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Advanced Med/Surg > Environmental Emergencies > Flashcards

Flashcards in Environmental Emergencies Deck (89):
1

Factor that cause Heat Related Illnesses

  • Humidity above 80%
  • Temperature above 95º F

2

Those at Risk for Heat Related Illness

  • Older adults
  • Blacks (poverty)
  • Construction/Agricultural workers
  • Men
  • Homeless
  • Illicit Drug Users
  • Outdoor athletes
  • Military personnel in countries w/ hot climates

3

Prevention of Heat Related Illness

  • Avoid alcohol & caffeine
  • Rest frequently
  • Limit activity at hottest time of day
  • Wear light weight & light color clothing
  • Check on elderly twice daily
  • Stay in air conditioning
  • Take cool showers

4

heat related syndrome due to dehydration caused by heavy perspiration and inadequate fluid intake w/ symptoms of HA, weakness, N&V in which the body temperature is not significantly elevated

Heat Exhaustion

5

Treatment for Heat Exhaustion

Monitor V/S

Monitor labs (Na+ & K+)

Give cooled IV fluids (NS)

6

medical emergency in which body temperature exceeds 104º F and heat regulatory systems fail leading to organ dysfunction & death

Heat Stroke

7

type of heat stroke that is suddenly onset as a result of strenuous activity in hot, humid conditions

Exertional Heat Stroke

8

type of heat stroke that occurs over a period of time due to exposure to hot, humid conditions generally affecting the ill & elderly

Class Heat Stroke or "Non-exertional" Heat Stroke

9

Key Features of Heat Stroke

  • Temp > 104º F
  • hot, dry skin
    • may or may not perspire
  • mental status change
  • V/S change
  • electrolyte imbalance
  • abnormal clotting

10

Treatment for Heat Stroke

  • Aggressive cooling until rectal temp reads 100º F 
  • High concentration O2
  • cooled IV fluids (NS)
  • Foley

11

Labs Monitored in Heat Stroke

  • Electrolytes
  • Cardiac Enzymes
  • Hepatic Enzymes
  • CBC
  • UA

12

Why do we treat shivering in Heat Stroke patients?

because it burns energy and raises body temp...it can also lead to seizures

13

Pit Vipers include:

rattlesnakes, copperheads, & cottonmouths

14

traingular headed snakes with two retractable, curved fangs that can regulate the amount of venom in their bite

Pit Vipers

15

Envenomation results in:

  • local & systemic toxic effects
  • local tissue necrosis
  • massive tissue swelling
  • fluid shifts
  • pulmonary edema
  • DIC 
  • death

16

Sequence of Symptoms in Pit Viper Bites

  1. pain
  2. bruising
  3. vesicles/bullae
  4. weakness/ N&V/ hypotension/ seizures
  5. chest pain
  6. anxiety
  7. minty/ rubbery/ metallic taste
  8. twitching

17

Pit Viper Bite vicitims need to be on ________ because _______ may occur.

cardiac monitor; dysrhythmias

18

Before coming to the hospital, victims of pit viper bites should:

  • immobilize the area of body bitten
  • maintain that area at level of the heart
  • keep calm

19

Treatment of Pit Viper Bite

  • O2
  • 2 large-bore IVs
  • Cardiac Monitoring
  • BP Monitoring
  • Tetanus Prophylaxis
  • Pain Medication
  • Measure & Document bite site q 15-30 min

20

drug given to snake bite victims made from sheep so that antibody fragments of IgG break down venom toxins

Crotalidae Polyvalent Immune Fab (Crofab)

21

Type III hypersensitivity reaction to Crofab that occurs 3-21 days after administration resulting in rash, fever, joint pain, pruiritus & urticaria

Serum Sickness

22

Crofab is contraindicated if the patient is allergic to _______.

papaya

23

Give Crofab cautiously to patients with:

  • prior known allergy to Crofab
  • Hypersensitivity to pineapples
  • pregnancy

24

Crofab vials are initially reconstituted with ___ mL of NS.

18

25

Crofab is further diluted into ___ mL of NS.

250

26

Initial Crofab dose should be administered over ___ minutes.

60

27

Initial Crofab administration rate is ___mL/ hour for observation of allergic reaction then increased to _____ mL/hour.

