Trauma, Poisoning & Environmental Emergencies - Cheat Sheet
Your final 30-minute revision guide to master trauma assessment, poisoning management, burn care, and environmental emergencies. Every item here is testable on the NLE. Focus on the ABCDE framework, antidote pairings, and critical formulas.
Multiple Trauma – ABCDE Framework & Hemorrhage Control
Formulas
Glasgow Coma Scale (GCS) = Eye Opening + Verbal Response + Motor Response
Meaning
Eye (1–4), Verbal (1–5), Motor (1–6); total 3–15
Watch out
Do NOT estimate GCS in an unresponsive patient without opening eyes. Always perform the full assessment. A GCS of 8 requires intubation for airway protection per protocol.
When to use
Assess level of consciousness in trauma; GCS ≤8 = risk of airway loss
Common values
Value
36.5–37.5°C
Symbol
Tb
Quantity
Normal core body temperature
Value
≤8 (intubate)
Symbol
GCS
Quantity
GCS cutoff for airway compromise
Value
90–110 mmHg (avoid over-resuscitation)
Symbol
SBP
Quantity
Systolic BP target (permissive hypotension in hemorrhage)
Important facts
- ABCDE priorities: Airway (+ C-spine control) → Breathing → Circulation (+ hemorrhage) → Disability (GCS) → Exposure (+ prevent hypothermia).
- Hemorrhage is the leading cause of preventable trauma death; control it with direct pressure first, then tourniquet for uncontrolled limb bleeding above the knee/elbow.
- Assume cervical spine injury in any significant blunt trauma; use jaw-thrust to open airway without extending neck.
- Immediately life-threatening chest injuries: tension pneumothorax (needle decompression), open pneumothorax (occlusive dressing), massive hemothorax, and flail chest.
- Two large-bore IVs (16–18 gauge) for major trauma; begin balanced resuscitation with blood products (1:1:1 ratio of packed RBCs:FFP:platelets) for ongoing hemorrhage.
- Keeping the patient warm IS a resuscitation priority; the lethal triad is self-perpetuating, so prevent hypothermia aggressively.
- Occult bleeding sites in trauma: chest (hemothorax), abdomen, pelvis, and thighs (femur fracture); reassess often for sudden decompensation.
- A stable trauma patient can decompensate rapidly from ongoing internal bleeding; continuous reassessment is non-negotiable.
Key definitions
Polytrauma / Multiple Trauma
Example
A motor-vehicle crash victim with a femur fracture (obvious) AND intra-abdominal bleeding (occult).
Injury to more than one body region or system; life threat often from hidden injuries, not the dramatic wound.
Tension Pneumothorax
Example
Absent breath sounds on one side + hypotension + JVD + tracheal deviation = treat with needle decompression at 2nd ICS midclavicular line.
Air trapped in pleural space causing lung collapse and mediastinal shift; immediately life-threatening.
Massive Hemothorax
Example
Penetrating chest trauma with breath sounds absent + dullness to percussion + hypotension.
Large blood accumulation in pleural space (>1500 mL) causing respiratory distress and shock.
Lethal Triad of Trauma
Example
Cold, shocked patient losing clotting factors = cannot stop bleeding + gets colder + acidotic organs fail.
Hypothermia + acidosis + coagulopathy; each worsens the others in a self-reinforcing death spiral.
Diagrams to know
- ABCDE primary survey flowchart with decision points for each system.
- Rule of Nines body diagram showing 9% segments for burn/trauma extent assessment.
- Tourniquet application landmarks (proximal to wound, above knee/elbow).
Burn Care – Assessment & Fluid Resuscitation
Formulas
Parkland Formula = 4 mL × body weight (kg) × %TBSA (lactated Ringer's) over 24 hours
Meaning
4 = empirical constant; mL = volume; kg = patient weight; %TBSA = percent total body surface area burned (use Rule of Nines)
Watch out
HALF in FIRST 8 HOURS, then the rest in next 16 hours. This is NOT divided into 4 equal quarters. Students often give it too evenly. Also, Parkland is a STARTING POINT—titrate to urine output, not just the formula.
