or
Ciprofloxacin 750mg po bid for 4-8 weeks
4
Q
In regards to wild animal attacks of larger animals what should you take into consideration for the victims injuries
A
Should raise suspicion of blunt and penetrating trauma, including deep arterial damage, nerve damage and internal organ damage
5
Q
If an animal attack occurs in a natural body of fresh water such as an alligator or crocodile bite, what antibiotics should be used?
A
Antibiotics should be directed against AEROMONAS HYDROPHILIA
- such as, trimethoprim-sulfamethaxazole (Bactrim DS) 800 mg/160 mg P/o q12 hrs for 7 days
Or
Doxycycline 100 mg BID for 7 days
6
Q
If an animal attack occurs in salt (ocean) water, what antibiotics should be used?
A
Antibiotics should be directed against Vibrio species
- such as, Doxycycline + Ceftriazone 1g IV daily
Or
Ceftriaxone 2g IV every 12 hours
7
Q
What are examples of mosquito-borne illnesses?
A
Encephalitis
Yellow fever
Dengue
Chikungunya
Zika
Lymphatic filariasis
8
Q
What are Hymenoptera insects?
A
Ants
Bees
Wasps
Insects that sting
9
Q
What are the signs of a Hymenoptera sting
A
A local reaction is the most common reaction, it consists of small red patch that burns and itches
The generalized reaction is diffuse red skin, hives, swelling of lips no tongue, wheezing, abdominal cramps and diarrhea
Stings to the mouth and throat are more serious because they could cause airway swelling
10
Q
If someone has been stung multiple times, what are some signs and symptoms they may exhibit
A
Vomiting
Diarrhea
Dyspnea
Hypotension
Tachycardia
Syncope
Skin infection
11
Q
What is the treatment for a sting
A
Remove the stinger - scrape away in HORIZONTAL fashion, try not to grab the stinger sac, but it is most important to remove it ASAP by any available means
Wash the site with soap and water
Place cold compress
Give oral analgesic
Topical steroid cream may be helpful or oral antihistamine
If hives occur with wheezing and respiratory difficulty then epi should be given immediately
12
Q
What types of diseases do ticks transmit
A
Lyme
Rocky Mountain spotted fever
Relapsing fever
Colorado tick fever
Ehrlichiosis
Babesiosis
Tularemia
Southern tick-associated rash illness (STARI)
13
Q
What is a non-infectious ascending paralysis similar to Guillain-Barré syndrome that may occur within five days after the tick attaches? What is the treatment?
A
Tick paralysis
- removal of the tick is curative
14
Q
How do you remove a tick
A
Use thin tipped tweezers or forceps to grasp the tick as close to the skin surface as possible
Pull tick straight upward with steady even pressure
15
Q
If Lyme, RMSF, tularemia or ehrlichiosis is suspected what can be initiated while evacuation is being planned
A
Doxycycline
- treatment for tick borne illnesses is supportive yet these may be indistinguishable early in the course, initiating treatment is appropriate
16
Q
What type of snake is a coral snake and what does its bite cause
A
Neurotoxic - cause respiratory paralysis
S/s: pitosis, Dysphagia, diplopia, and respiratory arrest via diaphragmatic paralysis
17
Q
What type of snake is rattle snakes or other pit vipers and what kind of reaction do they cause
A
Cytolytic - cause tissue destruction by digestion and hemorrhage due to hemolysis and destruction of the endothelial lining of blood vessels
18
Q
If a snake has a triangular head, elliptical pupils, keeled scales, nostrils plus IR pit and a single row of subcaudal scales. What type is it
A
Venomous snake
19
Q
If a snake has an oval shaped head, round pupil, no IR pit and double row of subcaudal scales what type is it
A
Nonvenomous
20
Q
A patient was bit by a snake and has local pain, redness, swelling, peri oral tingling, metallic taste, nausea/vomiting, hypotension and coagulopathy. What type of snake likely bit them
A
A cytolitic
21
Q
What is the treatment for a cytolytic snake bite
A
Remove threat and try to ID snake’
Immobilize and maintain bite site in NEUTRAL POSITION
Remove jewelry
Irrigate and clean bite
Do not apply TQ or try to extract venom
Loose dressing
Do not let the patient walk - limit exertion
MEDEVAC
22
Q
What are the signs and symptoms of a black widow spider bite?
