Surgery Exam 4

Front 1

what type of temperature measurement provides the core temp of deep structures of the body. and what is the temp at which the body functions best?

Back 1

PA catheter (pulmonary artery, in the heart!)
98.6 aka 37C

Front 2

The body maintains core temperature through what mechanism?

Back 2

metabolism

Front 3

the term used to describe how heat is transmitted to us via the external environment based on a different in body temp and environmental temp?

Back 3

thermal gradient

Front 4

what controls temp regulation in the body?

Back 4

hypothalamus

Front 5

increased CO
Increased resp rate

Is the body too hot or too cold?

Back 5

too hot

OR early stages of hypothermiaw

Front 6

transfer of heat through circulating air is known as? what makes this loss higher?

Back 6

convection
the windier it is the more heat loss we may have

Front 7

heat transfer from object to another, by direct physical contact. what can increase this heat loss?

Back 7

Conduction
if person is in contact with cold surface or icy cold water this can REALLY increase the amt of heat loss

Front 8

What are the 5 mechanisms of heat loss?

Back 8

1. convection
2. respiration
3. evaporation
4. conduction
5. radiation

Front 9

most heat loss/gain is a result of what mechanism?

Back 9

radiation 55-65%

Front 10

hypothermia is classified as temperature below what?

Back 10

<35C (95F)

Front 11

what are the two types of non-freezing local cold emergencies?

Back 11

Chillblains
trench foot

Front 12

pale skin
mottled
anesthetic sloughing
tx?

Back 12

trench foot
tx: skin care
elevation
rest

Front 13

pruritus
burning
paresthesias
Tx?

Back 13

Chillblains (Pernio)
tx:
supportive
gentle re-warming
bandage
elevate

Front 14

freezing of epidermis, and partial dermis, but not deeper layers. Tissue loss does not occur. resolves with re-warming

Back 14

frost nip

Front 15

cellular damage during frost bite can lead to what?

Back 15

permanent inflammation, tenderness, cold intolerance and even gangrene

Front 16

We DONT want to do all of the following pre-hospital to treat frost bite, except?
a. rub or massage
b. apply heat
c. rewarm
d. remove jewlery

Back 16

d. we do want to remove jewlery

Front 17

when rapidily rewarming an extremity with frost bite what temperature should the water be

Back 17

104-108F

Front 18

hypothermia is classified as temp of what?

Back 18

95F or below

Front 19

hypothermia as a result of systemic disease that compromises the body's temp mechanisms is known as primary or secondary ?

Back 19

secondary!

primary would be if you go out into the cold without a jacket, etc

Front 20

which of the following is not accurate about late stage hypothermia?
a.left shift of oxyhemoglobin dissociation curve --> less O2 rlease to tissues
b. depression of insulin release --> hyperglycemia
c. decrease of ADH release, with increased urine output
d. increased HR, BP, and RR

Back 20

d. is false. in late stage hypothermia you actually have depressed breathing, HR, and BP. (In early stage you see the increase.)

a. left shift in low temp situation and right shift in high temps (like exercise) (left shift means there is more affinity for the O2 and less released to the body)
b. yes, less insulin is released resulting in hyperglycemia
c. some patients with hypothermia will pee themselves!

Front 21

what stage of hypothermia do we see:
nausea, confusion, apathy, visual disturbances, lethargy, inability to do complex motor funcitons but can still walk and talk

Back 21

mild hypothermia

Front 22

what ecg changes might we see in a hypothermic patient?

Back 22

1. bradycardia
2. small absent P wave
3. abnormal ST segments, T wave
4. J wave (Osborn)

Front 23

THis ECG wave is associated with moderate hypothermia but has no prognostic significance

Back 23

J wave (Osborn wave)

Front 24

when would we use active core rewarming techniques?

Back 24

in a moderate to severe hypothermic patient who is not responding to AER and has unstable cardiac rhythms

Front 25

which of the following is not an AER technique?
a. warm bath
b. hot water bottles
c. heat lamps/ blankets
d. heated humidified O2

Back 25

d. heated humidified O2, warmed IV fluid, warm fluid lavage and extracorporeal rewarming are all ACR methods

Front 26

what is heat tetany?

