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81 Cards in this Set
- Front
- Back
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These are
Risk factors for what environmental injury? Intoxication smoking atherosclerosis arteritis hypovolemia diabetes vascular injury secondary to trauma infection |
Cold injury
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A superficial freeze injury characterized by lack of extracellular ice crystals and no progressive tissue loss;
Sx resolve with rewarming and no tissue is lost |
Frostnip
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What degree of frostbite
and what prognosis? partial skin freezing; erythema mild edema no blistering occasional skin desquamation after a few days. |
1st degree
good prognosis |
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What degree of frostbite
and what prognosis? full thickness skin freezing; substantial edema erythema clear blisters form black eschars numb aching throbbing |
2nd good
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What degree of frostbite
and what prognosis? hemorrhagic blisters with skin necrosis and blue-gray discoloration; feels like "a block of wood " subsequent burning throbbing and shooting pain. |
Third degree
poor |
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What degree of frostbite
and what prognosis? extension into subcutaneous tissue bone muscle tendon; there is little edema skin is mottled nonblanching cyanosis |
Fourth degree frostbite
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When does the frostbitten patient usually present?
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Subacute
less than 24 hours |
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How the injured extremity should be rewarmed in frostbite:
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Rapid rewarming-
extremity should be placed in gently circulating water @ temp of 40-42*C for 10-30 minutes until the extremity is erythematous and pliable |
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Should frostbite blisters be aspirated or
debrided? What should they be dressed with? |
Clear blisters yes
Hemorrhagic No. Dress with aloe vera |
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When are most surgeries for frostbite performed?
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Around 3 wks out
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What is the definition of hypothermia?
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Core body temperature below 95*F
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32-35oc (89.6-95of);
physiologic mechanisms are attempting to retain and generate heat; CO/HR/BP all increase in this stage. |
Pt is in the "responsive" stage
(or excitatory stage) |
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Below 32oc (89.6of);
progressive slow down of physiologic functions and metabolism; decreased oxygen usage and decreased carbon dioxide production CO/HR/BP all decrease in this stage. |
- pt is in the slowing stage
(aka adynamic stage) |
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Shivering stops with associated significant decrease in heat production- what temp?
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30-32oc (86-89of)
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What ekg change is characteristic of hypothermia?
may also see widening of PR QRS and QT intervals; tremors (with associated artifact) due to shivering T wave inversions and various dysrhythmias. |
Jwaves
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Pts whose core temp is below 30*C (86*F)
are at the most risk for what cardiac problem? |
Dysrhythmias
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What is the typical sequence of dysrhythmia deterioration in hypothermia?
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Sinus bradycardia -->
Atrial fibrillation with slow ventricular response --> Ventricular fibrillation --> Asystole ----> Big Dirt Nap |
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Why rough handling of the hypothermic patient is dangerous
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May cause ventricular fibrillation to develop
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What should be done for patients at risk for cardiac dysrhythmias
in regards to cpr in order not to induce V-fib? |
Careful palpation of the pulse for 30 to 60 seconds.
