Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

5th Time I've made a new class > ENVIROMENTAL NON-TRAUMA > Flashcards

ENVIROMENTAL NON-TRAUMA Flashcards

1
Q

What is a common pathogen found in wound infections from dog bites

A

Pasteurella multocida

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are examples of mosquito-borne illnesses?

A

Encephalitis
Yellow fever
Dengue
Chikungunya
Zika
Lymphatic filariasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are Hymenoptera insects?

A

Ants
Bees
Wasps
Insects that sting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the signs and symptoms of a black widow spider bite?

A

Generalized muscle pains
Muscle spasm
Rigidity
Abdominal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the treatment for a brown recluse spider bite

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the signs and symptoms of a scorpion sting

A

Muscle cramps
Twitching and jerking
Occasional hypertension
Convulsions
Pulmonary edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the treatment for scorpion bites

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the treatment for a jellyfish sting

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

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

A

Cone shell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the treatment for someone who has come in contact with coneshell

A

Pressure immobilization dressing and supportive care to include close monitoring of respiratory status

MEDEVAC. Usually resolves in 24-72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the treatment for a stingray or sting fish

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is defined as survival, at least temporarily, after suffocation by submersion in a liquid medium

A

Nonfatal drowning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What factors increase the risk of drowning

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are some physical findings of near drowning

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the treatment for near drowning

A

Rescue and immediate resuscitation
CPR if needed
Intubate if criteria is met
Supplemental oxygen to maintain spo2 above 94%
Remove wet clothes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

When would you intubate a near drowning patient

A

Signs of neurological deterioration
Inability to maintain a PaO2 above 60mmhg or SPO2 above 90%
PaCO2 above 50 mmhg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are examples of biological contaminants

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are five bacteria that commonly produce soft tissue infections in association with exposure to water or water related animals

A

Aeromonas species
Edwardsiella tarda
Erysipelothrix rhysiopathiae
Vibrio vulnificus
Mycobacterium Marinum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are examples of trauma that leads to infection

A

Puncture wounds due to fish hooks
Fish spines and lacerations due to boat motor propeller blades
Other objects present while swimming or wading

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the recommended initial empiric therapy for biologically contaminated water

A

Cephalexin 250mg po QID
Or
Clindamycin + Levofloxacin + metronidazole (flagyl)
Use if exposure to sewage- contaminated water or if soil - contaminated wound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the initial approach to any toxic inhalation situation

A

Scene safety is paramount

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Once the patient exposed to toxic inhalation is safely accessible to the IDC what is the mainstay of treatment

A

Supportive care with
High flow 100% oxygen
BVM ventilation - if requireed
Endotracheal intubation (ETI) as needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Inhaled agents manifest their toxic effects by four different mechanisms, what are the four mechanisms

A

Physical particulates
Simple asphyxiants
Chemical irritants
Chemical asphyxiants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is an example of physical particulates

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the signs and symptoms of physical particulate exposure

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the treatment for physical particulate exposure

A

Remove patient from source
Patients with signs of reactive airway disease should be treated with nebulized albuterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are examples of simple asphyxiants

A

They cause injury by merely being present in an environment and displacing the normal levels of atmospheric oxygen

Carbon dioxide
Nitrogen
Methane
Natural gas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

If the simple asphyxiants is CO2 how might the patient appear

A

Patients may experience a narcotic-like sleepiness as the initial effect of exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is the treatment for someone who has came in contact with a simple asphyxiants

A

The mainstay is gaining safe access to the patient
Administration of high concentration oxygen
cardiopulmonary support as needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are chemicals that are high reactive with water called

A

Hydrophilic chemicals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are hydrophilic inhaled agents

A

Hydrochloric acid
Ammonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What symptoms does someone have if they have come in contact with hydrophilic inhaled agents

A

These react quickly to moist membranes of the eyes and upper respiratory tree causing immediate intense burning and pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is the treatment for chemical irritants

A

Supportive care and irrigation of the eyes with water or saline
Patients with underlying asthma or COPD will likely benefit from nebulized albuterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is the most common example of a chemical asphyxiants

