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SU-18 ER > Altitude Emergencies > Flashcards

Altitude Emergencies Flashcards

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1
Q

at what altitude do we start to see issues?

A

> 8000 ft

can occur at > 5000 ft

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2
Q

altitude emergencies are influenced by

A

rate of ascent
final altitude
sleeping altitude
duration of altitude

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3
Q

RF of altitude emergencies

A

young males
PHYSICAL FITNESS FOES NOT PROCTECT

smoking, alcohol, overexertion, previous incident

asymptomatic hypoxia (COPD, CHF)

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4
Q

hypoxia

A

inability to reach tissue

decrease in barometric pressure causes less arterial oxygen tension and less diffusion of inspired air

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5
Q

hypoxemia

A

low oxygenation of blood

low arterial oxygen in blood due to decreased O2 in air

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6
Q

acclimatization in altitude emergencies

A

ventilation (increase)
increased CO and pulmonary perfusion
increased cerebral blood flow
increase in HG and erythropoietin (weeks)

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7
Q

acute mountain signess

A

HA + 1 or more of:

anorexia, N/v, fatigue, difficulty sleeping, light headedness

6-10 hrs after ascent

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8
Q

tx of AMS

A

slow/halt ascent
analgesics
Diamox prophylaxis (1-2 days earlier)
Dex if unable to descend

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9
Q

diamox and AMS

A

speeds up acclimatization

1-2 days before

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10
Q

HACE

A

severe AMS with ATAXIA or altered mental status

may progress to coma or death

typically occurs at >12,000 feet

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11
Q

first sign of HACE

A

ataxia

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12
Q

tx of HACE

A

immediate descent or evacuation
oxygen
dexamethasone

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13
Q

HAPE

A

non-cardiogenic pulmonary edema 2-4 days after ascent above 8000 ft

MC cause of altitude emergencies death

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14
Q

HAPE clinical features

A

persistent dry cough –> tachycardia and tachypnea at rest + cyanosis –> nocturnal ones and worsening symptoms at night –> dyspnea at rest and crackles in chest

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15
Q

pharm tx HAPE

A

nifedipine (should still descent)

Gamow bag

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16
Q

altitude emergencies summary of tx

A

medications + supplemental o2

stop ascent and attempt acclimatization

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17
Q

acetazolamide/diamox altitude emergencies

A

acclimatization 1-2 days before

little benefit in acute tx and NO HAPE

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18
Q

dexamethasone altitude emergencies

A

AMS and HACE

no HAPE

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19
Q

HAPE pharm

A

B-agonists

nifedipine

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20
Q

hyperbaric oxygen and altitude emergencies

A

BEST in HAVE

beneficial in HAPE

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21
Q

submersion injuries

A

common in toddlers and children, adolescents, elderly

second leading COD <15

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22
Q

wet drowning

A

atelectasis
v/q mismatch
breath holding and swallowing water
breathing water

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23
Q

dry drowingin

A

laryngospasm and glottis closure causing hypoxia

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24
Q

final common pathway of submersion injury

A

HYPOEXMIA

25
Q

fresh water drowning

A

hypotonic solution

inactivates surfactant = hemodilution and hemolysis of cells

hyopnatremia + hyperkalemia

26
Q

salt water drowning

A

osmotic gradients pulls fluid into alveoli from cells

suffocates after 8-10 minutes due to inability to exchange O2

27
Q

drowning pts are at risk for

A

ARDS and PNA

28
Q

categories of submersion injury

A

Asymptomatic
Symptomatic
cardiopulmonary arrest
obviously dead

29
Q

tx of drowning

A

CPR

intubation and rewarming
antibiotics

30
Q

Boyle’s law

A

pressure and volume inversely proportional

pressure increase = volume decrease (diving)