25 - 50; 250

28

The recommended initial dose of Crofab is __ to ___ vials.

4 - 6

29

Crofab should be administered within ___ hours of the bite.

6

30

Careful observation is needed during the infusion and for ___ after treatment.

1 hour

31

After Crofab administration, measure ___, _____, & _____ once daily in the hospital and immediately if bleeding occurs.

PT, fibrogen, & platelets

32

After discharge, patients having had Crofab need PT, fibrogen, & platelets measured ___ to ___ days & ____ to ___ days after last dose.

2 - 3; 5 - 7

33

After discharge after Crofab, avoid NSAIDS for ___ weeks.

2

34

snake found in the SE & SW part of the US that are non-aggressive & burrow in the ground with small, upright maxillary fangs

coral snakes

35

coral snakes have _____ & ______ toxins in their venom

nerve & muscle

36

coral snake venom is spread through the ______ system

lymphatic

37

coral snake bites are mildly painful because the vecom affects the ____________.

neurotransmission perception of pain

38

coral snake venom may be delayed ___ to ____ hours

12 -18

39

In severe cases of coral snake bites, ______ & _______ can occur.

respiratory problems & cardiac collapse

40

Early Signs of Coral Snake Bite

  • N&V
  • HA
  • abdominal pain

41

Neurological Symptoms of Coral Snake Bite

  • paresthesias
  • mental status change
  • cranial nerve deficits
  • peripheral nerve deficits

42

Cardiac Symptom of Coral Snake Bite

elevation in CK-Myoglobinuria

43

Before coming to the hospital, victims of coral snake bites should:

  • try to ID & kill snake
  • pressure immobilization of bite area

44

Treatment of Coral Snake Bite

  • continuous monitoring
  • 2 large-bore IVs
  • cross-match for blood products
  • airway support
  • intubation

45

For coral snake bite victims, the nurse should contact _______.

poison control

46

spiders known as fiddleback or violin spiders that hide in dark areas whose bite is either painless or sharply painful and can produce skin ulcers (classic "red, white & blue sign")...some victims show no reaction while others develop necrotic wound in 1-3 days

Brown Recluse Spider

47

First Aid for Brown Recluse Spider bite

  • apply ice during 1st 4 days
  • elevate affected extremity
  • local wound care
  • rest

48

Treatment for Brown Recluse Spider Bite

  • topical antiseptic & dressing
  • pain medication
  • antihistamines
  • antibiotics
  • tetanus prophylaxis
  • skin grafting

49

spider that is shiny black with red hourglass pattern on the abdomen (female) or black with gray & white markings (male) who bite in self-defense with neurotoxic venom who bite is painless or sharply painful leaving tiny red puncture marks with usually no progression besides local reaction

Black Widow Spider

50

Symptoms of Reaction to Black Widow Spider Bite

  • severe abdominal pain***
  • muscle rigidity/ spasm
  • HTN
  • N&V
  • facial edema
  • eyelid drooping
  • twitching

51

Treatment for Black Widow Spider Bites

  • monitor V/S especially BP
  • monitor for seizures
  • give O2
  • pain medication
  • muscle relaxers
  • tetanus prophylaxis

52

insect found in most states that injects venom through their tail producing mild symptoms of pain & inflammation

scorpion

53

Treatment of scorpion bite

  • pain medication
  • wound care

 

54

scorpion whose bite can produce a potentially fatal systemic response that are found in trees & woodpiles or personal items left on the ground like shoes or clothes

bark scorpion

55

Symptoms of Bark Scorpion Bite

  • pain at site upon gentle tapping***
  • cranial nerve deficits
  • skeletal muscle deficits
  • high fever
  • HTN
  • GI disorders
  • pulmonary edema
  • cardian dysrhythmias
    • death (rarely)

56

Treatment for Bark Scorpion Bite

  • monitor V/S
  • give O2
  • IV fluids 
  • ice compress
  • tetanus prophylaxis
  • pain medication
  • wound care
  • contact poison control
  • intubation

57

Systemic effects from bee/wasp stings develop based on _________ & __________.

venom load & patient's sensitivity

58

Symptoms of Systemic Response to Bee/Wasp Sting

  • Nausea/Vomiting
  • Diarrhea
  • Destruction of red/white blood cells and platelets

59

If the patient has an allergy to bee or wasp, the sting will result in:

  • Itching
  • Hives
  • Swelling of lips/tongue rapidly leading to ANAPHYLAXIS!

