1- Environmental Emergencies Flashcards
What injury is associated w/ prolonged stationary posture, dehydration, wet clothings, lack of head/hand protection or footwear?
Frostbite
How is a frostbite injury classified?
By depth of injury and amount of tissues damage on appearance AFTER rewarming
Can freezing alone cause tissue death?
No, thawing also causes damage
The formation of arachidonic acid (promoting vasoconstriction), platelet aggregation (V/ATE), and subsequent ischemia, necrosis and gangrene are all part of what?
Thawing process of frostbite
What is the depth of freezing dependent on?
Temperature, velocity, and duration of exposure
Frostbite can occur anywhere is most common where?
Distal extremities (face, noses, ears, fingers, toes)
Pt presents with pale, waxy, hard and cold skin. Why dx are you concerning of and what is the initial tx?
Frostbite (clinical dx), tx w/ rewarming
What are the sx of first degree degree frostbite?
No blisters, numbness, central pallor w/ surrounding erythema, edema, desquamation, dysesthesia
What are the sx of 2nd degree frost bite?
Blisters of the skin w/ surround erythema and erythema
What are the sx of 3rd degree frost bite?
Tissue loss involving entire thickness of the skin, hemorrhagic blisters
What are the sx of 4th degree frost bite?
Tissue loss involving the entire thickness of the part, including deep structures, resulting in the loss of the part
What is the initial tx for frostbite?
Immersion in water b/w 101.5-102.2˚F until erythematous and pliable (20-30 min)
+/- IV opioids for pain (anticipated severe pain w/ rewarming
If pt w/ frostbite w/ cyanosis proximal to ITP joints, what imaging should you consider to assess circulation/tissue viability?
CTA or bone scan
If pt presents w/in 24hrs of frostbite injury w/ high risk of amputation and w/o any C/I what tx should you consider?
tPA followed by lovenox
After rewarming area of frostbite what is the next tx?
- Aloe cream 1 6 hrs w/ non-occlusive dressing
- Ibuprofen
ABX only if signs of infection
Td immunization if needed
What should not be done acutely after rewarming area of frost bite?
No blister or soft tissue debridement acutely
When can a pt w/ frostbite be d/c home?
Superficial frostbite
What are the d/c instructions for pt w/ superficial frostbite?
Ibuprofen, aloe, smoking cessation, close follow up
What is the tx course for deep tissue injuries associated w/ frost bite?
Admission + ortho/hang surgeon consults
Hypothermia is due to an involuntary drop in body temp below what?
95˚F
What are primary causes of hypothermia?
Due to exposure (wind, rain, water, snow)
What are secondary causes of hypothermia?
Lack of thermoregulation (alcoholism, DKA, meds, burns, shock, sepsis, cold IV infusions, newborns, NM disease)
Mild or HT 1 is classified by what body temps and sx?
Core temp 89.6-95˚F
Conscious, tachycardia, increased shivering
Mild or HT 2 is classified by what body temps and sx?
Core tempe 82.4-89.6˚F
Lethargy, bradycardia, loss of pupillary reflexes, decreased shivering