Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
57 Cards in this Set
- Front
- Back
|
When inhalation injury is present in burns, what should be done carefully to avoid exacerbating pulmonary edema and acute respiratory distress syndrome.
|
Fluid resuscitation
|
|
|
What are the indications for intubating a patient with inhalation burn injury?
|
(1) full-thickness burns of the face or perioral region, (2) circumferential neck burns, (3) acute respiratory distress, (4) progressive hoarseness or air hunger, (5) respiratory depression or altered mental status, and (6) supraglottic edema and inflammation on bronchoscopy.
|
|
|
In patients with suspected inhalation injury following a burn, what labs and imaging should be ordered?
|
Arterial blood gas analysis, carboxyhemoglobin level, chest radiograph, and ECG
Electrolyte, blood urea nitrogen, creatinine, and glucose levels |
|
|
Describe the Parkland formula:
|
4 mL of lactated Ringer's solution multiplied by the percentage of BSA burned (second- and third-degree burns only) multiplied by the body weight in kilograms.
Half of the total is given in the first 8 hours after injury and the rest during the next 16 hours |
|
|
What is the concern with circumferential burns? What is the potential treatment?
|
Compartment syndrome and distal circulation comprimise.
Escharotomy |
|
|
Burns that involve what parts of the body should almost never be treated as an outpatient?
|
Hands, face, feet, or perineum
Also consider joints |
|
|
What is the common medication that can be applied to burn wounds?
|
Silver sulfadiazine
Also, bacitracin and triple-antibiotic |
|
|
Patients with deep partial-thickness, full-thickness, and mixed-thickness burns should be referred to a plastic surgeon or burn care specialist in _ to _ days for reevaluation and consideration of skin grafting.
|
2 to 4
|
|
|
In regards to chemical burns, Acids tend to cause __________ necrosis with protein precipitation, and form a tough leathery eschar. The eschar typically limits deeper penetration of the agent. Alkalis produce ___________ necrosis and saponification of lipids.
|
coagulation
liquefaction |
|
|
Irrigation with what substance for treatment of Alkaline burns resulted in better overall prognosis when compared with water?
|
5% acetic acid
|
|
|
Hydrofluoric acid burns are treated how?
|
Copious irrigation
Immediately administer IV calcium and magnesium, using standard slow IV rates, before laboratory results are available calcium gluconate |
|
|
Hydrofluoric acid burns are different than other acid burns in what way?
|
Acts like alkalis and will cause progressive tissue loss, including bony destruction.
Free fluoride ions are released, causing deeper burns and toxicity by immobilization of intracellular calcium and magnesium and poisoning of cellular enzymatic reactions. |
|
|
What type of burn can Airbag deployment create? Treatment?
|
Alkali burn. Sodium hydroxide. Nitric oxide. Ammonia. Copious irrigation.
Also can have occular involvement. |
|
|
Standard household electricity is AC. Electricity in batteries and lightning is DC. Low-frequency (50- to 60-Hz) __ can be more dangerous than similar levels of __ because the alternating current fluctuations can result in ventricular fibrillation
|
AC
DC |
|
|
What are potential medical treatments for myoglobinuria in the setting of electrical shock injury?
|
sodium bicarbonate and mannitol therapy. Alkalinize the urine. Promote diuresis.
|
|
|
Uncomfortable inflammatory lesions of the skin caused by long-term intermittent exposure to damp, nonfreezing ambient temperatures.
|
Chilblains or pernio
|
|
|
Describe the Classification of Frostbite Injuries (1-4)
|
First degree - Numbness, erythema, swelling, desquamation, dysesthesia
Second degree - Blisters of the skin Third degree - Tissue loss involving the entire thickness of the skin Fourth degree - Tissue loss involving the entire thickness of the part, including deep structures, resulting in the loss of the part |
|
|
Describe initial management of frostbite?
|
Warm water. Heating of the frozen area should be avoided, because dry heat may cause further injury. Thawing should not be attempted until the risk of refreezing is eliminated.
|
|
|
Treatment of Frostbite (7 different steps)
|
1. Immersion in or application of water at 40°C–42°C (104.0°F–107.6°F) until affected area is pliable and erythematous; do not begin rewarming until risk of refreezing is eliminated
2. Topical aloe vera cream every 6 h 3. No blister or soft tissue debridement acutely 4. Meticulous local care 5. Tetanus immunization 6. Parenteral narcotics for pain management 7. Ibuprofen, 12 milligrams/kg/d PO, in divided doses Optional Treatment 1. Topical bacitracin ointment for infection prophylaxis 2. Penicillin G, 500,000 units IV every 6 h for prophylaxis for susceptible organisms 3. Topical silver sulfadiazine cream for prophylaxis (do not use on face) |
|
|
Hypothermia is defined as a temperature below what degree celcius?