60

First Aid for Bee/Wasp Stings

  • Quick removal of stinger  by tweezers but also by gently scraping it off with edge of knife blade, credit card, or needle
  • Apply ice

61

Treatment for Bee/Wasp Stings

  • Large bore IV
  • Oxygen support
  • Benadryl
  • Epi pen
  • Protonix
  • Steroids- Solu-medrol

62

For Animal or Human Bites, the Nurse must:

Notify Authorities

63

Most lighting strikes occur during: 

summer afternoons/evenings

64

First Aid for Lightning Strikes:

  • A, B, C’s
  • CPR if in cardiac arrest
  • Spinal Immobilization

65

Prevention of Hypothermia & Frostbite:

  • Layer clothing
    • Wear synthetic instead of cotton
  • Sunscreen
  • Sunglasses
  • Hat

66

core temperature of below 95º F

Hypothermia

67

Conditions that promote hypothermia:

  • Cold water immersion (drowning)
  • Acute illness
  • Advanced age
  • Medications
  • Malnutrition
  • Inadequate shelter

68

First Aid for Hypothermia:

  • Remove wet clothing
  • Apply warm, dry clothes
  • Heating blankets
  • High carb drinks
  • No alcohol or caffeine

69

Treatment for Hypothermia

  • Monitor ABC’s
  • Warm IV fluids
    • Internal rewarming methods (warm fluids in all ways)
  • Oxygen
  • Heated bladder lavage

70

In patient with hypothermia, do not give any drugs until core body temp is above _____ ºF

86

71

least severe type of frostbite consisting of increased blood flow & edema

1st Degree Frostbite

72

type of frostbite consisting of arge fluid filled blisters with skin necrosis

2nd Degree Frostbite

73

type of frostbite with small blisters containing dark fluid affecting body part that is numb, blue or red and does not blanch and necrosis occurs

3rd Degree Frostbite

74

Most severe type of frostbite with no blisters or edema & affected body is numb, cold and bloodless.  Necrosis extends to muscle and bone.  Gangrene develops and amputation may occur.

4th Degree Frostbite

75

First sign of frostbite that means you must get inside and get warm:

white, waxy appearance on nose, cheeks, & ears

76

Treatment of Frostbite:

  • Rapid rewarming in a water bath of 104 to 108 degrees
  • IV fluids
  • IV opiates
  • Keep affected extremity above heart level
  • Assess hourly for compartment syndrome
  • Tetanus prophylaxis

77

syndrome occuring at high elevations resulting in hypoxia

High Altitude Disease (HAD)= Altitude Sickness

78

Supplemental O2 is needed at elevations over _________ feet to prevent illnesses including death.

18,000

79

Risk Factors for High Altitude Disease

  • Obesity
  • Chronic illnesses
  • Cardiovascular disease
  • Alcohol use
  • Dehydration

80

High Altitude Disease becomes common above _______ feet.

8,200

81

Altitude related illness that is the most common cause of death

High Altitude Pulmonary Edema (HAPE)

82

Altitude related illness that is rare but life threatening & has occurred at altitudes as low as 8200 feet

High Altitude Cerebral Edema (HACE) 

83

In high altitudes, early recognition of __________ or __________ is crucial for quick descent to lower levels.

ataxia or change in LOC

84

occurs when water washes out alveolar surfactant leading to alveolar collapse and shunting, shunting leads to hypoxemia & acidosis...air replaced by water

Drowning

85

In drowning, death occurs from ___________ & ___________.

bronchospasm and cerebral edema

86

Questions to ask about drowning victim:

  • How long were they under?
  • Fresh or salt water?
  • Any injuries?
  • Were they drinking alcohol?
  • Temperature of water?

87

First Aid for Drowning

  • Spine stabilization
  • Airway clearance
  • Ventilatory support
  • CPR if needed

88

Treatment for Drowning

  • ABCs
  • NG tube
  • PICC line

89