Environmental

Front 1

ENVIRONMENTAL EMERGENCIES

Back 1

ENVIRONMENTAL EMERGENCIES

Front 2

Identify important risk factors and predisposing factors for the incidence and severity of cold-induced injury:

Back 2

duration of exposure, humidity, wind, altitude, clothing, medical conditions and behavior

Front 3

Identify the most common skin surfaces affected by frostbite

Back 3

nose, ears, face, hands and feet

Front 4

Identify how frostnip differs from frostbite

Back 4

frostnip is superficial freeze injury characterized by lack of extracellular ice crystal formation and absence of progressive tissue loss. Frostbite more progressive

Front 5

Name the four degrees of frostbite severity

Back 5

1st*, 2nd* 3rd* 4th*

Front 6

Describe 1st* frostbite

Back 6

partial skin freezing; erythema, edema, hyperemia; no blisters; transient stinging and burning, throbbing and aching

Front 7

Describe second degree frostbite

Back 7

full-thickness injury; erythema, edema, vesicles with clear fluid; blisters that desquamate & form eschar; numbness, vasomotor disturbance if severe

Front 8

Describe third degree frostbite

Back 8

full-thickness skin & subQ freezing; violaceous or hemorrhagic blisters, skin necrosis, blue-gray discoloration; lack of sensation, feels like “block of wood”, shooting pain, burning, throbbing, aching occur later

Front 9

Describe forth degree frostbite

Back 9

full-thickness skin & subq freezing; muscle, tendon & bone freezing; little edema, mottled, deep red or cyanotic then dry, black & mummified; possible joint discomfort

Front 10

When does the frostbitten patient usually present to the ED

Back 10

subacutely (>24 hours after injury) in thawed state—can translate to longer hospital stay and greater tissue loss

Front 11

How should the injured extremity should be rewarmed in frostbite

Back 11

rapid warming is core of frostbite therapy & should be started ASAP. Place extremity in gently circulating water 144-107.6* (40-42 C) 10-30 min, til distal extremity is pliable and erythematous

Front 12

What is the pain management for frostbite

Back 12

treat with IV opiates during rewarming

Front 13

How should blisters be treated in the case of frostbite

Back 13

controversial. Clear blisters debrided or aspirated. Hemorrhagic should not. Both w/aloe vera cream every 6 hrs

Front 14

When is most surgery is done for frostbite

Back 14

early surgical intervention usually not indicated; however, escharotomy maybe indicated if eschar is preventing adequate ROM or circulation. Amputation may be necessary if wet gangrene or infection complicates recovery

Front 15

What is the role of tetanus and antibiotic prophylaxis for frostbite

Back 15

role of abx unclear but tx w/PCN-G seems beneficial. Topical bacitracin may be as good or better. Tetanus if frostbite is considered a tetanus-prone wound

Front 16

Define hypothermia and identify who is at risk

Back 16

core temp of <35* C (95*F). People 65+ account for 1/2 who die from hypothermia each year. Other risk groups: neonates & those w/altered sensorium

Front 17

Describe changes that occur with the following body temperatures: 32-35oC (89.6-95oF)

Back 17

“mild” hypothermia; excitation (responsive) stage; physiologic adjustments attempt to retain & generate heat. HR, CO, BP all rise, declining as temp lowers

Front 18

Describe changes that occur with the following body temperatures: Below 32oC (89.6oF)

Back 18

excitation gives way to slowing (adynamic) stage; progressive slowdown of bodily fxns & metabolism, decrease in O2 utilization & CO2 production

Front 19

Describe changes that occur with the following body temperatures: 30-32oC (86-89oF)

Back 19

shivering ceases, dysrhythmias develop; progresses from Bradycardia to a-fib w/slow vent response to v-fib & asystole

Front 20

What happens in patients at risk for dysrhythmias when they become hypothermic

Back 20

irritability of myocardium aggravated by manipulations, interventions and rough handling of patients

