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190 Cards in this Set
- Front
- Back
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What is the definition of Disaster?
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when needs excees resources
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What is the definition of Mass Casualty Incident?
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when healthcare need exceeds resources
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What is the 1st step in identifying MCI?
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knowing your capabilties
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What is the goal of a Mass Casualty Indicident (MCI)?
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do the GREATEST GOOD for the GREATEST # of survivors
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What is the core concept of S in DISASTER??
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Support- what do I need to get the job done?
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MASS triage is dependent on what?
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resources available
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What 2 groups are helped during M of MASS triage?
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M-move 1. ambulatory pts who are the minimal initial group 2. can't walk/talk but can follow directions are the delayed initial group
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What is the sort category during the Assess stage of MASS?
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Immediate Initial Group
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Which group do you help first w/MASS?
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Immediate Initial Group
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What kind of patient is sorted as Red?
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Immediate Initial group---life threatening, limb amputation, abc's disrupted, unresponsive etc.
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What kind of patient is sorted as Yellow?
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Delayed---needs definitive care but should not worsen rapidly if initial care is delayed
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What kind of patient is sorted as Green?
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Minimal Initial group- walking wounded, cuts, treated and released, possible source of volunteer help
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What kind of patient is sorted as Black?
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Expectant Group- severely injured w/little or no chance of survival
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Once all pts. Have been triaged, what should be done?
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count in each category, advise triage officer, move immediate to collection point and mark w/red flag
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In what order do you send your MASS triage pts? Order of groups
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Immediate---Delayed---Minimal----Expectant
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How should you move a dead pt?
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DON'T
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What should be done during the recovery period of a MASS triage?
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AAR---after action review. So you can learn all you can from the incident
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What is the leading cause of mortality among National Disasters in the US?
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Floods!!
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How much water is required to move most vehicles?
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2 feet!
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What is the manin difference btwn natural disasters and unintentional disasters?
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natural disasters can be tracked before impact
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What are the 2 most important factors in decreasing mortality in natural disasters?
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Advanced warning and shelter access
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What is the most effective warning system for natural disasters?
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Local Sirens
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What is "all hazards"?
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collection of various man-made and natural events that have the capacity to cause multiple casualties
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What kind of blast causes damage to air-filled organs?
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Primary blast injuries
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What kind of blast injury is a tympanic membrane rupture?
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Primary blast injuries
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What type of blast injury woul dcause blunt injuries and eye injuries?
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secondary blast injuries
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What type of blast injury would cause body displacement or strxl collapse?
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tertiary blast injuries
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What type of blast injury would an amputated arm classify as?
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tertiary blast injuries
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What type of blast injury would a compartment syndrome classify as?
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tertiary blast injuries
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What type of blast injury would burns be?
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Quaternary blast injuries
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What type of blast injury would result from a "dirty bomb"?
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Quinary Blast Injury
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What is the most common blast injury??
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ruptured tympanic membrane
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What are 3 factors that determine the impact and effect of explosives and traumatic events?
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1. size of charge 2. distance from blast 3. air or water surrounding
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What type of blast injury is responsible for the MAJORITY of casualities resulting from an explosive event? (except strxl collapse)
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secondary blast injuries
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What is the primary determinant of the severity of blast injury??
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magnitude of the positve phase impulse PPI "aka peak overpressure"
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What is it called when a primary blast injury causes your alveolar walls to tear and it disrupts the alveolar capillary inface?
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Pulmonary Blast Injury---disrupts alveolar to capillary interface
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Pt. can not finish a sentence w/1 breath. What do you suspect?
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Pulmonary Blast Injury
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What will a pulmonary blast injury look like on chest radiograph?
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butterfly
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What is responsible for most of the sudden deaths that occur w/in the first hour after blast exposure?
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Arterial Gas Embolism---DIRECT communication btwn pulmonary vasculature and bronchial tree
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What often manifests as rapid decompensation immediately following intubation and positive pressure ventilation?