A

Carbon monoxide

Other examples are cyanide gas and hydrogen sulfide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What are signs of CO poisoning

A

Headache
Chest pain
Decreasing mental status
Frequently the patient progresses to a coma and death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the treatment for CO poisoning

A

Supportive care with high flow oxygen via NRB or ET tube for comatose patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is the characteristic smell associated with H2S

A

Rotten egg smell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

How does someone with cyanide poisoning present

A

Unresponsive, hyperventilation and hypertension without evident cyanosis

  • you don’t see cyanosis with cyanide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the sequence of administration of the typical cyanide antidote kit

A

Inhaled amyl nitrate
IV sodium nitrate
IV sodium thiosulfate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What has been shown to enhance the effectiveness of IV cyanide antidotes

A

High flow oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

what are the factors at presentation that have been associated with poor prognosis for near drowning

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

what type of body of water has a generally less concern for contamination.

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

what is the most common route for posioning

A

Ingestion

other forms include: inhale, injection, transdermal, ocular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

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

A

toxidrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

what are Anticholinergic agents

A

Antihistamines (primarily diphenhydramine), phenothiazines, muscle relaxers, antidepressants. Jimson weed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

what are Anticholinergic Sx:

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

what is the emergency care for an anticholinergic overdose

A

mostly supportive
iv, o2, monitor
GI decontamination with activated charcoal
treat hyerthermia and seizures (benzos)
acutely aggitated then give benzo
MEDEVAC/MEDADVICE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what is the most serious adverse effect of SSRI’s

A

serotonin syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

what are the clinical features of serotonin syndrome

A

Cognitive/Behavior- confusion, agitation, coma, anxiety, hypothermia
Autonomic- hyperthermia, tachycardia, dialated pupils, salivation
Neuromuscular- MYOCLONUS, rigidity, tremor, ataxia, nystagmus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

what is the treatment for serotonin syndrome

A

d/c all serotoninergic agents and provide supportive care
MEDEVAC to closest ED
Administer benzos for muscle rigidity or seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What are examples of sedative and hypnotics

A

barbiturates
benzodiazepines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

how would a patient present if they ingested a sedative or hypnotic

A

Respiratory depression is the most common vital sign abnormality in severe overdoses
sedation
dizziness
slurred speech
confusion
ataxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

what is the treatment for sedative and hypnotic ingestion

A

assess airway and stabilize ABC’s
activated charcoal
flumazenil/romazicon - limited role
medevac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

what is the mainstay of treatment for ethanol intoxication

A

observation and supportive care

75
Q

Opiods are an agonist on what three receptors

A

Mu
Kappa
Delta

76
Q

what receptor is responsible for analgesia, sedation, respiratory depression, and cough supression

A

Mu receptors

77
Q

what are the clinical features of opiod ingestion

A

cns depression
miosis
respiratory depression
bradycardia
hypothermia
death may result from resp arrest

78
Q

what is the treatment for opiod intoxication

A

airway and ventilator support are most important consideration
activated charcoal
Naloxone (narcan)

79
Q

what are the clinical features of cocaine, amphetamines, stimulants ingestion

A

psychomotor agitation
mydriasis
diaphoresis
tachycardia
tachypnea
hypertension
hyperthermia

80
Q

what is the treatment for stimulant ingestion

A

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
Q

ASA toxicity causes respiratory alkalosis due to direct effect on what

A

the medullary respiratory center

82
Q

what is the acid base status criteria for ingestion of salicylates

A

150mg/kg - mild- N/V/ GI irriation

150mg/kg - 300mg - mod - vomit, tachypnea, tinnitus, sweating

> 300mg/kg - severe

83
Q

what are the symptoms of someone who ingested a toxic amount of salicylates

A

tachypnea
tinnitus
N/V
acid base abnormalities
AMS
Pulmonary edema
arrhythmia
hypovolemia
thrombocytopenia
hepatic effects