Front 21

Briefly explain the treatment in regards to the following: Cardiac dysrhythmias

Back 21

most rhythm disturbances (Bradycardia, a-fib or flutter require no therapy & revert spontaneously with rewarming. V-fib may be refractory to therapy until pt is rewarmed

Front 22

Briefly explain the treatment in regards to the following: Active core rewarming

Back 22

internal organs including heart preferentially warmed, decreasing myocardial irritability & returning cardiac fxn. May include warmed O2 & IV fluids

Front 23

Briefly explain the treatment in regards to the following: Active external rewarming

Back 23

application of exogenous heat to body surface often effective. Warm water immersion effective but impractical. Commercial products (Bair-Hugger) often successful

Front 24

Briefly explain the treatment in regards to the following: Passive rewarming

Back 24

allows pts to rewarm on own using endogenous heat produced by metabolism. Slow. Inappropriate for those w/cardiovascular compromise

Front 25

Define Heat syncope

Back 25

variant of postural hypotension resulting from cumulative effect of relative volume depletion, peripheral vasodilation & decreased vasomotor tone

Front 26

Define Prickly heat

Back 26

pruritic, maculopapular, erythematous rash over clothed areas of body; an acute inflammation of sweat ducts caused by blockage of pores

Front 27

Define Heat edema

Back 27

self-limited process manifested by mild swelling of feet, ankles & hand that appears within 1st few days of exposure to hot environment

Front 28

Define Heat cramps

Back 28

px, involuntary, spasmodic contractions of skeletal muscles, usually calves, in people who are sweating profusely & replace losses w/water or other hypotonic solutions. Due to relative deficiency of NA, K and fluid at cellular level

Front 29

Define Heat exhaustion

Back 29

acute heat-related illness. volume depletion. weakness, malaise, lightheadedness, fatigue, dizziness, NV, HA, myalgia ortho hypotn, tachycardia, tachypnea, diaphoresis, syncope

Front 30

Define heatstroke and discuss risk factors and CNS changes associated with it

Back 30

core temp 40*+ CNS dyfxn, anhidrosis. multiple organ involvement, high mortality. Risk groups: chronically ill, old, workers, athletes, military, coaches, kids left in heet. CNS changes: irritability, confusion, bizarre, combative, hallucinations, seizures, coma; decorticate decerebrate posturing, hemiplegia, status epilepticus

Front 31

Describe the features of a hymenoptera sting including local reactions: (wasps, bees and ants)

Back 31

pain, erythema, edema pruritus. urticarial lesion contiguous w/sting site; may involve neighboring joints. Mouth or throat sting can produce airway obstruction

Front 32

Explain the following regarding anaphylactic reaction to hymenoptera sting: Initial symptoms

Back 32

itching eyes, facial flushing, heneralized urticaria, dry cough

Front 33

Explain the following regarding anaphylactic reaction to hymenoptera sting: Long-term management and preventive care:

Back 33

provide insect sting kit with epi and instruct in its use. Recommend Medic Alert tags

Front 34

Explain the following regarding anaphylactic reaction to hymenoptera sting: Treatment

Back 34

remove stinger (not just scraping); wash w/soap-water; ice; oral antihist, analgesics, NSAIDS; opioids; elevate, rest affected limb; abx for 2nd* infection; anaphylaxis-epipen IM & massage site. Observe for several hrs. IV antihist, H2 antagonists

Front 35

Explain the following regarding anaphylactic reaction to hymenoptera sting: How symptoms intensify

Back 35

chest or throat constriction, wheezing, dyspnea, cyanosis, abdominal cramps, diarrhea, nausea, vomiting, vertigo, chills, fever, laryngeal stridor, shock, syncope, involuntary bowel or bladder action, bloody, frothy sputum

Front 36

Explain the following regarding anaphylactic reaction to hymenoptera sting: How soon the majority occur

Back 36

within 15 minutes (nearly all withing 6 hours)

Front 37

Describe Acute Mountain Sickness (AMS) in regard to the following: Incidence:

Back 37

varies by location depending on ease of access, rate of ascent and sleeping altitude