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Arterial gas Embolism
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What is the primary goal when treating someone w/ Arterial gas embolism?
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keep airway pressure less than vascular pressure
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What are some symptoms of arterial gas embolism?
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chest pain, blindness, cutis marmorata, focal neuro deficit, and tongue blanching
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What is Traumatic Rhabdomyolysis?
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Crush Injury---sustained large muscle compression
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How is compression of muscle dangerous?
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releases intracellular toxins and these could be toxic when circulate thru blood stream
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What will be seen on an EKG w/a crush injury patient?
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Peaked T waves due to HYPERKALEMIA or wide complex dysrhytmias
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What is the initial treatment of someone w/crush injury??
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IV of normal saline (give 1-1.5 L an hour) ASAP to achieve goal of 200-300 cc/hr urine output
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What is the treatment of Hyperkalemia?
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IV of glucose and insulin, and inhaled B2 agonist, CaCl in critical collapse
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What are some late complications of Crush Injury?
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acute renal failure and diffuse intravascular coagulation
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What is the problem--- severe pain, especially w/passive range of motion of the extremity?
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Compartment syndrome
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What causes traumatic asphyxiation?
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chest compression
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What is retrograde flow of blood and transmission of pressure from the right heart into the great veins of the head and neck?
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Traumatic Asphyxiation
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Who are most vulnerable to traumatic asphyxiation?
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children--chest are more pliable b/c cartilaginous
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What are some presenations of traumatic asphyxia?
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respiratory distress, chest ecchymoses, diffuse petechiae, facial edema, cyanosis, retinal hemorrhage, cerebral anoxia signs
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What the treatment of traumatic asphyxia??
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GET THEM OUT! Most important!
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Most mortality from traumatic asphyxia result from what?
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Pulmonary damage
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Most morbidity from traumatic asphyzia result from what?
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Neuro damage
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What is it called when there is release of radioactive materials into human populated areas w/out a nuclear explosion?
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Radiological attack
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What is it when there is nuclear detonation and a massive explosion??
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Nuclear weapon
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What is a residual radiation hazard from a nuclear explosion?
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Fallout---a miz of over 200 different isotopes aof 36 elements
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What reaches the ground during the 1st 24 hours after detonation?
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Early Fallout---makes up about 50-70% of total radioactivity. Highest degree of risk.
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What are fine invisible particles that settle in low concentrations after a detonation?
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Delayed Fallout
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Which has a greater level of risk?? Early or Delayed Fallout?
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Early Fallout---makes up about 50-70% of total radioactivity. Highest degree of risk.
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What is radiation consisting of directly or indirectly ionozing particles or photons?
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Ionizing Radiation
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List the radiation types from least harmful to most harmful.
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Alpha---Beta---Gamma---Neutron particles (ABGN)
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What type of radiation consists of "passing thru the individual"?
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Irradiation
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What is the name for Radiation sickness?
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Acute Radiation Syndrome (ARS)
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What is the immediate effect of radiation?
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Cell Membrane Damage--- Prodromal- 0.5-3.0 Gy (onset of naseau, vomitting, diarrhea)
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What determines the respiratory component of Acute Radiation Syndrome?
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dose and rate
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Pneumonitis and Fibrosis are seen w/what type of ARS?
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Respiratory Component
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What are the 2 biggest causes of deaths from burns??
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Infection and Organ System failure
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What type of cream do you give for burn therapy?
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Mafenide Acetate Cream
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What can you use for burn therapy for covering?
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artificial skin, skin graft, silver nylon fabric
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What makes up most of the distribution of nuclear detoration?
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Combined injuries---65-70%
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What are 2 things necessary for detection of exposure?
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Peripheral blood lymphocytes as a biodosimeter and Andrews Lymphocyte Nomogram
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Above what level of radiation do all pts become expectant?
