POISONING & ACCIDENTS

POISONING & ACCIDENTS
1. Burns 1st= only epidermis, red no blister; 2nd = hyperemic, blister; partial thickness; 3rd = full thickness, leathery no pain; 4th = electrical injuries, damage to nerves & bone; entry & exit burn; Fluid resc. If > 20% Parkland formula = 3-4 ml/kg LR x % burn RULE of 9's: head = 9; ant trunk= 18 post trunk = 18, each incr. ext = 9; each decr. ext = 18, Perineum = 1

2. Common Poisons & Antidotes: Aspirin = Dialysis; Acetaminophen =N-acetylcystine; Digitalis = lidocaine; Methanol & Ethylene Glycol = Ethanol; CO = O2; Narcotics = Narcan, Naloxone; Iron = Deferoxamine; Cu, As, Pb = Penicillamine; Cyanide = Sodium nitrite, or sodium thiosulfate

3. Types of Fx Open(compound); Simple(closed); Greenstick (incomplete, children usually); Spiral (twisting breakage); Comminuted (multi bone fragments)

4. Vertebral Fx Most common cause of paraplegia & quadriplegia, Compression Fx seen in elderly due to osteoporosis & DJD

5. Hip Fx Avascular necrosis of femoral head if blood flow is compromised; Tx: immobilization, bedrest, surgery; Prevention= safety & Ca supplement in women

6. Skull Fx Signs of Fx: 1.Battle's Sign = discoloration over mastoid bone; 2. Blood draining from ears, 3. Bruising of orbit, CN palsies, CSF leakage from ears & nose

7. Rib Fx Most common thoracic injury; usually 5-9, local pain worse w/ inspiration

8. Colles Fx most common wrist fx; breakage & displacement of distal radius, Attempted to break fall on outstretched hand

9. Elbow Fx <10 care =""> Volkman's Ischemic Contracture

10. Pelvic Fx MVA, 30% blood volume can be lost; Tx as if shock victim

11. Tibial Fx Compartment syndrome= bleeding into tight compartments=> blood supply compression=>muscle ischemia; 6 Ps = pain, pallor, pulselessness, puffiness, parathesia & paresis (weakness) or paralysis. Surgical opening of compartment

12. Sprains Tx = RICE => Rest, Ice, Compression, Elevation

13. Concussion transient loss of consciousness; Coup = bruising under site of injury; Contrecoup = bruising on side contralateral to injury

14. Blunt Eye Trauma periorbital echymosis, hyphema (bleed into anterior chamber; edema; Blowout Fx = Fx of orbital bone; Aspirin & anticholinergics are contraindicated

15. Blunt Ear Trauma Auricular Hematoma (cauliflower ear) Tx prompt drainage to prevent dissolution of cartilage

16. Dog & Cat Bites Pasturella multocida; Tx tetanus & rabies if needed, antibiotics

17. Snake Bite Splint affected area & transport; In US usually pit vipers

18. Spider Bite Black Widow: Vomiting, abd pain, shock; Tx Calcium gluconate & methocarbamol; Local bite Tx not needed
19. Brown Recluse: bite becomes black scab w/ assoc fever, rash, vomiting & jaundice; DIC can occur; Tx: Dexamethasone, dapsone, colchcine & total excision of lesion

20. Hypovolemic Shock Hemorrhage, Burns, Vomiting, Diarrhea; pale skin, JVD, incr. vasc resistance, incr. pulse Tx: rehydrate, transfusions,

21. Septic Shock Infection, gangrene, necrosis,CV obstruction; pale/pink skin; flat neck veins, incr. pulse incr. or decr. vascular resistance Tx ventilation, Fluids, antibiotics

22. Cardiogenic Shock Pale skin, flat neck veins, incr. pulse, incr. vascular resistance; Tx: medication for underlying problem, pacemaker,

23. Neurogenic Shock Spinal cord injuries, drug OD; Pink skin, flat neck veins, normal => low pulse, low vascular resistance Tx: ventilation, fluids, drainage