|
35
Shivering ceases when body temperature falls below 30°C to 32°C |
|
|
What EKG are seen in hypothermia?
|
The Osborn or J wave—a slow, positive deflection at the end of the QRS complex—is characteristic, though not pathognomonic, of hypothermia
|
|
|
Why does an ABG or VBG become non-reliable in hypothermic patients?
|
Because the blood gas analyzer warms the blood to 37°C (98.6°F), thus increasing the partial pressure of dissolved gas, the machine will report a higher partial pressure of oxygen and carbon dioxide and a lower pH than the actual values at the patient's body temperature
|
|
|
What are some active core rewarming techniques in hypothermia? What temp should these be at?
|
Active core rewarming at 40°C (104°F)
Inhalation rewarming Heated IV fluids GI tract lavage Bladder lavage Peritoneal lavage Pleural lavage Extracorporeal rewarming Mediastinal lavage by thoracotomy 40 degrees celcius |
|
|
What mechanisms does high external temperature and high humidity prevent cooling someone down?
|
When the external temperature rises to >35°C (>95°F), the body can no longer radiate heat to the environment and becomes dependent on evaporation for heat transfer. As humidity increases, the potential for evaporative heat loss decreases. Sweat that drips from the skin does not provide any cooling benefit and only exacerbates dehydration. As a result, the combination of high temperature and high humidity essentially blocks the two main physiologic mechanisms that the body uses to dissipate heat.
|
|
|
Acute inflammation of the sweat ducts caused by blockage of the sweat pores following exposure to heat is called what? Treatment?
|
Prickly heat or heat rash
antihistamines |
|
|
What is the treatment for mild and more severe heat cramps?
|
Many electrolyte solution drinks (sports drinks) are commercially available and are much more palatable. Patients with more severe symptoms require IV rehydration with normal saline
|
|
|
What differentiates heat exhaustion from heat stroke?
|
Heat exhaustion:
Normal to elevated temperature [<40°C (<104°F)] Nausea, vomiting, headache, malaise, dizziness Orthostatic hypotension Heat stroke Symptoms seen in heat exhaustion plus: Elevated temperature [>40°C (>104°F)] Neurologic abnormalities: inappropriate behavior, confusion, delirium, ataxia, coma, seizures Anhidrosis or sweating |
|
|
What are the 2 cardinal signs of heat stroke?
|
altered mental status
temp >104 |
|
|
What are potential medical treatments in anaphalyxis from a bee sting?
|
0.3-0.5 1:1000 epinephrine IM
25 to 50 mg Benadryl PO, IV, IM 50 mg Ranitidine IV Mehylprednisolone 125 mg IV or Prednisone 60 mg PO |
|
|
What are the potential systemic effects of a black widow bite?
|
Hemolysis, are seen more often in children and typically occur 24 to 72 hours after the bite. Other effects include nausea, vomiting, fever, chills, arthralgias, thrombocytopenia, rhabdomyolysis, hemoglobinuria, and renal failure.
|
|
|
What are some potential therapies for brown recluse bites? (none have been proven)
|
Various treatments have been advocated for brown recluse spider bites, including antihistamines, antivenom, colchicine, dapsone, hyperbaric oxygen, surgical excision, steroids, and topical nitroglycerin.
Most are self-limiting and heal without any medical intervention. |
|
|
Victims frequently complain of muscle cramp–like spasms in large muscle groups, (Severe abdominal wall musculature pain and cramping is well described.) although physical examination of the "cramping" extremity rarely reveals rigidity in what spider bite?
|
Black widow
|
|
|
Of black widow and brown recluse antivenom, which actually works?
|
Administration of black widow antivenom often causes rapid resolution of symptoms and can significantly shorten the course of illness.
|
|
|
What is the saying that applies to coral snake bites and whether than they are poisonous?
|
Red on yellow, kill a fellow; red on black, venom lack." This rule is not always true outside of the U.S.
|
|
|
What is the initial treatment and further treatment of Catfish, lionfish, scorpionfish, stingray envenomations?
|
Submerge injury in hot water [45°C (113°F)]for up to 90 min.
Irrigate with normal saline (0.9%). Explore and debride wound. Administer antibiotics and analgesics. Update tetanus immunization if needed. Elevate extremity. Observe for development of systemic symptoms. |
|
|
What is the treatment of Box jellyfish stings?
|
Blot area. Apply topical antihistamines or corticosteroid cream for itching.
