Lecture 7: Environmental Emergencies Flashcards
1
Q
What is good samaritan law?
A
Not liable when providing emergency care.
Stay within your scope ideally
Must turn over to emergency personnel once they arrive.
2
Q
What are the 3 stinger type insects with venom?
A
- Bee
- Hornet
- Wasp
Can only differentiate via allergy testing
3
Q
How long might it take for insect venom to cause anaphylaxis?
A
15-30 mins, maybe even more
4
Q
What is the average epi dose for a child? Cutoff? Adult?
A
- Child < 33 lbs: 0.1mg
- For a child/person 33-66 lbs: 0.15 mg
- For an adult: 0.3 mg
Anterolateral thigh is main site.
5
Q
How much epi remains in an autoinjector after injection?
A
1.7 mL
6
Q
How does carbon monoxide poisoning present?
A
- HA
- N/V
- Weakness
- Confusion
- Syncope
- Cherry red skin is pretty rare
Will affect multiple people simultaneously
7
Q
How do you treat carbon monoxide poisoning?
A
- 320 minutes of RA
- 74 minutes of 100% O2
- 23 minutes in hyperbaric chamber
8
Q
What is the spectrum of heat illness?
A
- Heat Edema
- Heat Syncope
- Heat Cramps
- Heat Exhaustion
- Heat Stroke
9
Q
Demographics most at risk for heat illness
A
- Young/elderly
- Obese/thin
- Mental illness
- Drugs/ETOH
- Limited hydration/nutrition
- Depends on if its hypernatremic or hyponatremic
10
Q
Management of Heat edema
A
- Mild swelling d/t vasodilation and venous stasis
- Elevate ext + rest
11
Q
Management of heat syncope
A
- Vasodilation + intravascular redistribution
- Oftentimes normal Na or hypernatremic
- Treat as heat edema, but consider IVF.
12
Q
Management of heat cramps
A
- Painful spasms d/t hyponatremia
- Temp is normal or slightly elevated
- Moist/dry skin
- Cool them and give them 6% carb & electrolyte (gatorade)
- Avoid heat/exertion for 1-3d
13
Q
Features of heat exhaustion
A
- Unable to maintain CO
- Muscle cramps + tachy + hypotension + temp of around 104F
- Could have dark urine
- Either hypo or hypernatremic.
Most accurate core temp is via rectal.
14
Q
What is required to treat heat exhaustion?
A
Water with electrolytes
15
Q
What are the additional symptoms of heat stroke over heat exhaustion?
A
- Dysfunction of heat regulation due to hyperthemia + end organ dmg
- Neural dmg, hepatic dmg, and vascular dmg occur
- CV collapse due to vascular volume loss
16
Q
Characteristics of a thyroid storm
A
- Zero TSH, but very higher T3/T4
- Temp > 38C
- N/V/D/Abd pain
- Shaking of hands, anxious
- Tachy, HTN, sweating
High mortality if untreated.
17
Q
S/S of heat stroke
A
- HA/dizziness/N/V/AMS
- Hematuria, hematemesis, bruising/petechiae, oozing
- Hot, flushed, Dry
- Tachycardic with bounding pulse
- Hypotensive
18
Q
Management of Heat Stroke
A
- Rapid cooling
- Severe shivering = BZD after electrolyte check
- Monitor core temp until safe zone of 101.5-102
- If unresponsive…. internal lavage to cool the brain
- IV NS bolus for hypotension and rhabdo
- Goal Urine output: 50-100 mL/hr
- Supplemental O2
19
Q
What is ICU criteria for heat stroke?
A
- Hemodynamic instability
- Rhabdo
- LFTs elevated/severe lyte abnormalities
- Unknown etiology
20
Q
What are the poor prognostic signs of heat stroke?
A
- Extreme hyperpyrexia (107F+)
- Hyperkalemia w/ rhabdo
- Coma persists after cooling
- Marked LFT elevation
21
Q
MC RFs for trench foot
A
- Military
- Agriculture
- Homeless
22
Q
What is trench foot?
A
Standing in cold water < 40F for long periods of time.
23
Q
How does frostbite initially present?
A
- Paresthesias
- Pruritis
- Loss of sensation
- Loss of fine motor control
24
Q
What are the 4 degrees of frostbite?
A
- Erythema and edema
- Blisters
- Skin necrosis, hemorrhagic blisters, SubQ
- Full thickness, non-blanching dry, black & mummified with eschar, loss of body parts
25
How do you treat Frostbite Raynaud's?
Treat as stage 3.
