Environmental

Question 1

Which drowing victims should have c spine immobilisation?

Answer 1

• diving injury
• dumping surf
• watercraft associatd

Question 2

What temperature should be achieved for ceasing CPR on a drowned hypothermic patient?

Answer 2

> 32 degree celcius

if fails to rise despite maxiaml rewarming consult with ICU as if pt is truely dead they won’t rewarm. May have to pronounce dead while cold

Question 3

minimum observation period for minor drowing, normal obs, no resus needed

Answer 3

6 - 8 hrs

if very well doesn’t need bloods or cxr, just observe. No need for prophylactic Abs unless water heavily contaminated

Question 4

Poor prognostic indicators for drowned vicitum

Answer 4

• pH < 7.1
• submerged > 5 minutes
• no bystander CPR
• delay in CPR > 10 minutes
• no spontaenous breathing
• coma on arrival to ED
• unreactive pupils (and temp > 32)
• CPR > 25 minutes ad ongoing

Question 5

What Ix are needed for heat stroke?

Answer 5

-FBC
-chem20
- CK
- coags
- urinalysis (myoglobinaemia)
- VBG
- ECG

Question 6

Definte these terms
- heat exaution
- heat stroke

Answer 6

• heat exhaustion: hyperpyrexia, vomiting, headache, lethargy, weakness. Normal mental state. Problem is dehydration
• heat stroke: life threatening, core temp > 40, acute mental state changes- irritability, confusion ,ataxia, coma, seizures, protein denaturation causing systemical inflammatory response, DIC, severe dehydration, multiorgan failure

Question 7

How to cool a patient in heat stroke?

Answer 7

• spray with water and fan
• ice packs to grion, axilla, neck
• stop shivering with benzodiazpines
• Give sodium chloride 0.9%, cold if avaiable but aim for low normal BP - will have leaky vessels and risk pulmonary oedema

paracetamol apprently has no role
invasive measures like cold peritoneal, gastric, rectal, bladder lavage are lacking evidence and are invasvie

Question 8

What drugs in ED can cause malignant hyperthermia

Answer 8

• methoxyflurane
• suxamethonium

Question 9

Signs of malignant hyperthermia?

Answer 9

-tachycardia
- tachypnoea (if not paralysed)
- hypercarbia
- metabolic and respiratory acidosis
- hyperkalaemia
- cardiac dysrythmias
- hypotension
- skeletal muscle rigidity
- hyprethermia

treatment with dantrolene - prevent myocyte calcium release 2.5mg/kg IV repeat up to 10mg/kg IV

Question 10

Drug induced syndromes that can cause hyperthermia and example of an agent

Answer 10

• neuroleptic malignant syndrome: antipsychotics, metoclopramide
• serotonin toxcity: SSRI, MOA, tramadol/tapentadol, st Johns wort
• sympathomimetic syndrome: amphetamines, MDMA, MOA
• malignant hyperthermia: methoxyflurane
• Anticholinergic toxicity: antihistamies, mushrooms
• uncoupled oxidative phosphorylation: salicylate overdose

Question 11

non drug causes of hyperthermia

Answer 11

• severe catatonia
• heat stroke
• sepsis
• tetanus
• thyrotoxicosis
• phaechromocytoma

Question 12

organ complications for hypothermia

Answer 12

Neuro: slowed cognition, motor function, sensory impairment, coma, cerebral oedema
cardiac: arrhythmias, bradyarrhytmias, AF, VF
Resp: hypoventilation, pulmonary oedema
Renal: acute tubular necrosis, cold diuresis
haem: plts dysfuntion, DIC
gastro: pancreatitis

Question 13

In addition to a FBC and chem20 what blood tests are useful for hypothermia?

Answer 13

ABG - check oxygenation (sats probe won’t work on vasoconstricted skin)
Lipase - pancreatitis
CK - rhabdo
Glucose - metabolism can be dysrupted, exclude hypo as cause of coma
coags - DIC

Question 14

risk factors for biphasic allergic reaction?

Answer 14

• > 1 dose of adrenaline
• severe anaphphylaxis

Question 15

% risk of biphasic rection with anaphylaxis

Answer 15

5%

Question 16

weight based dose of adrenaline?

Answer 16

10mcg/kg

Question 17

A infant is not responding to IM adrenaline for anaphylaxis. What is a really fast way to make a solution of IV adrenaline that is 1mcg/ml

Answer 17

Inject 1000mcg vial adrenaline into 1L saline