emed II exam I envi emed II exam I enviro

emed II exam I envi emed II exam I enviro

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o prolonged exposure to nonfreezing cold and moisture: pale, mottled, pulseless –does not improve quickly with rewarming. The foot becomes hyperemic and painful. Perfusion returns 2-3days bullae and edema are late findings trench foot
painful inflammatory lesions typically affecting hands, feet, ears after exposure to intermittent damp nonfreezing conditions. Localized edema, erythema, cyanosis up to 12 hours after exposure; burning parasthesias, tender blue nodules after rewarming chilblains (pernio)
burning, stinging, numbness, 1st-4th degree, tx w/ imaging to det extent of tissue involvement, rapid rewarming, wound care, warm in 37C 10-15 min, thrombolysis, analgesia, tetanus frostbite
frost bite is very superficial and is characterized by a central area of pallor and anesthesia of the skin surrounded by edema 1st degree frost bite
frost bite- large blisters w/ clear fluid surr by edema and erythema developing w/in 24 hrs and extending to or nearly to the tips of digits. blisters may form an eschar, but this later sloughs off, revealing healthy granulation tissue (no tissue loss) 2nd degree frost bite
frost bite- injury is deeper than second, blisters are smaller, hemorrhagic and more proximal. Forms a black eschar in one to several weeks 3rd degree frost bite
frost bite- extends to muscle and bone, involves complete tissue necrosis mummification occurs in 4-10 days 4th degree frost bite
core body temp <35C (95F), from heat loss due to conduction, convection, radiation or evaporationShivering, tachycardia, tachypnea, HTN; may see loss of pupillary and gag reflexes, confusion, comatose, dysrhythmias such as PR, QRS, QT prolongation hypothermia
what is the progression of cardiac effects of hypothermia o Initial increase in HR, BP, and RR- then HR, BP and RR decrease- then dysrhythmia's, finally asystole
Slow positive deflection at the end of the QRS seen in hypothermia obsborn j wave
what are the three stages of tx of hypothermia (1) passive rewarming (2) active external rewarming (3) active core rewarming at 40C
– Repeated Exposure Over Many Days, Is a Transient Processo Sweat at a Lower Temperature- to cool oneself, Higher Sweat Rateo Increased Peripheral Blood Flow, Increased Aldosterone Production acclimitazation
the apparent temperature, considers the humidity, add 15F for sunlight heat index
Painful, Involuntary Spasm of Skeletal Muscle during Exercise or Shortly After, Manual Labor when not use to the heat, Self Limited, Rest, Electrolyte replacement heat cramps
o Maculopapular eruption from Inflammation and obstruction of the sweat ducts¦ Tx w/ Antihistamines +/- May warrant antibiotics against staphylococcus aureus prickly heat
Self Limiting to Days to 6 wks, Mild Swelling to Hands & Feet, Pooling of Interstitial Fluid, Not Involving the Pretibial Area- Diuretics are of No Use- Cutaneous vasodilation, Dependent extremities- Elevation – first, Compressive stocking – second heat edema
o Dizzy, Weak, Headache, Vomiting, Tachycardia, Tachypnea, Diaphoresis, Have a Normal Mental Status, Temperatures to 104F, Is a Diagnosis of ExclusionRest & Volume Replacement is Treatment heat exhaustion
o a form of postural hypotension, volume depletion, must r/o other causes, rehydrate the patient heat syncope
– Core Temperature Is > 104.9F, CNS Dysfunction-Combative, Bizarre, Coma & Seizures, Anhidrosiso Classic is Non-exertional, Exertional is Mainly in the Youngo High Mortality with Multi-Organ Failure heat stroke
what temperature should you cool someone to in heat related illness o Cool to 104F & stop to Avoid Over Shoot & Hypothermia
what are the initial complications of heat illnesses seizure/ coma, CHF, rhabdomyolysis, hypotension
what are the delayed complications of heat illnesses increased K+, RF, decreased Ca+, cerebral edema, DIC, hepatic failure
How do you treat a local reaction from a wasp/ bee/ stinging ant remove stinger, ice, diphenhydramine, maybe antibiotics, maybe steroids
how do you treat an anaphylactic reaction from a wasp/ bee/ stinging ant remove stinger, ABC’s, epinephrine, albuterol/epinephrine, diphenhydramine, solu-medrol, aminophylline
Warm, Dry Areas(Woodpiles, Cellars) – Initially Painless, Blister, Bluish Discol, Necrotic Ulceration over 23-4 Days+/- fev, chills, vom, arthralgias, myalgias, petechiae, hemolysis, seizure, RF, DIC, deathTX: tetanus, wound care, abx brown recluse (LOXOSCELES RECLUSA):
who are brown recluse bites worse in kids <7yo
o Range over entire US although different species- Female Only can Penetrate Human Skin- Orange & Red Hourglass on the Abdomen- Wood-piles, Basements, Garages, Sheds Black widow (LATRODECTUS MACTANS):
Mildly Painful Immediately, Than Develops a Target Like Lesion the bite is much larger than a tick bite – May experience diffuse muscle cramps, hypertension, tachycardia, headache, nausea, vomiting, diaphoresis, respiratory failure, shock, and coma Black widow (LATRODECT MACTANS):
how do you treat black widow (L. Mactans) spider bites Treatment: Local wound treatment, Supportive care, Analgesics and benzodiazepines for cramping• Lactrodectus anti-venom, derived from horse serum is rapidly effective• observe
large size, Venom is Very Mild, Usually Not Systemic- Can Flick Hairs 1-2 Meters which may embed into skin, conjunctiva and cornea-examine with slit lamp- Hairs Are Irritating Causing a Contact dermatitisBites may occur- treat local wound care tarantulas
