Envir./Burn/Biohaz. (W13)

describe heat cramps, s/s, why they occur

- severe cramps in large muscle groups that are fatigued by heavy work, most commonly related to dehydration

- s/s: BRIEF and intense pain, nausea, tachy, pallor, weakness, diaphoresis

tc/management of heat cramps

rest and rehydration, avoid exercise for 12hrs after

describe heat exhaustion and s/s

- prolonged exposure to heat over hours or days

- s/s: fatigue, n/v, extreme thirst, anxiety, hypotension, tachycardia, increased body temp (99.6-105.8)

when is hospitalization considered for heat exhasution

older adult, chronically ill, those who dont improve in 3-4hrs

tx/management of heat exhaustion

rehydration, cooling with moist sheet

describe heat stroke and s/s

- most serious emergent form of heat stress, failure of hypothalamic thermoregulatory processes

- s/s: hot, dry skin, temp >105.8, AMS, hypotension, tachypnea & tachycardia, weakness, absence of sweating

interventions/management for heat stroke

- rapidly decrease body temp! (remove clothing, cover with wet sheets, place in front of fan, immerse in cool water bath, ice packs to groin and axilla, peritoneal lavaging)

- monitor temp, for rhabdo, control shivering (chlorpromazine IV)

superficial vs deep frostbite

- superficial: pale to blue skin, mottled, crunchy, tingling/numb/burning

- deep: involves muscle/bone/tendon/white, hard, insensitive to touch

interventions for frostbite

remove jewerly, do NOT rub/massage, gradually rewarm, analgesia, water rewarming (98.6-100.4), amputation

describe hypothermia and s/s

- core temp <95; mild (93-95), mod (86-95), severe (<86)

- s/s: shivering, AMS, cyanosis, dysrhythmias, hypotension, hypoventilation, dilated pupils

complications of hypothermia

irritabl myocardium = vfib, decreased blood flow = dehydration, thickened blood = thrombus, anaerobic metabolism = acidosis

management/interventions for hypothermia

remove wet clothing, apply dry/warm blankets, radiant lights, heat devices, warm IV fluids, warmed humidified O2, warmed peritoneal fluids

describe submersion injury/drowning, what is a complication

hypoxia resulting from prolonged submersion in water, IF ASPIRATION OF LIQUID = ARDS

risks of aspiration of fresh water vs salt water

- fresh: hypotonic, fluid overload and bacterial/chemical pneumonia

- salt: hypertonic, draws fluid into alveoli, more pronounced pulmonary edema, resp failure, cerebral edema

priority care for drowning

evaluate ABCs, correct hypoxia and acidosis, may need mechanical vent

how long do drowning victims need to be observed? why?

for at least 23hrs because they can initially be asymptomatic but still develop symptoms later

symptoms of insect stings

- mild: pain, itching, burning

- severe: hypotension, laryngeal spasms, edema ,anaphylaxis

- can be immediate or delayed up to 48hrs!

how do you remove a stinger

SCRAPE IT! don't use tweezers because can pump in more venom

s/s and management of snake bites

- s/s: swelling, discoloration, blistering, lymphadenopathy, paresthesia, n/v, edema, tachycardai, HA, hypotension, muscle twitching

- tx: move person to safe are first, remove restrictive clothing, immobilize & maintain limb below heart, no alc or stim, antivenom (crofab)

lyme disease cause, manifestations and tx

-s/s: tick bite, appears in 7days, flu-like sx, bulls eye rash

- tx: doxycycline, cefuroxime, amoxicillin

tick must be attached for __hrs to transmit lyme disease

36hrs

rocky mountain spotted fever manifestations and tx

- s/s: pink macular rash on palms, wrists, soles, feet & ankles within 10 days; fever, chills, myalgia, HA, can be FATAL

- tx: doxycycline

manifestations and tx of black widow (female is neurotoxic)

- s/s: pin-prick sensation, severe pain starting 15-60mins after bite, systemic sx w/i 30mins; n/v, htn, abd cramps, dyspnea, tachycardia, chest pain, siezures

- tx: cool area, reduce muscle spasms (robaxin or valium), BP control, tetanus prophylaxis

manifestations and tx of brown recluse bite (cytotoxic)

- s/s: local tissue reaction in 2-8hrs, purple purpure ring around bite, painful, progressive ischemia and necrosis

- tx: ice, elevate, monitor for systemic toxicity

complications of animal/human bites and tx

- infection & mechanical destruction of tissues

- tx: copious irrigation, debridement, tetanus prophylaxis, analgesics, ABX, rabies prophylaxis

how does the rabies prophylaxis schedule work

initial weight based injection of rabies immune globulin (RIG) around wound edges; then 5 IM injections of human diploid cell vaccine (HDCV) on days 0, 3, 7, 14

who needs to be consulted when a pt presents with suspected poisoning

poison control (they can give recs on tx)

describe the components of the most effective intervention for poisonings

- activated charcoal given orally or gastric tube within 60 MINUTES of poison ingestion