When to use
Major burns requiring IV fluid resuscitation; administer HALF the calculated volume in the first 8 hours from time of injury, remainder over next 16 hours.
Urine output target = 0.5 mL/kg/hour (adults); 1 mL/kg/hour (children & electrical burns)
Meaning
mL/kg/hour = desired urine production; use as endpoint for resuscitation adequacy
Watch out
Children and electrical burns need HIGHER urine targets (1 mL/kg/hr) because of risk of rhabdomyolysis and acute kidney injury. Do NOT use adult target for these groups.
When to use
Titrate IV fluids during burn resuscitation; if output too low, give more fluid; if too high, reduce to avoid fluid overload.
Common values
Value
≥15–20% (adults); ≥10% (children)
Symbol
TBSA
Quantity
%TBSA threshold for major burn requiring resuscitation
Value
0.5 mL/kg/hour
Symbol
UOP
Quantity
Target urine output (adults)
Value
4 mL/kg/%TBSA
Symbol
k
Quantity
Parkland constant
Important facts
- AIRWAY FIRST in burn care: intubate early (before edema closes the airway) if any signs of inhalation injury (facial burns, singed nasal hair, soot, hoarseness, stridor).
- Stop the burning process: remove clothing and jewelry, but do NOT peel away adherent material.
- Parkland = starting point; titrate to urine output (0.5 mL/kg/hr adults), NOT strictly to formula.
- Suspect carbon monoxide (CO) poisoning in enclosed-space fires; treat with 100% high-flow oxygen.
- Pulse oximetry is FALSELY NORMAL in CO poisoning because it cannot distinguish carboxyhemoglobin from oxyhemoglobin; carboxyhemoglobin gives false high O₂ sat reading.
- Cover burn wounds with clean dry dressings; provide analgesia; maintain warmth (burned patients lose heat rapidly).
- Inhalation injury increases fluid needs; urine output target may be higher.
- Watch for compartment syndrome in deep circumferential burns; may need escharotomy.
Key definitions
Rule of Nines (Adult)
Example
Full-thickness burn to anterior torso (18%) + both arms (18%) = 36% TBSA.
Head 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, perineum 1%.
Superficial (1st degree) Burn
Example
Red skin after sun exposure; blanches with pressure; intact sensation.
Erythema only; epidermis damaged; painful; heals without scarring (sunburn).
Partial-Thickness (2nd degree) Burn
Example
Exposure to boiling water; pink/red base with blisters; very painful (nerve endings intact).
Epidermis + upper dermis destroyed; blistering, wet appearance, painful; heals with possible scarring.
Full-Thickness (3rd degree) Burn
Example
Prolonged flame or contact burn; white/charred, non-blanching, insensate.
All skin layers + subcutaneous tissue destroyed; leathery, painless (nerves burned); requires grafting.
Inhalation Injury
Example
Fire in enclosed space; signs = singed nasal hair, soot in mouth, hoarseness, stridor → intubate EARLY.
Thermal or chemical damage to airway/lungs from smoke/hot gases; airway edema develops rapidly.
Diagrams to know
- Rule of Nines diagram for anterior and posterior body surface area assessment.
- Burn depth classification with skin layer illustrations.
- Parkland formula calculation timeline showing first 8 hours vs. next 16 hours.
Reactions or equations
Carboxyhemoglobin (COHb) + O₂ → Oxyhemoglobin (via high-flow O₂)
Note
100% O₂ accelerates CO elimination; do NOT rely on pulse oximetry to confirm normal O₂ in CO poisoning.
Conditions
Enclosed-space fire; incomplete combustion produces CO
Poisoning & Overdose – Decontamination & Antidotes
Common values
Value
~1 hour post-ingestion (up to 4 hours for some agents)
Symbol
t
Quantity
Time window for activated charcoal efficacy
Value
Within 8 hours of ingestion
Symbol
t_NAC
Quantity
NAC most effective window (acetaminophen)
Value
~60 minutes
Symbol
t₁/₂
Quantity
Naloxone half-life
Important facts
- Most poisoned patients are managed with SUPPORTIVE CARE (ABCs); specific antidotes are the exception, not the rule.
