Environmental Emergencies

Front 1

Factors and Cold Related Injury

Back 1

Can be freezing or non freezing. Related to temperature, duration of contact, humidity, altitude, clothing, and behavior. Most avoidable cause is inappropriate clothing.

Front 2

Chilblains

Back 2

Is a non freezing cold injurty that occurs in damp climates and presents as mild inflammatory lesions such as edema, erythema, cyanosis, plagues, or nodules on extremities. Appears up to 12 hours after exposure and is associated with Raynauds.

Front 3

Trench Foot

Back 3

Is prolonged cooling in damp areas. Presents in three stages Initial phase, hyperemic phase, and late phase.

Front 4

Initial Phase of Trench Foot

Back 4

Pale mottled, numb, and pulseless.

Front 5

Hyperemic Phase of Trench Foot

Back 5

Severe burning pain and return of proximal sensation.

Front 6

Late Phase of Trench Foot

Back 6

Edema. Bullae. Pain.

Front 7

Treatment of Trench Foot

Back 7

Supportive care involving rewarming, bandage, elevate, and monitoring for sings of infection.

Front 8

Classification of Frostbite

Back 8

1st Degree - involving partial thickness of skin with erythema, hyperemia, and burning pain.
2nd Degree - Full thickness vesicles with clear fluid
3rd Degree - Involves subcutaneous tissue resulting in hemorrhagic bullae, blue gray discolaration
4th Degree - Muscle with little edema that appears dry black and mummified.

Front 9

Treatment of Frostbite

Back 9

Do not rewarm in field. Place in 40 to 42C bath. Administer IV analgesics. After thawing debride clear blisters and leave hemmoragic ones alone. Provide tetanus prophylaxis and give NSAIDS 400mg q12h)

Front 10

Hypothermia

Back 10

Is a temperature below 35C or 95F.

Front 11

Epidemology of Hypothermia

Back 11

50% of patients are older than 65. Altered senssorium.

Front 12

Stages of Hypothermia

Back 12

30-35C (90-95F) : Mild. Patient shivers and becomes tachycardic and increased cardiac output.
<30 (86F) : Hemodynamically unstable HR, BP, RR all decreased
25-28C (77-82.4F) : Spontaneous asystole and VF.

Front 13

ECG and Hypothermia

Back 13

Is the appearance of the osborn wave (j wave). A camel hump appearance on the R wave.

Front 14

Hypothermia Treatment

Back 14

Remove cold clothing. Provide heating blankets.
Active warming includes warm IV, GI lavage, bladder lavage, peritoneal lavage, and bypass with extracorporeal re-warming.

Front 15

Epidemology of Heat Injuries

Back 15

Affects old and young.

Front 16

Risk factors for Heat Injuries

Back 16

Dehydration. Alcohol. Drug Use. CVD. Burns. Scleroderma. Prolonged exerction in heat.

Front 17

Medications and Heat Injuries

Back 17

Antipsychotics. Anticholingergics. Diuretics. Sympathomimetics.

Front 18

Heat Edema

Back 18

edema of the extremities

Front 19

Heat Tetany

Back 19

Hyperventilation and respiratory alkalosis

Front 20

Heat Exhaustion

Back 20

Syncope. Tachycardia. Tachypnea. Hyperthermia.

Sweating.

Front 21

Heat Stroke

Back 21

Temp greater than 40.5C (>104.9) with anhidrosis and CNS dysfunction. Admitt

Front 22

Thermal Burn Estimation

Back 22

Adults - Head and Each Arm 9%. Back, Trunk, Legs 18%

Children - Head, back, trunk 18%. Legs 13.5%

Front 23

Transfer Criteria for Thermal Burns

Back 23

>10% Partial thickness of BSA for less than 10 yo and >50yo

>20% Partial thickness of BSA for all others
>5% BSA full thickness
Partial or Full Thickness invovling Hands, face, feet, genitalia, perineum, major joints.

Front 24

Special Cases for Thermal Burn Transfers

Back 24

Electrical Burns. Inhalation Injury. Circumferential burns of the extremities or chest.

Front 25

Parkland Formula

Back 25

4mLx Body Weight in kg x %BSA = Total fluid replacement in first 24 hrs. Bolus 1/2 in the first 8 hrs. Remaining fluid in 16 hours.

*For peds use 3 mL.

Front 26

Treatment of Thermal Burns

Back 26

ABC. Intubate early. Saline soaked dressing. Large burn use sterile dressings. Analgesia. Tetanus.

Front 27

Minor Burn Treatment

Back 27

Silver sufadizine creme, no face. Daily dressing changes initially.

Front 28

Mild CO Toxicity Presenation

Back 28

Nausea. Dizzieness. Headache. Weaknes.

Treat 100% O2 for 4hrs. Except Pregnancy HBO.

Front 29

Serous CO Toxicity

Back 29

LOC. Confusion. Focal neuro deficitis. Myocardial ischemia. Persistent hypotention. Persisten acidosis.

Treat with hyperbaric chamber for 90min. Repeat every 3 to 6 hrs.

Front 30

Pulse Ox and CO Poisoning

Back 30

Useless as it reads the same.