A
Generalized muscle pains
Muscle spasm
Rigidity
Abdominal pain
23
Q
What is the treatment for a black widow spider bite
A
Pain may be relieved with pain control and muscle relaxants (benzodiazepines and supportive care)
24
Q
What are the signs of a brown recluse spider bite
A
Progressive local necrosis as well as hemolytic reactions (rare) bite is usually painless
25
What is the treatment for a brown recluse spider bite
Pain management and close monitoring initially
Consider ABx prophylactic in field setting
Bites occasionally progress to extensive local necrosis and may require excision of the bite and oral corticosteroid
26
What are the signs and symptoms of a scorpion sting
Muscle cramps
Twitching and jerking
Occasional hypertension
Convulsions
Pulmonary edema
27
What is the treatment for scorpion bites
Supportive care is appropriate for North American species
Neurological or neuromuscular dysfunction = consult poison control
Suction oral secretions, airway management, cardiac monitor, iv fentanyl, benzo for spasm, unless getting anti venom
28
What is the treatment for a jellyfish sting
Rinse the area with seawater - not fresh water, fresh water promotes nemocyst activation
Remove tentacle with gloved hand, scrape off any remaining nemocyst by covering with sand/shaving cream and scrape off with straight edge or use tape.
Vinegar x 30 seconds deactivates nemocyst
29
What marine life is extremely deadly and presents with mild to severe pain, stinging or numbness, and local to total paralysis when patient comes in contact
Cone shell
30
What is the treatment for someone who has come in contact with coneshell
Pressure immobilization dressing and supportive care to include close monitoring of respiratory status
MEDEVAC. Usually resolves in 24-72 hours
31
What is the treatment for a stingray or sting fish
Remove/irrigate to remove fragments
PLACE WOUND IN WATER HEATED TO 40-45C (104-113F) FOR 30 MIN INTERVALS
Poison control for all envenomations
Local anesthetic can be used if hot water doesn’t work but not in combination
Prophylactic ABx is indicated
- doxycycline 100 mg BID for 7 days
32
What is defined as survival, at least temporarily, after suffocation by submersion in a liquid medium
Nonfatal drowning
33
What factors increase the risk of drowning
Inadequate adult supervision
Inability to swim or overestimation of capability
Risk-taking behavior
Use of alcohol or drugs
Hypothermia
Concomitant trauma, stroke of MI
Seizure disorder
34
What are some physical findings of near drowning
Pulmonary - SOB, crackles and wheezing. Chest radiograph can vary from normal to pulmonary edema
Neurological- edema and elevations in intracranial pressure
Cardiovascular - arrhythmias
Acid base/electrolytes - metabolic or respiratory acidosis
Renal - renal failure rarely occurs
35
What is the treatment for near drowning
Rescue and immediate resuscitation
CPR if needed
Intubate if criteria is met
Supplemental oxygen to maintain spo2 above 94%
Remove wet clothes
36
When would you intubate a near drowning patient
Signs of neurological deterioration
Inability to maintain a PaO2 above 60mmhg or SPO2 above 90%
PaCO2 above 50 mmhg
37
What are examples of biological contaminants
Harmful algal blooms (red tide)
Bacteria - fecal Coli forms
Viruses and parasites that could harm unprotected diver
Biological contaminants may present in storm water run off and pose hazard do not swim or dive within 36 hours of a storm event
38
What are five bacteria that commonly produce soft tissue infections in association with exposure to water or water related animals
Aeromonas species
Edwardsiella tarda
Erysipelothrix rhysiopathiae
Vibrio vulnificus
Mycobacterium Marinum
39
What are examples of trauma that leads to infection
Puncture wounds due to fish hooks
Fish spines and lacerations due to boat motor propeller blades
Other objects present while swimming or wading
40
What is the recommended initial empiric therapy for biologically contaminated water