84
Q

what is the treatment for salicylate intoxication

A

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
Q

what is the major cause of overdose and overdose related liver failure

A

acetaminophen (APAP)

86
Q

what are the stages of APAP toxicity

A

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
Q

what is the treatment for APAP toxicity

A

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
Q

what is the pathophysiology of insecticides/organophosphate

A

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
Q

what are the clinical features of nerve agents

A

SLUDGE
salivation
lacrimation
urinary incont
defecation
GI pain/dismotility
Emesis

90
Q

what is the treatment for nerve agent exposure

A

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
Q

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

A

heat edema

92
Q

what is the treatment for heat edema

A

no special treatment. can elevate legs and use support hose if patient insists on tx

93
Q

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

A

prickly heat, also called Miliaria

94
Q

what is the treatment for prickly heat aka miliaria

A

chlorhexidine in a light cream or lotion

95
Q

what is painful, involuntary, spamodic contractions of skeletal muscles, usually those in the calves, although they may involve the thighs and shoulders

A

heat cramps

96
Q

what is the treatment for heat cramps

A

fluid and salt replacement
rest in cool enviroment
cases of heat cramps will respond to IV rehydration with NS

97
Q

what is hyperventilation resulting in respiratory alkalosis, paresthesia of the extremities, circumoral peresthesia, and carpopedal spasms

A

heat tetany

98
Q

what is the treatment for heat tetany

A

remove from the heat and decrease resp rate.

99
Q

what is postural hypotension resulting from the cumulative effect of relative volume depletion, peripheral vasodialation and decreased vasomotor tone

A

heat syncope

100
Q

what is the treatment for heat syncope

A

remove from heat
oral or IV hydration
rest

101
Q

what are the signs and symptoms of heat exhaustion

A

malaise
lightheaded
fatigue
dizziness
n/v
frontal headache
orthostatic hypotension
tachypnea
diaphoresis
syncope
temp can be normal to 104F

102
Q

what is the treatment for heat exhaustion

A

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
Q

what is the signs and symptoms of heat stroke

A

irritability
confusion
bizarre behavior
combative
hallucinations
seizure
coma
CNS dysfunction
any neuro deficit

104
Q

what is the treatment for heat stroke

A

ABC’s
high flow oxygen
continuous cardiac monitor
pulse ox
IV; NS solution
actively cool patient
serial monitor of core temps

105
Q

what is the signs and symptoms of chilblains

A

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
Q

what is the treatment for chilblains

A

supportive
rewarm skin gently
soothing lotion to relieve itching
Nifedipine 30-60mg PO QD x 7days

107
Q

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

A

first degree

108
Q

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

A

second degree

109
Q

what degree of frost bite is when skin forms a black eschar in one to several weeks and feels “like a block of wood”

A

third degree

110
Q

what degree of frost bite extends to muscle and bone. Involves complete tissue necrosis with mummification occuring in 4-10 days

A

fourth degree

111
Q

what is the field treatment for frostbite

A

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
Q

hypothermia is defined as a core temperature below what degree

A

95F

113
Q

what are the temperature stages of hypothermia

A

mild: 90-95F
Moderate: 82-90F
Severe: Below 82F

114
Q

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

A

cold stressed (not hypothermic)
- temperature: 35-37C (95-98F)

115
Q

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.

A

mild hypothermia
- temperature: 32C-35C (90-95F)

116
Q

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

A

moderate hypothermia
- temperature: 28-32C (82-90F)

117
Q

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?

