NBME Shelf Review Part 4: Environmental
This lecture covers various emergency medical scenarios related to environmental factors, providing guidelines and treatment protocols.
General Bite Wound Management
- Irrigation: Thoroughly irrigate all bite wounds.
- Tetanus: Ensure tetanus immunization is updated.
- Suturing:
- Low-risk bites: Get sutured.
- High-risk bites:
- Cosmetic areas (e.g., face): Suture and provide antibiotics.
- Non-cosmetic areas: Leave open and provide antibiotics.
Rabies
- Administer rabies vaccine if:
- There is any suspicion of a bat bite (e.g., bat in room or cave exposure).
- Bitten by a wild animal that cannot be monitored.
- Bitten by a domestic animal showing symptoms during observation.
Black Widow Spider Bite
- Characteristics:
- Painful bite.
- Symptoms include abdominal pain, diaphoresis, myalgias, and muscle spasms/cramping.
- Treatment: Supportive care.
Pit Viper Bite
- Effects: Causes coagulopathy/DIC and swelling around the bite site.
- Treatment: Administer CroFab antivenin.
Brown Recluse Bite
- Characteristics: Painless bite leading to ulceration/necrosis around the bite site.
Altitude Illnesses
Acute Mountain Sickness (AMS)
- Symptoms: Headache, nausea, and vomiting.
- Treatment: Acetazolamide or descent.
High Altitude Pulmonary Edema (HAPE)
- Symptoms: Shortness of breath.
- Treatment: Supplemental oxygen and immediate descent; consider nifedipine or sildenafil.
High Altitude Cerebral Edema
- Symptoms: Ataxia, confusion, Cushing's reflex (bradycardia, hypertension, Cheyne-Stokes respirations).
- Treatment: Supplemental oxygen and immediate descent; consider dexamethasone.
Digit Amputation
- Procedure:
- Wrap digit in saline-soaked gauze.
- Place in a plastic bag.
- Put on ice and send to a surgeon.
Tooth Avulsion
- Treatment:
- Reimplant the avulsed tooth into the socket.
- Alternatively, place it in a glass of milk.
Frostbite
- Treatment:
- Remove wet clothing.
- Rewarm affected areas at body temperature.
Additional Reading