Cephalexin 250mg po QID
Or
Clindamycin + Levofloxacin + metronidazole (flagyl)
Use if exposure to sewage- contaminated water or if soil - contaminated wound
41
What is the initial approach to any toxic inhalation situation
Scene safety is paramount
42
Once the patient exposed to toxic inhalation is safely accessible to the IDC what is the mainstay of treatment
Supportive care with
High flow 100% oxygen
BVM ventilation - if requireed
Endotracheal intubation (ETI) as needed
43
Inhaled agents manifest their toxic effects by four different mechanisms, what are the four mechanisms
Physical particulates
Simple asphyxiants
Chemical irritants
Chemical asphyxiants
44
What is an example of physical particulates
Small, solid particles that are carried by gases or atmospheric air into the body through inhalation (dust or soot)
- this situation is commonly encountered with cases of smoke inhalation
45
What are the signs and symptoms of physical particulate exposure
Physical findings= burns to the face, signed nasal vibrissae, soot in the oropharynx, nasal passages, proximal airways and carbonaceous sputum
Excessive coughing and some degree of SOB
Upper airway injury = difficulty breathing, edema that impairs airway diameter
Lower airway injury = SOB and productive cough
46
What is the treatment for physical particulate exposure
Remove patient from source
Patients with signs of reactive airway disease should be treated with nebulized albuterol
47
What are examples of simple asphyxiants
They cause injury by merely being present in an environment and displacing the normal levels of atmospheric oxygen
Carbon dioxide
Nitrogen
Methane
Natural gas
48
If the simple asphyxiants is CO2 how might the patient appear
Patients may experience a narcotic-like sleepiness as the initial effect of exposure
49
What is the treatment for someone who has came in contact with a simple asphyxiants
The mainstay is gaining safe access to the patient
Administration of high concentration oxygen
cardiopulmonary support as needed
50
What are chemicals that are high reactive with water called
Hydrophilic chemicals
51
What are hydrophilic inhaled agents
Hydrochloric acid
Ammonia
52
What symptoms does someone have if they have come in contact with hydrophilic inhaled agents
These react quickly to moist membranes of the eyes and upper respiratory tree causing immediate intense burning and pain
53
What is the treatment for chemical irritants
Supportive care and irrigation of the eyes with water or saline
Patients with underlying asthma or COPD will likely benefit from nebulized albuterol
54
What is the most common example of a chemical asphyxiants
Carbon monoxide
Other examples are cyanide gas and hydrogen sulfide
55
What are signs of CO poisoning
Headache
Chest pain
Decreasing mental status
Frequently the patient progresses to a coma and death
56
What is the treatment for CO poisoning
Supportive care with high flow oxygen via NRB or ET tube for comatose patient
57
What is the characteristic smell associated with H2S
Rotten egg smell
58
How does someone with cyanide poisoning present
Unresponsive, hyperventilation and hypertension without evident cyanosis
- you don’t see cyanosis with cyanide
59
What is the sequence of administration of the typical cyanide antidote kit
Inhaled amyl nitrate
IV sodium nitrate
IV sodium thiosulfate
60
What has been shown to enhance the effectiveness of IV cyanide antidotes
High flow oxygen
61
what are the factors at presentation that have been associated with poor prognosis for near drowning
submersion of >5 minutes
time to effective basic life support > 10 minutes
resuscitation duration > 25 minutes
age > 14 y/o
Glascow coma <5
persistent apnea requiring cpr in ED\
Arterial blood pH <7.1 upon presentation
62
what type of body of water has a generally less concern for contamination.
river or large body of water has flow or circulation allowing removal or dilution of suspected contaminants.