Back 26

hyperventilation resulting in resp. alkalosis, paresthesia, carpopedal spasm. Usually associated with intense periods of heat stress.
need to remove patient from heat and reduce respirations

Front 27

when a patient experience heat exhaustion what will their skin feel like?

Back 27

cold and clammy
however will have dry tongue, mouth, and increased thirst.

Front 28

How do we dx heat exhaustion?

Back 28

1. hx and physical
2. CBC
3. lytes
4. LFT
5. BUN/Cr
6. urine specific gravity

Front 29

what is the heat stroke triad?

Back 29

1. hyperpyrexia ( >104.9F, >40.5C)
2. CNS dysfnx, altered mental status
3. Anhidrosis (not sweating)

Front 30

what will you find on physical exam in someone with heat stroke?

Back 30

1. seizures (75%)
2. no sweating
3. tachycardia
4. hypoglycemia
5. respiratory alkalosis
6. lactic acidosis

Front 31

most deaths are from ________ not snakes

Back 31

insects

Front 32

the family that includes, honeybees, wasps, ants, hornets is known as?

Back 32

hymenoptera

Front 33

hymenoptera venom may contain what?

Back 33

histamine
serotonin
Amines
Phopholipiase
Hyaluronidase

Front 34

10 or more stings may induce what kind of reaction?

Back 34

no longer anaphylactic, its a toxin overload

Front 35

what is the major cause of death associated with bee or wasp stings?

Back 35

anaphylactic rxn

Front 36

most anaphylactic deaths occur within how long?

Back 36

within 30 min of being stung

Front 37

allergen componen of single or multiple stings may induce an antigen antibody _____ mediated systemic anaphylactic reaction

Back 37

IgE (edema?)
Histamine, SRS-A + other factors are released within minuts. producing sx

Front 38

Serum sickness like presentation appearing about two weeks after a sting
Symptoms include:
Headache
Malaise
Fever
Polyarthritis
Generalized pruritus

Back 38

delayed reaction

Front 39

unusual reaction may present similar to?

Back 39

EVAN
encephalopathy
vasculitis
Autohomic dysfunction
Neuritis

Front 40

What is the tx for anaphylactic reactions?

Back 40

1. ABCs
2. severe airway compromise - intubate or surgical airway
3. local wound care
4. iv fluids
5. antihistamines : 50-100mg IV dipenhydramine (Benadryl)
6. Steroids (methylprednisolon 125 mg IV or hydrocortisone 2mg/kg IV
7. H2 blockers
for life threatening sx include
1. epinephereine
2. albuterol nebulizer tx for bronchospasm
3. hypotensive pts require large volumes of fluid. may need dopamine infusion titrated to effect

Front 41

what is first line in anaphylactic rx? other than the meds?

Back 41

FLUIDS!

Front 42

which patient requires ICU admission?
A. patient with systemic reaction with persisting sx
B. patient with anaphylactic rxn

Back 42

both!

refer pts with serious rx to immunologist for desensitziation and 3 pens

Front 43

this spider has a potent neurotoxin. that causes acetylcholine depletion and nerve terminals = leading to painful mm spasm

Back 43

black widow (latrodectus mactans)

Front 44

Immediate sharp, stinging pain at the bite site followed by cramping and numbness that slowly spreads

Back 44

neurotoxin from latrodectus mactans (black widow)

Front 45

dizziness, headache, nausea, itching, increased salivation,weakness
Patient may develop cramps that mimic an acute abdomen or myocardial infarction

Back 45

bite from latrodectus mactans (black widow)

Front 46

Muscle twitching, weakness, paralysis, drooping eyelids
Diaphoresis, fever
Hypertension
Edema, skin rash, conjunctivitis, itching
Shock, respiratory depression
May see two small fang marks

Back 46

neurotoxin from latrodectus mactans

Front 47

how do we tx black widow bite?

