Hiking around
Heat wave
Creepy crawlies
At the shore
Feel the burn
100
A patient presenting to the ER with a target sign rash after a suspected or known tick bite requires this treatment.
What is doxycycline. Patient likely was bitten with a deer tick, and is now susceptible to lyme. Treat with 14-21 days of doxycycline 100mg BID empirically. Have the patient follow up with their regular doctor for further testing. Also- remember doxy causes photosensitivity. Advise sunscreen to your woods-loving patients.
100
Increased sweating, behavioral modifications, decreased heat production, and dilation of blood vessels are your body's natural response to this environmental hazard.
What is heat. Your body carefully regulates between core body temperatures of 95 and 104. The body transfers heat 60% through radiation and 30% through evaporation. At an outside temperature of 95 degrees its solely by evaporation. Humidity decreases the cooling power of sweat.
100
These two broad families of snakes make up the majority of venomous snakes in the United states
What are Crotalinae and Elapidae. Crotalids are a family of pit vipers (copperhead, coppermouth, rattlesnakes) that generally carry a hematopoetic toxin. Disease manifests as shock, noncardiogenic pulmonary edema, myonecrosis and coagulopathy. They can be identified by a triagular, arrow shaped head with a smoothed tapered body. Their facial pits are located between the eye and the nostril Elapidae are coral snakes (red on yellow kill a fellow) and carry a neurotoxin.
100
This traumatic injury requires high suspicion in anyone who presents after a drowning/near drowning episode
What is cspine injury. All patients should be placed in a collar and cleared once the possibility of traumatic injury leading to drowning can be ruled out.
100
The rule of nines is used to calculate this percentage to see if it is appropriate to transfer a patient to a higher level of care.
What is BSA burned. The body is broken up into areas that are approximately 9% on burned area. The back of the patient's hand equals 1% of burned area. other high risk areas: perineum, hands and feet, circumferential injury, electrical burns, burns crossing over major joints, inhalation injury, burns complicated by trauma, or burns in medically complicated patients.
200
After walking in the woods, a patient presents to the ED with a contact dermatitis with a linear pattern on her lower legs and arms. She remembers seeing "leaves of three." She was likely exposed to this substance, and requires this treatment.
What is poison ivy. local exposures require decontamination, and likely aluminium acetate cream or petroleum jelly. Topical hydrocortisone can also be helpful. Avoid drying agents like calamine unless it is weaping. For severe cases with widespread rash, a small burst of prednisone will be useful for symptom management.
200
These two mechanism of heat injury are important to recognize for potential complications of treatment management
What is classical and exertional Classical heat injury occurs during times of high environmental heat. The environmental temperatures and humidity levels overwhelm natural heat loss mechanisms, which cause a slow rise in core temperature over a few days. Electrolyte abnormalities are very common. High risk are the elderly, children, psychiatric disabilities, and those who are on medications that impair heat loss mechanisms Exertional heat injury is from exercise and strenuous activity, when heat production/gain exceed the removal of heat.
200
This is the proper disposition for anyone who is bitten by a venomous snake
Admitted. Obs for dry bites without evidence of local edema. Admit all children with a lower extremity bite even if asymptomatic. Obs management: Compartment syndrome checks, checking for spread of edema, NV checks, elevation of extremity.
200
These two physiologic parameters can help to stratify the risk of complications in drowning victims.
What is Pulmonary dysfunction and mental status. If a patient has a GCS> 13 and a POx> 95%, you can observe for 4-6 hours. If the patient has no wheezing or pulmonary symptoms and normal mental status, they can be safely discharged home.
200
This type of burn only effects the epidermis. It has no blisters, but can be painful. A sunburn is a type of this burn.
What is First degree. Healing time is about 7 days and does not scar. Skin can peel. symptomatic treatment only.
300
The family order name of this insect class causes more deaths annually then snake bites
What is hymenoptera. This class of insects includes wasps, honey bees, and hornets, and ants. They main systemic effect is anaphaylaxis, which requires previous exposure to the antigen. Systemic effects can also occur from venom toxicity, which happens when a person has multiple envenomations (stung by a bee hive). This includes nausea, vomiting, drowsiness, myonecrosis, ATN, hyperkalemia, and in rare cases seizures.
300
Non specific symptoms like nausea, headache, tachycardia, and normal to slightly elevated body temperature are the symptoms of this disorder
What is heat exhaustion. Heat exhaustion comes in 2 flavors: water depletion (elderly and those working in hot environments) and salt depletion (acclimated individuals who replace fluid losses with large amounts of hypotonic solutions.) Always draw a BMP, CPK, CBC, Treat with electrolyte and volume repletion and removal from heat source. Most people with heat exhaustion do not need to be admitted unless they have severe electrolyte abnormalities and severe underlying conditions.
300
This medication is only given for moderate or severe envenomation with this reptile
What is CroFab CroFab is a antivenom derived from sheep sensitized with western/eastern diamondback rattlesnake, mojave rattlesnake and cottonmouth. The degree of envenomation determines the need for CroFab None: fang marks- no local or systemic effects (dry bite 25%) Mild: Local pain and swelling without systemic toxicity Mod: progressive swelling from fang marks, some systemtic toxicity (mild coagulopathy, diaphoresis, hemocencentration, vomiting) Severe: rapid swelling of extremity, severe coagulopathy, hypotension, and pulmonary edema
300
Drowning in water of this temperature has the worst prognosis if the patient requires ED CPR or is in asystole after submersion.
