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64 Cards in this Set
- Front
- Back
Factors and Cold Related Injury
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Can be freezing or non freezing. Related to temperature, duration of contact, humidity, altitude, clothing, and behavior. Most avoidable cause is inappropriate clothing.
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Chilblains
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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.
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Trench Foot
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Is prolonged cooling in damp areas. Presents in three stages Initial phase, hyperemic phase, and late phase.
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Initial Phase of Trench Foot
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Pale mottled, numb, and pulseless.
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Hyperemic Phase of Trench Foot
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Severe burning pain and return of proximal sensation.
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Late Phase of Trench Foot
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Edema. Bullae. Pain.
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Treatment of Trench Foot
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Supportive care involving rewarming, bandage, elevate, and monitoring for sings of infection.
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Classification of Frostbite
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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. |
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Treatment of Frostbite
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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)
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Hypothermia
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Is a temperature below 35C or 95F.
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Epidemology of Hypothermia
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50% of patients are older than 65. Altered senssorium.
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Stages of Hypothermia
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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. |
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ECG and Hypothermia
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Is the appearance of the osborn wave (j wave). A camel hump appearance on the R wave.
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Hypothermia Treatment
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Remove cold clothing. Provide heating blankets.
Active warming includes warm IV, GI lavage, bladder lavage, peritoneal lavage, and bypass with extracorporeal re-warming. |
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Epidemology of Heat Injuries
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Affects old and young.
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Risk factors for Heat Injuries
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Dehydration. Alcohol. Drug Use. CVD. Burns. Scleroderma. Prolonged exerction in heat.
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Medications and Heat Injuries
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Antipsychotics. Anticholingergics. Diuretics. Sympathomimetics.
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Heat Edema
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edema of the extremities
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Heat Tetany
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Hyperventilation and respiratory alkalosis
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Heat Exhaustion
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Syncope. Tachycardia. Tachypnea. Hyperthermia.
Sweating. |
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Heat Stroke
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Temp greater than 40.5C (>104.9) with anhidrosis and CNS dysfunction. Admitt
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Thermal Burn Estimation
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Adults - Head and Each Arm 9%. Back, Trunk, Legs 18%
Children - Head, back, trunk 18%. Legs 13.5% |
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Transfer Criteria for Thermal Burns
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>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. |
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Special Cases for Thermal Burn Transfers
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Electrical Burns. Inhalation Injury. Circumferential burns of the extremities or chest.
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Parkland Formula
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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. |
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Treatment of Thermal Burns
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ABC. Intubate early. Saline soaked dressing. Large burn use sterile dressings. Analgesia. Tetanus.
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Minor Burn Treatment
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Silver sufadizine creme, no face. Daily dressing changes initially.
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Mild CO Toxicity Presenation
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Nausea. Dizzieness. Headache. Weaknes.
Treat 100% O2 for 4hrs. Except Pregnancy HBO. |
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Serous CO Toxicity
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LOC. Confusion. Focal neuro deficitis. Myocardial ischemia. Persistent hypotention. Persisten acidosis.
Treat with hyperbaric chamber for 90min. Repeat every 3 to 6 hrs. |
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Pulse Ox and CO Poisoning
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Useless as it reads the same.
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Fires and Inhaled Toxins
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CO and Cynide. Cyanide only treat with sodium thiosulfate.
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Epidemiology of Electrical Injuries
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20% toddlers. 25% adolescents. 25% Occupational
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Electrical Injuries and Resistance
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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.
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Burn to the Mouth Complication
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Ruptured labial artery.
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Complications of Electrical Injuries
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Rhabdomyolysis. Renal failure.
Corneal burns may result in cataract. Hearing loss. |
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Treatment of Electrical Injury
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ABC. Supporitive.
Admit for high voltage injury, LOC, chest pain, burns, neurological or vascular injury to extremity, abnormal EKG. |
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Keraunoparalysis
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Is when ther eis a potential difference between legs resulting in powerful vasoconstriction resulting temporary parylsis.
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Eye and Ear Complications of Lightening Strike
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Tympanic memebrane rupture. Half patients develop ocular problems, most common being cataracts.
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Treatment of Radiation
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ABC and supportive care.
Remove clothing. Obtain swab from wounds, nasopharynx, oropharynx. Gently wash and irrigate. Obtain baseline CBC. |
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Epidemology of Submersion Injuries
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<4 and adolescents.
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Dry Drowning
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Laryngospasm when water enters larynx.
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Aspiration of Water and Lung
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Leads to surfactant loss causing atelectasis and breakdown of alveolar capillary membrane. This results in non cardiogenic pulmonary edema.
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Treatment of Submersion
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C-spine.
Baseline labs and ABG. CXR EKG Supplemental O2 Postive pressure ventilation NG Tube |
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Dybarism
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Barotrauma of Decent. Decompression Sickness. Barotrauma of Ascent
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Barotrauma of Decent
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Compression from sinus squeeze, external ear squeeze, middle ear squeeze and internal ear squeeze.
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Barodontalgia
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Pain in tooth due air bubble in tooth.
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Aerogastralgia
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Air expansion in GI.
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Subcutaneous emphysema
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Is air bubbles in the cutaneous are in the throacic cage. Is a form of barotrauma of ascent.
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Sudden loss of consciouness upon surfacing
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Gas embolism. Hyperbaric oxygen as soon as possible.
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Nitrogen Narcosis
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At elevated pressures, such as diving, inert gases have an anethetic property similar to the effect of ethanol. Reversed upon ascent.
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Types of Altitude Sickness
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Acute hypoxia. Acute Mountain Sickness. High Altitude Cerbral Edema. High Altitude pulmonary edema.
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Acute Mountain Sickness
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Lightheadedness and dyspnea with rapid ascent 2000m or higher. Hang over symptoms with fluid retention. Prophylaxsis with acetazolamide.
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HACE
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High altitude with cerbral edema occurs due to decreased oxygen leading to dilation of cerebral blood vessels. Presents with altered mental status, ataxia, coma.
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Treatment of HACE
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Descent. Oxygen. Steroids.
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HAPE
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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.
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Treatment of HAPE
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Oxygen. Descent. PEEP. Vasodilators.
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Common Aerobic Dog Bite Bacteria
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Strep. Staph. Pasteurella.
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Immunocompromised and Dog Bites
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Capnocytophagia canimorsus can cause sever sepsis, DIC< renal failure, endocarditis. 25% mortality.
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Where to Close Dog Bit
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Scalp. Face. Trunk.
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Prophylactic Antibiotics and Dog Bite
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Augmentin. Or Clindamycin and Cipro.
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Cat Bites
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80% Become infected mostly with Pasteurella multocida. Treat with augmentin, cefuroxime, or doxycycline.
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Rabies Stages
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Incubation - 20-90days
Prodrome - 2 to 10 days Neurologic - 2-7 days Coma - 0-4 days |
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Treatment of Rabies
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Clean wounds with soap and water. Administer 20IU/kg of Immunoglobulin. Give 1cc vaccine on days 0, 3, 7, 14, 28.
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Crotalids Treatment
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Crofab 10 vials. Compartment syndrome, treat with fasciotomy.
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