Irrigate with saline. Apply 5% acetic acid (vinegar) topically. Observe for development of systemic symptoms. Remove tentacles. Provide supportive care. Administer Chironex antivenin. |
|
|
Any neurologic symptom or sign referable to the circulation to the central nervous system in the setting of barotrauma associated with scuba diving ascent should be considered to be secondary to what process?
|
cerebral arterial gas embolism resulting from Pulmonary Barotrauma from ascending too quickly
|
|
|
What is the treatment of decompression sickness and arterial gas embolism in the setting of diving injury.
|
100% oxygen, increasing tissue perfusion with IV fluids, and hyperbaric chamber
|
|
|
What is the diving reflex?
|
Bradycardia, apnea, peripheral vasoconstriction, and central shunting of blood flow when submerged in water.
|
|
|
In Mushroom ingestions, if toxicity begins ______, the clinical course will be benign. If symptoms _______, the clinical course will be more serious and potentially fatal.
|
Sooner <2 hrs
Later >6 hours |
|
|
General treatment for toxic mushroom ingestion is what?
|
activated charcoal 0.5 to 1.0 gram/kg, PO or by nasogastric tube
supportive cares |
|
|
Muscarinic mushroom intoxication are characterized by what symptoms? What is the antidote?
|
salivation, lacrimation, urination, defecation, GI hypermotility, and emesis). In addition to the SLUDGE syndrome, patients with muscarine ingestions can develop diaphoresis, muscle fasciculations, miosis, bradycardia
Atropine |
|
|
What does the poison Amanitin come from and what does it do?
|
Amanita Mushrooms. CNS symptoms.
Cells that undergo rapid protein synthesis and turnover, including cells of the GI tract mucosa, hepatocytes, and renal tubular epithelium |
|
|
_____________ is one of the most common causes of death in early mushroom toxicity
|
Hypoglycemia is one of the most common causes of death in early mushroom toxicity
|
|
|
The neurologic symptoms associated with gyromitrin (mushroom toxin) are successfully treated with high-dose _____________.
|
pyridoxine
B6 |
|
|
High doses of penicillin have been advocated to treat ________ (type of mushroom) poisoning, because penicillin blocks the uptake of amatoxin into the liver by its shared active transport system.
|
amatoxin
|
|
|
What is the treatment of foxglove ingestion? What medication does it mimic?
|
GI decontamination with activated charcoal
Monitoring of potassium level Antidysrhythmics Digoxin-specific Fab antibody for dysrhythmias Digoxin Oleander |
|
|
When do you use whole bowel irrigation in addition to activated charcoal in poisonous plant ingestions?
|
Whole-bowel irrigation using polyethylene glycol electrolyte solution should be added when a potentially toxic intact seed has been ingested
|
|
|
Ingestion of Jimsonweed and Deadly nightshade cause what class of prodromal symptoms? What are the symptoms?
|
Anticholinergic
Hyperthermia ("hot as a hare"), flushed skin ("red as a beet"), dry skin and mucous membranes ("dry as a bone"), mydriasis ("blind as a bat"), and hallucinations or delirium ("mad as a hatter"). |
|
|
What is the medication given to treat anti-cholinergic symptoms?
|
Physostigmine, a cholinesterase inhibitor, antagonizes both the central and peripheral effects
|
|
|
Why would a patient need systemic steroids for poison ivy? What are other symptomatic treatments?
|
Facial, genital, or widespread involvement requires systemic steroid therapy for at least 10 to 14 days.
Treatment consists of antipruritic and topical therapies (oatmeal baths and topical steroids). |
|
|
Acute Mountain Sickness is a syndrome characterized by what symptoms?
|
AMS is a syndrome characterized by headache, GI disturbances, dizziness or light-headedness, and sleep disturbance
|
|
|
Treatment of acute mountain sickness?
|
Immediate descent for worsening symptoms
Low-flow oxygen if available Acetazolamide, 250 milligrams PO twice a day, and/or dexamethasone, 4 milligrams PO every 6 h Hyperbaric therapy |
|
|
Acetazolamide can cross reactive with what group of allergies?
|
Sulfa
|
|
|
What are the different types of high-altitude syndromes in order of severity?
|
1) Acute Mountain Sickness
2) High Altitude Cerebral Edema 3) High Altitude Pulmonary Edema |
|
|
What is the primary treatment of all the high-altitude syndromes?
|
Descent
|
|
|
Altered mental status, ataxia, stupor are seen in what condition when climbing a mountain? Treatment?
|
High-Altitude Cerebral Edema
oxygen supplementation, descent, and Dexamethasone therapy |