31
Q

henry’s law

A

gas enters liquid in proportion to partial pressure

descent = increased partial pressure

boddy tissue absorbs N faster and diver descends

ascend too quick = nitrogen gas bubble in body tissue = severe pain

32
Q

descent barotrauma

A

middle ear squeeze

hemorrhage and edema

influx of water may cause extreme vertigo and disaster

MC medical problem associated with diving

33
Q

grade of descent barotrauma

A

0 = pain only

2= erthemia and mild hemorrhage

4= free blood

5= free blood + perforation

34
Q

sinus barotrauma

A

air trapped in sinuses

can cause epistaxis

tx with decongestants

35
Q

mask squeeze

A

descend without equalizing pressure - negative air pressure in mask and rupture of capillary beds = conjunctival hemorrhage and skin ecchymosis

36
Q

nitrogen narcosis

A

increased nitrogen solubility causes intoxication at high partial pressure

37
Q

DESCENT dz list

A
  1. barotrauma
  2. sinus squeeze
  3. mask squeeze
  4. nitrogen narcosis
38
Q

ascent injury

A

gas expansion

  1. barodontalgia
  2. GI barotrauma
  3. pulmonary/AGE
  4. decompression sickness
39
Q

barodontalgia

A

when descending air fills cavities then ascent causes air to expand and can’t escape = pain

40
Q

GI barotrauma

A

air trapped in GI tract

limited to when you resurface and release air

41
Q

pulmonary barotrauma

A

air not released = expand in rupture to surrounding tissue

can have AGE

42
Q

AGE

A

air gets into pulmonary veins = gets into left heart = systemic cirulcatoin

CAN CAUSE STROKE

immediate decompression and oxygenation

43
Q

decompression sickness

A

nitrogen forms bubbles I ascent too rapid

direct and indirect effect

44
Q

direct effect DCS

indirect effect

net effect

A

bubbles in joints, SC, pulmonary and vascular system

indirect: inflammatory response, clotting, inflammatory cascade
net: decreased tissue perfusion, ischemic injury

45
Q

type 1 DCS

A

nigges
skin bends
lymphatic involvement
the bands - shoulder joint MC affected

46
Q

type 2 DCS

A

staggers - N gets in spinal cord sheath

the chokes

47
Q

differentiating AGS and DCS

A

time of onset

AGE – rapid
DCS - over hours

48
Q

Lightning injuries clinical symptoms

A

cardiac arrhythmia, nruologic abnormalities, cardiopulmonary arrest

tympanic membrane rupture

cataracts

DIC

feathering burns

49
Q

pathognomonic lighting injury sign

A

featuring burns

due to electron showers

50
Q

pearls of Lightning injuries

A

damage to exterior does not predict interior damage

respiratory arrest is prolonged, ventilate

51
Q

HoTN and Lightning injuries

A

not an expected finding

if seen, look for hemorrhage

52
Q

cardiac manifestations Lightning injuries

A

spontaneous circulation, HTN, tachycardia

specific tx not nee. bc BP and pulse spontaneously return

MI unusual and prolonged rescucitative effort often successful

53
Q

neuro injury Lightning injuries

A

victims are unconscious and have temporary paralysis

seizure due to injury or hypoxia

ALWAYS CT

54
Q

Lethal neuro injuries Lightning injuries

A

heat induced coagulation of cerebral cortex

development of epidural or subdural hematoma

hemorrhage

55
Q

ocular injury

A

opthalmic injuries common in lightening strike victims

common to get cataracts

56
Q

MSK manifestations of Lightning injuries

A

shoulder dislocation
spinal fracture

RHABDO uncommon

57
Q

cutaneous injuries Lightning injuries list (6)

A
  1. Lichtenberg figures
  2. flat burns
  3. punctuate burns
  4. contact burns
  5. superficial erythma
  6. contact wound
58
Q

lichtenberg figures

A

pathognomonic

superficial feathering or fern pattern burns

disappear within 24 hrs

59
Q

contact burns

A

occur when metal close to skin is heated from lightening current

SU-18 ER (11 decks)

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