486 Emergency Medicine
common. About 10% of cases have progressive, systemic symptoms including
nausea, vomiting, dizziness, respiratory distress, and further hypersensitivity.
Therefore, assessment of this patient’s airway and circulation are imperative.
Continuous monitoring is indicated to detect hemodynamic instability.
Local wound care (b)may be performed after the patient is deemed
stable. Beginning IV fluids (d)may be done if the patient becomes hemo-
dynamically unstable but is not initially warranted. Tetanus prophylaxis
(a)may be administered after the initial assessment. IV antihistamines, not
oral(e), may be given as indicated. It is unclear as to whether this patient’s
symptoms of dizziness are a result of trauma or initial systemic effects of the
envenomation and therefore continuous monitoring is warranted.
441.The answer is d.(Rosen, pp 1972-1978.)In all critically ill patients,
it is important to remove clothing, obtain a rectal temperature and initiate
continuous monitoring, including an ECG, while assessing the ABC status
of the patient. The clinician must initiate advanced cardiac life supportand
rewarmthe patient once a rectal temperature has confirmed hypothermia.
A tympanic temperature is not accurate below 94°F. It is important to remem-
ber that severely hypothermic patients who appear dead have a good chance of
a normal neurologic outcome with continued resuscitation and rewarming.
Remember that a patient is not dead until they’re warm and dead!Those
at extremes of age, users of sedative hypnotics, undomiciled individuals,
and those with chronic illness, altered mental status, or sepsis are at most
risk for hypothermia. Rewarming should begin with removing all wet cloth-
ing and placing warm blankets over the patient with progressiveattempts
made to rewarm the patient; mechanical warming blanket, warm IV fluids, gas-
tric lavage/peritoneal warming, and lastly cardiopulmonary bypass.
Defibrillation(a)and cardiac pacing (b)are not currently indicated in this
patient. Osborne (J) waves are indicative of a junctional rhythm, as seen in this
patient, and are consistent with hypothermia. Prolongation of any interval,
bradycardia, asystole, atrial fibrillation/flutter, and ventricular tachycardias may
also be seen.
442.The answer is a.(Rosen, pp 788-793.)Only two venomous lizards are
found in the world, both of which whose natural habitat is in the southwestern
United States and Mexico. These animals are usually not aggressive, despite
the Gila monster’s name, and bites are usually a result of direct handling as
in this case. Both the Gila monster and the Mexican-beaded lizard are easily
identified by their thick bodies, beaded scales with either white and black