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environmental emergencies Flashcards

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1
Q

define hypothermia

A

core temperature 95 or less

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2
Q

classify hypothermia based on mild-mod-sev

A

mild: 89.6-95
mod: 96.98.5
severe: less than 86

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3
Q

define conduction

A

transfer of heat by direct contact (water immersion)

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4
Q

define convection

A

transfer of heat by movement of heated material (wind disrupting heat around body)

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5
Q

define radiation

A

uses electromagnetic transmission

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6
Q

define evaporation

A

conversion of liquid to vapor (10-15% body heat loss)

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7
Q

what is the MCC of hypothermia

A

ethanol

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8
Q

which clothing makes you colder more, wet clothing or not wet?

A

wet clothing

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9
Q

what medical illnesses are related to hypothermia

A

DM, PVD, ASVD, neuropathy, and psychiatric illness

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10
Q

which group is the MC affected by hypothermia?

A

males 30-49 y/o and extremities

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11
Q

what is the pathophysiology of hypothermia?

A

decreased HR
hypoventilation with CO2 retention leading to hypoxia and respiratory acidosis
Decreased mucocillary clearance
Slowed mentation, motor function, and speed of reasoning
Decreased platelet function
Decreased activity of coagulation factors
Cold diuresis
Impaired insulin release
After-drop occurs

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12
Q

when does shivering cease?

A

90F

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13
Q

what occurs at 86F or less (hypothermia)

A

increased arrhythmias (osborn J waves)

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14
Q

when should you withhold cardiac meds and defibrillation

A

until temp 82.4F or greater

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15
Q

how do you treat hypothermia?

A

warmed oxygen and IV fluids (NS)
active external warming (blankets)
gently circulating water
active core warming

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16
Q

what is the pathophysiology of frost bite

A 
cold exposure
formation of extracellular ice crystals which damage cell membranes and their osmotic gradient
intracellular dehydration
intracellular ice crystal formation
cell death
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17
Q

anesthetic central white plaque with peripheral erythema

A

first degree frostbite

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18
Q

clear or milky-filled blisters surrounded by erythema and edema

A

second degree frostbite

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19
Q

hemorrhagic blisters that progress to a hard black eschar

A

third degree frostbite

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20
Q

complete necrosis and tissue loss

A

fourth degree frostbite

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21
Q

how to treat frostbite?

A 
elevate and splint extremity
wrap extremity in dry sterile gauze
debride white or clear blisters
cover with aloe vera every 6 hours
tetanus as indicated
analgesics (ASA/NSAIDS, narcotics)
antibiotics have no role
no smoking
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22
Q

ultraviolet keratitis can develop within ____ hour of exposure

A

1 hour

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23
Q

how does UV keratitis present?