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above 4.5 Gy
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What should be given to a pt w/in one hour of exposure to plutonium (or other soluble transuranics)?
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Calcium-DPTA
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What should be given to a pt if more than an hour has passed since exposure or it is a subsequent dose?
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Zinc-DPTA
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What is given for Cesium?
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Insoluble Prussian Blue
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What is given for radioactive iodine or technetium?
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300 mg for 7-14 daysPotassium Iodide-- must treat w/in 4 hours and no more than 12 hours
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What is given for radiostable water?
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Tritium--- for fluids like 3-4 L a day. Reduces half life
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What is given for radiostrontium or ammonium chloride?/
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Aluminum Phosphate
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What is given for removal of uranium?
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Sodium bicarbonate or Potassium Chloride inorder to alkalinate urine for remobe of uranium
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What is Bioterrorism?
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intentional use of a pathogen or biological product to cause harm to human and other living organisms, to influence conduct of government, or intimidate or coerce a civilian population
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Give an example of "asymmetric warfare"
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Bioterrorism
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What is a criminal act that causes illness?
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Bioterrorism
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Give 2 examples of intentional biological events.
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Anthrax and smallpox
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Give 2 examples of natural biological events.
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SARS and West Nile
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What are 2 types of Bioterrorism release?
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Overt Release and Covert Release
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What category would an emerging pathogen be if it could be engineered in the future for mass dissemination?
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Category C--- has possiblity of being dangerous, has potential to
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What category requires specific enhancement of CDC's diagnostic capacity and disease surveillance?
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Category B
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What category requires special action for public health preparedeness?
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Category A
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What are 2 emerging infx disease that can be used as bioterrorism agents?
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Nipah and Hanta virus
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What is not categorized yet, but is an emerging infx disease that poses a sig. public health threat?
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SARS
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What Bioterrorism release type has notice of release provided, may have a threat, creates fear?
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Overt Release
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What Bioterrorism release type has no notice or threat, and is difficult to detect??
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Covert Release
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A clinician makes a diagnoses and notifies the heatlh department. What type of bioterrorism release is described?
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Covert Release
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How does the CDC categorize the overall risk to national security?
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Divides bioterrorism agents into A,B, C
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What are the Category A agents?
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Anthrax, smallpox, plague, botulism toxin, tularemia, viral hemorrhagic fever
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What are 2 emerging infx diseases that possess a sign. Public health threat?
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Avian Flu and SARS
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How is anthrax used for bioattack?
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Spores!
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What is the Incubation for Inhalation Anthrax?
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2-43 days
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What are the symptoms of Inhalation Anthrax?
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Prodrome and abrupt onset of fulminant illness (sudden high fever, respiratory distress, shock, meningitis in 1/2)
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What is seen on imaging for Inhalation Anthrax?
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wide mediastinum and pleural infusion
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What is the incubation period for cutaneous anthrax?
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1-7 days
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What is the characteristic symptoms of Cutaneous Anthrax?
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itchy papule--ulcer--black eschcar w/ surrounding edema and erythema, regional adenopathy, systemic symptoms, will resolve
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What is the incubation period for Gastrointestinal Anthrax?
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1-7 days
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What is the symptoms of GI Anthrax?
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presents as febrile illness w/bloody diarrhea
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What type of anthrax is not likely after a bioattack?
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GI Anthrax
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How do you contract GI anthrax?
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eating undercooked infected meat
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How would you diagnose Anthrax?
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blood culture positive in less than 24 hours. If inhalation- fever and widened mediastinum. If Cutaneous--culture fluid UNDER eschcar
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What is the incubation period for Botulism?
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12-36 hour "incubation". Can range from 2h to 8 days!
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What MUST be present to diagnose Botulism?
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Bulbar palsies--ptosis, blurred vision, dry mouth, dysarthria, trouble swallowing
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What BT agent causes descending skeletal muscle paralysis w/no fever?
