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Flashcards in Environmental Deck (71):
1

Define Hypothermia

core temperature < 95°F

2

Define conduction heat loss

Transfer of heat by direct contact: Water immersion

3

Define convection heat loss

Transfer of heat by movement of heated material: wind disrupting heat around body

4

Define radiation heat loss

uses electromagnetic transmission

5

Define Evaporation heat loss

Conversion of liquid to vapor – usually accounts for 10-15% of body heat loss

6

At what temperature does shivering stop?

90°F (32.2°C)

7

At what temperature do you see increased arrhythmias? EKG changes?

86°F (30°C)
Osborn J wave

8

At what temperature should you withhold cardiac medications and defibrillation

>82.4°F (>28°C)

9

Hypothermia treatment

1. Warmed oxygen and IV fluids
2. Active external rewarming
3. Gently circulating water* (104-107.6 °F, 40-42°C)
4. Active core rewarming

10

What is the triad of sx's in heat stroke?

1. Hyperthermia (> 105°F)
2. CNS dysfunction
3. Anhydrosis (no sweating)

11

List the vespids

1. Yellow Jackets
2. Hornets
3. Wasps

12

List the Apids

Honey
Bumblebees

13

What is the MCC of allergic reaction secondary to insect stings

Yellow Jacket= Hymenoptera Sting

14

What is the MCC of death from envenomation

Upper airway obstruction

15

Hymenoptera Sting Treatment

1. Remove stinger
2. Apply ice pack and elevate extremity
3. Antihistamines – Benadryl
4. Epinephrine
5. Steroids
6. Beta agonists

16

Where are brown recluse spiders MC?

Midwestern and southern US

17

Brown recluse appearance

Light brown to tan in color with dark violin-shaped mark on dorsal cephalothorax

18

What is the most active enzyme in the brown recluse?

Sphingomyelinase D

19

Skin Appearance from brown recluse bite

Mildly erythematous lesion-->Firm and Dry-->Bluish blister-->Necrosis

20

Brown recluse bite treatment

Supportive
No antivenin available
Surgery once clearly demarcated

21

Another name for brown recluse?

Loxosceles

22

Another name for black widow spider

Latrodectus

23

Where are black widow spiders MC?

North America

24

Black widow appearance

Shiny black with red hourglass on abdomen

25

What is the venom/toxin the Black widow spider releases?

Alpha-latrotoxin

26

What it the hallmark clinical presentation with a black widow spider bite?

Muscular cramping
-Abdomen!
-Chest
-Back

27

Complications of a black widow spider bite?

1 .Shock
2. Respiratory Failure
3. Coma

28

Black widow spider bite treatment

1. Narcotics
2. Benzodiazepines (Valium)
3. Antivenin
4. Ca Gluconate 10%

29

Lice treatment

Lindane

30

Scabies treatment

1. Elemite or Lindane
2. Calamine lotion
3. Oral antipruritic agents (atarax)
4. Analgesics

31

Effects of venom from snake bites?

1. Local tissue injury
2. Systemic vascular damage
3. Hemolysis*
4. Fibrinolysis
4. Consumption of fibrinogen and platelets

32

Cardinal features of snake bite

1. One or more fang marks
2. localized pain
3. erythema
4. ecchymosis
5. progressive edema

33

Sx's of a snake bite

1. N/V
2. Paresthesias of mouth and tongue (metallic taste)
3. Tacyhcardia
4. Hematuria
5. Low platelets

34

Snake bite treatment

1. Elevate extremity
2. Constriction bands-2 inches wide, occludes venous outflow only
3. Observe- If asymptomatic after 8 hrs, discharge

35

Who do you always admit with a snake bite?

Children

36

Antivenin indications in snake bites

1. Worsening swelling
2. Coagulation abnormalities: low platelets, PT>20 sec
3. Systemic effects: Hypotension
4. ALL Copperhead bites

37

List the types of antivenins used in snake bites

1. Antivenin Crotolidea Polyvalent (ACP)
2. Polyvalent Immune Fab (CroFab, FabAV)= 5x more potent

38

What scorpion is ONLY found in AZ?

