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Clinical Disciplines-ER > Environmental > Flashcards

Environmental Flashcards

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1
Q

Define Hypothermia

A

core temperature < 95°F

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2
Q

Define conduction heat loss

A

Transfer of heat by direct contact: Water immersion

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3
Q

Define convection heat loss

A

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

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4
Q

Define radiation heat loss

A

uses electromagnetic transmission

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5
Q

Define Evaporation heat loss

A

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

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6
Q

At what temperature does shivering stop?

A

90°F (32.2°C)

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7
Q

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

A

86°F (30°C)

Osborn J wave

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8
Q

At what temperature should you withhold cardiac medications and defibrillation

A

> 82.4°F (>28°C)

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9
Q

Hypothermia treatment

A
  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
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10
Q

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

A
  1. Hyperthermia (> 105°F)
  2. CNS dysfunction
  3. Anhydrosis (no sweating)
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11
Q

List the vespids

A
  1. Yellow Jackets
  2. Hornets
  3. Wasps
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12
Q

List the Apids

A

Honey

Bumblebees

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13
Q

What is the MCC of allergic reaction secondary to insect stings

A

Yellow Jacket= Hymenoptera Sting

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14
Q

What is the MCC of death from envenomation

A

Upper airway obstruction

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15
Q

Hymenoptera Sting Treatment

A
  1. Remove stinger
  2. Apply ice pack and elevate extremity
  3. Antihistamines – Benadryl
  4. Epinephrine
  5. Steroids
  6. Beta agonists
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16
Q

Where are brown recluse spiders MC?

A

Midwestern and southern US

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17
Q

Brown recluse appearance

A

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

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18
Q

What is the most active enzyme in the brown recluse?

A

Sphingomyelinase D

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19
Q

Skin Appearance from brown recluse bite

A

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

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20
Q

Brown recluse bite treatment

A

Supportive
No antivenin available
Surgery once clearly demarcated

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21
Q

Another name for brown recluse?

A

Loxosceles

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22
Q

Another name for black widow spider

A

Latrodectus

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23
Q

Where are black widow spiders MC?

A

North America

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24
Q

Black widow appearance

A

Shiny black with red hourglass on abdomen

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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

Clinical Disciplines-ER (4 decks)

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