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Uses the body's own metabolism and endogenous heat; used in pts who have become hypothermic over a period of days
Pts must have intact thermoregulatory mechanisms and heat producing ability. |
Passive rewarming
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What type of rewarming is
Indicated in pts with Severe hypothermia hypothermia secondary to illness and pts with cardio-vascular compromise. |
Active external rewarming
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Will not be effective in cardiac arrest;
the peripheral vasodilation that this induces can cause blood pooling and what is called a "rewarming shock; " also may cause "rewarming acidosis" |
Active external rewarming
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Internal organs are preferentially warmed restoring cardiac function early;
few of the complications as seen in external rewarming but it can be quite invasive and is not always available. |
Active core rewarming
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The greatest risk factor for death from hypothermia
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Asphyxia prior to their hypothermia episode
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Elderly patients
r/o CHF as a cause of pedal edema otherwise not much for treatment resolves spontaneously leg elevation and support hose can help Does not progress to the pretibial region. |
Heat edema
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Risk factors are dirty
tight clothes with lots of sweating Can progress into a chronic dermatitis if not taken care of Chlorhexidine in a cream or lotion is treatment of choice. |
Prickly heat
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Non acclimatized or
unconditioned individuals performing hard labor are at risk If mild salt tablets dissolved in water good IV if more severe. |
Heat cramps
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Painful
involuntary spasmodic contractions of muscles (usually calves) occurring mostly in people sweating profusely and replacing with water drinking. |
Heat cramps
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Acute heat-related illness that reflects significant volume depletion and may or
may not have elevated temp Often characterized by nonspecific weakness malaise lightheadedness nausea etc Cool hydrate and rest. |
Heat exhaustion
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The presence of a core temp higher than 40 degrees C (104 F)
CNS dysfunction and anhidrosis (lack of sweating) Anhidrosis may or may not be present. |
Heatstroke
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Alcoholics
Chronic illness Congenital CNS Dz Diarrheal disease Mobility limited Prior history Very old Very young Rx:: Antipsychotics Anticholinergics Cardio drugs B-Blockers etc Tranquilizers |
Risk factors for
Heat Stroke |
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Urticarial lesion contiguous with sting site
May have joint involvement A local reaction in mouth or throat can cause airway obstruction. |
Hymenoptera sting
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Multiple stings
(like with African killer bees) may resemble anaphylaxis but is not. |
Toxic reaction
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A delayed reaction
with signs and symptoms of fever malaise headache urticaria etc may occur how long after a sting? |
5-14 days
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How soon the majority of hymenoptera sting reactions occur
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Majority react in first 15 min
almost all within 6 hrs. |
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Symptoms progress to chest or
throat constriction wheezing dyspnea cyanosis abdominal cramps N/V laryngeal stridor shock and possible death |
How symptoms of hymenoptera stings intensify
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The shorter the time between sting and onset
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The more severe the reaction is.
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Localized Rales are detectable
Fundoscopy can reveal venous torsion and dilatation and retinal hemorrhage is possible Nonspecific HR and BP are variable and usually normal Fluid retention is hallmark |
Acute Mountain Sickness
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What is the tx for AMS and HACE?
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AMS- mild to mod is
Acetazolamide HACE & AMS for both use: Steroids Oxygen descent |
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Type I is mainly joint pain and possible lymphedema
Type II is "serious" DCS including neurological symptoms involving the CNS vestibular or "staggers" and cardiopulmonary DCS or "chokes". |
Decompression sickness
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Musculoskeletal manifestations -
Joint and extremity pain skin pain is from what? AKA: ? |
Decompression sickness
aka: "cutis marmorata" |
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Decompression sickness Tx
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Tx:
oxygen IV fluids Rapid Recompression therapy with Hyperbaric oxygen chamber. Use of dive tables dive computers for safety and prevention |
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Drowning
Age distribution - 3 peaks |
Age distribution - 3 peaks
toddlers under one adolescents and elderly 2nd leading cause of death under 15 yo. |
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The temperature at which cell damage from heat occurs.
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45 degrees C
or 113 degrees F |
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What zone of the burn: tissue is irreversibly destroyed with thrombosis of blood vessels.
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Zone of coagulation
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What zone of the burn: where there is stagnation of the microcirculation
This zone can become progressively more hypoxemic and ischemic if resuscitation is not adequate. |
Zone of stasis
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What zone of the burn: there is increased blood flow
In this zone there is minimal damage to the cells and spontaneous recovery is likely. |
Zone of hyperemia
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How to estimate the percentage of burn on an adult using the Rule of Nines.
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The area of the back of a patient's hand is approximately what percent body surface area?
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1 percent
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What type of burn?
only the epidermis red painful tender no blisters heals in 7 days symptomatic tx only |
1st degree
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What type of burn?
extend into the dermis and are divided into superficial partial-thickness and deep partial-thickness burns usually caused from hot water/liquids steam grease or flame. |
Second-degree burns
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What is the difference between a
superficial partial thickness burn & a deep partial thickness burn? |
DEEP BURN =
Past Pappilary Into Reticulr + 21 day Recovery Whitened tissue (Not Red) Deep extends past the papillary layer into the reticular layer takes more than 21 days to heal turns white instead of red and moist may need surgical debridement |
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Entire thickness of the skin;
all epidermal and dermal structures are destroyed skin is charred pale painless and leathery will not heal spontaneously. |
Third-degree or
full-thickness burns |
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Who is considered high risk in regards to burns?