Front 38

Sickness (AMS) in regard to the following: Factors affecting susceptibility

Back 38

low hypoxic ventilatory response and low vital capacity, acclimatization

Front 39

Sickness (AMS) in regard to the following: Symptoms

Back 39

light-headedness, breathlessness, headache, anorexia, nausea, vomiting, lassitude, weak, Irritability, sleepiness, inner chill, HA, dyspnea, vomiting, oliguria; w/cerebral edema (HACE) ataxia, altered LOC, coma

Front 40

Sickness (AMS) in regard to the following: Physical findings

Back 40

HR-BP vary, may have postural hypotension. Rales. Fundoscopy: dilation, retinal hemorrhages. Peripheral and facial edema

Front 41

Sickness (AMS) in regard to the following: HACE and HAPE

Back 41

HACE: severe form AMS w/progressive CNS deterioration—characterized by altered mental status, ataxia, stupor, coma. HAPE: high altitude pulmonary edema

Front 42

Sickness (AMS) in regard to the following: Treatment and prevention

Back 42

mild: don't progress higher elevation. Definitive tx is descent & oxygen.

Front 43

Discuss decompression sickness in regard to the following: Signs and symptoms

Back 43

px in joints, extremities skin, lymphedema, deep px unrelieved but not worsened with movement; poorly localized back pain; cough, hemoptysis, dyspnea, chest pain, CV collapse; truncal contruiction or girdle-like px, ascending parylysis. fatigue, vertigo, hearing loss, tinnitus, disequilibrium

Front 44

Discuss decompression sickness in regard to the following: What happens in the blood

Back 44

bubbles form when body saturated w/inert gas experiences decrease in pressure causing liberation of gas. Is it stinky?

Front 45

Discuss decompression sickness in regard to the following: Treatment and prevention

Back 45

100% O2, IV fluids, rapid recompression w/hyperbaric oxygen. Adjuncts include corticosteroids, asa, heparin, lidocaine (heparin may be harmful)

Front 46

Identify the following regarding drowning: Where it is most likely to occur

Back 46

pools, bodies of water, toilets, buckets, bathtubs.

Front 47

Identify the following regarding drowning: Additional risks

Back 47

spinal cord injuries after diving in shallow water or boating accidents; hypothermia, panicking, syncope; seizures, other premorbid conditions

Front 48

Identify the following regarding drowning: Associated problems and their treatment

Back 48

ARDS – avoid lung overdistension and ventilator-associated lung trauma. May need infusion of dopamine or epinephrine

Front 49

Identify the following regarding drowning: Resuscitation measures

Back 49

CPR, high-flow O2 or bag-valve-mask, ET tube. Warmed isotonic IV fluids, warming adjuncts

Front 50

Identify the following regarding drowning: Age distribution: three peaks

Back 50

toddlers and young children, adolescents and young adults, elderly

Front 51

Identify the temperature at which cell damage occurs

Back 51

45 degrees (113 F)

Front 52

Describe the three zones of a burn wound

Back 52

1)zone of coagulation: tissue irreversibly destroyed w/thrombosis of blood vessels 2)zone of stasis: stagnation of microcirculation 3)zone of hyperemia: increased blood flow

Front 53

Describe a method of determining burns size using the back of a patient’s hand

Back 53

back of pt’s hand is 1% BSA. The number of “hands” that equal area of burn can approximate the % of BSA burned

Front 54

Define First degree burn

Back 54

only epidermal layer of skin. E.g. sunburn. Red, px, tender, no blisters. tx symptomatic

Front 55

Define Second degree burn

Back 55

extend to dermis. 2 types: superficial partial-thickness & deep partial-thickness burns.
Superficial: epidermis & superficial dermis injured. Deeper laters spared. caused by hot water. Blistering of skin, red moist. px to touch. Deep: deep later of dermis. Damage hair follicles, sweat sebaceous glands. Hot liquids, steam, grease, flame. blistered & exposed dermis pale white to yellow. Burned area doesn't blanch; no cap refill, no px