Front 31

Fires and Inhaled Toxins

Back 31

CO and Cynide. Cyanide only treat with sodium thiosulfate.

Front 32

Epidemiology of Electrical Injuries

Back 32

20% toddlers. 25% adolescents. 25% Occupational

Front 33

Electrical Injuries and Resistance

Back 33

Most resistance if found in bone, fat, tendon. If patient is complaining of thigh pain, may be possible bone heated up so much it burned the surrounding tissue. resulting in compartment syndrome. Least resistant i muscle, vessels, and nerves.

Front 34

Burn to the Mouth Complication

Back 34

Ruptured labial artery.

Front 35

Complications of Electrical Injuries

Back 35

Rhabdomyolysis. Renal failure.
Corneal burns may result in cataract.
Hearing loss.

Front 36

Treatment of Electrical Injury

Back 36

ABC. Supporitive.
Admit for high voltage injury, LOC, chest pain, burns, neurological or vascular injury to extremity, abnormal EKG.

Front 37

Keraunoparalysis

Back 37

Is when ther eis a potential difference between legs resulting in powerful vasoconstriction resulting temporary parylsis.

Front 38

Eye and Ear Complications of Lightening Strike

Back 38

Tympanic memebrane rupture. Half patients develop ocular problems, most common being cataracts.

Front 39

Treatment of Radiation

Back 39

ABC and supportive care.
Remove clothing.
Obtain swab from wounds, nasopharynx, oropharynx.
Gently wash and irrigate.
Obtain baseline CBC.

Front 40

Epidemology of Submersion Injuries

Back 40

<4 and adolescents.

Front 41

Dry Drowning

Back 41

Laryngospasm when water enters larynx.

Front 42

Aspiration of Water and Lung

Back 42

Leads to surfactant loss causing atelectasis and breakdown of alveolar capillary membrane. This results in non cardiogenic pulmonary edema.

Front 43

Treatment of Submersion

Back 43

C-spine.
Baseline labs and ABG.
CXR
EKG
Supplemental O2
Postive pressure ventilation
NG Tube

Front 44

Dybarism

Back 44

Barotrauma of Decent. Decompression Sickness. Barotrauma of Ascent

Front 45

Barotrauma of Decent

Back 45

Compression from sinus squeeze, external ear squeeze, middle ear squeeze and internal ear squeeze.

Front 46

Barodontalgia

Back 46

Pain in tooth due air bubble in tooth.

Front 47

Aerogastralgia

Back 47

Air expansion in GI.

Front 48

Subcutaneous emphysema

Back 48

Is air bubbles in the cutaneous are in the throacic cage. Is a form of barotrauma of ascent.

Front 49

Sudden loss of consciouness upon surfacing

Back 49

Gas embolism. Hyperbaric oxygen as soon as possible.

Front 50

Nitrogen Narcosis

Back 50

At elevated pressures, such as diving, inert gases have an anethetic property similar to the effect of ethanol. Reversed upon ascent.

Front 51

Types of Altitude Sickness

Back 51

Acute hypoxia. Acute Mountain Sickness. High Altitude Cerbral Edema. High Altitude pulmonary edema.

Front 52

Acute Mountain Sickness

Back 52

Lightheadedness and dyspnea with rapid ascent 2000m or higher. Hang over symptoms with fluid retention. Prophylaxsis with acetazolamide.

Front 53

HACE

Back 53

High altitude with cerbral edema occurs due to decreased oxygen leading to dilation of cerebral blood vessels. Presents with altered mental status, ataxia, coma.

Front 54

Treatment of HACE

Back 54

Descent. Oxygen. Steroids.

Front 55

HAPE

Back 55

High altitude Pulmonary Edema occurs due to increased sympathetic activity leading to decreased lung compliance and increased pulmonary vein pressure. Net effect is pulmonary edema.

Front 56

Treatment of HAPE

Back 56

Oxygen. Descent. PEEP. Vasodilators.

Front 57

Common Aerobic Dog Bite Bacteria

Back 57

Strep. Staph. Pasteurella.

Front 58

Immunocompromised and Dog Bites

Back 58

Capnocytophagia canimorsus can cause sever sepsis, DIC< renal failure, endocarditis. 25% mortality.

Front 59

Where to Close Dog Bit

Back 59

Scalp. Face. Trunk.

Front 60

Prophylactic Antibiotics and Dog Bite

Back 60

Augmentin. Or Clindamycin and Cipro.

Front 61

Cat Bites

Back 61

80% Become infected mostly with Pasteurella multocida. Treat with augmentin, cefuroxime, or doxycycline.

Front 62

Rabies Stages

Back 62

Incubation - 20-90days
Prodrome - 2 to 10 days
Neurologic - 2-7 days
Coma - 0-4 days

Front 63

Treatment of Rabies

Back 63

Clean wounds with soap and water. Administer 20IU/kg of Immunoglobulin. Give 1cc vaccine on days 0, 3, 7, 14, 28.

Front 64

Crotalids Treatment

Back 64

Crofab 10 vials. Compartment syndrome, treat with fasciotomy.