A

does not become symptomatic until 6-12 hours later

severe pain, FB sensation, tearing, conjunctival injection

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24
Q

how do you treat UV keratitis

A

self-limited
analgesics, cold compress
polarized sunglasses

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25
which pts are at risk of heat injuries?
``` age extremes confusional states limited water access alcoholics mental illness chronic disease ```
26
define radiation in regards to heat injuries
occurs when air temp is less than body temp
27
define hyperthermia
rise in body temperature when heat production exceeds heat loss - fever is rise of core body temp in response to circulating cytokines
28
what is the pathophysiology of heat injuries?
increased endogenous heat production decreased heat dispersion thirst is poor gauge of hydration status exercise increases metabolic rate 20-25 times above baseline
29
which meds increase heat production?
``` neuroleptics hallucinogens amphetamines anesthetics LSD cocaine ```
30
which meds inhibit sweating?
``` antihistamines neuroleptics TCAs atropine antispasmodics ```
31
what is the duration of acclimatization of heat injuries for adults/children?
7-10 days for adults | 14 days for children
32
define prickly heat aka heat rash
acute inflammation of sweat ducts caused by blockage of pores pruritic, maculopapular erythematous rash found over clothed areas of body
33
how do you treat prickly heat aka heat rash
antihistamines | supportive care
34
define heat cramps
painful involuntary spasmodic contractions | usually sweat profusely but replace with water only
35
how do you treat heat cramps
rest in cool environment | replacement of fluids and electrolytes
36
what is the presentation of heat exhaustion
dizzy, weak, malaise, N/V, headache, myalgias syncope, orthostasis, sinus tach, tachpnea normal mental status
37
how do you treat heat exhaustion?
rest and volume/electrolyte replacement (Do Mg first before fixing K)
38
what is the triad of heat stroke
hyperthermia (105F or more) CNS dysfunction anhydrosis (not sweating)
39
UV keratitis causes
sun reflecting on water/snow | welding
40
how does heat stroke present?
seizure, decreased BP, increased HR, increased RR increased Na and BUN Decreased K, Ca, Phos, Mg Elevated Transaminate levels 5% develop renal failure (rhabdomyolysis) 25% develop ARDS
41
how to treat Heat stroke?
IV fluids at 250cc/hr with foley to monitor UO Diagnostics Reduce temp rapidly to 104F Remove clothing apply "strategic ice packs" TOC = evaporative cooling Diazepam 0.1-0.3 mg/kg to inhibit shivering
42
What are poor heat stroke prognostic factors?
``` delayed rapid cooling AST 1000 or greater DIC prolonged coma hypotension renal failure in first 48 hours ```
43
How does jellyfish envenomation present?
pruritic pain, wheals, urticaria
44
how do you treat jellyfish envenomations?
vinegar to remove nematocyst (isopropyl alcohol) topical anesthetics oral analgesics no ABX
45
how do stingray/catfish envenomations present?
pain, bleeding
46
how do you treat stingray envenomation?
irrigation, removal of foreign debris hot water immersion ABX controversial
47
what are vespids
yellow jackets, hornets, wasps that sting multiple times
48
what are apids
honey and bumblebees that are barbed stingers
49
what is the MCCC of allergic reaction secondary to insect stings
yellow jacket
50
what is the MCC of death from envenomation?
hymenoptera stings usually from upper airway obstruction
51
where are the nest locations of yellow jackets?
ground
52
where are the nest locations of wasps?
under leaves or window sills
53
where are the nest locations of hornets?
bushes, low-lying limbs
54
how does a local reaction of hymenoptera sting present?
pain, erythema, edema, pruritis, and swelling
55
how do systemic/anaphylactic reactions of hymenoptera stings present?
occur within 15 minutes itchy eyes, facial flushing, urticaria, dry cough, dyspnea, wheezing, abdominal cramps, N/V/D, fever, arthralgias IgE mediated histamine release
56
how to treat hymenoptera stings?
``` clean with soap and water, remove stinger apply ice pack and elevate extremity antihistamines - benadryl epinephrine steroids beta agonists D/C with auto-injector of epinephrine ```
57
brown recluse spider bites are MC where
midwestern and southern us
58
where are brown recluse spiders hiding
woodpiles sheds garages closets
59
what is the most active enzyme of brown recluse spider
sphingomyelinase D
60
how do brown recluse spider bites progress
mildly erythematous lesion that becomes firm and dry over days to weeks and becomes bluish blister then necrosis
61
