Wilderness Med Flashcards
(47 cards)
1
Q
Our baseline metabolism raises our body heat ___ every hour
A
1.1 degrees celsius
2
Q
Fortunately we transfer heat into the environment via
A
- Conduction: direct contact
- Convection: air currents
- Radiation: being in space that is cooler than our own body
- Evaporation (most effective way we lose heat)
3
Q
Physiologic changes under heat stress
A
- HR increases
- peripheral vasodilation
- sweating
4
Q
Risk factors for heat illness
A
- young and old
- Meds (anticholinergic, BB, lithium)
- alcohol
- Obesity
- CHF
- mental illness
- athletes, laborers, military
- low socioeconomic position
5
Q
Tx of heat cramps
A
electrolyte repletion, NS IV
*often after exercise
6
Q
Tx of heat syncope
A
Horizontal positioning
7
Q
Tx of heat edema
A
leg elevation, compression hose, acclimatization
8
Q
Tx of heat rash
A
chlorhexidine cream
*usually under clothed areas (macular-papular rash)
9
Q
Definition
Volume depletion in the setting of heat stress
A
heat exhaustion
10
Q
signs and sx of heat exhaustion
A
- Fatigue
- Nausea/vomiting, anorexia
- Heat cramps
- LOC: dizzy/syncope
- HR and RR increased
- Skin: pale, cool, clammy, flushed
11
Q
heat illnesses
A
- minor heat illnesses
- heat exhaustion
- heat stroke
12
Q
tx of heat exhaustion
A
- Rest
- Cool environment
- CBC and chemistry (Cr)
- IV fluids
- Consider admission for elderly patients or those with significant electrolyte abnormalities
13
Q
Life-threatening rise in internal temperature
Classic and exertion
A
heat stroke
14
Q
signs and sx of heat stroke
A
- LOC: Disoriented, irritable, combative, unresponsive
- Altered mental status*** (Helps differentiate from heat exhaustion), hallucinations, seizures
- Ataxia
- Increased HR and RR
- Skin: Hot, wet or dry, flushed
- Core temp > 104 degrees
- Elevated Transaminases in liver function and Cr
15
Q
How does humidity effect our cooling mechansim
A
more difficult to cool off
16
Q
Tx of heat stroke
A
- Aggressive cooling*** (evaporative or immersive)
- Ice packs, cooling blankets, lavage
- Airway monitoring and management
- Avoid antipyretics ie. NSAIDs (DONT HELP–> too hot)
- IV fluids if hypotensive after cooling
- Admission
17
Q
what is drowning definition
A
Respiratory impairment from submersion in a liquid
18
Q
Describe the physiology of drowning
A
Submersion - panic - breath holding - struggle - hypoxia - loss of consciousness - respiratory arrest - cardiac arrest
19
Q
What factors affect drowning survivability (these factors lead to better outcomes)
A
- Shorter
- Colder (lowers metabolic needs)
- Cleaner
- Younger
- Calmer
- BLS sooner
20
Q
Management/work up of drowning
A
- ECG to evaluate heart rhythm
- Chest XR
- Pulse ox, capnography, ABG
- CBC and chemistry
- ABCs and rewarming
- Monitor for respiratory signs and symptoms
- watch for 4-6 hrs
21
Q
common bites and stings
A
- Venomous Snakes
- Spiders
- Bed Bugs
- Hymenoptera
22
Q
Signs and sx of crotalid envenomations
A
- Fang marks
- Swelling and pain
- Bruising, blistering, necrosis
- Weakness, sweating, chills
- Nausea, vomiting
- Numbness, lymph node swelling
23
Q
Signs and sx of Elapid envenomations
A
- Local swelling
- Nausea, vomiting
- Dizziness
- Respiratory difficulty
24
Q
Snake bite initial management
A
Do not need the snake, pictures preferred
- Keep patient calm
- Immobilize the limb (prevent if from dispersing in blood more)
- Monitor degree of symptoms
- Avoid tourniquets (can overly concentrate in 1 area), ice, electricity, suction
- Clean wounds
- Close monitor of ABCs– need cardiac monitoring
Supportive care for pain, nausea - Possibly use Antivenin
- *reassess every 30 min for systemic sx
- *use wound/skin pen to outline rednesses
25
When do we consider Antivenin?
