Environment & Tox Emergencies: Communicable Infections

Question 1

Measles
(3 C’s)

Answer 1

• high contagious
• incubation period 8-12 days
• conjunctivitis, coryza (stuffy nose), cough
• Koplik spots (near molars)

-maculopapular rash from head to toe

-treat s/s & immunizations

Question 2

Mumps

Answer 2

• contagious 16-18 days

-swollen salivary glans leadt to puffy cheeks and swollen jaw

Question 3

Rubella

Answer 3

• contagious up to a week prior to symptoms and a week after rash
• rash starts on face

-complications is birth defects and arthritis

Question 4

Pertussis
(whooping cough)

Answer 4

• high contagious incubation 7-10 days
• attaches to the respiratory tract and limit the child’s ability to clear secretions

-coryza (sneezing), low grade fever

• paroxysmal bursts of coughing “whooping”
• petechial rash above nipple lien from broken blood vessels
• swab in nasopharynx
• tx with erythromycin, supportive care

Question 5

Chickenpox
(Varicella)

Answer 5

• infectious 48 hr before rash appears

-contagious until all skin lesions crust over

-airborne precautions

• purulent vesicular rash starts on trunk with fever & urticaria (rash)

*No ASA

• varicella zoster vaccine

Question 6

Shingles

Answer 6

• lesions follow path of nerve dermatomes
• pain develops first followed by lesions and do not cross body midline
• pain control and antivirals
• varicella zoster vaccine

Question 7

Diphtheria

Answer 7

• incubation 1-8 days
• sore throat, low grad fever, *thick gray membranes covering tonsils (throat culture)
• tx with erythromycin

Question 8

Mono
(epstein -barr virus)

Answer 8

• spread by body fuids
• fatigue, lymphs, myalgia(muscle aches)
• splenomegaly
  -monospot blood test

Question 9

cdiff

Answer 9

• antibiotic associated diarrhea
• gram +, anaerobic, bacillus
• standard & contact isolation
• treat with flagyl

Question 10

active pulmonary tuberculosis (TB)

Answer 10

• chronic cough, night sweats, fever, chills, weight loss
• CXR, sputum culture
  -negative pressure, standard & airborne
  -tx with rifampin (stains body fluids bright orange) and isoniazid

Question 11

Burns

Answer 11

-carbonaceous sputum & stridor indicates oral burns, intubate immediately
-perform escharotomy for circumferential chest burn and you cannot ventilate

Question 12

Burn Formula

Answer 12

2 adult, 3 peds, 4 electrical

-LR at 2ml/kg x TBSA
-1st half of the total volume of fluid over the 1st eight hours from time of burn injury

*adult urine output 0.5-1.0 ml/kg/hour
*ped urine output 1-2 ml/kg/hour

Question 13

Electrical burns

Answer 13

-risk of rhabodo
- ^ IVF
- ECG monitoring for 24 hrs
-risk of vfib

Question 14

Lightening burns

Answer 14

-Lichtenberg feathering
- ruptured tympanic membrane
-cataracts long term

Question 15

Chemical exposure to lime powder

Answer 15

brush off dry chemical first

Question 16

Chemical exposure to asphalt

Answer 16

cool and apply emollient to loosen, must have physician order

Question 17

Chemical exposure to phenol (carbolic acid)

Answer 17

copious irrigation with 50% MiraLAX and water

Question 18

Chemical exposure to hydrofluoric acid (rust remover)

Answer 18

irrigate for at least 30mins, until pain relief then apply 2.5% calcium gluconate gel

Question 19

Chemical exposure to lye, cement, or ammonia

Answer 19

large volumes of irrigation due to chemical causes liquefaction and destroys tissue

Question 20

What causes carbon monoxide poisoning?

Answer 20

When you breathe Co in, it attaches to and replaces the oxygen on the hemoglobin molecule, resulting in carboxyhemoglobin and reducing the oxygen content of the blood known as the silent killer

Question 21

What is the treatment for carbon monoxide poisoning?

Answer 21

-S/S: headache with n/v, seizures, & cherry red skin

• DX with carboxyhemoglobin (do not trust SpO2)

-TX with 100% high flow o2 with tight fitting mask until level is <10%

Question 22

What causes cyanide poisoning?

Answer 22

-burning of plastics or carpets

-interferes with cellular respiration

Question 23

What is the treatment for cyanide poisoning?

Answer 23

S/S: smell of bitter almonds on breath, headache, dizziness, and seizures

TX: Cyanide kit (inhaled amyl nitrite), IV sodium nitrite, IV sodium thiosulfate or VitB 12 (pink urine)

Question 24

black widow spider bite

Answer 24

-appearance has a red hourglass on abdomen of female spider

-S/S: sting to dull ache of bite, abdominal cramping, muscle spasm, HT, tachycardia, N/V

-TX: ice, elevate, benzos for muscle spasms, anitvenin

Question 25

brown recluse spider bite (fiddle back violin shape)

Answer 25

S/S: painless bite, pruritus, redness, blister, bluish ring, fever, chills, N/V, necrotizing ulcer over time TX: wound care, removal of necrotic tissue, hyperbaric oxygen therapy, antibiotics, steroids

Question 26

pit viper snakes

Answer 26

-most snake bites are dry bites, does no require antivenin -S/S progressive edema, blood filled vesicles -TX: 2 large bore IVs, remove constructive clothing, immobilize limb in neutral position, antivnenom -No ice!

Question 27

coral snakes (red on yellow, kill a fellow; red on black, venom lack)

Answer 27

-neurotoxic venom causing respiratory paralysis -S/S: respiratory distress, local paresthesia, diplopia, ptosis, difficulty swallowing, > salivation -TX: supportive care, possible antivenom

Question 28

stingrays

Answer 28

-venom coated barbed stingers create severe pain and swelling -immerse in warm water for up to 2hrs until relief of pain

Question 29

jellyfish

Answer 29

-nematocysis are stinging darts that fire producing sever pain and reddened welts -TX: rinse in normal saline and remove tentacles using forceps -water stimulates venom

Question 30

dog bites

Answer 30

-associated with underlying crush injury -15% become infected -leave open and consider rabies prophylaxis or watch dog closely for rabies

Question 31

cat bites

Answer 31

-highest rate of infection of animal bites because of long fangs -saliva contains pasteurella which leads to cellulitis -leave wound open unless on face

Question 32

human bites

Answer 32

-saliva carries 10 bacteria per milliliter and can transmit hepatitis B -requires copious irrigation and debridement -usually left open and bulky dressing is applied to decrease movement

Question 33

submersion injury

Answer 33

-inadequate decompression after exposure -increased pressure resulting in bubbles growing in tissues that cause local damage known as the "bends" -body absorbs nitrogen during ascent -S/S: sob, crepitus, numbness & tingling, petechial rash, seizures, joint discomfort -TX: oxygen administration, fluids, analgesic, position patient on left side in Trendelenburg, hyperbaric oxygen therapy