- Activated charcoal: adsorbs within ~1 hour of ingestion; CONTRAINDICATED with unprotected airway (aspiration risk); ineffective for alcohols, iron, lithium, corrosives.
- NEVER induce vomiting after caustic/corrosive ingestion or hydrocarbon ingestion (re-exposure + aspiration = worse harm).
- Routine gastric lavage and ipecac are NO LONGER recommended.
- Key antidote pairings (MEMORIZE): opioids ↔ naloxone; acetaminophen/paracetamol ↔ NAC; organophosphates ↔ atropine + pralidoxime; digoxin ↔ digoxin-specific Fab; benzodiazepines ↔ flumazenil (cautious).
- Naloxone: reverses opioid respiratory depression; may need repeating (shorter half-life than many opioids); titrate to restore breathing, not full alertness.
- N-acetylcysteine (NAC): most effective for acetaminophen within 8 hours; replenishes glutathione to prevent hepatic necrosis.
- Flumazenil for benzodiazepines: USE WITH CAUTION—can precipitate seizures in chronic users or mixed overdoses; NOT given routinely.
- Atropine for organophosphate poisoning dries secretions (muscarinic reversal); pralidoxime reactivates cholinesterase (nicotinic effect).
- Additional antidote pairs: beta-blockers ↔ glucagon; heparin ↔ protamine sulfate; warfarin ↔ vitamin K; iron ↔ deferoxamine; methanol/ethylene glycol ↔ fomepizole; cyanide ↔ hydroxocobalamin.
Key definitions
Activated Charcoal
Example
Theophylline overdose: give activated charcoal if airway protected and gag reflex intact.
Binds many ingested toxins in the gut; most effective within ~1 hour of ingestion; adsorbs via surface area.
Contraindication to Activated Charcoal
Example
Comatose patient with acetaminophen overdose → do NOT give charcoal; secure airway first or skip charcoal.
Unprotected airway (decreased consciousness, no gag reflex) due to aspiration risk; also ineffective for alcohols, iron, lithium, corrosives.
Toxidrome
Example
Anticholinesterase toxidrome = SLUDGE (Salivation, Lacrimation, Urination, Defecation, GI distress, Emesis).
Constellation of signs/symptoms typical of a class of toxins; helps narrow diagnosis.
Diagrams to know
- Toxidrome identification flowchart (sympathomimetic, anticholinergic, cholinergic, opioid, sedative).
- Decision tree for activated charcoal use (airway protected? ingestion within 1 hour? toxin binds to charcoal?).
- Timeline for antidote efficacy (e.g., NAC window, fomepizole for methanol).
Reactions or equations
Acetaminophen + low glutathione → hepatic necrosis
Note
NAC restores glutathione; most effective within 8 hours of ingestion.
Conditions
Overdose; glutathione depleted
Opioid + naloxone → reversal of respiratory depression
Note
Naloxone half-life ~60 min; many opioids last longer, so redose may be needed.
Conditions
Opioid overdose with apnea/bradypnea
Organophosphate compound + acetylcholinesterase inhibition → muscarinic + nicotinic toxidrome
Note
Atropine blocks muscarinic effects; pralidoxime reactivates enzyme if given early.
Conditions
Exposure to pesticide/nerve agent
Bites & Stings – Snakes, Insects, Animals
Common values
Value
0.3–0.5 mg (1:1000 concentration)
Symbol
E
Quantity
Epinephrine dose for anaphylaxis (IM)
Important facts
- Snakebite management: IMMOBILIZE limb at or below heart level; keep patient calm (movement ↑ venom spread); mark swelling edge with time; transport URGENTLY.
- DO NOT apply ice, do NOT cut and suck, do NOT use arterial tourniquet (these worsen outcome).
- Give ANTIVENOM if signs of envenomation present (progressive local swelling, systemic toxicity, coagulopathy).