Back 47

1. ice
2. clean wound
3. tetanus
4. nitroprusside if HTN >130
5.mm relaxants + analgesia (CaCl)
6. Anti-venin: only for very old/young, pregnant, preexistng conditions

Front 48

bite may feel sharp with little to no pain, or only mild stinging
necrotoxic

Back 48

brown recluse (loxosceles reclusa)

Front 49

by what day will you see aseptic necrosis from a brown recluse bite?

Back 49

day 5-7.
starts off with sharp bite, no pain until 2 hrs then local pain wth blue gray halo and then dark bleb, that grows until it rutpure and then necrosis

Front 50

these systemic side affects can be seen from what? Severe
DIC – very rare
Hemolysis
Renal failure
Convulsions
Heart failure
Death

Mild:
Fever, chills
Malaise
Nausea, vomiting
Joint pain

Back 50

brown recluse - loxosceles reclusa

Front 51

what is the tx for a brown recluse bite?

Back 51

1. careful cleansing with water and soap
2. tetanus
3. analgesics
4. steroids within 24 hrs
5. monitor vitals and UO
6. Abx
7. wound management - surgical consult?

Front 52

Extreme restlessness, agitation
Roving eye movements
Poor coordination, slurred speech, difficulty swallowing
Salivation, wheezing, stridor
Tachycardia, tachypnea, hypertension, nausea, vomiting

Back 52

neurotoxin from centuroides sculpturatus

Front 53

what drugs dont you want to give for neurotoxin scorpion sting?

Back 53

opiates - barbiurate preps contraindicated

Front 54

how do we treat scorpion neurotoxin bites?

Back 54

1. antivenin
2. ventilatory support
3. atropine (to counteract cholinergic effects)
4. opiods for pain
5. Diazepam for mm spasms and szs

Front 55

90% of snake bites occur in what months? what are the peak months?

Back 55

april to october - peak: june to august (snakes most active when warm)

Front 56

which is the large aggressive rattlesnake that can measure from 4.5 to 6.5 feet?

Back 56

western diamonback

Front 57

what is the rattlesnake found in CT?

Back 57

timber rattlesnake

Front 58

highly toxic, dark, mainly black rattlesnake found in the SE

Back 58

cottonmouth snake

Front 59

seen in what class of snakes?

Pain, swelling
Progressive edema
Bruising
Blood-filled vesicles

Back 59

pit vipers

Front 60

which snake has possible neurotoxin and hemotoxin?

Back 60

rattlesnake

Front 61

"red on yellow..."

Back 61

kill a fellow
red on black venom lack

Front 62

most coral snake bite deaths occur from?

Back 62

respiratory arrest within 36 hrs

Front 63

Fang marks that continue to ooze unclotted blood indicate:

Back 63

envenomization

Front 64

these sx are seen from what?
Shock and hypotension
Compartment syndrome
Fluid shifts
Hemolysis
Coagulopathies
Petechiae and bleeding
Pulmonary edema
Neurotoxicity

Back 64

snake bites

Front 65

• Pain and swelling
• Progressive edema
• Bruising
• *Blood-filled vesicles
what kind of venomous snake?

Back 65

pit viper

Front 66

• No pain or swelling
• Tingling around bite
• Muscular incoordination and weakness
• Increased salivation
• Difficulty swallowing
• Respiratory distress
what kind of venomous snake?

Back 66

coral snake

Front 67

therapy for venomous snake bites?

Back 67

1. stabilize
2. exam
3. prophylaxis - tetanus
4. debridement
5. antivenin

Front 68

what marine animal is responsible for the most envenomation?

Back 68

jelly fish, protugese man of war = coelenterates

Front 69

jelly fish have stinging cells called?

Back 69

nematocytes

Front 70

the deadliest jelly fish in the world?

Back 70

irukandji jellyfish

Front 71

for what kinds of jelly fish stings would you use vinegar first line? In which type would you NOT use it?

Back 71

use for box jelly fish and tropical water jelly fish and can follow with seawater
do NOT use on Portuguese man-of-war jellyfish

Front 72

what causes the most severe pain the animal kingdom?

Back 72

scorpionfish