what are symptoms of brown recluse spider bites?
``` F/C N/V myalgias petechia seizure ```
62
what tests do you order for brown recluse spider bites
CBC BMP Coags UA
63
how to treat brown recluse spider bites?
supportive no antivenin available surgery once clearly demarcated no proven benefit for steroids, ABX, dapsone, early excision, hyperbaric oxygen, topical NTG
64
what is another name for brown recluse spider
loxosceles
65
what is another name for black widow spider
latrodectus
66
where are black widow spiders located?
North America except Alaska
67
where do black widow spiders hide?
attics, barns, sheds, garage, firewood, and hay bales
68
what do black widow spiders look like?
shiny black with red hourglass on abdomen
69
what do brown recluse spider look like?
light brown to tan in color with dark violin-shaped mark on dorsal cephalothorax
70
what is the pathophysiology of black widow spider bites?
alpha-latratoxin venom releases acetylcholine and NE at neurosynaptic junction inhibits their reuptake muscle contractions and fatigue
71
what is the hallmark of envenomation in black widow spider bites
muscular cramping (abdomen > chest, back); onset 30-90 minutes post-bite and peaks in 3-12 hours
72
what are other symptoms of black widow spider bites?
N/V, diaphoresis, HTN, tachycardia, anxiety, agitation, irritability, weakness, H/A, periorbital edema shock, coma, respiratory failure
73
how do you treat black widow spider bites?
narcotics benzodiazepines antivenin (horse serum) - indicated for life-threatening HTN and increased HR, respiratory difficulty, refractory pain, pediatrics, pregnant, and elderly Calcium gluconate
74
how does lice present?
intensely pruritic wheals waists, shoulders, axillae, neck eggs not easily brushed off
75
how to treat lice?
lindane (avoid in young children and pregnant females) fine combing of hairs sterilize clothing and bed liners
76
how do scabies present?
hands and feet between digits | white zigzag threadlike pattern
77
how do you treat scabies?
elemite or lindane calamine lotion oral antipruritic agents (atarax) analgesics
78
what are the snakes that make up 90-95% of bites
rattlesnakes copperheads moccasins
79
what is the MC time for snake bites to occur?
August-October
80
Who is the MC to have a snake bite and where?
Male in his UE | Kids would have in LE
81
What are the cardinal features of snake vites?
one or more fang marks, localized pain erythema ecchymosis progressive edema
82
what are S&S of snake bites?
N/V, weakness, paresthesias of mouth and tongue (metallic taste), tender lymphadenopathy, increased HR, dizzy, hematuria, decreased platelets
83
what tests do you order for snake bites?
CBC, CMP, Coags, UA, T/S
84
How to treat snake bites?
``` elevate extremity constriction bands ABX not indicated Observe for at least 8 hours, if asymptomatic, D/C admit all children with bites Peds treated same as adults ```
85
When are antivenins indicated for snake bites?
worsening swelling, coagulation abnormalities (decreased platelets, PT > 20 seconds), systemic effects (hypotension), all copperhead bites
86
what are examples of antivenins
antivenin crotolidea polyvalent (ACP) | polyvalent immune fab (CroFab, FabAV) - 5.2 times more potent than ACP
87
what is the name for scropions
centruroides excilicauda (bark scorpion)
88
where do you find scorpions?
wood piles, crevices, shoes, clothing
89
what is the pathophysiology of scorpions?
venom activates sodium channels which causes immediate paresthesias, tachycardia, increased secretions, increased temperature, diaphoresis, and SLUDGE
90
how do scorpion stings present?
pathognomonic roving eye movements fasciculations difficulty swallowing
91
scorpion envenomation grade 1
local pain and/or paresthesias
92
scorpion envenomation grade 2
pain and/or paresthesias remote from site of sting
93
scorpion envenomation grade 3
CN/automatic or somatic dysfunction blurred vision, roving eye movements, hypersalivation, tongue fasiculations, dysphagia, dysponia restlessness, involuntary shaking or jerking
94
scorpion envenomation grade 4
CN/autonomic and somatic nerve dysfunction
95
what is the treatment of choice for scorpions?
supportive cool compress +/- midazolam continuous infusion
96
What is anascrop
centruroides immune Fab Equine injection for scorpion sting
97
how does one present with cactus sting?
pain and potential for multiple foreign bodies
98
how can you remove cactus FB?
Elmer's glue
99
how do you treat cactus sting?
all that is required is removal of spines and local wound care
100
define drowning
process resulting in primary respiratory impairment from submersion/immersion in a liquid medium