Centruroides exilicauda (bark scorpion)

39

Sx's in a scorpion sting?

1. Immediate paresthesia
2. Tachcardia
3. Increased secretion
3. Increased temperature
4. Diaphoresis

40

Pathognomonic findings in a scorpion sting?

1. Roving eye movements
2. Tongue Fasciculations

41

Scorpion sting treatment

1. Cool compress
2. +/- midazolam continuous infusion
3. Anascorp

42

How do you remove cactus

Elmers glue

43

What is the one of the MCC of death in children 1-18 y.o?

Drowning

44

Risk factors for drowning

1. African Americans-Except for 0-4 year olds
2. Unsupervised bath/pool time
3. Bath seat use
4. Seizure
5. Alcohol use

45

What are good prognostic factors in drowning?

1. Age < 14 years of age
2. CPR in the field
3. CPR < 25 minutes
4. Detectable pulses on arrival

46

What are poor prognostic factors in drowning?

1. Submersion > 5 minutes
2. No resuscitation for > 10 minutes
3. Fixed and dilated pupils
4. GCS < 5
5. pH < 7.1

47

Drowning treatment

1. Oxygen if SaO2 < 92%
2. If survive to ER, admit for at least 24 hours

48

What is the second MCC of accidental death in US?

Thermal burns

49

What age population has the highest death rates from thermal burns?

1. 65+
2. <4 y.o,

50

First degree burn definition

1. Epidermis only
2. Painful and red
3. No blisters

51

Give an example of a first degree burn

Sunburn

52

Second degree burn definition

1. Through Dermis=partial thickness
2. Blisters
3. Painful

53

Third degree burn definition

1. Skin-to-fat=Full thickness
2. Charred, pale
3. PAINLESS

54

Burn treatment

1. Tetanus prophylaxis
2. IV LR (isotonic saline)

55

What is the Parkland formula?

Fluid (LR) Administration:
1/2 given in first 8 hours
Remaining ½ over next 18 hours

56

Burn admission criteria

1. 10-50 y.o: Partial thickness > 15% and full thickness > 5%
2. < 10yo and > 50yo:
Partial thickness > 10% and full thickness > 3% in

57

Hyperbaric Tx Indications in CO poisoning

1. CO-Hgb >25-30%
2. Cardiac involvement
3. Severe acidosis
4. Transient or prolonged unconsciousness
5. Neurological impairment
6. Age >36 years old
7. Pregnancy

58

What skin sx would you expect to see in CO poisoning?

Cherry red skin

59

What is the MCC of cyanide poisoning?

Smoke inhalation
Cyanide is a byproduct of burning

60

What lab finding is strongly suggestive of cyanide poisoning?

Lactate >8

61

Clinical/exam findings in cyanide poisoning?

1. Severe metabolic acidosis*
2. Smells like bitter almonds
3. Usually are not cyanotic

62

Cyanide treatment

1. Oxygen
2. Hydroxycobalamin=Vitamin B 12
3. Amyl nitrite
4. Sodium nitrite
5. Sodium thiosulfate


63

What is the cornerstone of therapy in chemical burns?

Hydrotherapy

64

Are 60-70% of electrocutions high or low voltage sources?

Low voltage

65

What kind of current is the most dangerous?

Alternating current

66

What is the most resistant to electrical injuries?

Bone

67

What is the least resistant to electrical injuries?

Nerves

68

What is the primary cause of immediate death in electrical injuries?

Cardiopulmonary arrest

69

What is the MCC of death in direct current lightening injuries?

Cardiac arrest

70

What is the MC neurological even in lightening injuries?

Temporary LOC

71

What is Pathognomonic in lightening injuries?

Fernlike pattern rash