closed body of water has no flow and significantly less potential for dilution of contaminants
63
what is the most common route for posioning
Ingestion
other forms include: inhale, injection, transdermal, ocular
64
what refers to the collection of signs and symptoms after an exposure to a substance called a "toxic fingerprint". it includes grouped abnormalities of vitals, appearance, skin, eyes, mucus membranes, lungs, heart, lungs, heart, abdomen and neurological examinations
toxidrome
65
what are Anticholinergic agents
Antihistamines (primarily diphenhydramine), phenothiazines, muscle relaxers, antidepressants. Jimson weed
66
what are Anticholinergic Sx:
Inhibition of PNS
Absent bowel sounds, mydraisis, hyperthermia, dry skin/mucus membranes, urinary retention, confusion/agitation, tachycardia, flushed skin
Pt are commonly acutely agitated however not typically aggressive and violent as compared to sympathomimetic patients
67
what is the emergency care for an anticholinergic overdose
mostly supportive
iv, o2, monitor
GI decontamination with activated charcoal
treat hyerthermia and seizures (benzos)
acutely aggitated then give benzo
MEDEVAC/MEDADVICE
68
what is the most serious adverse effect of SSRI's
serotonin syndrome
69
what are the clinical features of serotonin syndrome
Cognitive/Behavior- confusion, agitation, coma, anxiety, hypothermia
Autonomic- hyperthermia, tachycardia, dialated pupils, salivation
Neuromuscular- MYOCLONUS, rigidity, tremor, ataxia, nystagmus
70
what is the treatment for serotonin syndrome
d/c all serotoninergic agents and provide supportive care
MEDEVAC to closest ED
Administer benzos for muscle rigidity or seizures
71
What are examples of sedative and hypnotics
barbiturates
benzodiazepines
72
how would a patient present if they ingested a sedative or hypnotic
Respiratory depression is the most common vital sign abnormality in severe overdoses
sedation
dizziness
slurred speech
confusion
ataxia
73
what is the treatment for sedative and hypnotic ingestion
assess airway and stabilize ABC's
activated charcoal
flumazenil/romazicon - limited role
medevac
74
what is the mainstay of treatment for ethanol intoxication
observation and supportive care
75
Opiods are an agonist on what three receptors
Mu
Kappa
Delta
76
what receptor is responsible for analgesia, sedation, respiratory depression, and cough supression
Mu receptors
77
what are the clinical features of opiod ingestion
cns depression
miosis
respiratory depression
bradycardia
hypothermia
death may result from resp arrest
78
what is the treatment for opiod intoxication
airway and ventilator support are most important consideration
activated charcoal
Naloxone (narcan)
79
what are the clinical features of cocaine, amphetamines, stimulants ingestion
psychomotor agitation
mydriasis
diaphoresis
tachycardia
tachypnea
hypertension
hyperthermia
80
what is the treatment for stimulant ingestion
mainstay of treatment is adequate sedation and continuous monitoring of vital signs
obtain EKG
benzos will often improve tachycardia, hypertension and agitation
active cooling
treat seizure with benzo
TREAT CARDIAC CHEST PAIN WITH ASA, NITRO, BENZO
81
ASA toxicity causes respiratory alkalosis due to direct effect on what
the medullary respiratory center
82
what is the acid base status criteria for ingestion of salicylates
150mg/kg - mild- N/V/ GI irriation
150mg/kg - 300mg - mod - vomit, tachypnea, tinnitus, sweating
>300mg/kg - severe
83
what are the symptoms of someone who ingested a toxic amount of salicylates
tachypnea
tinnitus
N/V
acid base abnormalities
AMS
Pulmonary edema
arrhythmia
hypovolemia
thrombocytopenia
hepatic effects
84
what is the treatment for salicylate intoxication
ABC, cardiac monitoring, IV access
administer activated charcoal 1gm/kg
check glucose, if low admin glucose (maintain above 80)
admin sodium bicarb if available
85
what is the major cause of overdose and overdose related liver failure
acetaminophen (APAP)
86
what are the stages of APAP toxicity
Stage 1 - first 24 hours - nonspecific. N/V, malaise, anorexia
Stage 2 - day 2-3 - N/V may improve and evidence of toxicity may develop RUQ pain, elevated bilirubin/jaundice
Stage 3 - day 3-4 - progression to hepatic failure. Lactic acidosis, coagulopathy, renal failure, encephalopathy, N/V
Stage 4 - those who survive will begin to recover
87
what is the treatment for APAP toxicity
ABC, cardiac monitor, iv access
NAC (N-acetylcysteine) specific antidote for APAP toxicity.
