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Medicine II: Emergency Medicine > Environmental Emergencies > Flashcards

Flashcards in Environmental Emergencies Deck (52):


Cold tissue injury without frozen tissues


What are the signs and symptoms of chilblains?

Red pruitic lesions where exposed to cold. Lymphocytic vasculitis common

Edema and blistering that is aggrevated by warmth


How do we treat chilblains?

• Elevated on a soft surface, like a pillow
• Allow to warm at room temperature
• DO NOT massage or apply heat


When do we know the damage accrued by frostbite?

Degree determined once area is warmed because all look the same at first


What are the signs and symptoms of frost bite?

Skin is white or blue–white, firm or hard (frozen), cool, and insensitive

Mild frostbite sx: numbness, paresthesias, pruritus, and lack of fine motor control

More severe sx: ↓ ROM, blister formation, and prominent swelling

May not show sx until rewarmed → tenderness/throbbing pn, discolored, loses elasticity, immobile


What are the classifications of frostbite?

First Degree = Freezing w/o blistering; peeling is occasionally present.

Second Degree = Freezing w/ clear blistering.

Third Degree = Freezing w/ death of skin, hemorrhagic blisters, and subcutaneous involvement.

Fourth Degree = Freezing w/ full-thickness involvement (including bone); ultimate loss/deformity of body part


How do we treat frostbite?

Superficial: rewarm by remove wet clothing and apply constant warmth

Full thickness: rewarm in waterbath w/ abx in it; must be 40°C–42°C (104°F–107.6°F). DO NOT begin this unless the threat of refreezing is gone

Protect body part, clean well, give PCN prophylaxis


What is an example of immersion syndrome? What is immersion syndrome?

trench foot; prolonged immersion in cold water causing alternating arterial vasospasm and vasodilatation


What are the signs and symptoms of immersion syndrome?

first = cold and anesthetic

Hyperemia (excessive blood flow to an area) after 24–48 hrs = parts become warm, w/ intense burning and tingling pain, blistering, swelling, redness, ecchymoses, ulceration

Post-hyperemic phase: after 2–6 wks, limbs are cyanotic, w/ ↑ sensitivity to cold


What are the complications of immersion syndrome?

Complications include lymphangitis, cellulitis, thrombophlebitis, and wet gangrene


How do we treat immersion syndrome?

Best before hyperemia stage: Protect from trauma or infection and Rewarm gradually by air exposure (not ice or hot); do not soak or massage skin.

Prevent ulcers by elevation, protection of site
Hospitalize and bed rest until ulcers are healed


What are the signs and symptoms of heat edema?

swelling of feet and ankles due to vasodilatation and venous stasis

Usually in nonacclimatized ppl (elderly), assoc w/ sitting/standing for long time


How do we treat heat edema?

support hose, elevation, NOT diuretics


What is heat syncope?

fainting after exertion in heat. Vasodilation of muscular and cutaneous veins


What are the signs and symptoms of heat syncope?

skin is cool and moist, weak pulse, and transient hypoTN

core temp is normal or mild ↑


How do we treat heat syncope?

rest in recumbent position, cooling, rehydration; eval elderly for other causes of syncope


What are heat cramps?

Spasms of the voluntary muscles of the abdomen and extremities, Due to salt depletion


What are the signs and symptoms of heat cramps?

skin cool or warm, moist or dry. The core temp is normal or mild ↑ while the Serum Na may be norm or low


How do we treat heat cramps?

GATORADE!!!! I swear this is what the book says!!

oral fluid and salt replacement with 0.1–0.2% salt solution OR IV NS; rest for 1-3 days


What is heat exhaustion?

prolonged heat exposure (hours to days) and is due to sodium depletion, dehydration, accumulation of metabolites, or a combination of these factors. Rapidly leads to heat stroke


What are the signs and symptoms of heat exhaustion?

dehydration sx, headache, nausea, vomiting, malaise, muscle cramps, and dizziness.

Core temp <104F, 40C


What are the types of heat exhaustion?

Types: (usually a combo of both)

• Hypernatremic = primary water loss; person in hot environment does not have enough water

• Hyponatremic = primary salt loss; person sweats excessively and replaces w/ pure water


How do we treat heat exhaustion?

put in cool place, rehydration, IV fluids NS or LR

Serum Na may be very low


What is heat stroke?

A dysfunction of the heat-regulating mechanism


What are the signs and symptoms of a heat stroke?

altered mental status (can be coma), skin is hot, flushed, dry (may be sweaty)

The core temp >105.8, 41C
• early- HTN, tachycardia
• late- HypoTN
• liver damage with elevated enzymes, oliguria
• Rhabdomyolysis and multiorgan dysfunction.
• Illness and death result from destruction of cerebral, cardiovascular, hepatic, and renal tissue


How do we treat a heat stroke?

