idc 10030 environmental hazards

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What is the txmt for opiate poisoning?

narcan 2mg IV q3 mins to a max dose of 10mg

What is the txmt for barbiturate overdose?

there is no antidote

What is the txmt for anticholinergic toxicity?

physostigmine salicylate 0.5-2mg IV over 5 mins. Repeat q
30-60mins PRN

What are the organophosphate toxicity mild signs/symptoms?

anorexia, dizziness, weakness, anxiety, substernal discomfort, and tremors

What is the antidote for organophosphate toxicity?

atropine 2mg IM q 5-10 min. until atropinization
pralidoxime (2 Pam) 1 gm over 5 -10 mins.

What is a corrosive?

any poison that directly destroys tissue

What is an irritant?

a poison that produces irritation or inflammation

What is venom?

a poisonous substance secreted by an animal or insect

What is toxicity?

the quality or degree of being poisonous

What is a poison?

any substance which, when ingested, inhaled, applied topically, injected or developed within the body in small amounts, may cause structural damage or functional disturbance

What is the quickest method for evacuating the GI tract?

emesis

What are the contraindications for emesis?

drowsiness, unconsciousness, convulsing, corrosive ingestion, petroleum distillate ingestion

How much water do you instill for a gastric lavage?

30-50 cc of NS or tap water

What is a very hazardous way to evacuate the GI tract that accelerates excretion of substances already absorbed into the blood?

diuresis-observe for pulmonary edema and do not use without m.o. approval

What is used to deactivate nerve agents/organophosphates?

atropine

What is used to deactivate acetaminophen?

acetyl cysteine

What is used to deactivate hydroflouric acid?

calcium gluconate

How do you make a demulcent (soothes irritated tissue, precipitates heavy metals, helps block absorption) out of eggs?

egg whites beaten in 500ml of water or milk

What is the pH of an acid?

<7.0

What is the txmt for ingested alkali poisoning?

200ml of water or milk

What is H2S?

hydrogen sulfide gas

How is hydrogen sulfide gas produced?

produced by bacterial action on sewage

What does hydrogen sulfide gas smell like?

rotten eggs

What is the antidote for hydrogen sulfide?

sodium nitrite 300mg IV slow infusion and amyl nitrate ampule

What is ciguatera also known as?

fish poisoning

What is the txmt for methanol poisoning?

ethanol or fomepizole, which prevents metabolism

What is crotalidae also known as?

pit vipers

What snakes fall under the crotalidae species?

rattle snakes, cotton mouths (water moccosins), and copperheads

What are the signs/symptoms of pit viper bites?

edema and localized pain within 10 minutes, ecchymosis progressing to petechiae and hemorrhagic vessiculation, weakness, diaphoresis, faintness, and lymphadenitis

What are the signs and symptoms of a elapidae bite?

local edema, parasthesias, muscle weakness, slurred speech, ptosis, diplopia, dysphagia, stridor, fasciculation, respiratory paralysis, nausea, vomiting, euphoria, dizziness, and diaphoresis

What is the major immediate cause of death from an elapidae bite?

respiratory arrest secondary to neuromuscular weakness

What is another name for sea snakes?

hydrophida

What are the signs/symptoms of a sea snake bite?

onset is immediate to 6 hrs, euphoria, malaise, anxiety, muscle aches, thick tongue, hypersalivation, ascending paralysis, ocular and facial paralysis, ptosis, and papillary changes

What is another name for widow spiders?

lactrodectus

What is another name for hobo spiders?

tengenaria

What is another name for a funnel web spider?

atrax

What are the signs and symptoms of the widow spiders?

numbing pain, blanching, and edema at the site, muscle spasms (characteristic), nausea, salivation, sweating, tachycardia, restlessness, fear of death (pavor mortis)

What are the signs and symptoms of a hobo/northwestern brown spider bite?

headache, nausea, vomiting, weakness, lethargy, visual disturbances, memory loss, lesion similar to a brown recluse

What are the signs and symptoms of the funnel web spider bites?

intense pain at bite site, wheal formation, local erythema, local sweating and piloerection, perioral stinging, nausea, vomiting, salivation, and lacrimation

What are the three subgroups of the order hymenoptera?

apidae (honey bees/bumble bees-like to be away from humans and are passive
vesidae (yellow jackets, hornets, and wasps-can sting multiple times
formicide (ants)

What are corals, sea anemones, jellyfish, and portuguese Man O'War also known as?