- Oral/NG tube dose: 140mg/kg loading, then 70mg/kg q4h for 17 additional doses
- IV dose: 150mg/kg loading then 50mg/kg over the next 4 hours then 100mg/kg over next 16 hours
88
what is the pathophysiology of insecticides/organophosphate
binds irreversibly to and inhibit cholinesterases in the nervous system and skeletal muscle. leads to the accumulation of acetyl-choline at synapse and NMJ
89
what are the clinical features of nerve agents
SLUDGE
salivation
lacrimation
urinary incont
defecation
GI pain/dismotility
Emesis
90
what is the treatment for nerve agent exposure
decontamination
- PPE
- Wash patient with soap/water
- handle and dispose runoff
Monitor v/s
ATROPINE 1MG REPEAT Q5MIN UNTIL RESP SECRETIONS IMPROVE
Pralidoxine - 2PAM should not be admin without Atropine, treats neuromuscular dysfunction
MEDEVAC
seizures=benzos
support airway and breathing
91
what is a self limiting process manifested by mild swelling of the feet, ankles, and hands that appears within the first few days of exposure to heat enviroment
heat edema
92
what is the treatment for heat edema
no special treatment. can elevate legs and use support hose if patient insists on tx
93
what is a skin rash caused by trapped sweat travels to the surface becomes clogged. Presents as a pruritic maculopapular rash over clothed areas of the body
prickly heat, also called Miliaria
94
what is the treatment for prickly heat aka miliaria
chlorhexidine in a light cream or lotion
95
what is painful, involuntary, spamodic contractions of skeletal muscles, usually those in the calves, although they may involve the thighs and shoulders
heat cramps
96
what is the treatment for heat cramps
fluid and salt replacement
rest in cool enviroment
cases of heat cramps will respond to IV rehydration with NS
97
what is hyperventilation resulting in respiratory alkalosis, paresthesia of the extremities, circumoral peresthesia, and carpopedal spasms
heat tetany
98
what is the treatment for heat tetany
remove from the heat and decrease resp rate.
99
what is postural hypotension resulting from the cumulative effect of relative volume depletion, peripheral vasodialation and decreased vasomotor tone
heat syncope
100
what is the treatment for heat syncope
remove from heat
oral or IV hydration
rest
101
what are the signs and symptoms of heat exhaustion
malaise
lightheaded
fatigue
dizziness
n/v
frontal headache
orthostatic hypotension
tachypnea
diaphoresis
syncope
temp can be normal to 104F
102
what is the treatment for heat exhaustion
volume and electrolyte replacement and rest
rapid infusion of IV NS
move patient to shade
place pt supine with feet elevated
remove excess clothing
cool patient til core temp is 101
hydrate
transport to ED
103
what is the signs and symptoms of heat stroke
irritability
confusion
bizarre behavior
combative
hallucinations
seizure
coma
CNS dysfunction
any neuro deficit
104
what is the treatment for heat stroke
ABC's
high flow oxygen
continuous cardiac monitor
pulse ox
IV; NS solution
actively cool patient
serial monitor of core temps
105
what is the signs and symptoms of chilblains
pt complains of pruritus and burning paresthesia
localized edema
erythema
cyanosis
The skin is pale, mottled, anesthetic, pulseless and immobile which initially does not change after rewarming
106
what is the treatment for chilblains
supportive
rewarm skin gently
soothing lotion to relieve itching
Nifedipine 30-60mg PO QD x 7days
107
what degree of frost bite is very superficial and has transient burning and stinging, central area of pallor and anesthesia of skin surrounded by edema
first degree
108
what degree of frost bite is large blisters containing clear fluid surrounded by edema and erythema develops in 24 hours. blisters may form eschar but later sloughs off revealing healthy granulation tissue
second degree
109
what degree of frost bite is when skin forms a black eschar in one to several weeks and feels "like a block of wood"
third degree
110
what degree of frost bite extends to muscle and bone. Involves complete tissue necrosis with mummification occuring in 4-10 days
fourth degree
111
what is the field treatment for frostbite
remove wet and constrictive clothes
elevate and wrap extremities involved
dry sterile gauze on affected fingers and toes separated
avoid the cold
DO NOT RUB FROSTBITE AREAS, THIS CAN CAUSE FURTHER TISSUE DAMAGE
Avoid stoves or fires to rewarm tissue.
