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MED SURG III
EXAM 1 - POISONING, INSECT BITES, HEAT & COLD COMPLICATIONS
| Question | Answer |
|---|---|
| Heat Stroke | Causes thermal injury at the cellular level, resulting in coagulopathies, and widespread damage to the heart, liver, and kidneys. |
| Heat Stroke Symptoms | Profound CNS dysfunction of confusion, bizarre behavior, coma, seizures. Elevated temperature (105* F or higher), hot, dry skin, anhidrosis (absence of sweating), tachypnea, hypotension, and tachycardia |
| Heart Exhaustion Symptoms | High body temp, headaches, anxiety, syncope, profuse diaphoresis, gooseflesh, and orthostasis |
| Cardinal Manifestations of Heat Illness | Muscle cramps, especially in the shoulder, abdomen, and lower extremities, profound diaphoresis, and profound thirst. |
| Goal in Heat Illnesses | Reduce high temp as quickly as possible, as the risk of death increases related to the duration of hyperthermia. |
| Frostbite | Trauma from exposure to freezing temps and freezing of the intracellular fluid & fluids in the intercellular spaces. Results in cellular and vascular damage, and can result in venous stasis, and thrombosis. Ranges from 1st Degree (redness) to 4th Degree (full-depth tissue destruction) |
| Most Common Areas for Frostbite | Feet, Hands, Nose, & Ears |
| Management of Frostbite | Constrictive clothing & jewelry are removed, wet clothing is removed as quickly as possible. If a lower extremity is involved, the patient should not be allowed to ambulate as this may exacerbate tissue damage. Frozen extremity is placed in a circulating bath at 9.6 - 104 * F for 30-40 minute spans. It is important to give analgesics during warming, as it can be very painful. DO NOT MASSAGE. |
| Hemorrhagic Blebs | May develop 1 hour to a few days after rewarming, and are left intact and not ruptured |
| Non-Hemorrhagic Blisters | Are debrided to decrease the inflammatory mediators found in the blister fluid |
| Whirlpool Baths | Are used for the affected body part to aid in circulation and debridement of necrotic tissue and to help prevent infection in Frostbite |
| Escharotomy | Incision through the eschar to prevent further tissue damage, allow normal circulation, and permit joint motion in Frostbite |
| Fasciotomy | Used to treat compartment syndrome in Frostbite |
| Hypothermia | When the core internal temp is 95* or less, as a result of exposure to cold or inability to maintain body temp in the absence of low ambient temperatures. |
| Hypothermia Symptoms | Physiologic changes in all organ systems. Progressive deterioration, with apathy, poor judgement, ataxia, dysarthria, drowsiness, pulmonary edema, acid-base abnormalities, coagulopathy, and eventual coma. Cardiac output and BP are so weak that peripheral pulses become undetectable. Cardiac arrythmias may also occur, as well as hypoxemia and acidosis. |
| Rewarming in Hypothermia | Can be Active Internal (core) and passive (spontaneous) or active external warming |
| Active Internal Warming | Used for moderate to severe hypothermia (82.5* - 90* F) and include cardiopulmonary bypass, warm fluid administration, warmed humified oxygen by ventilator, and warmed peritoneal lavage. Monitoring for ventricular fibrillation as the patient's temperature increases |
| Passive External Rewarming | Used for mild hypothermia (90* - 95* F). Uses over-the-bed heaters to the extremities and increases blood flow to the acidotic, anaerobic extremities. The cold blood from the peripheral tissues has high lactic acid levels. As the blood returns to the core, it causes a significant drop in the core temp, and can potentially cause cardiac arrhythmias and electrolyte disturbances. |
| Active External Rewarming | Uses forced air warming blankets. Care must be taken to prevent extremity burn from these devices, because the patient may not have effective sensation to feel the burn. |
| Fresh-Water Aspiration | Results in a loss of surfactant and therefore, the inability to expand the lungs |
| Salt-Water Aspiration | Leads to pulmonary edema, from the osmotic effects of the salt within the lungs |
| Management of Drowning | Managing hypoxia, acidosis, and hypothermia. Monitor ABGs, pH, use of endotracheal intubation with PEEP, supplemental oxygen. Close monitoring of VS, serial ABGs, ECG, ICP assessments, serum electrolytes, I&O's, serial chest x-rays. |
| Decompression Sickness | Also known as the bends. Occurs in patients who dive, high altitude flying, or commercial aircraft flights within 24 hours after driving. Results from formation of nitrogen bubbles that occur with rapid changes in atmospheric pressure, which can become air emboli in the bloodstream and produce stroke, paralysis, or death |
| Symptoms of Decompression Sickness | Joint or extremity pain, numbness, hypesthesia, and loss of ROM. Neurological symptoms mimicking those of a stroke or spinal cord injury (indicate air embolus). Cardiopulmonary arrest can also occur in severe cases, and is usually fatal. |
| Management of Decompression Sickness | All patients with decompression sickness need rapid transfer to hyperbaric chambers. A patent airway and adequate ventilation are established. Oxygen is given, chest x-ray obtained. IV of LR or NS. In an air embolus, the HOB should be lowered. If aspiration is suspected antibiotic agents and other treatments are prescribed |