Front 56

Define Third degree/full thickness burn

Back 56

entire thickness of skin. All epidermal and dermal structures destroyed. caused by flame, not oil, steam or contact w/hot object. Skin charred, pale, no px & leathery. Doesn't heal spontaneously; surgical repair, skin graft necessary, significant scarring

Front 57

Define Fourth degree burn

Back 57

muscle, bone. life-threatening. Amputation or extensive reconstruction sometimes required

Front 58

Identify which patients are considered “high risk” according to age and underlying medical problems

Back 58

highest 18-35. Male female 2:1 for injury & death. Children 1-5 & elderly have higher incidence of scalds. Death rate higher in patients >65

Front 59

Understand the American Burn Association’s criteria for transfer to a burn unit:

Back 59

2nd* >10% BSA, burns involving face, hands, feet, genitalia, perineum or major joints, any 3* burn, electrical, chemical burns, inhalation injury, preexisting medical disorders

Front 60

Describe the general initial treatment of major burns in the ED

Back 60

Hx. ABC's. C-spine prn. check for inhalation injury or airway compromise; start IV’s in nonburned areas; Head-toe assessment, ID & tx. Consider NG tube, place urinary catheter, draw labs, Wound care

Front 61

For inhalation injury, describe the following: Signs and symptoms that can help determine smoke exposure

Back 61

Hx of fire in enclosed space, facial burns, singed nasal hair, soot in mouth or nose, hoarseness, carbonaceous sputum, expiratory wheezing

Front 62

For inhalation injury, describe the following: Consequences of particulate matter in the lungs

Back 62

leads to bronchospasm, airflow obstruction, atelectasis; tracheal & bronchial epithelial sloughing; pulmonary edema

Front 63

For inhalation injury, describe the following: Two major toxic inhalants: Three groups of toxic inhalants

Back 63

tissue asphyxiants, pulmonary irritants, systemic toxins. 2 major tissue asphyxiants: carbon monoxide, hydrogen cyanide

Front 64

For inhalation injury, describe the following: Location of direct thermal injury in the airway

Back 64

damages endothelial cells, produces mucosal edema of small airways & decreases alveolar surfactant activity

Front 65

For the control of pain, identify the drug of choice and the preferred route of administration

Back 65

IV morphine and anxiolytics

Front 66

Explain the following regarding treatment of minor burns in the ED:

Explain the following regarding treatment of minor burns in the ED: What qualifies as a minor burn

Back 66

isolated doesn't involve hands, face, feet or perineum. Shouldn't cross major joints or be circumferential. Involve < 10% BSA; no major medical problems; pt reliable

Front 67

Explain the following regarding treatment of minor burns in the ED: How they are cleaned

Back 67

with mild soap and water or dilute antiseptic solution

Front 68

Explain the following regarding treatment of minor burns in the ED:Treatment of blisters

Back 68

left intact or drained, or overlying epithelium may debrided, depending on size & location. Debride lg blisters or over mobile joints; leave sm blisters on nonmobile areas intact

Front 69

Explain the following regarding treatment of minor burns in the ED:Use of topical antimicrobials

Back 69

reduces bacterial colonization & enhance healing. Variety available. Silver sulfadiazine cream, Bacitracin or triple-abx ointments

Front 70

Explain the following regarding treatment of minor burns in the ED: When the burn should be reassessed

Back 70

if sxs of infection; evaluate at 24 hrs to assess depth and extent of burn.

Front 71

Explain the following regarding treatment of minor burns in the ED:How to decrease edema in an extremity

Back 71

elevate for 24-48 hours following injury

Front 72

Explain the following regarding treatment of minor burns in the ED:How often dressings should be changed

Back 72

twice daily while weeping, then once a day until healed.

Front 73

Explain the flashover phenomenon and why someone is often able to survive a lightening strike

Back 73

electrical current travels over surface of body; less likely to cause internal cardiac injury or muscle necrosis. Wet skin may decrease risk of internal injury

Front 74

Describe the general work up following CO exposure of the patient with only mild symptoms

Back 74

measure carboxyhemoglobin level and do an EKG