112
hypothermia is defined as a core temperature below what degree
95F
113
what are the temperature stages of hypothermia
mild: 90-95F
Moderate: 82-90F
Severe: Below 82F
114
if a patient has normal mental status with shivering, functions normally, and is able to care for themselves. what stage of hypothermia are they in and what is the estimated core temp
cold stressed (not hypothermic)
- temperature: 35-37C (95-98F)
115
if a patient is alert but their mental status may be altered, shivering is present, not functioning normally, and not able to care for themselves. Has Tachypnea, tachycardia, initial hyperventilation, ataxia and so called "cold diuresis" what stage of hypothermia are they in and what is the estimated core temp.
mild hypothermia
- temperature: 32C-35C (90-95F)
116
if a patient has a decreased level of consciousness, and may be conscious or unconscious with or without shivering. Has CNS depression, drop in heart rate hypoventilation and hyporeflexia, what stage of hypothermia are they in and what is the estimated core temp
moderate hypothermia
- temperature: 28-32C (82-90F)
117
if a patient is unconscious, not shivering. Has pulmonary edema, hypotension, bradycardia, loss of oculocephalic reflexes, what stage of hypothermia are they in and what is the estimated core temp?
severe/profound hypothermia
- Temperature: <28C (<82F)
118
below what temperature does pupils dialate
below 29C
119
what lab studies do you want to conduct on someone suspected to have hypothermia
FINGERSTICK GLUCOSE*** (they need fuel inside to reheat)
ELECTROCARDIOGRAM***
Bun/creatine
CBC
serum lactate
CK
ABG
120
what stage of hypothermia is rewarmed with passive external rewarming such as with a blanket
mild
121
what stage of hypothermia is rewarmed with active external rewarming such as with a hypothermic blanket
moderate and refractory mild
122
what stage of hypothermia is rewarmed via active internal rewarming and possible extracorporeal rewarming such as with a warmed IV line
severe and some cases of refractory moderate
123
if a patient who is hypothermic suffers cardiac arrest when would you not perform resusicitations
nonsurvivable injury or fatal illness
so frozen, chest compressions are impossible
nose/mouth are blocked with snow
- Efforts should be continued until patient s core temp reaches 32 to 35C (90-95F)
124
what is the treatment of choice for mild hypothermia
passive external warming
125
what are the symptoms of HACE
severe headaches
confusion
truncal ataxia
urinary retention
focal deficits
papilledema
nausea/vomiting
seizures
126
what is the treatment for HACE
immediate descent for at least 610 meters, continuing until symptoms improve
- oxygen
- acetazolamide 250mg orally q8-12h
- dexamethasone 4-8mg orally q6h
- if immediate descent is impossible, a portable hyperbaric chamber should be used
127
decrease in atmospheric pressure reduces PiO2 causing the body to compensate how and leads to what
by increasing heart rate, RR, vasodialation, and lactic acid build up (increase in hydrogen ions) leading to acidosis
128
when does symptoms of AMS usually occur
usually occurs at elevations above 2500 meters (8250 feet) and more common in unacclimated individuals
129
what is the leading cause of death from altitude illness
high altitude pulmonary edema
130
when does HAPE usually occur
levels above 3000 meters (9480 feet)
Early symptoms may appear within 6-36 hours after arrival at a high alt area
131
What are the signs of HAPE
Incessant dry cough
SOB disproportionate to exertion
Headache
Decreased exercise performance
Fatigue
Dyspnea at rest
Chest tightness
Later = wheezing, orthopnea, hemoptysis
132
What are the physical signs of HAPE
May resemble severe pneumonia
Tachycardia
Mild fever
Tachypnea
Cyanosis
Prolonged respiration
Rales and Rhonchi
133
What is High altitude cerebral edema
An extension of the central nervous system symptoms of Acute mountain system and results from cerebral vasogenic edema and hypoxia.