| Antivenin Administration | Most effective if given within 4 hours of the bite, but no more than 12 hours after. he decision to administer is based on the worsening tissue injury and evidence of systemic coagulopathic symptoms. Before administering and every 15 minutes after administration the circumference of the affected part is measured. Total dose is 4-6 hours. There is no limit to the number of vials that can be given |
| Envenomation | Injection of a poisonous material by sting, spine, bite, or other means. |
| Symptoms of envenomation | Edema, Ecchymosis, Hemorrhagic Bullae, Leading to necrosis at the site. Lymph node tenderness, nausea, vomiting, numbness, and metallic taste in the mouth. May progress to fasciculations, hypotension, paresthesia, seizures, coma. |
| Management of Envenomation | Have the person lie down, remove clothing, provide warmth, cleanse wound, cover with light sterile dressing, immobilize the inured body part below the level of the heart. |
| Crotalidae Polyvalent Immune Fab Antivenom | Does not require pretesting for an allergic reaction, but careful monitoring for allergic reaction is needed. |
| Brown Recluse Spider Bite | Painless. Systemic effects such as fever and chills, nausea and vomiting, malaise, and joint pain develop within 24 to 72 hours. The site may appear purple in color within 2-8 hours after the bite. Necrosis occurs in the next 2-4 days in approx. 10% of cases. Surgical debridement may be needed. Wound care consists of cleansing with soap and water, and hyperbaric oxygen treatments. They typically heal within 2-3 months. |
| Tick Diseases | Caused by infected deer ticks. Rocky Mountain Spotted Fever, Tularemia, West Nile Virus, and Lyme Disease. |
| Tick Removal | Tweezers using a straight upward pull, and the patient should be informed of the signs and symptoms of diseases |
| Stage 1 | Present with erythema margins (bulls-eye) rash that appears within 4 weeks after the tick bite, with a peak manifestation after 7 days. Typically at least 5 cm in diameter. right red borders. companied by flulike symptoms such as chills, fever, myalgia, fatigue, & headache. Rash may disappear without treatment in about 4 weeks. |
| Stage II | Presents within 4-10 weeks, and includes memory loss, joint pain, poor motor coordination, adenopathy, and cardiac abnormalities. Facial nerve palsy is the most common manifestation of stage II |
| Stage III | Can begin anywhere from weeks to a year after the bite. Has serious long-term chronic sequelae, including arthritis, neuropathy, myalgia, and myocarditis. Even after treatment of antibiotics some may experience long-term effects of fatigue and arthralgias. Some existing longer than 10 years |
| Corrosive Poison | Alkaline and Acid Agents that can cause tissue destruction after coming in contact with mucous membranes. |
| Alkaline Poisoning Products | Lye, Drain Cleaners, Toilet Bowel Cleaner, Bleach, Non-phosphate Detergents, Oven Cleaners, and Button Batteries |
| Acid Poisoning Products | Toilet Bowel Cleaners, Pool Cleaners, Metal Cleaners, Rust Removers, Battery Acid |
| Hemoperfusion | Detoxification of the blood by processing it through an extracorporeal circuit and an adsorbent cartridge containing charcoal or resin, after which the cleansed blood is returned to the patient |
| Corrosive Poisoning Management | Often given water or milk for dilution. Unless acute airway edema or obstruction, potential for vomiting, or clinical evidence of esophageal, gastric, or intestinal burn or perforation occurred. |
| Gastric Emptying in Corrosive Management | Gastric Lavage (only useful within 1 hour of ingestion). Activated Charcoal (one that can be absorbed by charcoal) |
| Vomiting in Acid or Alkaline Poisons | Should never be induced. |
| Carbon Monoxide Poisoning | Exerts its toxic effect by binding to circulating hemoglobin and thereby reducing the oxygen-carrying capacity of the blood. |
| Carbon Monoxide Poisoning Symptoms | Intoxication from cerebral hypoxia. Headache, muscular weakness, palpitations, dizziness, confusion, and can rapidly lead to coma. Skin color can range from pink or cherry-red to cyanotic and pale. Pulse Ox may reveal high hemoglobin saturation, which may be deceiving, as it carries the poison and not oxygen |
| Management of Carbon Monoxide | Needs immediate treatment. Move to fresh air, open all doors and windows, loosen tight clothing, initiate traditional CPR, prevent chilling, wrap in blankets, keep as quiet as possible, do not give alcohol or permit the patient to smoke. 100% oxygen is given at atmospheric or preferably hyperbaric pressures. There may be permanent brain damage. |
| Chemical Burns | A wet chemical should be removed as soon as possible with copious amounts of water. Dry substances should be gently brushed off the skin before the area is flushed. Area should be flushed with a constant stream of cool water as the patient's clothing is removed. |
| Deluge | Is the decontaminate shower, in the ED and is the optimal place for total body flushing of chemical substances. |
| Food Poisoning | Sudden illness after ingestion of contaminated food or drinks. |
| Botulism | Serious form of food poisoning that requires continuous surveillance |
| Food Poisoning Management | Large volumes of electrolytes and fluids are lost in vomiting and diarrhea. Hypovolemic Shock may occur. Antiemetics are given parenterally as prescribed if the patient cannot tolerate fluids or meds by mouth. |
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