What is the management of a patient with a lightning strike?
- chem, troponin, EKG
- observation for 12-24 hrs for monitoring late cardiac injury
- 30% die within 1 hr due to resp failure or fatal arrhythmia
what is mask barotrauma?
a serious rare complication of scuba diving from the intense negative pressure from the mask during descent.
- can cause orbital hemorrhage : diplopia, proptosis, visual loss
- sinus barotrauma: sinus pain, headache, epistaxis- may cause pneumocephalus which should be treated with abx ppx
- ear barotrauma- may cause fluid or blood to fill behind TM or may cause rupture
what is decompression sickness?
- caused by quick ascent leading to air bubbles in the blood and tissues. Can cause joint pain, headache.
- may also get a PE from air embolism which will present with respiratory sxs and would need a CT to diagnose.
- treat with hyperbaric oxygen (HBO).
What is the appropriate management of a submersion injury
- Asymptomatic drowning episodes should be monitored for 6-8 hrs. They may be discharged if lung exam, sPO2, and CXR are normal.
What is High Altitude Illness?
characterized by cerebral and pulmonary syndromes that occur following initial ascent.
What is Acute mountain sickness/HACE?
Acute mountain sickness/High altitude cerebral edema: a spectrum of disease with AMS characterized by headache, dizziness, vomiting and fatigue in the setting of cerebral vasodilation due to hypoxemia.
High altitude cerebral edema (HACE): on the spectrum with AMS but is rapidly fatal. Caused by cytotoxic process. Characterized by signs/symptoms of encephalopathy such as ataxia, worsening mental status, irritability, confusion.
Treat with supplemental O2 or descent if needed.
What is HAPE? and how do you treat it?
occurs 2-4 days following rapid ascent. Usually preceded by AMS. S/S include dyspnea, blood-tinged sputum. It’s kind of like getting PPHN.
Treatment first treatment is rest, O2 via face mask and reassessment. O2 reverses the increase in pulmonary artery pressure and improves symptoms.
for < 2000m, may reassess in 2 hrs. in cases of HAPE that the pt is at >4000 meters, it is recommended to immediately descend
What is the treatment of heat stroke?
- Conductive cooling with ice packs is the most rapid cooling method. Or immerse in ice water.
- Cooling may result in shivering. Treat shivering with benzos
- Dantrolene was previously indicated but NOT INDICATED ANYMORE
What are the s/s of frostbite?
s/s include pain, swelling and numbness. loss of sensation is a poor prognostic sign.
How do you manage victims of hypothermia?
hypothermia victims- particularly from ice water (<10 degrees)- have the highest rate of survival after cardiac arrest (20-30%). There is also a high rate of neurologic recovery.
Aggressive rewarming in the hospital includes use of CP bypass or ECMO. ECMO/bypass is the most efficient rewarming method and should take precedence.
next best would be pulmonary lavage, then gastric/bladder lavage. this patient should be rewarmed before declaring the pt dead. CPR should be given while pt is being rewarmed until the body is 32-24 degrees.
What are the diagnosis and treatment of Carbon monoxide poisoning?
- Caused by an increase in carboxyhemoglobin which binds to HB 250x stronger than oxygen. diagnosed with elevated carboxyhemoglobin on co-oximetry.
Treat with O2 via NRB.
Indications for HBO: LOC at the scene, AMS, organ ischemia (on EKG or pH <7.1), CO-Hb >25% or pregnant and CO-Hb> 20%.
- Half-life of CO-hb is 30 minutes when placed in HBO, 1.5hrs on NRB, and 4.5 hrs on RA.
What are the diagnosis and treatment of Cyanide poisoning?
- diagnosed with elevated lactate > 10.
- Treat with hydroxocobalamin 70mg/kg IV and sodium thiosulfate 1.65mL/kg IV immediately.
- sidenote - metHb is therapeutic in cyanide poisoning as it binds to cyanide to form cyanomethemoglobin
What are the s/s of acute radiation sickness?
can cause hematopoietic syndrome- decrease in lymphocytes occurs first. The lymphocyte count within the first few days correlates to severity of exposure: < 100 is lethal, 100-1000 is severe but potentially survivable.
GI syndrome- nausea, vomiting and diarrhea that occur with moderate, severe and lethal exposures
What is the s/s of hydrofluoric acid exposure?
HF is used in rust remover, paint remover, and to clean car rims. HF is a weak acid- the fluoride chelates calcium locally and causes neuropathic pain.
Treat by repleating the local calcium with calcium chloride soaked- this usually will rapidly relieve symptoms. For more severe injuries, you may give IV calcium gluconate.
what are the signs and symptoms of rocky mountain spotted fever and how do you treat it?
Presents with a classic rash on the palms and soles (ankles and wrists), fever, malaise, myalgias, arthralgias. Rash starts as small macules that transform to petechiae with time. May progress to meningitis with fever, headache, photophobia, seizures
treat with DOXYCYCLINE
what are crotalid snakes?
Pit vipers are Rattle snakes, copperheads and cotton mouths. They have triangular head, elliptical eyes, and tail with a rattle.
what are the sign/symptoms of a crotalid snake bite?
local pain, swelling and ecchymosis, with oozing/bleeding due to systemic coagulopathy (dec fibrinogen and plts). May also cause a metallic taste, nausea, vomiting, chills, and diaphoresis
what is the management/treatment for crotalid snake bites?
Treatment;
- Best is to place the limb in a DEPENDENT POSITION and immobilize to minimize movement.
- check coags and CBC, and observe 12-24h to ensure further symptoms do not develop since it is often not possible to know which type of snake bit the child.
- Crofab: derived from sheep, lower risk of serum sickness/death. indications for use are: worsening local injury, coagulopathy, systemic symptoms such as hypotension DIC or AMS. 4-6 vials given IV (not IM)- do not weight adjust or do a test dose or give steroids as pretreatment. Should discuss with local poison center.
how do you differentiate a coral snake from a king snake?
Red- yellow- black- red- yellow- black- yellow- red- yellow (Red on YELLOW KILLS A FELLOW)
For king snakes, it’s red- black- yellow- black
what are the signs/symptoms of a coral snake bite? how do you manage it?
Neurotoxic venom that can cause paralysis and respiratory failure several hours after the bite. Thus observation for 24hrs is recommended.
what are the signs/symptoms of a scorpion bite? how do you treat it?
Centruroides scorpions release neurotoxins → excitation of the autonomic and skeletal system but also may cause local swelling and pain.
- Neuro sxs: paresthesia, weakness, cranial nerve palsies, roving eye movements, restlessness, hyperactivity and resp distress.
- Late sxs include hemolysis, fever, weakness.
Treatment is supportive with benzos and analgesics. There is an anti-toxin called anascorp and can be given if needed.
what are the symptoms of a black widow spider bite? how do you treat it?
Black Widow: has an hourglass shape on its belly.
Release a neurotoxin that causes sympathomimetic symptoms. It causes intense muscle spasms of the chest and abdomen.
Treat with benzodiazepines and opiates
what are the symptoms of a brown recluse spider bite? how do you treat it?
causes local hemorrhagic blisters, necrosis, and ulceration.
Multiple therapies have been tried including HBO, heparin, steroids, local excision and debridement with no improvement. TREATMENT IS OBSERVATION AND CLOSE F/U WITH PLASTIC SURGERY
how do you treat a sting from a spiny fish?
Spiny fish: stingrays, lionfish, and scorpionfish
stingrays may cause hypotension requiring IVF/pressors.
Lionfish sting can cause severe local pain.
Toxin is heat labile and can be disabled with hot water.