134
what is the treatment for HAPE
immediate descent for at least 610 meters continuing until symptoms improve
oxygen
acetazolamide - 250mg orally every 8-12hrs
dexamethasone - 4-8mg orally every 6 hours
135
What is defined as circulatory insufficiency that creates an imbalance between tissue oxygen supply and demand resulting in global tissue hypoperfusion
Shock
136
What are the 4 categories of shock
Hypovolemic
Cardiogenic
Distributive
Obstructive
137
What type of shock is caused by decreased intravascular volume secondary to blood loss or loss of fluid and electrolytes
Hypovolemic
138
What can cause hypovolemic shock
Trauma
Massive hemorrhage
GI bleed
Burns
VOMITING AND DIARRHEA
Excess sweating
DKA - hyperosmolar states
139
What are some signs of hypovolemic shock
Tachycardia
Hypotension
Mental status change
Oliguria
Cold extremities
Weak pulse
140
What is the treatment for hypovolemic shock
The goal is to maintain adequate tissue perfusion
- fluid replacement of LR, if losing blood then need to give blood transfusion (PRBC,FFP and platelets)
- Vasosupressors such as norepinephrine 0.02, epinephrine 0.014-0.5mcg/kg, or dopamine 1-20mcg/kg
141
What is cardiogenic shock
Pump failure secondary to AMI, cardiac contusion, arrhythmia, valvular incompetence, or stenosis
142
What are the findings of someone having cardiogenic shock
Hypotension
Mental status change
Oliguria
Cool extremities
JVD
Tachypnea
Pulmonary edema
Irregular pulse if arrhythmia
143
What is the treatment for cardiogenic shock
Initial management focuses on airway stability and improving pump function until definitive treatment re-establishes adequate cardiac output
- follow ACLS if cardiac arrest
- Fluid replacement requires smaller fluid challenge (250ml)
- Epinephrine 0.014-0.5mcg
- Dopamine 1-20 mcg/kg
- Dobutamine 2-20mcg/kg
144
What type of shock causes a reduction in systemic vascular resistance
Distributive
145
What are the etiologies of distributive shock
Septic - overwhelming infection with a massive release of bacterial endotoxins causing inability to maintain perfusion
Anaphylaxis - caused by massive histamine release
Neurogenic - caused by spinal cord injury
146
What is the most common cause of distributive shock
Septic
147
What are the findings for septic shock
Evidence of infection (fever/tachycardia) in setting of persistent hypoperfusion
CBC- elevated WBC
Hx should tell you
148
What are the findings of anaphylaxis shock
Diffuse urticaria, angioedema, bronchospasm, SOB, fullness of throat, hoarseness
History of insect bite, exposure to certain food
149
What are the findings of neurogenic shock
Evidence of spinal cord injury and hypotension without tachycardia
Unresponsive to fluid resuscitation, bradycardia
Warm, dry skin
150
What is the treatment for septic shock
ABC’s, O2, IV, monitor
Primary treatment is to treat the underlying infection with early initiation of broad spectrum ABx
- Ertapenum 1g IV daily
Fluid resuscitation with LR
If unresponsive to 2L of fluid then epinephrine, norepinephrine
151
What is the treatment for anaphylaxis shock
ABC’s, O2, IV, monitor
Epinephrine 0.1-0.5mg SC/IM
IV fluids
Benadryl 50mg IV as needed
Zantac 50mg IV q6h prn or 150mg BID
Solumedrol 125mg IM/IV q4h PRN (corticosteroid)
152
What is the treatment for neurogenic shock
ABCDE (trauma primary survey to include neurological exam)
Maintain cervical spine protection
Rapid infusion of LR or NS should treat most hypotension
Secondary survey
153
What is shock mostly due to extra cardiac causes of cardiac pump failure and often associated with poor right ventricle output
Obstructive
154
How does obstructive shock present
