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X Emergency Med Exam 2 > Environmental Emergencies > Flashcards

Environmental Emergencies Flashcards

(53 cards)

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1
Q

Risk factors for frostbite

A 
Lack of protective head/hand or footwear/wet clothing
Dehydration
Alcohol and smoking
Prolonged stationary posture
Protective ointments on head or face
Previous cold injuries
History of PVD or raynauds
Homeless
Vasoconstrictive meds
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2
Q

How to classify frostbite

A

Depth of injury and amt of tissue damage on appearance after rewarming

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3
Q

What happens with frostbite?

A

Thawing process starts a cascade (freezing alone doesn’t cause tissue death)
Ischemia, necrosis and gangrene

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4
Q

Presentation of frostbite

A

Can occur anywhere but mostly distal extremities (face, nose, ears, fingers or toes)
Before rewarming it looks pale and feels hard and cold
Numbness and tingling

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5
Q

Classification of frostbite

A

Done after rewarming process

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6
Q

First degree frostbite

A

Numbness, central pallor with surrounding erythema and edema, desquamation and dysesthesia

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7
Q

Second degree frostbite

A

Blisters of skin with surrounding edema and erythema

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8
Q

Third degree frostbite

A

Tissue loss involving entire thickness of skin, hemorrhagic blisters

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9
Q

Fourth degree frostbite

A

Tissue loss involving entire thickness of the part, including deep structures resulting in losing that part

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10
Q

Management of frostbite

A

Immersion in water 37-39C until erythematous and pliable (20-30 min)
IV opioids for pain
Maybe anticoagulation (if present in 24 hrs of injury and have high risk of amputation)
No blister or soft tissue debridement acutely
Maybe prophylactic abx
Td immunization PRN

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11
Q

Treatment of choice for frostbite

A

Aloe vera cream q 6 hrs with non-occlusive dressing

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12
Q

When can you discharge pts with frostbite home>

A

If can have appropritate f/u
Ibuprofen PO
Aloe vera cream
Discourage tobacco

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13
Q

Causes of hypothermia

A

Primary (cold exposure)
Secondary (become hypothermic in a temp that wouldnt normally cause it)
*bbs can cause this and also think with anti-hyperglycemics

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14
Q

Definition of hypothermia

A

Core temp below 35C

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15
Q

Classifications of hypothermia

A

Mild: core temp 32-35 F (89.6-95F ) and have confusion, tachycardia, increased shivering
Moderate: core temp 28-32 (82.4-89.6 F) and have lethargy, bradycardia, arrhytmia, loss or pupillary reflex, decreased shivering
Severe: temp below 28 C (82.4 F) and have coma, hypotension, arrhythmia, pulm edema and rigidity

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16
Q

How to get temp with severe hypothermia

A

Esophageal temp probe can be introduced with ET intubation

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17
Q

Labs for mod to severe hypothermia

A 
Fingerstick glucose
ECG/CXR
BMP and CBC with diff
Coag studies
O2 saturation (probably put probe on ears or forehead)
ABG
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18
Q

Initial management for hypothermia

A

ABCs
Endotracheal intubation maybe
Treat hypotension with warmed crystalloid 42C and dopamine PRN
Treat any arrhythmias (but defib not great ,<30C)

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19
Q

Rewarming for mild hypothermia

A

Passive external rewarming, remove wet clothes and cover with warm blankets

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20
Q

Rewarming for moderate hypothermia

A

Warmed humidified oxygen, forced air warming systems
Beware of intial paradoxical drop in core temp due to return of cold blood from extrems to core
SO rewarm the trunk first to minimize risk of core temp after drop

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21
Q

Rewarming for severe hypothermia

A 
Active internal and external rewarming like moderate AND
Pleural and peritoneal irrigation with warm saline (40-42C)
Extracorporeal options (hemodialysis, cardiopulm bypass, continuous arteriovenous rewarming)
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22
Q

One of leading causes of death in young athletes

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A

Heat emergencies

23
Q

Risk factors of heat emergencies

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A 
Strenuous exercise in high ambient temps and/or humidity
Lack of acclimatization
Poor fitness
Obesity
Dehydration
Acute illness
External loads
24
Q

Presentation of heat cramps

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A

Intense muscle pain and spasm with no other signs of exertional heat stroke
“salty sweaters” so sweat with high salt conc
Heavy sweating with fluid replacement via water or other hypotonic solutions (K, Na or Mg deficiency)
Cramping in limited area, short and no risk for rhabdo

