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Accident and Emergency > Approach to environmental emergencies > Flashcards

Approach to environmental emergencies Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Define environmental emergencies.

A

Medical conditions resulting from or worsened by exposure to an adverse environment (weather, terrain, or unique atmospheric
conditions)

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2
Q

Name 4 weather conditions that affect our ability to the environment.

A
  • Wind
  • Rain
  • Snow
  • Temperature extremes
  • Humidity
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3
Q

Give 3 disposing factors to EEs.

A
  • Very young
  • Elderly
  • Comorbidities
  • Medications/ intoxication
  • Recklessness
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4
Q

Mention the steps of the general approach in EEs.

A
  • Pertinent history
  • Identify life-threatening condition
  • ABCDE
  • Full exam
  • Manage life threatening condition
  • Minimize further exposure
  • Manage associated illness/injury
  • Appropriate disposition for continued management
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5
Q

Give 5 causes of hyperthermia in the context of EEs.

A
  • Heat gain exceeds heat loss
  • Abnormal excess in body temperature
  • Co-morbid factors
  • Climate
  • High ambient temperature
  • High humidity
  • Exercise and activity
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6
Q

Mention 6 risk factors of hyperthermia.

A
  • Age
    • Elderly
    • New born
  • Pre-existing illness
    • Heart disease
    • Dehydration
    • Obesity
    • Fever
    • Fatigue
    • Diabetes
  • Drugs
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7
Q

What is the critical problem in heat exhaustion?

A

Dehydration and salt depletion

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8
Q

How is heat exhaustion diagnosed? (4)

A
  • Vague malaise, fatigue, headache
  • Temperature <40 degrees celsius
  • Tachycardia, orthostatic hypotension, clinical dehydration
  • Mental status intact
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9
Q

Give 4 signs and symptoms of heat exhaustion.

A
  • Dilated pupils
  • Weak rapid pulse
  • Rapid shallow breathing
  • Pale cool diaphoretic skin
  • Possible heat cramps
  • Collapse
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10
Q

How is heat exhaustion managed? (7)

A
  • Airway
    • Patency: look out for secretions
  • Breathing
    • Is the patient breathing?
    • Initial tachypnea
    • Risk of aspiration if seizure
    • Pulmonary edema
  • Circulation
    • tachycardia
    • Hypotension
    • cardiac monitor essential.
    • Dysrhythmias
  • Disability
    • GCS
    • Pupils: Dilated
  • Exposure
    • Fever
    • sweating

Rest
Fluid replacement with normal saline

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11
Q

How is heat stroke diagnosed? (5)

A
  • Core temp >40 degrees celsius
  • Hot skin and persistent sweating
  • Marked elevation of hepatic transaminase levels
  • Coma, seizures, delirium
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12
Q

Give 3 clinical features of heat stroke.

A
  • Impaired judgment/ inappropriate behavior
  • Tachycardia, tachypnea
  • Flushed warm skin, sweating
  • Vomiting, diarrhea
  • If coagulopathy- purpura, hemoptysis, hematemesis
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13
Q

Give 6 differential diagnosis of heat stroke.

A
  • Central nervous system hemorrhage
  • Toxins, drugs
  • Seizures
  • Malignant hyperthermia
  • Neuroleptic malignant syndrome
  • Serotonin syndrome
  • Thyroid storm
  • High fever, sepsis
  • Encephalitis, meningitis
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14
Q

Mention 4 immediate investigations for heat stroke.

A
  • RBS
  • FBC
  • ABG
  • U+E+ Creatinine
  • Liver function
  • Coagulation
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15
Q

Mention 4 ongoing investigations for heat stroke.

A
  • CXR
  • ECG
  • Creatine kinase
  • CT scan brain
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16
Q

Define prickly heat.

A

An acute inflammatory disorder of the skin that occurs in tropical climates (heat rash)

17
Q

Give 2 clinical features of heat rash.

A
  • Clinically, this initially produces intensely pruritic vesicles on an erythematous base. The rash is confined to clothed areas, and the
  • affected area is often completely anhidrotic.
18
Q

How is heat rash treated? (2)

A

Chlorhexidine cream, discharged home, with a dermatologic follow-up.

19
Q

What are heat cramps?

A

Muscle spasms (arms, legs, abdomen) - typically in muscles that are fatigued by heavy work.
Occurs when the body loses too much salt during sweating and not enough ingested –
calcium, water

20
Q

Give 5 clinical features of heat cramps.

