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Flashcards in Environmental Emergencies Deck (101):
1

Distribution of Electrical Injuries

Young children
Adults

2

Severity of Electrical Injuries

Voltage
Duration
Type (AC, DC)
Current path through body
Environmental factors

3

Greatest Damage in the Body from Electrical Injuries

Nerves
Blood vessels
Muscle

4

Which wound site is often larger than the other in electrical injuries?

Exit wound site

5

Low Voltage AC Current Effects

Muscular tetany
Continuous grasping of source

6

High Voltage AC and DC Current Effects

Single violent muscular contraction
Throw victim from source
Increased risk of blunt/blast injury

7

Electrical Cardiac Changes in Low Voltage AC Current

V-fib

8

Electrical Cardiac Changes in High Voltage AC and DC Current

Asystole
Respiratory arrest

9

Physical Exam in Electrical Injuries

Primary survey
Secondary survey
ABC's
C-spine immobilization
2 large bore IVs

10

CNS Physical Exam Findings

Transient LOC
Agitation, confusion
Coma
Visual disturbances: pupils fixed and dilated or asymmetric

11

Spinal Cord Injuries from Electrical Injuries

Fractures
Ascending paralysis
Spinal cord syndromes

12

Peripheral Nerve Injuries from Electrical Injuries

Involve hand touching a power source

13

Cutaneous Wounds in Electrical Injuries

Entry/exit points
Degree of burns of entry/exit points

14

Treatment of Burns from Electrical Injuries

Cleansed and dressed with silver sulfadizine
Careful neuromuscular compromise and compartment syndrome

15

Oral Injuries with Electrical Injuries

Kids
Vascular injury to labial artery

16

What section of the body generates the greatest amount of heat when exposed to electrical current?

Long bones

17

Which areas have the greatest destruction in electrical injuries?

Deep tissue surrounding long bones

18

Treatment of Electrical Burns

ABCs
C-spine
Dysrhythmias
Aggressive fluid replacement
Labs
EKG
Watch electrolytes closely
Wound care
Myoglobinuria
Tetanus prophylaxis
Treat seizures
General surgeon consult
ENT consult (kids)
OB consult

19

Labs in Electrical Burns

Electrolytes
BUN/Creatinine
Creatine kinase
Serum and urine myoglobin (rhabdo)
CBC

20

Monitoring in Electrical Burns

CV monitoring
Development of compartment syndrome
I&O: 100+ mL/h
Rhabdomyolysis
Renal Failure

21

Types of Lightening Strikes

Direct strike
Side flash
Ground current
Step potential

22

What kind of current is lightening?

DC current

23

Effects of Lightening Strikes

Immediate cardiac arrest (sustained asystole)
Respiratory arrest

24

Minor Injuries Associated with Lightening Strikes

Stunned patient
Confusion, amnesia
Short term memory problems
Headache
Muscle pain
Parasthesias
Temporary visual or auditory problems

25

Other Signs or Symptoms of a Lightening Strike

Pupil dilation
Anisocoria
Ruptured TM
Fern-like erythematous skin marking

26

Treatment of Lightening Strikes

Aggressive resuscitation
ACLS and CPR
Cardiac monitoring, SAO2, BP
2 large bore IVs
High flow O2

27

Secondary Survey for Occult Injuries with Lightening Strikes

Cutaneous burns
Ocular involvement
Auditory involvement
Musculoskeletal fractures

28

Labs for Lightening Strikes

Electrolytes
BUN/Creatinine
Creatine kinase
Serum and urine myoglobin (rhabdo)
CBC

29

Treatment for Lightening Strikes

Labs
Tetanus prophylaxis
Moderate to severe: CCU
Mild: admit, monitor cardiac and neuro status

30

What is the 3rd most common cause of accidental death in the US?

Drowning

31

Near Drowning Risk Factors

Inability to swim
Overestimation of swimming capabilities
Risk-taking behaviors
ETOH or drugs
Inadequate supervision
Hypothermia
Concomitant trauma, CV, MI
Hyperventilation

32

Pathophysiology of Drowning

Period of panic
Loss of normal breathing pattern
Reflex inspiratory efforts
Aspiration
Reflex laryngospasm

33

Pathophysiology of Dry Drowning

Laryngospasm
Hypoxia
LOC

34

Pathophysiology of Wet Drowning

Aspiration of water
Dilution and washout of surfactant
Diminished gas transfer
Atelectasis
V/Q mismatch

35

Pathophysiology of Fresh Water Drowning

Transient hemodilution
Blood cells swell and burst

36

Pathophysiology of Salt Water Drowning

Draws blood out of blood stream
Build up of sodium in alveoli
Decreased/stopping of oxygen from reaching blood

