little white coats

Showing posts with label Environmental. Show all posts

For treatment of burns, why might bacitracin be favored relative to silver sulfadiazine even though its antimicrobial coverage is less broad?

because silver sulfadiazine causes:

allergy in patients with sulfa sensitivity
permanent silver staining of the skin and therefore should not be used on the face or other cosmetically sensitive areas
severe hemolysis in patients with G6PD
sulfonamide kernicterus in children less than 2 months and therefore should be avoided in pregnant women, newborns and nursing mothers

Source

Hall, R., Watts, L., and Bashiti, S. "Thermal Burns" Critical Decisions in Emergency Medicine. March 2012.

What is optimal method to remove a tick?

The generally recommended approach is to use tweezers or small forceps and:

grasp the tick as close to the skin as possible
pull straight up gently but firmly trying to avoid jerking, twisting, or crushing
if mouthparts remain in the skin, they should be left alone as they will normally be expelled spontaneously

Below is a video of two novel methods that seem promising as well.

Source

Sexton, D. "Evaluation of a tick bite for possible Lyme disease" Up to Date. 2011 Jan.

Video source: http://www.youtube.com/watch?v=x9dsmFVPDqs

What is the work up and disposition of a patient who presents after a shock from house hold electrical current?

Patients with low-voltage electrical injury who have only minor cutaneous burns or persistent minor symptoms may be discharged safely if they have a normal ECG and no urinary heme pigment.

Source

Marx: Rosen's Emergency Medicine, 7th ed.

Why are people in Japan who are exposed to radiation being given supplemental iodine?

To limit the amount of radioactive iodine uptake by the thyroid. Further info regarding the administration of potassium iodide as a thyroid blocking agent in radiation emergencies can be found on he FDA website.

Source

Wingard, J. "Treatment of radiation injury in the adult" Up to Date. 15 March 2011.

Name a treatment option for cold induced ischmic limb injury which is not responding to active rewarming measures.

Intravenous or intraarterial thrombolytic therapy has been reported in two retrospective studies to reduce the rate of major amputation.

Source

Sheridan, R. et al. "Case 41-2009: A 16-Year-Old Boy with Hypothermia and Frostbite" N Engl J Med 31 Dec 2009.

Is it possible to get struck by lightning while residing in the comfort of your own home?

Yes.

There have been several case reports of people talking on land line phones who have been struck by lightning which occurs via a contact strike when lightning strikes an object the victim is holding and current is transferred from the object through the victim to the ground.

But that's not it. Check out this video of an unfortunate mom who was struck at home while washing dishes.

Source

Tintinalli, J. Emergency Medicine: A Comprehensive Study Guide. 6th ed.

Patients having contact with over how many volts of electricity should be admitted for observation?

600 V, even if there is no apparent injury.

Household voltage is generally 110 - 220 V.

Source

Tintinalli, J. Emergency Medicine: A Comprehensive Study Guide. 6th ed.

What role can a microwave play in ED resusitation?

To warm IV fluids. For standard 1 L bag, microwave on high power x 2 minutes then shake to mix.

Source

Danzl, Daniel MD. "Accidental Hypothermia." Marx: Rosen's Emergency Medicine: Concepts and Clinical Practice, 6th ed. 2006.