A

severe/profound hypothermia
- Temperature: <28C (<82F)

118
Q

below what temperature does pupils dialate

A

below 29C

119
Q

what lab studies do you want to conduct on someone suspected to have hypothermia

A

FINGERSTICK GLUCOSE* (they need fuel inside to reheat)
ELECTROCARDIOGRAM*
Bun/creatine
CBC
serum lactate
CK
ABG

120
Q

what stage of hypothermia is rewarmed with passive external rewarming such as with a blanket

A

mild

121
Q

what stage of hypothermia is rewarmed with active external rewarming such as with a hypothermic blanket

A

moderate and refractory mild

122
Q

what stage of hypothermia is rewarmed via active internal rewarming and possible extracorporeal rewarming such as with a warmed IV line

A

severe and some cases of refractory moderate

123
Q

if a patient who is hypothermic suffers cardiac arrest when would you not perform resusicitations

A

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
Q

what is the treatment of choice for mild hypothermia

A

passive external warming

125
Q

what are the symptoms of HACE

A

severe headaches
confusion
truncal ataxia
urinary retention
focal deficits
papilledema
nausea/vomiting
seizures

126
Q

what is the treatment for HACE

A

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
Q

decrease in atmospheric pressure reduces PiO2 causing the body to compensate how and leads to what

A

by increasing heart rate, RR, vasodialation, and lactic acid build up (increase in hydrogen ions) leading to acidosis

128
Q

when does symptoms of AMS usually occur

A

usually occurs at elevations above 2500 meters (8250 feet) and more common in unacclimated individuals

129
Q

what is the leading cause of death from altitude illness

A

high altitude pulmonary edema

130
Q

when does HAPE usually occur

A

levels above 3000 meters (9480 feet)

Early symptoms may appear within 6-36 hours after arrival at a high alt area

131
Q

What are the signs of HAPE

A

Incessant dry cough
SOB disproportionate to exertion
Headache
Decreased exercise performance
Fatigue
Dyspnea at rest
Chest tightness

Later = wheezing, orthopnea, hemoptysis

132
Q

What are the physical signs of HAPE

A

May resemble severe pneumonia
Tachycardia
Mild fever
Tachypnea
Cyanosis
Prolonged respiration
Rales and Rhonchi

133
Q

What is High altitude cerebral edema

A

An extension of the central nervous system symptoms of Acute mountain system and results from cerebral vasogenic edema and hypoxia.

134
Q

what is the treatment for HAPE

A

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
Q

What is defined as circulatory insufficiency that creates an imbalance between tissue oxygen supply and demand resulting in global tissue hypoperfusion

A

Shock

136
Q

What are the 4 categories of shock

A

Hypovolemic
Cardiogenic
Distributive
Obstructive

137
Q

What type of shock is caused by decreased intravascular volume secondary to blood loss or loss of fluid and electrolytes

A

Hypovolemic

138
Q

What can cause hypovolemic shock

A

Trauma
Massive hemorrhage
GI bleed
Burns
VOMITING AND DIARRHEA
Excess sweating
DKA - hyperosmolar states

139
Q

What are some signs of hypovolemic shock

A

Tachycardia
Hypotension
Mental status change
Oliguria
Cold extremities
Weak pulse

140
Q

What is the treatment for hypovolemic shock

A

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
Q

What is cardiogenic shock

A

Pump failure secondary to AMI, cardiac contusion, arrhythmia, valvular incompetence, or stenosis

142
Q

What are the findings of someone having cardiogenic shock

A

Hypotension
Mental status change
Oliguria
Cool extremities
JVD
Tachypnea
Pulmonary edema
Irregular pulse if arrhythmia

143
Q

What is the treatment for cardiogenic shock

A

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
Q

What type of shock causes a reduction in systemic vascular resistance

A

Distributive

145
Q

What are the etiologies of distributive shock

A

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
Q

What is the most common cause of distributive shock

A

Septic

147
Q

What are the findings for septic shock

A

Evidence of infection (fever/tachycardia) in setting of persistent hypoperfusion
CBC- elevated WBC
Hx should tell you

148
Q

What are the findings of anaphylaxis shock

A

Diffuse urticaria, angioedema, bronchospasm, SOB, fullness of throat, hoarseness

History of insect bite, exposure to certain food

149
Q

What are the findings of neurogenic shock

A

Evidence of spinal cord injury and hypotension without tachycardia
Unresponsive to fluid resuscitation, bradycardia
Warm, dry skin