What is What is warm water. It is often difficult to determine the length of submersion, so resuscitation time is often a direct predictor of anoxic brain injury. There are rare occurrences of patients making a complete recovery from drowning in icy water, so prolonged resuscitation is warranted. Warm water submersion often involves significant anoxia and organ ischemia prior to resuscitation, and prognosis is universally very poor.
300
This type of burn only involves the epidermis and either the superficial or deep dermis. It commonly occurs with hot water scalds or grease burns.
What is a partial thickness burn. The superficial partial thickness burn spares sweat glands and hair follicles. Can blister. Usually heals in 14-21 days without a scar Deep partial thickness burns are difficult to distinguish from full thickness. you may have blistered skin over skin with pale dermis exposed. absent cap refill and pain sensation to area. usually takes 3-8 wks to heal and causes a permanent scar. All patients with partial thickness between 15-25% BSA or 10-20% BSA in children and elderly should be admitted. Above that should be transferred to a burn center.
400
When ingested, this plant's toxicity looks similar to digitalis toxicity with hyperkalemia, and conduction abnormalities.
What is foxglove/oleander. The treatment is digi-fab.
400
Hyperthermia above 104F and altered mental status is a hallmark of this life threatening heat illness that is universally fatal if not treated.
What is heat stroke. other symptoms include ataxia (cerebellum is very susceptable to heat) and any other type of neurologic symptoms including seizure and focal deficits. Only 1/2 of the patients sweat. There is no diagnostic test and differential diagnosis is pretty extensive. cbc, bmp, blood gases, coagulation profiles, and head CT are used to rule out other causes of hyperpyrexia and altered mental status. Also be cautious! Heat exhaustion (although classified as a minor heat illness) can progress to heat stroke!
400
This medication has to be re-dosed until control of symptoms.
What is CroFab 4-6 viles to start, then maintenance dosing 2 viles every 6 hours x 3 additional doses. End of treatment is control or arrest of swelling and lab values trending toward normal. You can stop before a coagulopathy corrects itself.
400
Jellyfish stings rarely present to the ED. When they do, you can do this to make your patient more comfortable.
What is decontaminate and wash the area with vinegar. Acetic acid neutralizes nematocysts. Do not wash with fresh water, because it is thought to stimulate nematocyst discharge. Most people can go home with oral analgesia. Covering of wound is only indicated if severe burn/bubbling is observed. Systemic signs and symptoms after jellyfish sting are rare. If they do present, it is recommended to watch the patient for 8 hours.
400
Charred, pale, painless, and leathery skin are the hallmark for this type of burn
What is full thickness (or 3rd degree). It causes severe scarring and skin grafts are often necessary. < or = 10% should be hospitalized. > 10% should go to a burn center. 4th degree burns effect muscle and bone, and should always be transferred.
500
This mushroom species accounts for 95% of mushroom related deaths. When ingested, it is 20-30% fatal
What is Amanita species. These mushrooms kill in 3 phases: I: 5-24 hours post exposure- gastroenteritis symptoms II: 12-36 hours- transient improvement III: 2-6 days- severe hepatic and renal toxicity, possibly requiring transplantation.
500
This treatment for heat stroke is more conservative than you would think.
What is evaporation cooling. Using misting fans with room temperature water is the proper treatmetn. Using cool water just cools the skin and promotes shivering which increases internal heat production. The goal is to cool until 39C (102.2) then stop to avoid hypothermia. Also- hypotension should be treated with NS. Avoid fluid overload, and do not bolus. Also avoid pressures if able, because they shunt perfusion away from the skin. Fluids should go to maintain urine output. Can give benzos for seizures and shivering. Caution: ARDs, heat shock liver, coagulation abnormalities can all occur ALWAYS ADMIT!
500
Being bitten by this snake requires you to give 5 viles of antivenom prior to symptom onset
What is Elapidae (coral snake/ cobra) Their venom is a potent neurotoxin, with a delay of systemic symptoms up to 13 hours after bite that may not be reversible. Grade 0: No envenomation. Fang scratches with mild local swelling and no systemic symptoms. Grade 1: Moderate: Fang punctures, minimal local swelling, systemic symptoms but no complete respiratory paralysis within 36 hours Grade 2: Severe, but complete paralysis within 36 hours of the bite
500
Symptoms of this illness can occur minutes, hours, to days after resurfacing from water. Bonus: What is the definitive therapy for this illness? What should you consider if transport is necessary?
What is Decompression sickness. This disease process is related to the obstructive and inflammatory effects of inert gas bubbles in tissues and vascular system and can result in a variety of injury including pain in joints to pulmonary symptoms to paralysis. Decompression sickness occurs during ascent on usually prolonged dives. Flying can predispose to worsening of symptoms, and the risk/benefit of flying someone to HBO should be discussed with the accepting facility. 100% NRB and HBO should be offered to anyone exhibiting signs of decompression syndrome or air embolus.
500
These three substances comprise inhalation injury.
What are smoke, CO, and HCN They are tissue asphyxiants, pulmonary irritants, and systemic toxins thermal burns are only limited to the upper airway. particulate matter from smoke inhalation can cause bronchospam and ARDS. If there are any signs of airway damage (soot in nares, full thickness burns to the face or peri-oral burns, voice change) intubate sooner rather than later for potential airway edema. Also limit fluid resuscitation to avoid ARDS and pulmonary edema. Keep a look out for CO poisoning and HCN poisoning, which both can occur in fires.
M
e
n
u