1. rapid swelling
2. hypotension
3. coagulopathy
25% of snake bites are dry w/o venom
Reassess wound every 30 minutes– look for systemic sx (SOB, increased INR, fever)--> systemic symptoms then administer antivenin
26
Snake bite lab management
1. CBC (platelets),
2. Chemistry,
3. Coagulation studies,
4. LFTs,
5. D-dimer,
6. CPK
27
late management of snake bite management
1. Updated tetanus
2. Contact CDC/toxicology
3. Extended monitoring (8-12 hours)
4. Disposition depending on severity
28
signs and sx of widow spider bite
1. Initially red, itchy, painless
2. Progressive pain and anxiety
3. Target lesion
4. Muscular cramping in the back and abdomen
5. Burning, numbness in the feet
6. Headache, dizziness
7. N/V
29
Tx of widow spider bite
1. Wound care
2. Opioids and Benzos
3. IV fluids
4. Tetanus
5. Antivenin
6. Monitor for respiratory symptoms and hypotension
30
Signs and sx of Recluse spider bite
1. Red blister with painless bite
2. Progression to a non-healing wound
3. Chills, fever, generalized rash, weakness
* *more localized
* *Not found in CO
31
Lab studies for Recluse spider bite
1. CBC,
2. Chemistry,
3. Coagulation studies
32
Management of Recluse spider bite
1. labs
2. Update teatnus
3. wound care and monitoring
4. Infection management with antibiotics
5. Outpatient follow up, may need surgical debridement
33
Bed bugs are about the size of ____ and are usually found ___
- About the size of an apple seed
| - Hide on mattresses, clothing, along baseboards, under light switches
34
Signs and sx of bed bugs
1. Red bite, darker in the center
2. Itchy
3. Linear or clustered appearance
- "breakfast, lunch and dinner bit-- 3 bites in a row"
4. Face, neck, arms, hands, back
5. Severity varies, with systemic allergic symptoms of urticaria and itching possible
35
Tx of bed bugs
1. Topical steroid cream and antihistamine cream
2. Diphenhydramine for systemic symptoms
3. Monitor for infection, antibiotics as needed (secondary infection from scratch)
4. need to wash and dry everything on HIGH heat
36
What electrolyte abnormality might you expect with heat stroke?
Hypovolemic hypoatremic--> risk for cerebral pontine myelinolysis w/ rapid IV fluids
37
Signs and sx of Hymenoptera (stings)
1. Immediate pain**
2. Swelling and redness
3. Itching
4. Localized urticaria
5. Anaphylaxis
38
Tx of Hymenoptera (stings)
1. Remove the stinger**
2. Wound care
3. Supportive care (itch and pain)
4. Antihistamines
39
Signs and sx of anaphylaxis
1. Urticarial rash
2. Swelling of lips, tongue, hands, feet
3. Dysphagia
4. Dyspnea
40
Tx of anaphylaxis
1. Epinephrine
2. Diphenydramine
3. Famotadine
4. Prednisone
5. 6 hours of monitoring
41
- Swelling of deeper tissues
| - May be seen with allergic reactions
Angioedema
*due to bradykinin
42
Tx of angioedema
1. epi
2. antihistamines
3. steroids
* * might have to support the airway
4. Icatiband (new med that helps with angioedema complications)
5. +/- FFP
*4 and 5 are for ACEI angioedema
43
Coral snakes:
Snake colors: "red on yellow, ____"
"red touches black, __"
- red on yellow, kill a fellow
| - red touches back, safe for jack"
44
What are side effects of antivenin
Monitor for anaphylaxis and serum sickness (can be days after)
45
In general for spider bites management includes
-most the time its wound care and have pt monitor for systemic sx and reassurance
46
Describe the organ system involvement with anaphylaxis
4 organ systems involved:
1. Skin: urticaria, flushing
2. Resp.: stridor, wheezing, tachypnea
3. CV: decreased BP, syncope,
4. GI: N/V, diarrhea
*If they have 2 or more of these sx (from diff. symptoms) they are having anaphylaxis and use epi!
47
Angioedema is a SE of what medication
ACEI