ABCs, cooling is priority (cooling blankets, ice packs, fans, etc), monitor urine output.

Ice packs to axilla, post neck and inguinal regions


How do we get injured by lightning?

Injury from direct strike, splash (i.e. from trees, buildings, fences), step voltage (spreading on ground), upward leaders, and blunt trauma from concussive shockwaves

Injuries include burns, CNS (spinal, cerebral bleeds, seizures, ect), musculoskeletal (fx, blunt trauma), eye injury, and ear injury including hearing loss


What are the signs and symptoms of a lightning burn?

initially pulseless with mottled extremities, AMS

Blown pupil does not equal dead!!! Death from resp arrest (#1), V fib, asystole


How do we treat a lightning injury?

Immediate CPR

Treat like a trauma (c-spine precaution, internal injury). EKG, and laboratory tests including CK, cardiac enzymes, electrolytes, urinalysis with myoglobin, lactate, and hemogram. CT of the head


What are the types of electrical burns?

AC (found in houses) is more dangerous than DC


What are the signs and symptoms of electrical burns?

Shock- V fib, ectopic beats, sinus tachycardia or bradycardia, atrial fibrillation, and asystole. Seizures, deafness, blindness, aphasia, and neuropathy

Burns- small burns may mask extensive internal injury with 3rd spacing and rhabdomylosis • Remove from electric source by turning it off or pulling the victim away with a nonconductive material


How do we treat electrical burns?


Treat circulatory shock and burns as usual


What are the signs and symptoms of snake bites?

edema, hemorrhage, necrosis around site; systemic = hemolysis, thrombocytopenia, coagulopathy, vomiting, and, rarely resp failure


How do we treat snake bites?

1st Aid: none of that tourniquet, suck it out stuff; just immobilize site and hold below heart and transport

Hospital: ABCs, labs, IV access, antivenom





What are the signs and symptoms of bee and wasp stings?



How do we treat bee and wasp stings?

Oral pain control, tetanus prophylaxis, and diphenhydramine, unless anaphylaxis (then tx that)


What are the signs and symptoms of black widow bites?

severe pain in the bitten extremity and muscle spasms of the abdomen and trunk, Severe HTN/↑ HR can occur.


How do we treat black widow bites?

narcotic analgesics and antivenom in the seriously ill


What are the signs and symptoms of brown recluse bites?

local tissue destruction, initial pustule to a bull's eye like lesion to a larger craterlike ulcer


How do we treat brown recluse bites?

tetanus prophylaxis and local wound care


What are the signs and symptoms of scorpion stings?

local reactions including a painful sting site with or without erythema (most are harmless)


How do we treat scorpion stings?

ice for pain; unless it is this certain kind that is not in FL which produces systemic sx then put them in ICU


What are the signs and symptoms of stingray stings?

intense local pain, then 30 min later N/V, weakness, tachycardia, muscle cramps

Severe cases: syncope, paralysis, hypotension, cardiac arrhythmias, and death → RIP Steve Irwin ☹


How do we treat stingray stings?

wound care (irrigate, anesthetize, explore, etc), abx and tetanus


What are the signs and symptoms of sea snake bites?

initial bite is painless, but limb and respiratory paralysis as well as myolysis can occur


How do we treat

same as for land snakes and includes sea snake antivenom if paralysis or myolysis is present


What are the deadly jellies?

The deadly ones: Box Jellyfish, Irukandji, Portugese Man-o-war


What are the signs and symptoms of jelly stings?

extreme pain (local and distant), inflammatory rxn (most are not life threatening)

Systemic sx = bad (nausea and vomiting, autonomic changes, and paralysis)


How do we treat jelly stings?

Box: basic life support, vinegar, compression bandages, antivenom, pain control

Irukandji: supportive care and monitoring for complications

Portugese: remove tentacles, rinse with sea water, cold packs, pain meds


What are the signs and symptoms of near drowning?

unconscious, semiconscious, or awake and apprehensive. Cyanosis, trismus, apnea, tachypnea, and wheezing. A pink froth @ mouth = pulmonary edema. Tachycardia, arrhythmias, hypotension, shock, and cardiac arrest. Decerebrate or decorticate posturing


What is the prognosis and how do we treat near drowning?

Good outcome- rapid recovery of consciousness, quick response to CPR. Vomiting is common

Worse outcome - ARDS, hypoxic encephalopathy, or cardiac arrest

Tx: Maintain in prone position. Immediate CPR ….duh

High flow O2 with PEEP ventilation (positive end expiratory pressure) & Monitor temp and treat hypothermia.