101
define submersion
entire body is covered in liquid medium
102
define immersion
oral and nasal airways are covered in liquid medium
103
which group of people is drowning the MCC of death?
children 1-18 y/o
104
what are RF for drowning
``` african americans unsupervised bath/pool time bath seat use seizure alcohol use ```
105
what is the pathophysiology of drowning
``` struggle last inhalation effort moment of submersion or immersion tissue hypoxia, acidosis, hypercapnia larygnospasm or aspiration respiratory failure and death ```
106
how much water per kg can compromise surfactant in the alveoli
1-3 mL/kg
107
what is common during the drowning process?
vomiting
108
what are good prognostic factors of drowning
age < 14 y/o CPR in the filed CPR < 25 minutes detectable pulses on arrival
109
what are poor prognostic factors of drowning
``` submersion > 5 minutes no resuscitation for > 10 minutes fixed and dilated pupils GCS < 5 pH < 7.1 ```
110
which type of drowning victims should go to hospital?
all victims of drowning who required any form of resuscitation
111
how long should asymptomatic drowning victims be in hospital?
observed 4-6 hours post event
112
how to treat drowning?
Oxygen if SaO2 < 92% | if survive to ER, then admit for at least 24 hours
113
what is the second MCC of accidental death in US
thermal burns
114
what are the zones of thermal burns?
zone of coagulation zone of stasis zone of hyperemia or inflammation
115
what are the rule of nines for thermal burns
``` Head/neck - 9 Each UE - 9 (9x2) Each thigh - 9 (9x2) Each lower leg/foot - 9 (9x2) Clavicle to pubis - 18 Root of neck thru buttocks - 18 Perineum - 1 ROT = back of hand = 1% BSA ```
116
how does a first degree thermal burn present
epidermis only - painful, red, no blisters - sunburn
117
how does a second, degree, partial thermal burn present
partly through dermis - blisters, painful - hot liquids
118
how does a second degree, deep thermal burn present?
thru hair follicles and sweat glands - hot steam or oil
119
how does a third degree thermal burn present?
skin to fat - charred, pale, painless, leatherly feel
120
what are the major burn criteria
``` partial thickness 25% or more, BSA in 10-50 y/o, 20% or more if 10 year olds or less or 50 year olds or more full thickness 10% or more in anyone any burn to hands, face, feet, perineum any burn crossing major point circumferential limb burn inhalational or electrical injury burn with fractures burns in infants and elderly ```
121
what is minor burn criteria
<15% or less BSA in 10-50 y/o <10% 10 y/o or less or 50 y/o or older full thickness 2% or less BSA
122
how to treat thermal burns?
all get tetanus prophylaxis regardless of current status NG tube LR via 2 large bore peripheral IV's Keep UO 0.5-1.0cc/kg/hr for adult and 1.0cc/kg/hr for children IV narcotics sharply debride open blisters cover with sterile moist dressings without ABX ointment if pt to be transferred If D/C'ed, need 24 hour follow up
123
what is the parkland formula?
4cc/kg/%BSA 1/2 given in first 8 hours postburn remaining 1/2 over next 18 hours
124
what is thermal burn admission criteria?
partial thickness 15% or more and full thickness 5% or more in 10-50 y/o partial thickness 10% or more and full thickness 3% or more in 10 y/o or less and 50 y/o or greater anyone with partial or full thickness burn to face, hands, feet, perineum, across major joint, circumferential limb burn any electrical, chemical, inhalational burn immunocompromised burns with trauma (fractures)
125
3/4 of all fire related deaths are due to this
smoke inhalation (CO and/or cyanide poisoning)
126
suspect smoke inhalation if
``` facial, intraoral, or pharyngeal burns singed nasal hairs soot in mouth or nose hoarseness carbonaceous sputum wheezing ```
127
what is smoke inhalation pathophysiology
CO binds to Hgb to form carboxyhemoglobin CO has affinity for Hgb that is 200x that of oxygen Causes leftward shift of the Hgb oxygen dissociation curve
128
when should you suspect CO poisoning
if you have multiple family members with nonspecific symptoms, which resolve in the ED
129
what are normal CO-Hgb values
normal 2-5%
130
what are CO-Hgb values for msokers
higher 5-13%
131
Based on CO-Hgb levels, what are the symptoms
``` <10% = asymptomatic 10-30% = H/A, N/V, loss of dexterity 30-40% = confusion, lethargy, ST segment depression 40-60% = coma >60% = death ```
132
when is hyperbaric treatment indicated?
``` CO-Hgb > 25-30% Cardiac involvement severe acidosis transient or prolonged unconsciousness neurological impairment age > 36 y/o pregnancy ```
133
what is the MCC of cyanide poisoning
smoke inhalation