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Botulism
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What causes death in Botulism?
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Respirtory muscle paralysis
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What is the role of antitoxin for Botulism?
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prevents further damage---does NOT alter current damage
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What is the prophylaxis for Botulism?
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NONE exsists
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What BT has a safety pin appearance?
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Yersinia Pestis---Plague
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Where is the plague endemic in the US?
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prairie dogs in SW
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How is the plague endemic form passed to humans?
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prairie dogs-----via FLEA vector--Humans get bubonic form of plague
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What plague is used for bioattack?
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pneumonic plague
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What is the incubation of plague from an aerosolized BT?
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1-6 day incubation
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What are the symptoms of Plague?
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Abrupt, high fever, chills, malaise, cough w/bloody sputum, sepsis, rapidly progressive pneumonia
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What is the outcome of untreated plague?
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100% mortality
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What will an image of Pneumonia Plague look like?
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patchy infiltrates
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What is one of the deadliest disease w/a mortality rate of 30%?
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Small pox
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When did the US stop vaccinating smallpox and when did WHO declare it eradicated?
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1972, 1980
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What is the incubation period for smallpox?
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7-17 days (avg. 12 days), weaponized 3-5 days
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What is the key difference in smallpox clinical features?
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Severe Prodrome-- 2-3 days fever, myalgias, prostration, delerium, 10% light rash on face, and rash that starts on limbs and spreads to trunk
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Describe the rash seen w/ Small pox.
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macules--papules--vesicles--pustules. Are NOT IN CROPS, all in same stage of develop. Firm deep, umbilicated, scabs in 1-2 weeks
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What is the number 1 diagnostic for smallpox?
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history and physical!!!
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What type of supportive care is given for smallpox?
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penicillinase-resistant antibiotics, daily eye rinsing, hydration and nutrition
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When should someone w/ a febrille illness thought to be due to smallpox be isolated?
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BEFORE the rash appears
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Where is Tularemia an endemic?
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North America and Eurasia
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How are humans infected w/Tularemia?
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ticks, biting flies, infected animals (ulceroglandular)
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What is the incubation period for Tularemia?
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3-5 days (ranges from 1-14)
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Acute febrile illness w/prostration?
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Tularemia---80% will have pneumonia. May also have conjunctivitis, skin ulcer, or regional adenopathy
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what represents 90% of fatality from viral hemorrhagic fever?
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Ebola
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What is the incubation for ViralHemorrhagic Fever?
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2-21 days
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What BT has an initial presentation of nonspecific prodrome fever and can progress to generalized mucous membrane hemorrhage and shock?
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Viral Hemorrhagic Fever
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What is done to diagnose VHF?
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definitive diagnosis requires CDC! Can diagnose using ancillarytesting: Thrombocytopenia, Leukopenia, AST elevation
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What is the treatment for VHF?
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supportive care & Ribavirin
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What is the prophylaxis for VHF?
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NONE exsists
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What is done to prevent VHF infxn?
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ISOLATION! N-95 or better respirators, double glove, negative pressure room, etc.
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What are 3 examples of past flu pandemics?
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Spanish flu (1918), Asian Flu (1957), Hong Kong Flu (1968)
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DISASTER of BT, what is the lead role of law enforcement?
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Incident Command
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what are pre-positioned material managed by CDC and DHS and is vendor managed inventory?
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Strategic National Stockpile
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What are the 3 types of triage patients?
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1. Ill 2. Exposed but not ill 3. not exposed
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What is the BT agent? Pt. has flu like illness and upper respiratory symptoms.
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Inhalational Anthrax
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What is the BT? Pt. has a fever and a black eschcar scab.
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Cutaneous Anthrax
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What is the BT? Pt. has a fever, nausea, vomitting, and bloody diarrhea?
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GI Anthrax
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What BT is airborne?
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Smallpox and VHF
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Skin rash w/fever?