- contraindicated in diminished bowel sounds, paralytic ileus, ingestion of subtance that isnt absorbed well by charcoal

other interventions for poisonings

- enhance elimination with cathartics (ex. sorbitol) or bowel irrigation

- hemodialysis/hemoperfusion for severe acidosis

- urine alkalinization for phenobarb or salicylate poisoning

- chelating agents for amphetamine or quinidine

manifestations and antidote for acetaminophen poisoning

- s/s: malaise, n/v, liver failure in 1-2 days

- antidote: n-acetylcysteine (Mucomyst) or activated charcoal

management of acid or alkalis (bleach, determent, ammonia, etc)

dilute with water or milk, corticosteroids for alkali burns, gastric lavage, or ingestion, DO NOT induce vomiting

manifestations and tx of aspirin poisoning

- s/s: hemorrhage, tachycardia, hyperthermia, seizure, acidosis

- tx: charcoal, hemodialysis, acid-base

manifestations and tx of NSAID poisoning

- s/s: GI, renal, hepatic damage

- tx: charcoal, cathartics

s/s and tx of TCA overdose

- s/s: hypotension, SVT, prolonged QT, hypokalemia, acidosis

- tx: charcoal, cardiac monitoring, NaHCO3- infusion, DO NOT induce vomitting

management of alcohol poisoning

supportive care until ETOH is metabolized, in extreme case do dialysis

antidote for benzo poisoning and opioid poisoning

- benzo: flumazenil

- opioid: naloxone/Narcan

tx of cocaine poisoning

charcoal & cathartics

types of burns

thermal, chemical, electrical, chronic (chemo, radiation, SJS, GVHD)

first degree burn

superficial, only epidermis, redness/pink, pain & mild swelling, blanches with pressure

second degree burn

- superficial partial thickness: pink, moist, blisters

- deep partial thickness: edema, red, pain, blisters

third degree burn

full thickness, white & waxy with decreased sensation, eschar

fourth degree burn

subdermal burn to muscle tissue or bone that will need amputation

describe rule of nines

- calculates total body surface area (TBSA) burnt

- front of head (4.5%), back of head (4.5%), front of torso (18%), back of torso (18%), front of arms (4.5% each), back of arms (4.5% each), front of legs (9% each), back of legs (9% each), groin (1%)

describe the parkland formula

- determine how much LR to give a burn patient: 2-4ml/kg/%TBSA over 24hrs

- half of total in 1st 8 hours, the other half in the remaining 16 hours

why does intubation need to occur early in pts with burns to upper body

needs to be done before airway edema occurs (from burn and fluid resuscitation) and avoid the emergency cric

escharotomy vs fasciotomy

- escharotomy: incision through eschar to restore circulation to effected extremity or improve chest expansion

- fasciotomy: incision around connective tissues to relieve pressure from muscle compartment

fluid resuscitation is evaluated with ___ hourly

urine output

define debridement

removal of necrotic tissue from wound bed

what diet is needed for burn pts

high protein, high carb

mesh vs sheet graft

- mesh: stretched/thinned to cover a larger burn than what was taken from the donor site

- sheet: taken directly from donor and applied to site

principles of radiation therapy

dosimeter badge, keep patient in private room, complete bed rest until tx is finished, limit visits to 1hr, do not enter room if pregnant, keep everything in pt room

what to do in the case of radiation contamination

evacuate, remove outer clothing and place in plastic bag, wash/shower all exposed body parts

define decontamination

physical or chemical means to remove, inactivate or destroy

race pneumonic

rescue, alarm, contain, extinguish

type a fire extinguisher

paper, wood, cloth

type b fire extinguisher

oil, gas or grease

type c fire extigusher

electrical

pass pneumonic

Pull, Aim, Squeeze, Sweep

yellow and green medical gas colors

yellow = air and green = O2

describe anthrax

- bacteria that can be found naturally in soul, human can be infected through skin, GI, inhalation, and injection

- can be deadly if not tx with abx

tx regimine for anthrax

ABX (ciprofloxacin or doxycycline) for 60 days; vaccine available for at risk pts (military/farmers) as 3 shots over 4 wks

why are people not vaccinated for smallpox anymore

there has not been a case since 1977

describe the stages of smallpox manifestations

- incubation is 7-17 days

- pre-eruptive (prodome): fever & systemic complaints 1-4days before rash onset

- rash onset is more dense on limbs (whereas chickenpox is mroe dense on torso)

manifestations and tx of carbon monoxide poisoning

- dyspnea, HA, tachypnea, confusion, cyanosis, resp depression

- tx 100% O2 via non rebreather, bag ventilate, hyperbaric O2 therapy, intubation

describe hyperbaric O2 therapy

delivery of O2 at increased atmospheric pressures locally or systemically so O2 can diffuse into serum and transported to tissues more efficiently

describe silver sulfadiazine

a topical antibiotic cream applied to burn patients to prevent infection