134
what products would have cyanide released after burning
``` wool nylon acrylics foam rubber silk plastics cassava root jewelry and textile industries sodium nitroprusside ```
135
which fruit pits containing amygdalin related to cyanide
apricots bitter almonds cherries peaches
136
what is cyanide pathophysiology
cyanide disrupts mitochondrial production of ATP by binding to and inhibiting cytochrome oxidase causes cessation of aerobic cellular metabolism cellular asphyxiant ATP produced via anerobic pathway which leads to lactate production
137
what lab suggests cyanide poisoning
lactate > 8
138
what are mild cyanide symptoms
``` H/A nausea vertigo tachypnea HTN AMS ```
139
what are severe cyanide symptoms
``` dyspnea bradycardia hypotension arrhythmia unconsciousness convulsions CV collapse ```
140
what are cyanide poisoning findings
severe metabolic acidosis usually are not cyanotic smells like bitter almonds
141
how do you treat cyanide poisoning?
``` oxygen amyl nitrite sodium nitrite sodium thiosulfate hydroxycobalamin (vitamin B12) - causes transient HTN, chromaturia ```
142
define chemical burns
acids cause coagulation necrosis which limits penetration of chemical alkalis causes liquefaction necrosis
143
what is the cornerstone of therapy for chemical burns?
hydrotherapy (gentle flow not high pressure)
144
what chemical is found in hair dyes?
acetic acid
145
what is the 5th leading cause of fatal occupational injury and 2nd leading cause of death in construction industry?
electrocution
146
what group of people are most commonly injured with electrical cords and sockets?
children < 6y/o
147
which parts of body are most resistant to least resistant to electrical injuries?
``` bone fat tendon skin muscle blood vessels nerves ```
148
what is the pathophysiology of electrical injuries?
cell membrane disruption, edema, coagulation necrosis, ischemia, release of myoglobin (renal failure from rhabdomyolysis) extent of skin damage does not correlate with extend of damage below skin AC may precipitate V fib Thoracic muscle tetany, direct coronary artery spasm, and myocardial ischemia
149
what is the primary cause of immediate death with electrical injuries
cardiopulmonary arrest
150
what are the symptoms of electrical injuries
LOC, seizure, amnesia, H/A, weakness, compartment syndrome
151
what labs to obtain for electrical injuries
CBC, CMP, CK, myoglobins
152
how to treat electrical injuries
IV fluids to keep UO 1 cc/kg/hr or greater myoglobinuria - amp NaHCO3 to each liter of NS to keep UO 1.5-2cc/kg/hr tetanus prophylaxis as indicated
153
how to know when to discharge for electrical injuries?
may d/c if no evidence of electrothermal injury, normal exam and EKG, no heme in urine, if otherwise, admit
154
where do direct strike lightning occur?
open areas
155
which lightning strike is the most deadly?
direct strike because person becomes part of the main lightning discharge tunnel
156
occurs when lightning strikes a taller object near the victim, then a portion of the current jumps from the taller object to the victim; can injure several people at once
side flash
157
the lightning strike that is most common cause of lightning injuries and deaths to persons/animals
ground current
158
how does a conduction lightning strike occur
when person is touching an object through which the current is transversing (i.e. wires or other metal surfaces, indoor lighting injuries, electrical outlets, plumbing, water faucets/shower, corded phone, windows, doors)
159
how do streamers develop?
downward moving leader approaches the ground and is met by an upward moving current
160
what is the MCC of death with lightening injuries?
cardiac arrest (asytole)
161
what are symptoms of lightening injuries?
stunned, headache, myalgias, paresthesias, vision and hearing loss (usually gradually resolves)
162
what is the MC neurological event of lightening injuries?
temporary LOC
163
pathognomonic fernlike pattern
lightening injuries
164
what may you develop later in life with lightening injuries?
cataracts
165
what labs do you check with lightening injuries?
CBC, CMP, CK, EGK, +/- spine or CT brain
166
how do you treat lightening injuries?
supportive if survive to ER, admit do not need aggressive fluids
167
what is the treatment of choice for any anaphylactic reaction to a bee sting?
epinephrine
168
what is the pathognomonic physical exam finding in scorpion sting?
roving eye movements
169
what bite is associated with muscle cramps?
black widow spider
170
what is the most lethal form of acute mountain illness?
HAPE

disciplines exam 3 (1 decks)

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