- Insect stings (bee/wasp): remove retained stinger by scraping (not pinching); watch for anaphylaxis.
- Anaphylaxis from sting: treat with intramuscular epinephrine 0.3–0.5 mg IM (1:1000 concentration); repeat every 5–15 min if needed.
- Animal/human bite management: copious irrigation; assess for tendon/nerve injury; update tetanus; consider rabies PEP for mammal bites; antibiotics for high-risk wounds.
- Human bite carries HIGH risk of infection (oral flora); always give antibiotics.
- Rabies PEP (post-exposure prophylaxis): start immediately for ANY mammal bite; do not wait for animal test results.
Key definitions
Envenomation
Example
Cobra bite with fang marks + progressive limb swelling + coagulopathy = envenomation confirmed.
Injection of venom by a snake, spider, or other animal; causes local and/or systemic toxicity.
Dry Bite (Snake)
Example
Fang mark present but swelling does not progress beyond 2–4 hours; antivenom not needed.
Snake bite without venom injection; no progression of swelling or systemic effects.
Diagrams to know
- Snakebite assessment and management flow (immobilize → antivenom decision → observation).
- Anaphylaxis response protocol with epinephrine dosing.
- Rabies PEP timeline and vaccine schedule.
Heat-Related Illness – Heat Exhaustion vs. Heat Stroke
Common values
Value
>40°C (typically 40–43°C at diagnosis)
Symbol
Tc
Quantity
Heat stroke core temperature threshold
Value
Normal to mildly elevated (<40°C)
Symbol
Tc
Quantity
Heat exhaustion core temperature
Important facts
- CRITICAL DIFFERENCE: Heat exhaustion = intact mental status; heat stroke = altered mental status. This distinction determines urgency.
- Heat exhaustion treatment: rest in cool place, remove excess clothing, oral or IV fluids.
- Heat stroke is a MEDICAL EMERGENCY; priority is IMMEDIATE, AGGRESSIVE cooling—do NOT delay for transport or diagnostics.
- Cooling methods for heat stroke: remove clothing; evaporative cooling (mist + fan); ice/cold-water immersion; cold packs to groin, axillae, neck; cooled IV fluids.
- Time at high temperature determines survival and organ damage; every minute counts in heat stroke.
- Classic heat stroke: hot DRY skin; exertional heat stroke may STILL HAVE SWEATING—do NOT use sweating status to exclude heat stroke.
- Antipyretics (acetaminophen, NSAIDs) do NOT work in heat stroke because the problem is environmental heat load, NOT a raised hypothalamic set point.
- Complications of heat stroke: rhabdomyolysis, acute kidney injury, DIC, hepatic damage, cerebral edema.
Key definitions
Heat Exhaustion
Example
Athlete in hot weather with profuse sweating, dizziness, alert and oriented → rest, cool environment, fluids.
Heavy sweating, weakness, headache, nausea, dizziness; normal or mildly elevated temp; INTACT mental status.
Heat Stroke
Example
Core temp 42°C, confused, hot skin (dry in classic form, may still sweat in exertional) → IMMEDIATE aggressive cooling.
Core temperature >~40°C WITH altered mental status (confusion, seizures, coma); MEDICAL EMERGENCY.
Diagrams to know
- Heat exhaustion vs. heat stroke comparison table with management algorithms.
- Body cooling methods illustrated (evaporative, ice, cold packs locations).
Hypothermia – Core Temperature <35°C
Common values
Value
<35°C (core)
Symbol
Tc
Quantity
Hypothermia definition
Value
32–35°C
Symbol
Tc
Quantity
Mild hypothermia range
Value
<28°C
Symbol
Tc
Quantity
Severe hypothermia threshold
Important facts
- HANDLE THE PATIENT GENTLY; rough movement can trigger ventricular fibrillation in a cold, irritable heart (avoid jostling, aggressive rewarming initially).
- Rewarming by severity: passive external rewarming (warm blankets, warm environment) for MILD; active external + internal (warmed O₂, warmed IVs, warmed lavage) for MODERATE to SEVERE.
- PROLONG resuscitation efforts in cardiac arrest with hypothermia; maxim is 'NOT DEAD UNTIL WARM AND DEAD'.
- Hypothermic patients have survived prolonged cardiac arrest (>30 min in some cases) after full rewarming.
- Do NOT pronounce death until the patient is rewarmed and still has no output.
- Gradual rewarming is safer than rapid rewarming in moderate hypothermia (risk of after-drop: core temp paradoxically drops further when peripheral vessels dilate).
- Watch for dysrhythmias: bradycardia, atrial fibrillation ('Osborn wave' on ECG is characteristic but not diagnostic).
- Avoid hypothermia as a cause of altered mental status masking other injuries (head trauma, stroke); always assess fully after rewarming.
Key definitions
Hypothermia
Example
Lost hiker in cold; core temp 32°C, confused, bradycardic, slow breathing.
Core body temperature <35°C; causes progressive altered mental status, cardiac dysrhythmias, and potential cardiac arrest.
Mild Hypothermia
Example
Wet and cold swimmer; responsive to commands, active rewarming safe.
32–35°C; shivering, alert, walking possible.
Moderate Hypothermia
Example
Confused, slow reflexes, at risk of ventricular fibrillation with rough handling.
28–32°C; decreased shivering, altered mental status, risk of dysrhythmia.
Severe Hypothermia
Example
Core temp 24°C, unresponsive, barely palpable pulse, rigidity mimics death.
<28°C; minimal responsiveness, apparent cardiac arrest, profound bradycardia/bradypnea.
Diagrams to know
- Hypothermia severity classification with management by stage.
- Rewarming methods by severity (passive vs. active external vs. active internal).
- Cardiac monitoring in hypothermia (Osborn wave, bradycardia, atrial fibrillation).
Near-Drowning (Submersion Injury) – Hypoxia is the Killer
Common values
Value
2–24 hours post-submersion (peak 4–12 hours)
Symbol
t
Quantity
Window for secondary drowning onset
Important facts
- HYPOXIA is the lethal problem in submersion; airway + ventilation take ABSOLUTE PRIORITY.
- Begin rescue breathing + CPR EARLY; oxygenation is the intervention that matters most.
- Remove wet clothing and treat accompanying HYPOTHERMIA (water body temperature often <35°C).
- ANY submersion victim, even one who appears recovered, requires OBSERVATION because secondary drowning (delayed pulmonary edema) can develop hours later.
- Delayed pulmonary complications: aspiration pneumonitis, pulmonary edema, secondary infection, ARDS.
- No meaningful difference between fresh and salt water management acutely; treat hypoxia, not the osmolarity difference.
- Cervical spine injury possible with trauma mechanism (diving, waterslide); immobilize if indicated.
- Prognosis depends on: duration of submersion, water temperature (cold = protective), time to first rescue breath.
Key definitions
Submersion Injury (Near-Drowning)
Example
Child pulled from water, initially responsive, then deteriorates hours later from pulmonary edema (secondary drowning).
Non-fatal submersion with water aspiration; primary threat is HYPOXIA; recovery varies, including delayed complications.
Secondary Drowning
Example
Child initially OK after water rescue, then develops respiratory distress 4–12 hours later (fluid in lungs).
Delayed pulmonary edema developing hours after submersion; caused by aspiration and inflammatory response.
Fresh Water vs. Salt Water Aspiration
Example
Management is identical: airway, ventilation, oxygenation; difference (osmolarity, electrolytes) rarely affects acute intervention.
No meaningful clinical difference in ACUTE management; both cause hypoxia, hypoxemia, and pulmonary edema.
Diagrams to know
- Submersion injury management flowchart (rescue breathing → CPR → observation for secondary drowning).
- Timeline of pulmonary edema development in near-drowning victims.
Nursing Management Across All Emergencies – Priority Interventions
Important facts
- UNIVERSAL PRIORITY across all emergencies: ABCDE + prevent hypothermia (lethal triad in trauma).
- Airway always first (with C-spine precautions in trauma); ventilation second; circulation/hemorrhage control third.
- Continuous reassessment is non-negotiable; stable patients deteriorate suddenly.
- Two large-bore IVs + fluid resuscitation for major hemorrhage, burns, and shock; balance fluid resuscitation to avoid overload.
- In all poisoning cases, SUPPORTIVE CARE (ABCs) is the foundation; antidotes are secondary.
- Remove the patient from ongoing harm: heat source (heat illness), cold source (hypothermia), toxin (activated charcoal, decontamination).
- Prevent complications: aspirate protection in altered consciousness, immobilization in spinal injury, early airway in inhalation injury, cooling in heat stroke.
- Document vital signs, I&Os, skin color, level of consciousness, and time-critical interventions (tourniquet time, antidote time, cooling time).
Key definitions
NCM Level (Community Health Nursing Integration)
Example
In trauma, the nurse's NCM role = rapid assessment (NCM Level 1–2 triage) → immediate life-saving interventions (airway, hemorrhage) → escalation to surgeon.
RA 9173 mandates nurses assess, plan, implement, and evaluate care; in emergencies, the primary focus is immediate stabilization.
NANDA Nursing Diagnoses in Emergencies
Example
Trauma patient: Primary diagnosis = Ineffective Airway Clearance (from blood/edema) → Secondary = Decreased Cardiac Output (from hemorrhage).
Common diagnoses include Ineffective Airway Clearance, Decreased Cardiac Output, Impaired Gas Exchange, Risk for Hypovolemic Shock, Hypothermia, Hyperthermia.
Maslow Hierarchy Prioritization in Emergencies
Example
Burn patient: first need is airway/breathing (physiological) → fluid resuscitation (physiological) → wound coverage (safety) → emotional support (psychological).
Address physiological needs (oxygen, circulation, temperature) FIRST; only after stabilization, move to safety/psychological needs.
Diagrams to know
- Universal emergency management flowchart: assess ABCDEs → primary interventions → reassess → secondary interventions.
- Complication prevention pathways for each emergency type.
Must remember
- ABCDE primary survey in trauma ALWAYS: Airway (+ C-spine) → Breathing → Circulation (+ hemorrhage control) → Disability (GCS) → Exposure (+ prevent hypothermia). Hemorrhage is the leading preventable death; apply direct pressure, then tourniquet for uncontrolled limb bleeding.
- Lethal Triad of Trauma = Hypothermia + Acidosis + Coagulopathy; these are self-reinforcing and deadly. KEEPING THE PATIENT WARM IS A RESUSCITATION PRIORITY, NOT AN AFTERTHOUGHT.
- Burn Airway Rule: Intubate EARLY if any sign of inhalation injury (facial burns, singed nasal hair, soot, hoarseness, stridor). Airway edema develops rapidly and closes the airway; waiting to intubate is fatal.
- Parkland Formula = 4 mL × kg × %TBSA / 24 hours of lactated Ringer's. GIVE HALF IN FIRST 8 HOURS, the rest over next 16 hours. Titrate to urine output 0.5 mL/kg/hr (not strictly formula). This is a STARTING POINT.
- Pulse oximetry is FALSELY NORMAL in CO poisoning (cannot distinguish carboxyhemoglobin from oxyhemoglobin). Treat suspected CO poisoning with 100% high-flow oxygen immediately, regardless of O₂ sat reading.
- Activated Charcoal: Most effective within ~1 hour of ingestion. CONTRAINDICATED with unprotected airway (aspiration risk). NEVER induce vomiting for caustics or hydrocarbons. NEVER give charcoal to comatose patients without airway protection.
- High-Yield Antidote Pairings: Opioids↔Naloxone; Acetaminophen↔NAC (within 8 hours); Organophosphates↔Atropine+Pralidoxime; Digoxin↔Digoxin-specific Fab; Benzodiazepines↔Flumazenil (cautious); Beta-blockers↔Glucagon; Iron↔Deferoxamine.
- Heat Exhaustion vs. Heat Stroke: HEAT EXHAUSTION = intact mental status, cool/clammy skin, supportive care (rest + fluids). HEAT STROKE = altered mental status + core temp >40°C = MEDICAL EMERGENCY with immediate aggressive cooling (ice, evaporative, cold packs, cooled IVs). Antipyretics DO NOT WORK in heat stroke.
- Hypothermia Handling: 'NOT DEAD UNTIL WARM AND DEAD.' Handle gently (rough movement triggers VF in cold hearts). Rewarm by severity (passive for mild, active internal for severe). Prolong resuscitation efforts; cold-protected patients survive prolonged arrest after rewarming.
- Near-Drowning Priorities: HYPOXIA is the killer. Rescue breathing + CPR early. ANY submersion victim needs observation for SECONDARY DROWNING (delayed pulmonary edema hours later). Treat accompanying hypothermia. Fresh vs. salt water: no clinical difference acutely.
Last minute tips
- In any emergency, ASSESS FIRST, then act. A 30-second ABCDE assessment guides all priorities and prevents tunnel vision from a dramatic but survivable injury masking a lethal hidden one.
- Antidote timing matters: NAC for acetaminophen within 8 hours; fomepizole for methanol/ethylene glycol ASAP (before toxic metabolites form); naloxone within minutes (respiratory depression). Memorize these windows.
- Formulas on the NLE: Parkland (4 mL × kg × %TBSA), urine output targets (0.5 mL/kg/hr adults, 1 mL/kg/hr children/electrical burns), and GCS components. Practice calculating Parkland fluid for a 70 kg burn victim with 30% TBSA before the exam.
- Toxidrome recognition is a shortcut: SLUDGE (salivation, lacrimation, urination, defecation, GI, emesis) screams 'anticholinesterase poisoning → atropine.' Dry mouth, dilated pupils, agitation = anticholinergic → supportive care. Opioid overdose = respiratory depression → naloxone. Know these patterns.
- In exams, if a question asks about a heat-exposed patient with altered mental status and high core temp, the answer is HEAT STROKE = immediate cooling, NOT antipyretics. If mental status is intact, it is heat exhaustion. This distinction is tested repeatedly.
Comparison tables
Heat Exhaustion vs. Heat Stroke – Critical Distinction
| Feature | Heat Exhaustion | Heat Stroke |
|---|---|---|
| Core Temperature | Normal to <40°C | >40°C (typically 40–43°C) |
| Mental Status | INTACT; alert, oriented | ALTERED; confused, seizures, coma |
| Sweating | Heavy, profuse | Typically absent (dry skin), but may persist in exertional |
| Skin | Cool, clammy, flushed | Hot, often dry |
| Symptoms | Weakness, headache, nausea, dizziness, normal BP | Same + confusion, headache, hypotension, shock |
| Management Urgency | Supportive; rest + fluids | MEDICAL EMERGENCY; immediate aggressive cooling |
| Cooling Method | Cool environment, rest, oral/IV fluids | Evaporative (mist+fan), ice immersion, cold packs, cooled IVs |
| Complications | Rare if treated early | Rhabdomyolysis, AKI, DIC, organ damage, death |
Burn Depth Classification – Assessment & Prognosis
| Depth | Layers Involved | Appearance | Sensation | Healing | Scarring |
|---|---|---|---|---|---|
| Superficial (1st) | Epidermis only | Erythema (red), dry | Painful (intact nerves) | No intervention; self-heals in days | None |
| Partial-Thickness (2nd) | Epidermis + upper dermis | Pink/red, wet, blistering | Very painful; intact sensation | Heals with dressing care; 2–4 weeks | May scar |
| Full-Thickness (3rd) | All skin + subcutaneous tissue | White/charred, leathery, dry | Painless; nerves destroyed | Requires skin graft; does not self-heal | Definite scarring; contracture risk |
Hypothermia Severity & Management Approach
| Severity | Core Temp (°C) | Mental Status | Shivering | Rewarming Method |
|---|---|---|---|---|
| Mild | 32–35 | Alert, responsive | Active shivering | Passive external (blankets, warm environment) |
| Moderate | 28–32 | Confused, decreased response | Decreased/absent shivering | Active external + internal (warm O₂, IVs, lavage) |
| Severe | <28 | Unresponsive, apparent death | Absent | Active internal rewarming; ECMO/bypass if available; prolonged CPR |
Key Antidote Pairings – High-Yield for NLE
| Toxin/Overdose | Antidote | Key Notes |
|---|---|---|
| Opioids | Naloxone | Titrate to restore breathing; may repeat (short half-life) |
| Acetaminophen/Paracetamol | N-acetylcysteine (NAC) | Most effective within 8 hours; replenishes glutathione |
| Organophosphate/Anticholinesterase | Atropine + Pralidoxime | Atropine for muscarinic effects; pralidoxime reactivates enzyme |
| Digoxin | Digoxin-specific Fab | For life-threatening dysrhythmias or severe hyperkalemia |
| Benzodiazepines | Flumazenil | Cautious use; may precipitate seizures in chronic users |
| Beta-blockers | Glucagon | Bypasses blocked beta receptors to restore heart rate/contractility |
| Heparin | Protamine sulfate | Reverses anticoagulation; dose based on heparin dose |
| Warfarin | Vitamin K | Slow reversal (hours); use FFP if immediate reversal needed |
| Iron | Deferoxamine | Chelates iron; given IV/IM |
| Methanol / Ethylene Glycol | Fomepizole | Inhibits alcohol dehydrogenase; prevents toxic metabolite formation |
| Cyanide | Hydroxocobalamin | Preferred; binds cyanide; safer than older agents |
Trauma ABCDE Primary Survey – Immediately Life-Threatening Conditions
| ABCDE Component | Immediately Life-Threatening Condition | Immediate Action |
|---|---|---|
| Airway (A) | Airway obstruction (blood, vomit, foreign body, tongue, edema) | Clear airway; jaw-thrust; intubate if needed; protect C-spine |
| Breathing (B) | Tension pneumothorax, open pneumothorax, massive hemothorax, flail chest | Needle decompression (tension), occlusive dressing (open), chest tube prep (hemothorax) |
| Circulation (C) | Exsanguinating hemorrhage (Class III–IV shock), cardiac tamponade | Direct pressure + tourniquet (limb); two large-bore IVs; begin blood products |
| Disability (D) | Expanding intracranial hemorrhage (decreasing GCS, unequal pupils, seizures) | Assess GCS + pupils; prepare for urgent CT/neurosurgery |
| Exposure (E) | Hypothermia (complicates resuscitation, causes lethal triad), hidden wounds | Fully undress; cover with blankets; prevent further heat loss; identify all injuries |
Diagrams
ABCDE Primary Survey & Immediate Life-Threatening Conditions
This flowchart walks through the ABCDE primary survey for multiple trauma, showing decision points at each stage and the immediately life-threatening conditions requiring urgent action. Use this to visualize the rapid assessment sequence and remember the priority order.
Trauma, Poisoning & Environmental Emergencies – Concept Overview
A comprehensive mind map showing how all major topics in this chapter relate to the central theme. Use this for a quick 30-second overview of what is covered, then drill into specific sections. The hierarchy shows primary concepts (trauma, burn, poison) and their subdivisions.
Burn Severity Assessment & Fluid Resuscitation Decision Tree
Decision tree for burn assessment and Parkland formula calculation. Shows when to intubate, how to calculate and administer fluids, and how to titrate based on urine output. Critical for exam success on burn questions.
Poisoning & Overdose – Decontamination & Antidote Management
Flowchart showing the systematic approach to poisoning: ABCs first, identify toxin, decide on decontamination (charcoal), then specific antidote if available. Emphasizes that most poisoned patients are managed with supportive care.
Heat Illness Progression – Heat Exhaustion to Heat Stroke
State diagram showing the progression from normal heat exposure to heat exhaustion and potentially heat stroke. The key branch is at 'HeatExhaustion': if treated, patient recovers; if ignored, progression to heat stroke. Highlights the critical importance of early recognition and intervention.