Approach to environmental emergencies Flashcards
Define environmental emergencies.
Medical conditions resulting from or worsened by exposure to an adverse environment (weather, terrain, or unique atmospheric
conditions)
Name 4 weather conditions that affect our ability to the environment.
- Wind
- Rain
- Snow
- Temperature extremes
- Humidity
Give 3 disposing factors to EEs.
- Very young
- Elderly
- Comorbidities
- Medications/ intoxication
- Recklessness
Mention the steps of the general approach in EEs.
- 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
Give 5 causes of hyperthermia in the context of EEs.
- Heat gain exceeds heat loss
- Abnormal excess in body temperature
- Co-morbid factors
- Climate
- High ambient temperature
- High humidity
- Exercise and activity
Mention 6 risk factors of hyperthermia.
- Age
- Elderly
- New born
- Pre-existing illness
- Heart disease
- Dehydration
- Obesity
- Fever
- Fatigue
- Diabetes
- Drugs
What is the critical problem in heat exhaustion?
Dehydration and salt depletion
How is heat exhaustion diagnosed? (4)
- Vague malaise, fatigue, headache
- Temperature <40 degrees celsius
- Tachycardia, orthostatic hypotension, clinical dehydration
- Mental status intact
Give 4 signs and symptoms of heat exhaustion.
- Dilated pupils
- Weak rapid pulse
- Rapid shallow breathing
- Pale cool diaphoretic skin
- Possible heat cramps
- Collapse
How is heat exhaustion managed? (7)
- 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
How is heat stroke diagnosed? (5)
- Core temp >40 degrees celsius
- Hot skin and persistent sweating
- Marked elevation of hepatic transaminase levels
- Coma, seizures, delirium
Give 3 clinical features of heat stroke.
- Impaired judgment/ inappropriate behavior
- Tachycardia, tachypnea
- Flushed warm skin, sweating
- Vomiting, diarrhea
- If coagulopathy- purpura, hemoptysis, hematemesis
Give 6 differential diagnosis of heat stroke.
- Central nervous system hemorrhage
- Toxins, drugs
- Seizures
- Malignant hyperthermia
- Neuroleptic malignant syndrome
- Serotonin syndrome
- Thyroid storm
- High fever, sepsis
- Encephalitis, meningitis
Mention 4 immediate investigations for heat stroke.
- RBS
- FBC
- ABG
- U+E+ Creatinine
- Liver function
- Coagulation
Mention 4 ongoing investigations for heat stroke.
- CXR
- ECG
- Creatine kinase
- CT scan brain
Define prickly heat.
An acute inflammatory disorder of the skin that occurs in tropical climates (heat rash)
Give 2 clinical features of heat rash.
- 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.
How is heat rash treated? (2)
Chlorhexidine cream, discharged home, with a dermatologic follow-up.
What are heat cramps?
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
Give 5 clinical features of heat cramps.
- Tachycardia
- Diaphoresis
- Faint, dizzy, exhausted
- Nausea, vomiting
- Mental status, temperature, BP are normal
Mention the electrolytes given to patients with heat cramps. (2)
- 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).
Mention the 5 mechanisms of heat loss.
- 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
Give 3 risk factors of hypothermia.
- 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
State the 2 ongoing investigations for hypothermia.
- CXR
- ECG
- Tachycardia
- AF
- J wave
- ST elevation
How is hypothermia managed? (7)
- 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
Define rewarming shock.
Venous pooling in warmed extremities secondary to
vasodilatation
Mention 4 techniques for rewarming.
- 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
Give 5 differential diagnosis for hypothermia.
- 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
What is the disposition of hypothermic patients? (3)
- Mild
- Can be observed in ED for 4-6hours and discharged home if stable
- Moderate
- Medical HDU
- Severe
- ICU
Define drowning.
Process of experiencing respiratory impairment from submersion/
immersion in a liquid medium.
State 5 risk factors of drowning.
- Epilepsy
- Toddlers
- Risky behavior
- Alcohol intoxication
- Comorbidities e.g. epilepsy, cardiopulmonary disease
- Trauma
- Attempted suicide
List the important things in primary survey for hypothermia.
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