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Younger than 10
above 50 underlying d’s |
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Full-thickness burns of the face or
perioral region Circumferential neck burns acute respiratory distress progressive hoarseness or air hunger Respiratory depression or altered mental status supraglottic edema and inflammation on bronchoscopy. |
Should be intubated immediately
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More than 10% BSA;
face hand feet genitalia perineum or major joints third degree complicating conditions burns with concomitant trauma long term rehab needed |
Indications for transfer to a burn unit
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Facial burns
singed nasal hair soot in mouth or nose expiratory wheezing bronchospasm upper airway edema |
Inhalation injury signs
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Where is direct thermal injury likely to occur in the airway?
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Usually limited to the upper airway
Thermal injuries below the vocal cords occur only in cases of steam inhalation. |
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Small particles may reach the terminal bronchioles
where they can initiate an inflammatory reaction leading to bronchospasm and edema. What is the cause? |
Particulate matter in the lungs
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What are the two major toxic inhalants?
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Carbon monoxide and hydrogen cyanide
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What is a lab used to determine
exposure or injury from smoke inhalation? |
Carboxyhemoglobin
bronchoscopy radionuclide scanning (to determine full extent of injury) |
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What should you look for when evaluating the airway in treating major burns?
How should you tx? |
Look for s/sx of inhalation injury
Airway Compromise or Wheezing = Intubation |
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What should be looked for on the head to toe assessment for a major burn?
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corneal burn
size and depth of burns ng tube and cath IV inserted |
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What should be done for wound care for
major burns- ED tx only- |
Clean
dry sheet initially small burns can be dressed with cool saline-soaked dressing NO antiseptic dressings! Accepting burn unit will give instructions on burn care. |
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Circumferential burns are at risk for
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Circulation compromise
so monitor distal pulses |
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The drug of choice and the preferred route of administration for major burns
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Morphine (IV)
anxiolytics |
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Burns that are isolated are classified as?
NOT ON THE FOLLOWING: Hands Face Feet Perineum Does not cross major joints Not Circumferential. |
Minor Burns
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What is used to clean minor burns?
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Mild soap and water
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What should be done for large blisters from minor burns?
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Debride if on mobile joints or
for noncompliant patients |
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What is a topical antimicrobial that is used for tx of minor burns?
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Silver sulfadiazine
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When should you reassess a minor burn after initial tx?
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24 hrs
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Why someone is often able to survive a lightning strike
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Lightening is direct current (DC)
instead of alternating current (AC) so it often travels over the surface of the body limiting internal (cardiac) injury. |
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2 complications of electrical burns
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Cardiac arrhythmia
spinal fracture/ CNS injury |
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Fatigue
malaise flu-like sx nausea difficulty thinking concentration memory emotional lability dizziness paresthesias weakness vomiting lethargy somnolence stroke coma seizure respiratory arrest |
Carbon monoxide
(CO) |
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Chest pain from myocardial ischemia
palpitations mottled skin due to poor circulation poor cap refill hypotension cardiac arrest |
Carbon monoxide
(CO) |
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Not accurate for any CO poisoning because it does not differentiate between carboxyhemoglobin and oxyhemoglobin.
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Pulse oximetry
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2 tests
General work up following CO exposure of the patient with only mild symptoms |
Carboxyhemoglobin (cohb)
checked and possibly ECG to detect silent MI |
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What percentage is an abnormal level of carboxyhemoglobin in a patient?
Is this different in smokers? |
Yes- nonsmoker is less than 2
smoker less than 9 |
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What is the tx for mild CO poisoning?
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100 percent O2 by nonrebreather for 4 hours
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tx for major CO poisoning
Hx LOC Altered Mental Status Cardio Vascular CV manifestations Pregnancy Persistent acidosis |
Hyperbaric O2 tx
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A pruritic
maculopapular erythematous rash over clothed areas of the body (other terms are lichen tropicus miliaria rubra or heat rash) |
Heat edema
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