Caribbean, Asia, and Africa highly toxic, Southern USA, NocturnalC.exilicauda: Immediate Pain/ Parasthesias/nausea/excessive secretions/roving eye movements/ fasciculations, resp arrest/tachycardia lasts 24-48hr scorpions (SCORPIONIDA_
how do you treat scorpion bites • Observe, supportive care, Anascorp within 4 hours, horse venom, medication for muscle spasm• Anti-venom in Arizona Only, not FDA approved
Infestation From Direct Contact, Primarily noted in intertriginous areas, Burrow Looks like a Zigzag, Whitish, Threadlike Channels, Pruritus Is main Problem TX: Lindane, NIX, RID, Permethrin or Ivermectin cream Which Stays 12 Hours scapies (SARCOPTES SCABIEI)
o Pruritus, Impetigo is Main ComplicationCalamine lotion, cool soaks and oral or topical antihistamines Fleas (SIPHONAPTERA):
o On Waist, Shoulders, Neck & Axillae, Causes Papular Wheals That Itch- Looks Like White Dandruff that Do Not Come Off- Pubic Lice Causes Bluish Spots on Belly & Thighs- Must Sterilize the Clothes Lice (ANOPLURA)
o Clusters of 3 pruritic papules, urticaria, wheals, and bulla, May be completely asymptomaticTreat symptomatically with topical steroids and anti-bacterials unless impetiginiousGive good instruction for at home removal bed bugs (hemiptera)
Venomous snake bites are typically caused by pit vipers (rattlesnakes, copperhead, water moccasin, and massasauga) or coral snakes! mostly in summer months snake bites
snake toxin that cause local tissue damage. cytotoxins
snake toxin that cause internal bleeding. hemotoxins
snake toxin that affect the nervous system. neurotoxins
snake toxin that act directly on the heart cardiotoxins
what are the three types of poisonous snakes in nyc • Timber Rattler(endangered) • Pygmy Rattler (massasauga) *Copperhead- *Found in City limits
Immediate burning pain, Subcutaneous edema around bite proximal spread- Petechiae, ecchymosis, hemorrhagic bullae- Weakness, fever, N/V, sweating, perioral numbness, metallic taste, fasciculations, hypotension, death pit viper bites
what are the exceptions to pit viper bites Mojave rattlesnakes are exceptions
Snake bites–Little pain and swelling, PtosisVertigo, paresthesias, fasciculations, slurred speech, drowsiness or restlessness, nausea, dysphagia, salivation, proximal muscle weakness, respiratory failure Coral, Mojave rattlesnake and exotics
antivenin grade pit vipers– neuro sx’s, shock, coma, death grade 4 (10-20 vials)
antivenin grade pit vipers-– generalized petechiae/ecchymosis, tachycardia and hypotension grade 3 (5-10 vials)
antivenin grade pit vipers- – Edema/erythema spreads to trunk with localized petechiae/ecchymosis grade 2 (5 vials)
antivenin grade pit vipers, pain, 1-5 inches grade 1
antivenin grade pit vipers, minimal pain w/ <1 inch erythema/ edema grade 0
• Eastern Coral Snake – 5 vials• Mojave Rattlesnake – 5 vials• ExoticsCall local zoo, Jacobi, Arizona Poison Center (602-626-6016) antivenin grading for coral and exotics
what is the treatment for snake bites – 2 large bore IV’s, Epinephrine, steroids, diphenhydramine, airway equipment- + skin testing (Horse serum, Fab)- Disposition: Coral snakes, Mojave rattlesnake, exotics ICU• Pit vipers ICU if antivenin, Observe 4-6 hrsantivenin dose
– In 2014: 130 alleged incidents, 72 of these unprovoked, Of attacks–60% surfers, 22% waders/swimmers, 8% diverso ABCDE, Control the bleeding, Assess for signs of hypothermia shark bites
is most common diving-related affliction barotrauma
descent-inability to equalize P causing TM bleeding/rupture, may result in conductive hearing loss. Forceful Valsalva during equalization>inner ear barotrauma tinnitus, sensorineural hearing loss, vertigo > bleeding from maxillary or frontal sinuses middle ear squeeze or barotitis media (descent barotrauma)
due to expansion of gas in body cavities • “reverse squeeze” may affect the ear or sinuses pulmonary over inflation/ burst lung, neuro sxs LOC, seizure, blindness, hemiplegia, disorientation, other sgs of stroke ascent barotrauma
• Pulmonary over-inflation or burst lung can occur during rapid, panicked ascents if divers fail to exhale or intrinsic pulmonary air trapping exists resulting in pneumo-mediastinum, pneumothorax, most serious is cerebral arterial gas embolism (CAGE) aascent parotrauma
o Compressed air, caisson (tunnel) workers, and high altitude pilots can present with decompression sickness (DCS). type I and type II Prolonged exposure may lead to cardiopulmonary “chokes” or vestibular “staggers” “bends” for joint pain decompression sickness (DCS)
mottled skin and deep pain of the joints of the shoulder or knee decompression sickness (DCS)
involves the CNS, typically the spine, ascending paralysis decompression sickness (DCS)
insufflation of TM on affected side causes eyes to deviate to the contralateral side, detects inner ear barotrauma fistula test (DCS/CAGE)
what indicates a statistically significantly poor outcome in a pt who has drowned – Duration of submersion >6 mins (most critical factor), Time to effective basic life support >10 minutes, Resuscitation duration >25 minutes- >14 years- GCS <5 – Persistent apnea and req of CPR in the ED- Arterial blood pH <7.1
most important initial treatment for victims of submersion injury and rescue breathing should begin as soon as the rescuer reaches shallow water or a stable surface. ventilation

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