37

Pulmonary End Organ Effects of Drowning

Fluid aspiration
Wash out of surfactant
Non-cardiogenic edema
Acute respiratory distress
S/S of ARDS

38

Neurologic End Organ Effects of Drowning

Neuronal damage
Cerebral edema
Elevated ICP

39

CV End Organ Effects of Drowning

Arrhythmias
Sinus bradycardia
Fibrillation

40

Acid-Base and Electrolyte Effects of Drowning

Metabolic and/or respiratory acidosis
No significant electrolyte imbalances

41

Prehospital Drowning Management

CPR
Neck in neutral position
Rescue breathing
Rewarming

42

ER Management of Drowning

Prehospital efforts continued
Seek out head and spinal cord injuries
Re-warming initiated

43

Re-warming Efforts in Drowning

Blankets
Bair hugger
Overhead warmers
Resuscitative efforts until 32-35C

44

Drowning Victims with CGS 13+ Management

O2
Observation 4-6 hours
Possible discharge home with someone
Reassess/admit

45

Drowning Victims with GCS Less than 13 Management

O2
CXR
Labs

46

Labs in Drowning Victims

ABGs
CBC
CMP
PT/PTT
UA
CK
Urine myoglobin
Urine drug screen

47

Inpatient Management of Neurologic Issues in Drowning Victims

Duration of LOC
Neuro state at presentation
Prevent secondary injury

48

Secondary Neurologic Injuries in Drowning Victims

Cerebral edema
Hypoxemia
Fluid and electrolyte imbalances
Acidosis
Seizure activity

49

Inpatient Management of Pulmonary Issues in Drowning Victims

Intubation for PEEP delivery
CXR when indicated
Bronchospasm: beta agonists

50

Factors Associated with a Poor Prognosis in Drowning

Duration of submersion (10+ minutes)
Time to effective BLS (10+ minutes)
Resuscitation duration (25+ minutes)
Hypothermia with core temp less than 33C
GCS of 5
Less than 3 years
Persistent apnea and CPR in ER
Arterial pH less than 7.1
Water temp 50+ F

51

Define Hypothermia

Core temperature less than 35C or 95F

52

Core Temperature of Mild Hypothermia

90-95F

53

Core Temperature of Moderate Hypothermia

82-90F

54

Core Temperature of Severe Hypothermia

Less than 82F

55

Individuals at Risk for Hypothermia

Elderly
Neonates
Individuals with altered sensorium

56

How is heat loss from the body?

Evaporation
Radiation
Conduction
Convection

57

How is heat preserved by the body?

Peripheral vasoconstriction
Shivering
Increase in metabolic rate

58

Presentation of Mild Hypothermia

Tachypnea
Tachycardia
Hyperventilation
Ataxia
Dysarthria
Impaired judgement
Shivering
"Cold diuresis"

59

Presentation of Moderate Hypothermia

Reduction in pulse and CO
Hypoventilation
A-fib
CNS depression
Hyporeflexia
Decreased renal flow
Loss of shivering
Paradoxical undressing

60

Presentation of Severe Hypothermia

Pulmonary edema
Oliguria
Areflexia
Coma
Hypotension
Bradycardia
Ventricular arrhythmias
Asystole

61

Diagnosing Hypothermia

Low-reading thermometer
Labs
EKG: Osborne or J waves

62

Labs in Diagnosing Hypothermia

Electrolytes
Hematocrit
Coagulation studies
ABGs

63

Management of Hypothermia

ABCs
Passive external rewarming
Active external rewarming
Active internal rewarming
Treat arrhythmias

64

Methods of Active External Rewarming

Warm blankets
Radiant heat
Warm baths
Forced warm air
CORE FIRST

65

Methods of Active Internal Rewarming

Pleural and peritoneal irrigation
Hemodialysis
Cardiopulmonary bypass
Warm humidified oxygen
Warm IV fluids
Bladder or GI irrigation

66

What arrhythmias occur with hypothermia?

