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74 Cards in this Set

  • Front
  • Back
Identify important risk factors and predisposing factors for the incidence and severity of cold-induced injury:
duration of exposure, humidity, wind, altitude, clothing, medical conditions and behavior
Identify the most common skin surfaces affected by frostbite
nose, ears, face, hands and feet
Identify how frostnip differs from frostbite
frostnip is superficial freeze injury characterized by lack of extracellular ice crystal formation and absence of progressive tissue loss. Frostbite more progressive
Name the four degrees of frostbite severity
1st*, 2nd* 3rd* 4th*
Describe 1st* frostbite
partial skin freezing; erythema, edema, hyperemia; no blisters; transient stinging and burning, throbbing and aching
Describe second degree frostbite
full-thickness injury; erythema, edema, vesicles with clear fluid; blisters that desquamate & form eschar; numbness, vasomotor disturbance if severe
Describe third degree frostbite
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
Describe forth degree frostbite
full-thickness skin & subq freezing; muscle, tendon & bone freezing; little edema, mottled, deep red or cyanotic then dry, black & mummified; possible joint discomfort
When does the frostbitten patient usually present to the ED
subacutely (>24 hours after injury) in thawed state—can translate to longer hospital stay and greater tissue loss
How should the injured extremity should be rewarmed in frostbite
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
What is the pain management for frostbite
treat with IV opiates during rewarming
How should blisters be treated in the case of frostbite
controversial. Clear blisters debrided or aspirated. Hemorrhagic should not. Both w/aloe vera cream every 6 hrs
When is most surgery is done for frostbite
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
What is the role of tetanus and antibiotic prophylaxis for frostbite
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
Define hypothermia and identify who is at risk
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
Describe changes that occur with the following body temperatures: 32-35oC (89.6-95oF)
“mild” hypothermia; excitation (responsive) stage; physiologic adjustments attempt to retain & generate heat. HR, CO, BP all rise, declining as temp lowers
Describe changes that occur with the following body temperatures: Below 32oC (89.6oF)
excitation gives way to slowing (adynamic) stage; progressive slowdown of bodily fxns & metabolism, decrease in O2 utilization & CO2 production
Describe changes that occur with the following body temperatures: 30-32oC (86-89oF)
shivering ceases, dysrhythmias develop; progresses from Bradycardia to a-fib w/slow vent response to v-fib & asystole
What happens in patients at risk for dysrhythmias when they become hypothermic
irritability of myocardium aggravated by manipulations, interventions and rough handling of patients
Briefly explain the treatment in regards to the following: Cardiac dysrhythmias
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
Briefly explain the treatment in regards to the following: Active core rewarming
internal organs including heart preferentially warmed, decreasing myocardial irritability & returning cardiac fxn. May include warmed O2 & IV fluids
Briefly explain the treatment in regards to the following: Active external rewarming
application of exogenous heat to body surface often effective. Warm water immersion effective but impractical. Commercial products (Bair-Hugger) often successful
Briefly explain the treatment in regards to the following: Passive rewarming
allows pts to rewarm on own using endogenous heat produced by metabolism. Slow. Inappropriate for those w/cardiovascular compromise
Define Heat syncope
variant of postural hypotension resulting from cumulative effect of relative volume depletion, peripheral vasodilation & decreased vasomotor tone
Define Prickly heat
pruritic, maculopapular, erythematous rash over clothed areas of body; an acute inflammation of sweat ducts caused by blockage of pores
Define Heat edema
self-limited process manifested by mild swelling of feet, ankles & hand that appears within 1st few days of exposure to hot environment
Define Heat cramps
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
Define Heat exhaustion
acute heat-related illness. volume depletion. weakness, malaise, lightheadedness, fatigue, dizziness, NV, HA, myalgia ortho hypotn, tachycardia, tachypnea, diaphoresis, syncope
Define heatstroke and discuss risk factors and CNS changes associated with it
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
Describe the features of a hymenoptera sting including local reactions: (wasps, bees and ants)
pain, erythema, edema pruritus. urticarial lesion contiguous w/sting site; may involve neighboring joints. Mouth or throat sting can produce airway obstruction
Explain the following regarding anaphylactic reaction to hymenoptera sting: Initial symptoms
itching eyes, facial flushing, heneralized urticaria, dry cough
Explain the following regarding anaphylactic reaction to hymenoptera sting: Long-term management and preventive care:
provide insect sting kit with epi and instruct in its use. Recommend Medic Alert tags
Explain the following regarding anaphylactic reaction to hymenoptera sting: Treatment
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
Explain the following regarding anaphylactic reaction to hymenoptera sting: How symptoms intensify
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
Explain the following regarding anaphylactic reaction to hymenoptera sting: How soon the majority occur
within 15 minutes (nearly all withing 6 hours)
Describe Acute Mountain Sickness (AMS) in regard to the following: Incidence:
varies by location depending on ease of access, rate of ascent and sleeping altitude
Sickness (AMS) in regard to the following: Factors affecting susceptibility
low hypoxic ventilatory response and low vital capacity, acclimatization
Sickness (AMS) in regard to the following: Symptoms
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
Sickness (AMS) in regard to the following: Physical findings
HR-BP vary, may have postural hypotension. Rales. Fundoscopy: dilation, retinal hemorrhages. Peripheral and facial edema
Sickness (AMS) in regard to the following: HACE and HAPE
HACE: severe form AMS w/progressive CNS deterioration—characterized by altered mental status, ataxia, stupor, coma. HAPE: high altitude pulmonary edema
Sickness (AMS) in regard to the following: Treatment and prevention
mild: don't progress higher elevation. Definitive tx is descent & oxygen.