coelenterates

What are the signs and symptoms of a sting by a coral, sea anemone, jellyfish, or portuguese man o'war?

urticarial wheals, pain, pruritis, weakness, nausea, vomiting, malaise, severe abdominal pain, dysphagia, fever, chills, muscle pain, body spasms, vertigo, ataxia, paralysis, delirium, syncope, dyspnea, and severe chest pain

What is the txmt for the sting of a coelenterate?

vinegar rinse (hot water)

What is the sea urchin also known as?

echinoderms

What is the txmt for a sea urchin sting?

hot water soaks, 115-125 degrees for 30-90 minutes with vinegar

Where is the venom located in a sting ray?

in the tail or dorsally

What are the venomous spiny fish?

stone fish, zebra fish, and lion fish

Where are the poisonous spines located on the venomous spiny fish?

along the dorsal, pectoral, and anal fins

What is the txmt for a sting from a venomous spiny fish?

hot water immersion for 30-90 minutes, clean and debride, pain control, tetanus, antibiotics for secondary infection

How do you treat the sting from a stone fish?

give antivenom

What medications should you avoid to help prevent cold injuries?

medications that promote peripheral vascularity such as morphine, thorazine, barbiturates, and CNS depressants. Also avoid tobacco and alcohol.

What is the temp. for a water bath used to treat hypothermia?

104-107.6

What is the temp. using heated humidified oxygen to rewarm a hypothermic patient?

110-115 degrees. It is used with other rewarming methods

What results from intermittent exposure to temps. above freezing accompanied by high humidity (32-35 deg)?

chilblains

What are the signs and symptoms of chilblains?

red pruritic skin lesions. after 3-6 hr exposures you will see no sequelae and/or subcutaneous vesicles with or without cyanosis. After 6-12 hr exposure you will see lasting edema, pain, ache, scaling, desquamation, and no deep tissue damage

What is cold water immersion syndrome also known as?

trench foot

What is a complication of chilblain?

pernio

What are the two phases of cold water immersion syndrome?

hyperemic phase-hot with intense burning
vasospastic phase-pale or cyanotic with diminished pulses

What results from crystallization of water in the skin and adjacent tissues and is produced by exposure to temps below the freezing point?

frostbite

What is first degree frostbite?

freezing without blistering or peeling, skin is red and yields to pressure, white or yellowish plaque at site, and edema is common

What is second degree frostbite?

freezing with clear blistering and peeling, skin is white and cold but still yields to pressure, superficial vesicles surrounded by erythema, appears 6hrs after thawing and can last 5 days

How do you prevent heat injuries?

physical conditioning, fluid and salt intake, acclimatization (8-10 days), and proper clothing

What are the signs and symptoms of heat exhaustion?

weakness, dizziness, stupor, headache, muscle cramps, cool/pale skin

What is the temp. in a heat exhaustion patient?

temp is variable but is usually >100degs.

What must you distinguish heat cramps from?

hyponatremia

What is a true emergency characterized by uncontrolled elevation of core body temp due to the failure of the hypothalamus?

heat stroke

What is the body core temp. for heat stroke?

106 or higher

What are the signs and symptoms of heat stroke?

muscle twitching progressing to convulsions, cessation of sweating (late sign and is hot/dry/flushed skin)

What is the sequence of events for a drowning victim?

hypoxemia, laryngospasm, fluid aspiration ineffective circulation, brain injury, and brain death (5-10 mins)

What is affected during salt water aspiration?

alveolar surfactant

What is decompression sickness (caisson dz, the bends)?

occupational hazard of divers, dissolved gases (nitrogen) saturate tissues from an increase in water pressure, escape as gas bubbles during ascent, water pressure increases one atmosphere every 35 feet below the surface

What is AGE?

arterial gas embolism-gas enters the arterial system and becomes blockages or emboli. CNS and heart most susceptible.

What must be ruled out in all cases of pulmonary over inflation syndrome?

AGE

What are the signs and symptoms of pulmonary over inflation syndrome?

sudden onset, dizziness, paralysis or weakness, blurred vision, parasthesia, convulsions, dyspnea, chest pain, ANY neurological deficit occuring within 10 minutes of surfacing

What are the signs/symptoms of pulmonary embolism?

abrupt onset of dyspnea, cough, hemoptysis (most common complaint)

What is the hallmark symptom of ear and sinus squeeze (barotrauma)?

pain

What are the signs/symptoms of sinus squeeze?

sinus pain while submerged. Blood or sero-sanguanous fluid in the mask.

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