25
Management for heat cramps
Hydrate and replace sodium losses (encourage oral POs) | Relax and stretch muscles
26
Presentation of heat stress
Same with heat cramps PLUS HA, n/v, dizzy, more diffuse muscle cramps, orthostatic hypotension and maybe near syncope PE: temp is normal or elevated BUT not higher than 40 C (104F) and no CNS impairment
27
Heat stress management
Remove from heat Bolus infusion of mod amt of IVF with short term increase in maintenance (normal saline) May need external cooling if not responding within 30 min of fluids etc
28
Cardinal features of heat stroke
Temp >40C plus AMS (irritable, confusion, irrational behavior, decorticate and decerbrate posturing, seizures, coma)
29
Management for heat stroke
``` Start fluids and monitor core temp Cool to 102.2 F (not too quick) Evaporative cooling Ice packs Immersion cooling Invasive cooling Admit based on response and labs ```
30
Evaporative cooling for heat stroke
Remove clothing, spray water on pts skin, direct fan over pt | Con is that its hard to keep electrodes on skin for monitoring
31
Ice packs for heat stroke
In axilla, neck and groin | But poorly tolerate
32
Immersion cooling for heat stroke
Pt placed partially in tub of ice water | Cons: can't put electrodes on, poorly tolerated, can't defibrillate
33
Invasive cooling for heat stroke
Cardiopulmonary bypass | Cons: invasive and not available everywhere
34
Black widows
Male are harmless Live outdoors Like warm weather
35
Brown recluse spider
6 or 8 eyes | Indoors and not common to AZ
36
How to diagnose a spider bite
Saw the spider | A skin lesion and or systemic findings associated with a bite
37
Tx for spider envenomation
Wound cleansing Tetanus PRN Treat secondary skin infection PRN
38
Presentation of mild black widow envenomation
Local wound and maybe spams adjacent to site
39
Presentation of moderate black widow envenomation
Spasms and muscle pain in bitten extremity, back, chest and abdomen Adjacent diaphoresis
40
Presentation of severe black widow envenomation
Severe pain and spasm and systemic features | N/v, HA, tachycardia, HTN
41
Management of black widow envenomation
Self limiting with sxs usually resolving 24-48 hrs Analgesics (maybe opioids if bad) Muscle relaxants Maybe antivenom
42
Presentation of brown recluse bite
Depressed macule, pale gray, eroded in center with halo of inflammation and hemorrhage Lesion may be very tender and extend to muscle tissue Necrosis someimtes Infrequent systemic sxs (malaise, n/v, fever, myalgia) Rare systemic rxn (rhabdo, DIC, acute hemolytic anemia-kids more)
43
Management of brown recluse bite
Debridement not beneficial Wound gets better in 5-10 days No antivenom here
44
What do scorpion stings usually look like?
Minimal swelling Regional LAD Increased skin temp and tenderness around wound (bark scorpion is venemous and can cause serious illness)
45
Presentation of bark scorpion sting
Pain and paresthesia over involved are Swelling absent with few skin changes Tachycardia, HTN, tachypnea, weakness, muscle spams and fasciculations
46
Management of bark scorpion sting
``` Ice pack on wound Oral NSAIDs Muscle relaxants Pain control Monitor for 8-12 hrs after sting Poison control: 800-222-1222 ```
47
Clinical features of rattlesnake bite
``` Fang marka Local tissue injury Fibrinolysis Thrombocytopenia Systemic effects ```
48
Mainstay of therapy for rattlesnake bite
Antivenom (treat all pts with progressive signs and sxs ASAP) *want to stop progression
49
How to define worse progression of sxs with rattlesnake bite
``` Worsening local injury (pain, ecchymosis, swelling) Abnormal labs (decreasing platelets, prolonged PT, decreased fibrinogen) Systemic manifestations (unstable, AMS) ```
50
What do coral snakes look like?
Brightly colored, red/black/yellow rings (red and yellow rings touch in coral snakes) -neurotoxin venom that does not cause marked localized injury
51
Management of coral snake bites
Admit b/c can take hours for effects of venom Start antivenom ASAP (irreversible if starts seeing effects of venom) Closely monitor resp function
52
Gila monster
Slow moving lizard ith venom No fangs, just short grooved teeth Prolonged bite to envenomate (can have fractures with the bite)
53
Management for gila monster bite
Remove lizard, clean wound and remove remaining teeth if fall out X-ray for fractures Tx and abx PRN Admit and monitor for envenomation sxs (weakness, light headed, paresthesis, diaphoresis, HTN) no antivenom

X Emergency Med Exam 2 (6 decks)

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