SimWars
This post is part of a series developed in preparation for participation in ACEP SimWars. It contains a review of several prominent emergency medicine topics which may be relevant for board preparation. Unless otherwise cited, content is based on HippoEM videos.
- Toxicology
- Dermatologic Emergencies
- Acid-Base Disturbances
- Thyroid Emergencies
- Adrenal/Pituitary Emergencies
- Oncologic Emergencies
- Bleeding Disorders
- Hematologic Emergencies
- Submersion Injury
- Radiation Exposure
- Hypothermia
- Heat Emergencies
- Electrical Injuries
- Bites
- Altitude and Dysbarism
- Pediatric Emergencies
Overview
- Spectrum
- Cramps
- Syncope
- Exhaustion
- Stroke
- Physiology of cooling
- Radiation: body warmer than environment, heat radiates away
- Evaporation: environment warmer than body, sweat promotes heat exchange, affected by ambient humidity
Heat cramps
- Mechanism: fluid/electrolyte depletion resulting in muscle cramps
- Management: IVF, electrolyte repletion, cooling
Heat syncope
- Mechanism: vasodilation resulting in hypotension
- Management: IVF, cooling, rule out alternative etiologies
Heat exhaustion
- Mechanism: similar to heat cramps
- Symptoms: influenza-like, headache, fatigue, dizziness, nausea, normal mental status distinguishes from heat stroke
- Findings: temperature <40°C
- Management: IVF, cooling
Heat stroke
- Mechanism: similar to heat cramps
- Symptoms: prodrome of heat exhaustion
- Signs: AMS, ataxia, seizure
- Findings: temperature >40°C
- Mortality: 30-80%
- Labs: AST/ALT, coagulopathy, DIC, rhabdomyolysis, ATN/AKI
- CXR: pulmonary edema
- Types
- Classical: elderly, dry skin, mild dehydration, increased mortality
- Exertional: young athlete, diaphoretic, increased morbidity (organ failure)
- Management
- Evaporative cooling
- Ice packs to large vessels
- GI lavage
- Liberal intubation
- Benzodiazepines or thorazine for inappropriate thermogenesis (shivering)
- Halt cooling at 40°C