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Environmental Emergencies Flashcards

(101 cards)

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1
Q

Distribution of Electrical Injuries

A

Young children

Adults

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2
Q

Severity of Electrical Injuries

A 
Voltage
Duration
Type (AC, DC)
Current path through body
Environmental factors
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3
Q

Greatest Damage in the Body from Electrical Injuries

A

Nerves
Blood vessels
Muscle

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4
Q

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

A

Exit wound site

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5
Q

Low Voltage AC Current Effects

A

Muscular tetany

Continuous grasping of source

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6
Q

High Voltage AC and DC Current Effects

A

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

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7
Q

Electrical Cardiac Changes in Low Voltage AC Current

A

V-fib

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8
Q

Electrical Cardiac Changes in High Voltage AC and DC Current

A

Asystole

Respiratory arrest

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9
Q

Physical Exam in Electrical Injuries

A 
Primary survey
Secondary survey
ABC's
C-spine immobilization
2 large bore IVs
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10
Q

CNS Physical Exam Findings

A

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

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11
Q

Spinal Cord Injuries from Electrical Injuries

A

Fractures
Ascending paralysis
Spinal cord syndromes

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12
Q

Peripheral Nerve Injuries from Electrical Injuries

A

Involve hand touching a power source

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13
Q

Cutaneous Wounds in Electrical Injuries

A

Entry/exit points

Degree of burns of entry/exit points

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14
Q

Treatment of Burns from Electrical Injuries

A

Cleansed and dressed with silver sulfadizine

Careful neuromuscular compromise and compartment syndrome

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15
Q

Oral Injuries with Electrical Injuries

A

Kids

Vascular injury to labial artery

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16
Q

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

A

Long bones

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17
Q

Which areas have the greatest destruction in electrical injuries?

A

Deep tissue surrounding long bones

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18
Q

Treatment of Electrical Burns

A 
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
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19
Q

Labs in Electrical Burns

A 
Electrolytes
BUN/Creatinine
Creatine kinase
Serum and urine myoglobin (rhabdo)
CBC
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20
Q

Monitoring in Electrical Burns

A 
CV monitoring
Development of compartment syndrome
I&O: 100+ mL/h
Rhabdomyolysis
Renal Failure
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21
Q

Types of Lightening Strikes

A

Direct strike
Side flash
Ground current
Step potential

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22
Q

What kind of current is lightening?

A

DC current

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23
Q

Effects of Lightening Strikes

A

Immediate cardiac arrest (sustained asystole)

Respiratory arrest

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24
Q

Minor Injuries Associated with Lightening Strikes

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

Emergency Medicine (17 decks)

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