A fib
A flutter
V fib
Asystole

67

Define Frostbit

Freezing of tissue

68

Pathophysiology of Frostbite

Immediate cold-induced cell death
Gradual development of localized inflammation and tissue ischemia
Worse in thawing and refreezing

69

Describe 1st Degree Frostbite

Central area of pallor and anesthesia of skin surrounded by edema
Superficial

70

Describe 2nd Degree Frostbite

Blister formation containing clear or milky fluid surrounded by edema/erythema within 24 hours
Superficial

71

Describe 3rd Degree Frostbite

Injury deeper than 2nd degree
Hemorrhagic blisters
Progress to black eschar over several weeks
Deep

72

Describe 4th Degree Frostbit

Extends to muscle and bone
Involves complete tissue necrosis
Deep

73

Presentation of Frostbite

Cold, numbness, and clumsiness of affected area
Insensate, white or grayish-yellow skin
Hard to waxy to touch
Possible bullae
Eschars or tissue necrosis

74

Diagnosis

Clinically
Technetium-99 scintigraphy

75

Prehospital Treatment of Frostbite

Remove wet clothing
Avoid walking on frostbitten feet
Don't rewarm if possibility of refreezing
Do not rub frostbitten areas
Avoid stove or fires to rewarm

76

Prognostic Factors in Frostbit

Temperature and wind velocity?
How long extremity frozen?
Refreezing occur?
Self-treatment?
Recreational drugs or alcohol used?
Predisposing medical conditions

77

Treatment of Frostbite in Hospital

Water bath heated to 40-42 C
Dry heat difficult to regulate
Thawing (15-30 minutes usually)
Bulky dressing
Elevation
Splinting
Tetanus prophylaxis
Topical aloe and ibuprofen
Possible tPA use
Surgical consultation

78

Managing Blisters in Frostbit

Drain, debride, and bandage non-hemorrhagic bullae that interfere with movement
Hemorrhagic bullae drained by aspiration
Minor bullae should be left alone

79

Reasons for Surgical Consult in Frostbite

Long term wound care
Daily hydrotherapy
Repeated debridement
Escharotomy
Possible delayed amputation

80

Short Term Complications of Frostbite

Infection
Gangrene
Autoamputation

81

Long Term Complications of Frostbite

Hypersensitivity to the cold
Increased risk of developing frostbite again
Chronic parasthesias to affected area
Decreased sensation to touch

82

2 Types of Heat Exhaustion

Water depletion
Salt depletion

83

Define Water Depletion Heat Exhaustion

Inadequate fluid replacement by individuals working in a hot environment

84

Define Salt Depletion Heat Exhaustion

Large volumes of thermal sweat are replaced by water with too little salt

85

Signs and Symptoms of Heat Exhaustion

Weakness
Malaise
Fatigue
Headache
Lightheadedness
Dizziness
N/V
Hypotension
Tachycardia
Tachypnea
Diaphoresis
Syncope

86

Treatment of Heat Exhaustion

Cool environment
Volume and electrolyte replacement
Mild: oral replacement
Moderate: 1-2 L saline, guided by electrolytes

87

Define Heatstroke

Life-threatening emergency that occurs when homeostatic thermoregulatory mechanisms fail
Body temp 105+

88

4 Factors Tissue Damage is Affected by

Body temp
Exposure time
Work load
Tissue perfusion

89

Signs and Symptoms of Heatstroke

CNS dysfunction
Cerebral edema
Ataxia
Irritability
Confusion
Bizarre behavior
Combativeness

90

Pathophysiology of Heatstroke

Functional hypovolemia compensated by vasoconstriction of splanchnic and renal vasculature

91

Severe Heat Stress Continues in Heatstroke

Splanchnic vasoconstriction will fail
Heated core blood increases ICP
Decreases mean arterial pressure

92

Diagnosis of Heatstroke

Exposure to heat stress
Signs of severe CNS dysfunction
Core temp 105+
Dry, hot skin
Sweating may persist
Marked elevation of liver transaminases

93

3 Ways Heatstroke can Kill

Vascular shock
Irregular pulse to heart attack
Kidney failure

94

Treatment of Heatstroke

ABCs
Primary survey
Cooling
Airway control
Fluid administration
Foley
Labs
Benzodiazepines (seizures)
Admission

95

Cooling Techniques in Heatstroke

Evaporative cooling
Cold-water immersion
Ice packing
Cold gastric lavage
Cold peritoneal lavage

96

Define Evaporative Cooling

Position fans close to undressed patient then spraying water on patient

97

Disadvantages of Evaporative Cooling

Shivering
Loss of EKG patches

98

Define Immersion Cooling

Place undressed patient in tub of ice water deep enough to cover trunk and extremities

99

Where should ice packs be placed to cool a patient?

Neck
Groin
Axillae

100

When should cooling efforts be discontinued in a patient with heatstroke?

40C or 104F

101

Labs for Heatstroke

ABGs
CBC
CMP
Liver enzymes
Lactate dehydronase
Creatinine phosphokinase
Uric and lactic acid
PT/PTT