Define Hypothermia
core temperature < 95°F
Define conduction heat loss
Transfer of heat by direct contact: Water immersion
Define convection heat loss
Transfer of heat by movement of heated material: wind disrupting heat around body
Define radiation heat loss
uses electromagnetic transmission
Define Evaporation heat loss
Conversion of liquid to vapor – usually accounts for 10-15% of body heat loss
At what temperature does shivering stop?
90°F (32.2°C)
At what temperature do you see increased arrhythmias? EKG changes?
86°F (30°C)
Osborn J wave
At what temperature should you withhold cardiac medications and defibrillation
> 82.4°F (>28°C)
Hypothermia treatment
- Warmed oxygen and IV fluids
- Active external rewarming
- Gently circulating water* (104-107.6 °F, 40-42°C)
- Active core rewarming
What is the triad of sx’s in heat stroke?
- Hyperthermia (> 105°F)
- CNS dysfunction
- Anhydrosis (no sweating)
List the vespids
- Yellow Jackets
- Hornets
- Wasps
List the Apids
Honey
Bumblebees
What is the MCC of allergic reaction secondary to insect stings
Yellow Jacket= Hymenoptera Sting
What is the MCC of death from envenomation
Upper airway obstruction
Hymenoptera Sting Treatment
- Remove stinger
- Apply ice pack and elevate extremity
- Antihistamines – Benadryl
- Epinephrine
- Steroids
- Beta agonists
Where are brown recluse spiders MC?
Midwestern and southern US
Brown recluse appearance
Light brown to tan in color with dark violin-shaped mark on dorsal cephalothorax
What is the most active enzyme in the brown recluse?
Sphingomyelinase D
Skin Appearance from brown recluse bite
Mildly erythematous lesion–>Firm and Dry–>Bluish blister–>Necrosis
Brown recluse bite treatment
Supportive
No antivenin available
Surgery once clearly demarcated
Another name for brown recluse?
Loxosceles
Another name for black widow spider
Latrodectus
Where are black widow spiders MC?
North America
Black widow appearance
Shiny black with red hourglass on abdomen
What is the venom/toxin the Black widow spider releases?
Alpha-latrotoxin
What it the hallmark clinical presentation with a black widow spider bite?
Muscular cramping
- Abdomen!
- Chest
- Back
Complications of a black widow spider bite?
1 .Shock
- Respiratory Failure
- Coma
Black widow spider bite treatment
- Narcotics
- Benzodiazepines (Valium)
- Antivenin
- Ca Gluconate 10%
Lice treatment
Lindane
Scabies treatment
- Elemite or Lindane
- Calamine lotion
- Oral antipruritic agents (atarax)
- Analgesics
Effects of venom from snake bites?
- Local tissue injury
- Systemic vascular damage
- Hemolysis*
- Fibrinolysis
- Consumption of fibrinogen and platelets
Cardinal features of snake bite
- One or more fang marks
- localized pain
- erythema
- ecchymosis
- progressive edema
Sx’s of a snake bite
- N/V
- Paresthesias of mouth and tongue (metallic taste)
- Tacyhcardia
- Hematuria
- Low platelets
Snake bite treatment
- Elevate extremity
- Constriction bands-2 inches wide, occludes venous outflow only
- Observe- If asymptomatic after 8 hrs, discharge
Who do you always admit with a snake bite?
Children
Antivenin indications in snake bites
- Worsening swelling
- Coagulation abnormalities: low platelets, PT>20 sec
- Systemic effects: Hypotension
- ALL Copperhead bites
List the types of antivenins used in snake bites
- Antivenin Crotolidea Polyvalent (ACP)
2. Polyvalent Immune Fab (CroFab, FabAV)= 5x more potent
What scorpion is ONLY found in AZ?
Centruroides exilicauda (bark scorpion)
Sx’s in a scorpion sting?
- Immediate paresthesia
- Tachcardia
- Increased secretion
- Increased temperature
- Diaphoresis
Pathognomonic findings in a scorpion sting?
- Roving eye movements
2. Tongue Fasciculations
Scorpion sting treatment
- Cool compress
- +/- midazolam continuous infusion
- Anascorp
How do you remove cactus
Elmers glue
What is the one of the MCC of death in children 1-18 y.o?
Drowning
Risk factors for drowning
- African Americans-Except for 0-4 year olds
- Unsupervised bath/pool time
- Bath seat use
- Seizure
- Alcohol use
What are good prognostic factors in drowning?
- Age < 14 years of age
- CPR in the field
- CPR < 25 minutes
- Detectable pulses on arrival
What are poor prognostic factors in drowning?
- Submersion > 5 minutes
- No resuscitation for > 10 minutes
- Fixed and dilated pupils
- GCS < 5
- pH < 7.1
Drowning treatment
- Oxygen if SaO2 < 92%
2. If survive to ER, admit for at least 24 hours
What is the second MCC of accidental death in US?
Thermal burns
What age population has the highest death rates from thermal burns?
- 65+
2. <4 y.o,
First degree burn definition
- Epidermis only
- Painful and red
- No blisters
Give an example of a first degree burn
Sunburn
Second degree burn definition
- Through Dermis=partial thickness
- Blisters
- Painful
Third degree burn definition
- Skin-to-fat=Full thickness
- Charred, pale
- PAINLESS
Burn treatment
- Tetanus prophylaxis
2. IV LR (isotonic saline)
What is the Parkland formula?
Fluid (LR) Administration:
1/2 given in first 8 hours
Remaining ½ over next 18 hours
Burn admission criteria
- 10-50 y.o: Partial thickness > 15% and full thickness > 5%
- < 10yo and > 50yo:
Partial thickness > 10% and full thickness > 3% in
Hyperbaric Tx Indications in CO poisoning
- CO-Hgb >25-30%
- Cardiac involvement
- Severe acidosis
- Transient or prolonged unconsciousness
- Neurological impairment
- Age >36 years old
- Pregnancy
What skin sx would you expect to see in CO poisoning?
Cherry red skin
What is the MCC of cyanide poisoning?
Smoke inhalation
Cyanide is a byproduct of burning
What lab finding is strongly suggestive of cyanide poisoning?
Lactate >8
Clinical/exam findings in cyanide poisoning?
- Severe metabolic acidosis*
- Smells like bitter almonds
- Usually are not cyanotic
Cyanide treatment
- Oxygen
- Hydroxycobalamin=Vitamin B 12
- Amyl nitrite
- Sodium nitrite
- Sodium thiosulfate
What is the cornerstone of therapy in chemical burns?
Hydrotherapy
Are 60-70% of electrocutions high or low voltage sources?
Low voltage
What kind of current is the most dangerous?
Alternating current
What is the most resistant to electrical injuries?
Bone
What is the least resistant to electrical injuries?
Nerves
What is the primary cause of immediate death in electrical injuries?
Cardiopulmonary arrest
What is the MCC of death in direct current lightening injuries?
Cardiac arrest
What is the MC neurological even in lightening injuries?
Temporary LOC
What is Pathognomonic in lightening injuries?
Fernlike pattern rash