Depends on etiology
- Massive PE: shock, JVD, elevated JVP, LE pitting edema
- Tension PTC: deviated trachea, absent breath sounds on one side
- Pericardial tamponade: distal or muffled heart tones, JVD, elevated JVP
155
What imaging would be useful in obstructive shock
Chest X-ray
CT of chest looking for PE
Echocardiogram for cardiac tamponade
Abdominal pressures performed through foley
156
What is the treatment for obstructive shock
ABCs, IV, O2, Monitor
Thrombolytics or Thrombus retrieval for PE’
Needle D/Chest tube for PTX
Pericardiocentesis to drain pericardial fluid
IV fluids
157
What is a life threatening condition of circulatory failure
Shock
158
What is cardiac output
Stroke volume x heart rate
159
What is overwhelming infection with a massive release of bacterial endotoxins causing inability to maintain perfusion
Sepsis
160
What is caused by massive histamine release and other vasoactive substances causing systemic vasodialation, potential airway compromise due to airway edema and bronchospasm
Anaphylaxis
161
What is caused by spinal cord injury resulting in loss of sympathetic stimulation and reduction in systemic vascular resistance.
Neurogenic
162
What is obstructive shock caused by
Massive PE
Tension pneumothorax
Pericardial tamponade
Restrictive cardiomyopathy
Abdominal compartment syndrome
163
what antibiotic is used to treat cat bites
amoxicillin/calvulanate 875/125mg BID
or
500/125mg TID
164
what level of hypothermia does shivering cease
severe
165
what temperature is considered heat stroke
over 104F
166
in advance stages of toxcitity from multiple stings, what will the victim experience
increased muscle activity
acute tubular necrosis
renal failure
panreatitis
coagulopathy
heart attack
stroke
167
what diseases do ticks transmit
lyme disease
RMSF
relapsing fever
colorado tick fever
ehrlichoisis
babesiosis
tularemia
southern tick associated rash illness (STARI)
168
what are the signs of a cytolitic snake bite
local pain
redness/swelling
perioral tingling
metallic taste
nausea and vomitting
hypotension
coagulopathy
169
what marine lifes toxin is heat liable
stingray
hot water - 40-45C / 104-113F
170
what is the most common physical particulate
soot
171
what are the four simple asphyxiants
carbon dioxide
nitrogen
methane
natural gas
172
what are the water loving or hydrophilic chemical irritants
hydrochloric acid
ammonia
173
what is the most common chemical asphixiant
carbon monoxide
174
what is a toxidrome
refers to the collection of signs and symptoms after an exposure to a substance "toxic fingerprint"
175
what is the most common EKG findings of an anticholinergic tox
sinus tachycardia
wide complex tachycardia and prolonged QT interval
176
what are the clinical features of cocaine
mydriasis
diaphoresis
tachycardia
tachypnea
hypertension
hyperthermia
may have chest pain, headache, dyspnea or focal neuro complaints
177
what are the methods of GI decontamination in overdose
activated charcoal
lavage
syrup ipicac
178
how many doses of NAC in total are given for APAP overdose
18 total of N-aceylcysteine
179
what is the pathophysiology of organophosphates
binds irreversibly to and inhibit cholinesterases in the nervous system in skeletal muscle
180
what is the toxidrome for organophosphates
SLUDGE
181
what is the temperature range for mild hypothermia
90-95F
182
when can resusitation measures for someone pulseless and submerged in water stop
efforts should be continued til the patients core temp reaches 32-35C or 90-95F
183
What are the most common mechanisms of accidental hypothermia
Convective heat loss to cold air
Conductive heat loss to water