150
Q

What is the treatment for septic shock

A

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
Q

What is the treatment for anaphylaxis shock

A

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
Q

What is the treatment for neurogenic shock

A

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
Q

What is shock mostly due to extra cardiac causes of cardiac pump failure and often associated with poor right ventricle output

A

Obstructive

154
Q

How does obstructive shock present

A

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
Q

What imaging would be useful in obstructive shock

A

Chest X-ray
CT of chest looking for PE
Echocardiogram for cardiac tamponade
Abdominal pressures performed through foley

156
Q

What is the treatment for obstructive shock

A

ABCs, IV, O2, Monitor
Thrombolytics or Thrombus retrieval for PE’
Needle D/Chest tube for PTX
Pericardiocentesis to drain pericardial fluid
IV fluids

157
Q

What is a life threatening condition of circulatory failure

A

Shock

158
Q

What is cardiac output

A

Stroke volume x heart rate

159
Q

What is overwhelming infection with a massive release of bacterial endotoxins causing inability to maintain perfusion

A

Sepsis

160
Q

What is caused by massive histamine release and other vasoactive substances causing systemic vasodialation, potential airway compromise due to airway edema and bronchospasm

A

Anaphylaxis

161
Q

What is caused by spinal cord injury resulting in loss of sympathetic stimulation and reduction in systemic vascular resistance.

A

Neurogenic

162
Q

What is obstructive shock caused by

A

Massive PE
Tension pneumothorax
Pericardial tamponade
Restrictive cardiomyopathy
Abdominal compartment syndrome

163
Q

what antibiotic is used to treat cat bites

A

amoxicillin/calvulanate 875/125mg BID
or
500/125mg TID

164
Q

what level of hypothermia does shivering cease

A

severe

165
Q

what temperature is considered heat stroke

A

over 104F

166
Q

in advance stages of toxcitity from multiple stings, what will the victim experience

A

increased muscle activity
acute tubular necrosis
renal failure
panreatitis
coagulopathy
heart attack
stroke

167
Q

what diseases do ticks transmit

A

lyme disease
RMSF
relapsing fever
colorado tick fever
ehrlichoisis
babesiosis
tularemia
southern tick associated rash illness (STARI)

168
Q

what are the signs of a cytolitic snake bite

A

local pain
redness/swelling
perioral tingling
metallic taste
nausea and vomitting
hypotension
coagulopathy

169
Q

what marine lifes toxin is heat liable

A

stingray
hot water - 40-45C / 104-113F

170
Q

what is the most common physical particulate

A

soot

171
Q

what are the four simple asphyxiants

A

carbon dioxide
nitrogen
methane
natural gas

172
Q

what are the water loving or hydrophilic chemical irritants

A

hydrochloric acid
ammonia

173
Q

what is the most common chemical asphixiant

A

carbon monoxide

174
Q

what is a toxidrome

A

refers to the collection of signs and symptoms after an exposure to a substance “toxic fingerprint”

175
Q

what is the most common EKG findings of an anticholinergic tox

A

sinus tachycardia
wide complex tachycardia and prolonged QT interval

176
Q

what are the clinical features of cocaine

A

mydriasis
diaphoresis
tachycardia
tachypnea
hypertension
hyperthermia
may have chest pain, headache, dyspnea or focal neuro complaints

177
Q

what are the methods of GI decontamination in overdose

A

activated charcoal
lavage
syrup ipicac

178
Q

how many doses of NAC in total are given for APAP overdose

A

18 total of N-aceylcysteine

179
Q

what is the pathophysiology of organophosphates

A

binds irreversibly to and inhibit cholinesterases in the nervous system in skeletal muscle

180
Q

what is the toxidrome for organophosphates

A

SLUDGE

181
Q

what is the temperature range for mild hypothermia

A

90-95F

182
Q

when can resusitation measures for someone pulseless and submerged in water stop

A

efforts should be continued til the patients core temp reaches 32-35C or 90-95F

183
Q

What are the most common mechanisms of accidental hypothermia

A

Convective heat loss to cold air
Conductive heat loss to water

5th Time I've made a new class (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions