Disaster Medicine

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Disaster Basics & Triage - Chaos Control Crew

  • Disaster: Event overwhelming local resources; MCI (Mass Casualty Incident).
  • Types: Natural (e.g., earthquake, flood), Man-made (e.g., CBRNE, industrial).
  • Phases: Mitigation → Preparedness → Response → Recovery.
  • Triage: "To sort". Rapidly prioritizes care. Goal: Greatest good for greatest number.
    • START: Adults. RPM (Respirations, Perfusion, Mental Status). <60 sec/pt.
    • JumpSTART: Pediatrics (1-8 yrs). Modified START.
    • SALT: Sort, Assess, Lifesaving Interventions, Treatment/Transport. Universal.
  • Categories (Color Codes):
    • 🔴 Red (I - Immediate): Critical, life-threatening, salvageable with immediate care.
    • 🟡 Yellow (II - Delayed): Serious injuries, can wait hours for definitive care.
    • 🟢 Green (III - Minor): "Walking wounded," minor injuries, self-care possible.
    • Black (0/IV - Expectant/Deceased): Unlikely to survive given resources; comfort care. Disaster Triage Tag System

⭐ START Triage: Apneic adult after airway opening = BLACK. JumpSTART (child): Apneic after airway opening + 2 rescue breaths = BLACK.

CBRNE Agents & Effects - Toxic Trouble Tactics

CBRNE: Chemical, Biological, Radiological, Nuclear, Explosive threats. Prioritize scene safety, decontamination, PPE.

  • Chemical Agents:
    • Nerve Agents (e.g., Sarin, VX): Cholinergic crisis (SLUDGEM). Rx: Atropine, Pralidoxime (2-PAM), Diazepam. 📌 SLUDGEM: Salivation, Lacrimation, Urination, Defecation, GI upset, Emesis, Miosis.
    • Vesicants (e.g., Mustard Gas, Lewisite): Skin blistering, airway damage. Rx: Decontaminate, supportive. Lewisite: Dimercaprol.
    • Cyanides (e.g., Hydrogen Cyanide): Blocks cellular respiration, hypoxia; cherry-red skin (late). Rx: Hydroxocobalamin, Sodium thiosulfate + Sodium nitrite.
    • Pulmonary Agents (e.g., Chlorine, Phosgene): Cough, dyspnea, acute pulmonary edema. Rx: Oxygen, supportive care.
  • Biological Agents:
    • Anthrax: Cutaneous (painless black eschar), Inhalational (widened mediastinum, hemorrhagic mediastinitis), GI. Rx: Ciprofloxacin/Doxycycline.
    • Plague (Yersinia pestis): Bubonic (painful buboes), Septicemic, Pneumonic (hemoptysis, rapid decompensation). Rx: Streptomycin/Gentamicin.
    • Smallpox: Febrile prodrome then centrifugal rash (all lesions in same stage of development). Rx: Tecovirimat, supportive care.
  • Radiological/Nuclear Agents:
    • Acute Radiation Syndrome (ARS): Dose-dependent syndromes (hematopoietic, GI, neurovascular). Rx: Supportive, cytokines (G-CSF), Potassium Iodide (KI) for $I^{131}$ thyroid protection.
  • Explosive Agents:
    • Blast Lung: Most common fatal primary blast injury.
    • Injury Types: Primary (blast wave overpressure), Secondary (projectiles), Tertiary (victim displacement), Quaternary (burns, crush, toxins).

Toxidrome-based Chemical Warfare Agent ID

⭐ Nerve agent poisoning requires rapid administration of atropine (to dry secretions & block muscarinic effects) and pralidoxime (to reactivate acetylcholinesterase, ideally within hours of exposure).

Response Systems & Public Health - Rescue & Recovery Rally

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High‑Yield Points - ⚡ Biggest Takeaways

  • Triage (START) is paramount: Categorize victims - Red (Immediate), Yellow (Delayed), Green (Minor), Black (Expectant/Deceased).
  • Incident Command System (ICS) ensures standardized, on-scene disaster management.
  • Disaster Cycle phases include Mitigation, Preparedness, Response, and Recovery.
  • Surge Capacity is the healthcare system's ability to handle a sudden patient influx.
  • Decontamination is critical for CBRN events, utilizing Hot, Warm, Cold zones.
  • Psychological First Aid (PFA) addresses immediate mental health needs of survivors.

Practice Questions: Disaster Medicine

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All are organophosphorus poisons, except.

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Flashcards: Disaster Medicine

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_____ is seizure activity for > 5 mins (continuous or intermittent) without fully regaining consciousness between episodes, resulting in brain injury and possibly death

TAP TO REVEAL ANSWER

_____ is seizure activity for > 5 mins (continuous or intermittent) without fully regaining consciousness between episodes, resulting in brain injury and possibly death

Status epilepticus

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