Discuss decompression sickness in regard to the following: Signs and symptoms
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
Discuss decompression sickness in regard to the following: What happens in the blood
bubbles form when body saturated w/inert gas experiences decrease in pressure causing liberation of gas. Is it stinky?
Discuss decompression sickness in regard to the following: Treatment and prevention
100% O2, IV fluids, rapid recompression w/hyperbaric oxygen. Adjuncts include corticosteroids, asa, heparin, lidocaine (heparin may be harmful)
Identify the following regarding drowning: Where it is most likely to occur
pools, bodies of water, toilets, buckets, bathtubs.
Identify the following regarding drowning: Additional risks
spinal cord injuries after diving in shallow water or boating accidents; hypothermia, panicking, syncope; seizures, other premorbid conditions
Identify the following regarding drowning: Associated problems and their treatment
ARDS – avoid lung overdistension and ventilator-associated lung trauma. May need infusion of dopamine or epinephrine
Identify the following regarding drowning: Resuscitation measures
CPR, high-flow O2 or bag-valve-mask, ET tube. Warmed isotonic IV fluids, warming adjuncts
Identify the following regarding drowning: Age distribution: three peaks
toddlers and young children, adolescents and young adults, elderly
Identify the temperature at which cell damage occurs
45 degrees (113 F)
Describe the three zones of a burn wound
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
Describe a method of determining burns size using the back of a patient’s hand
back of pt’s hand is 1% BSA. The number of “hands” that equal area of burn can approximate the % of BSA burned
Define First degree burn
only epidermal layer of skin. E.g. sunburn. Red, px, tender, no blisters. tx symptomatic
Define Second degree burn
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
Define Third degree/full thickness burn
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
Define Fourth degree burn
muscle, bone. life-threatening. Amputation or extensive reconstruction sometimes required
Identify which patients are considered “high risk” according to age and underlying medical problems
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
Understand the American Burn Association’s criteria for transfer to a burn unit:
2nd* >10% BSA, burns involving face, hands, feet, genitalia, perineum or major joints, any 3* burn, electrical, chemical burns, inhalation injury, preexisting medical disorders
Describe the general initial treatment of major burns in the ED
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
For inhalation injury, describe the following: Signs and symptoms that can help determine smoke exposure
Hx of fire in enclosed space, facial burns, singed nasal hair, soot in mouth or nose, hoarseness, carbonaceous sputum, expiratory wheezing
For inhalation injury, describe the following: Consequences of particulate matter in the lungs
leads to bronchospasm, airflow obstruction, atelectasis; tracheal & bronchial epithelial sloughing; pulmonary edema
For inhalation injury, describe the following: Two major toxic inhalants: Three groups of toxic inhalants
tissue asphyxiants, pulmonary irritants, systemic toxins. 2 major tissue asphyxiants: carbon monoxide, hydrogen cyanide
For inhalation injury, describe the following: Location of direct thermal injury in the airway
damages endothelial cells, produces mucosal edema of small airways & decreases alveolar surfactant activity
For the control of pain, identify the drug of choice and the preferred route of administration
IV morphine and anxiolytics
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
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
Explain the following regarding treatment of minor burns in the ED: How they are cleaned
with mild soap and water or dilute antiseptic solution
Explain the following regarding treatment of minor burns in the ED:Treatment of blisters
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
Explain the following regarding treatment of minor burns in the ED:Use of topical antimicrobials
reduces bacterial colonization & enhance healing. Variety available. Silver sulfadiazine cream, Bacitracin or triple-abx ointments
Explain the following regarding treatment of minor burns in the ED: When the burn should be reassessed
if sxs of infection; evaluate at 24 hrs to assess depth and extent of burn.
Explain the following regarding treatment of minor burns in the ED:How to decrease edema in an extremity
elevate for 24-48 hours following injury
Explain the following regarding treatment of minor burns in the ED:How often dressings should be changed
twice daily while weeping, then once a day until healed.
Explain the flashover phenomenon and why someone is often able to survive a lightening strike
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
Describe the general work up following CO exposure of the patient with only mild symptoms
measure carboxyhemoglobin level and do an EKG