A
  • Tachycardia
  • Diaphoresis
  • Faint, dizzy, exhausted
  • Nausea, vomiting
  • Mental status, temperature, BP are normal
21
Q

Mention the electrolytes given to patients with heat cramps. (2)

A
  • Mild cases without concurrent dehydration
    * orally with a 0.1% or
    0.2% salt solution or
    14 to 12 teaspoon of
    table salt dissolved in
    1 quart of water),
    which is the general
    limit of palatability.
  • Severe cases respond rapidly to an
    intravenous (IV), isotonic salt solution
    (0.9% NaCl).
22
Q

Mention the 5 mechanisms of heat loss.

A
  • Conduction: Heat transfer form body to another object
  • Convection: Heat transfer through circulating air
  • Evaporation: Body cooling through sweating
  • Radiation: Heat loss directly into the environment
  • Respirations
23
Q

Give 3 risk factors of hypothermia.

A
  • Exposure- homeless, military personnel, hunters, sailors, skiers, climbers, boaters, swimmers, and survivors of some natural disasters like
    floods.
  • Extremes of age
  • Comorbidity and medication
  • Intoxication
24
Q

State the 2 ongoing investigations for hypothermia.

A
  • CXR
  • ECG
    • Tachycardia
    • AF
    • J wave
    • ST elevation
25
Q

How is hypothermia managed? (7)

A
  • Initial stabilization
  • A
    • Position
    • Airway device
    • Intubation may be
      necessary unless the patient is alert or has intact protective airway reflexes
  • B
    • Pulse oximetry not reliable.
    • put every patient with moderate to severe hypothermia on Oxygen
  • C
    • Obtain IV/IO access
    • Moderate or severe hypothermia should initially receive a 500-mL fluid challenge of warm 5% dextrose in normal saline solution.
    • Ringer’s lactate solution should be avoided because the cold liver inefficiently metabolizes lactate.
    • Fluids administered IV should be heated to 42° C.43
    • Commercially available fluid and blood warmers.
    • Microwave IV fluids in plastic containers.
    • A 1-L bag of crystalloid requires an average of 2 minutes on high power
  • D
    • Check and correct RBS
  • E
    • Minimise further exposure
    • Remove patient from the cold environment and protect from further heat loss
    • Remove wet clothing
    • Warm the patient
    • Rewarming
26
Q

Define rewarming shock.

A

Venous pooling in warmed extremities secondary to
vasodilatation

27
Q

Mention 4 techniques for rewarming.

A
  • Airway rewarming (complete humidification at 40–45°C):
  • Heated IV (40–42°C) D5.9 NS
  • Heated gastric irrigation via NG or orogastric tubes
  • Pleural irrigation (0.9 NS at 30–42°C)
  • Heated peritoneal lavage (0.9 NS at 40–45°C):
  • Hemodialysis
  • Extracorporeal rewarming
28
Q

Give 5 differential diagnosis for hypothermia.

A
  • Dermal disease- Burns, Exfoliative dermatitis, Severe psoriasis
  • Drugs- Alcohol, Phenothiazines, Sedative hypnotics
  • Iatrogenic- Aggressive fluid replacement, Heat stroke treatment
  • Metabolic- Hypoadrenalism, Hypopituitarism, Hypothyroidism
  • Neurologic- Acute spinal cord transection, Head trauma, Stroke, Tumor, Wernike’s disease
  • Neuromascular insufficiency- Age extreme, Impaired shivering, Lack of acclimatization
  • Sepsis
29
Q

What is the disposition of hypothermic patients? (3)

A
  • Mild
    • Can be observed in ED for 4-6hours and discharged home if stable
  • Moderate
    • Medical HDU
  • Severe
    • ICU
30
Q

Define drowning.

A

Process of experiencing respiratory impairment from submersion/
immersion in a liquid medium.

31
Q

State 5 risk factors of drowning.

A
  • Epilepsy
  • Toddlers
  • Risky behavior
  • Alcohol intoxication
  • Comorbidities e.g. epilepsy, cardiopulmonary disease
  • Trauma
  • Attempted suicide
32
Q

List the important things in primary survey for hypothermia.

A

A
* Assess patency
* Secretions?
* Position airway
* Suspect C-spine esp with floods
and mechanism of immersion
B
* Tachypnea, hypoxemia
* Signs of respiratory distress
* Wheezes
* Crepitations
C
* Peripheral circulatory insufficiency
D
* Can have low GCS
E
* Usually hypothermic
* May have other obvious injuries

Accident and Emergency (5 decks)

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