26
How do you rewarm frostbite?
* Rapid rewarming via water @ 98.6-102.2F for 15-60
* **Do not partially rewarm**
* If severe, treat as a burn! (Wound care and infection management)
27
Hypothermia stages
Under 32C, you cannot rewarm yourself!
| You can only recover alone in stage 1
28
Outpatient tx of hypothermia
* Insulate from ground
* Dry
* Keep Supine!
* Warm liquids, keep environment > 82F
* O2 is main concern
29
Hypothermia management
* Rewarm in 24C or higher environment
* Horizontal/supine
* If in VFIB, you get **1 shot to defib until core temp is 30C**
30
Overview of acute mountain sickness
* Primarily occurs above 9k feet unless ill
* Decreases in PO2
* HA w/ anorexia, weakness, dizziness, imsomnia, etc
* Untreated => HAPE => HACE
| By the time youre at 15k, arterial blood = venous blood at seas level.
## Footnote
Everest PO2 is even lower than fetal umbilical PO2
31
How does your body attempt to compensate high altitude sickness?
* Tachypnea
* Renal excretion of HCO3
* Edema
* Hypoxic pulmonary vascoconstriction
* EPO, hgb, and o2 affinity increase
32
How do you help treat acute altitude sickness?
* Hike up slow
* Gingko biloba & acetazolamide
* Steroids delay
* Amphetamines can help
* **Sleeping lower is ideal!**
* **Cure: Descent off the mountain**
| Alternatives to descent: hyperbaric O2 bags
33
Why does HAPE occur?
* Hypoxic vasoconstriction increases right sided pressures
* Decreased exercise capacity
* Cough, rales, tachypnea, pulmonary HTN
34
What is indicative of HACE? Tx?
* Acute mountain sickness
* Retinal hemmorhages
* Papilledema
* Tx: Descent
* Tx: dexamethasone to help
35
When should you admit for HACE?
If still symptomatic > 2 hrs post tx.
36
What snakes does CroFab cover?
* Copperhead (pit viper)
* Rattle (Pit viper)
* Cottonmouth
37
Management of a pit viper bite
* Do not restrict
* Watch for compartment syndrome
* Only considered a **dry bite if nothing occurring after 12 hrs.**
* N/V/hemolysis/coagulopathy
* Poison control: 1-800-222-1222
38
How do you remember snake venom?
* Red touch yellow, kills a fellow.
* Red touch black, venom lack
| Coral snake
39
Empiric tx for tick bite
Doxycycline 100mg BID
| Alpha gal cannot be treated.
40
What is the concern with doxycycline in children?
Staining of teeth/weakening of enaml
41
What is the MC culture of black widow bites?
MRSA
| aka treat it with vanco
## Footnote
Presents like a cellulitis
42
Where are brown recluses endemic to?
* Georgia
* Illinois
* Missouri
* Arkansas
| Causes an acid like effect
43
What injuries occur with lightning?
* Electrical asystole **responsive to CPR**
* Treat burn entrance and exit as major burns
* Bunt force trauma can cause pneumomediastinum or hemorrhage
* Eye injuries (cataracts)
* Ear ringing/tinnitus (TM perf)
44
What is the mainstays of treatment for drowning?
* CPR asap
* Oxygen is main priority
* Obs 4-6 hrs after symptoms resolve
45
Tx of inhalation burns
* ACLS
* 100% O2 w/ humidity
* LR at KVO rate
46
What might suggest inhalation burns?
* Facial burns, **singed nasal hairs**
* Soot
* Hoarseness, carbonaceous sputum, wheezing
* Hypoxemia
47
How do we manage external burns?
* Extract
* Remove burned clothing & jewelry
* Pour cool water over burns (way longer if its chemical)
* Keep warm and transport
| Body temp regulation is impaired
48
What formulas help calcuate LR rate for external burns?
* Parkland
* Modified Brooke
* Depends on Total BSA of burn
49
Rule of 9s for burns
* H&N: 9%
* Each full arm: 9%
* Entire trunk: 38%
* Groin: 1%
* Each leg: 18%
| > 9% is Burn unit
50
How do acidic and alkaline burns and heavy metal burns differ?
* Acid burns, causing scabbing which limits depth.
* Alkaline combined with lipids and saponify
* Metal burns need water to dilute
* Treat all chemical burns as full thickness
51
What can occur from ascending too fast in scuba diving?
* Lung burst, due to rapid expansion of lungs
* Air embolism, due to nitrogen dissolving and expanding
* Mediastinal emphysema