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Smallpox
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What BT is droplet borne?
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Plague (pneumonic)
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Acute Pulmonary Syndrome w/Fever? 2
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Plague & Anthrax
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Flu-like syndrome w/Fever?
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Tularemia or SARS
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Excessive bleeding w/fever?
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Viral Hemorrhagic Fever
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What has toxin effects w/out a fever?
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Botulism
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Chemical Agents can be divided in to what 5 categories?
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nerve agents, blood agents, irritant agents, incapacitating, vessicants
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Example of Blood agents.
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Cyanides
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Example of Nerve Agents. 4
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Tabun, Sarin, Soman, VX
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Example of Nerve Agents, 4
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Phosgene, chlorine, ammonia, pepper spray
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Example of Vessicants, 3
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Mustard, Lewisite, Phosgene Oxime
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What is the MAO of Nerve Agents?
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inhibit Acetylcholinesterase, so increase in Ach floating around, increase parasym. Activity
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What is the mnenomic for muscarineic effects?
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DUMBELS
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What is the mnenomic for nicotinic effects?
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days of the week, MTWHFS
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What is seen w/ low exposure to Nerve agents?
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miosis, dim vision, eye pain, rhinorrhea, dyspnea, sweatingand fasiculation
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what is seen w/HIGH exposure to Nerve agents?
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LOC, seizures, apnea, flaccid paralysis
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What are the Antidotes for Nerve agents?
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Atropine (2 mg), Pralidoxine (2-PAM) (1 gram), Benzodiazepines, PRN for seizures
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What is the maximun cumulative dose for atropine?
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max= 20 mg
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How much atropine should be given to someone w/nerve gas probs?
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until secretions are drying and ventilation is easy
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What is the solubility of Irritant gases? From highly soluble to low solubule.
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Ammonia (nose), Chlorine (nose and lungs), Phosgene (lungs)
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What irritant gases aer considered Immediate??
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Airway compromise and Severe SOB
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What would a pt. w/mild SOB and no airway compromise be? Irritant gas pt.
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Delayed
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What would a irritant gas pt. w/ mild mucous symtoms be classified as?
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Minimal
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What would a irritant gas pt. w/ respiratory arrest be classified as?
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Expectant
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Burning wood, plastic, etc. releases what??
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cyanide gas-- may play role in smoke inhalation and fire related deaths
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combustion of carbon from plastics gives acrylonitriles and pits of plants release what???
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cyanide
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What are some antidotes for cyanide?
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3 drug-antidote kit or Hydroxocobalamin
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What is included in a 3 drug antidote kit for cyanide??
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Amyl Nitrate (30 sec)---Na Nitrite (300 mg IV)----Na Thiosulfate (12.5g IV)
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How much Hydroxobobalamin should be admistered for cyanide?
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5 g IV---chelates cyanide
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What are some blister agents "Vesicants"?
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Sulfur Mustards, Lewisite, Phosgene Oxime
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What is the most widely used chemical weapon?
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Mustard--- morBIDITY is HIGHER
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What chemical weapon penetrates cells and generates toxic intermed. And alkylates DNA/RNA and proteins?
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Mustards--- most suspecitible are rapidly dividing cells
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Erythema, Bullae and coagulation necrosis?
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Mustards!
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what is the best treatment for vesicants?
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Immediate decontamination---must be within 2 minutes
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What are 2 antidotes for vesicants?
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NAC for mustard, BAL for Lewisite
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What type of chemical agents are not meant to be lethal but to cause an inability to perform one's mission?
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Incapacitating Agents
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Give an example of Incapcitating Agents.
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BZ--- Quinuclidinyl Benzilate)---Aerosolized Anticholinergic
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What would cause Anticholinergic Toxidrome?
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BZ!!!!!
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What is considered for BZ treatment?
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Benzodiazepines or PHYSOSTIGMINE (1-2 mg)
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