Environmental and Toxicological Emergencies Flashcards

A construction worker collapsed after working in a confined space. Bystanders report the smell of rotten eggs. Which immediate action is most important for the flight crew's safety?

Answer: Don self-contained breathing apparatus before approaching the patient

Hydrogen sulfide is immediately dangerous to life; crew must use SCBA before entering the space to avoid becoming secondary victims.

During air transport, a patient with severe hypothermia (core temp 28°C) develops ventricular fibrillation. After the first defibrillation attempt fails, what is the most appropriate next action?

Answer: Withhold further defibrillation until core temperature exceeds 30°C

Below 30°C, the hypothermic heart is refractory to defibrillation; current guidelines recommend withholding additional shocks until rewarming achieves at least 30°C.

A child ingested an unknown mushroom in the woods. The child now has excessive salivation, lacrimation, urination, defecation, and bronchospasm. Which mushroom toxidrome is this consistent with?

Answer: Muscarine toxidrome (e.g., Clitocybe or Inocybe species)

The SLUDGE/DUMBELS constellation of symptoms represents cholinergic excess consistent with muscarine-containing mushrooms.

A patient exposed to chlorine gas at an industrial accident arrives with coughing, wheezing, and conjunctival irritation. What is the priority airway management concern specific to chlorine inhalation?

Answer: Anticipate delayed pulmonary edema up to 24 hours after exposure

Chlorine gas exposure can cause delayed-onset pulmonary edema hours after initial exposure, requiring prolonged monitoring even in initially stable patients.

A mountaineer is being evacuated with acute mountain sickness and is unable to descend. Which pharmacological agent is most effective for preventing progression to HACE?

Answer: Acetazolamide

Acetazolamide accelerates acclimatization by stimulating increased ventilation and is the primary pharmacological prophylaxis and treatment for AMS/HACE.

While transporting a patient after a brown recluse spider bite, which systemic complication is most concerning in the first 24–72 hours?

Answer: Hemolysis, DIC, and acute renal failure

Loxoscelism (systemic brown recluse envenomation) can cause intravascular hemolysis, disseminated intravascular coagulation, and subsequent renal failure.

A patient arrives with suspected iron overdose. After stabilization, which antidote is used for significant iron toxicity?

Answer: Deferoxamine

Deferoxamine is a chelating agent that binds free iron to form ferrioxamine, which is then renally excreted, and is the specific antidote for iron toxicity.