CCPC - Environmental Emergencies

Question 1

Heat Stroke vs. Exhaustion: tipping point

Answer 1

Heat Stroke is defined as when a patient develops altered mental status/ there is a change in level of consciousness

Question 2

Heat Exhaustion / Heat Stroke - Labs

Answer 2

Serum Osmolality - High (>270)
Sodium - Normal to low
—-
Exhaustion: sodium and potassium low / everything else high
Stroke: sodium low / everything else high
—-
Swan-Ganz:
- everything low EXCEPT SVR
- hypovolemic
—-
Remember: heat stroke is an immune mediated response
—-
Tx:
- stroke: active cooling to sub 102; watch for rhabdo/elevated lactate/hypotension/stroke (low sodium)
- exhaustion: remove from environment/give fluids

Question 3

DIC Values

Answer 3

• ALWAYS goes off clotting numbers
• PT/PTT/INR: low

Question 4

Hypothermia

Answer 4

Cardiac Sy - Osborne Wave/J Wave

Mild:
- tachycardic and vasoconstricted (HTN)
Moderate:
- 28 to 38 degrees Celsius
- Paradoxical Undressing (you start to think it’s hot; strip down);
- Osborne/J wave presents

Severe:
- < 28 degrees
- asystolic

Lose body heat through conduction/convection/radiation/evaporation/breathing

After-drop phenomena:
- a hypothermic patient who — through passive external warming — has a dump of cold/acidic blood shunting back to central circulation; patient goes into VTach/Vfib and dies
- moderate to severe hypothermia + passive external warming leads to this

Remember:
ACTIVE INTERNAL = least likely to cause after drop phenomena (ECMO)
Passive internal = warm IV fluids
Passive external = most likely to cause after drop phenomena

Question 5

Fresh Water Drowning

Answer 5

• hypotonic relative to plasma disrupting alveolar surfactant
• pulled into pulmonary circulation by osmosis
• blood dilution leads to hemolysis, hyperkalemia, hyponatremia
• leads to VT/VF within 2-3 mins

Question 6

Sea Water Drowning

Answer 6

• high osmotic gradient draws fluid into alveoli; washes out surfactant
• osmosis pulls water from blood into lungs; turns blood to thick sludge; causes arrest from high cardiac work-load

Question 7

Shallow Water Blackout

Answer 7

• usually seen in teens
• they want to dive deep, but without any assistance.
• to do this, they blow off a lot of CO2 by hyperventilating (as your CO2 is rising it will take it longer for your brain to feel it needs to breathe), then hold their breath and dive; staying underwater for minutes; O2 going down; pass out

Question 8

Mammalian Diving Reflex

Answer 8

If you instantly are submerged in cold water (basically freezing)… this shunts the blood to the core and decreases your metabolic demand.

Lowers HR; can drowned in cold water for way longer.

Why “you’re not dead until you’re warm and dead.”

Question 9

Dry Drowning

Answer 9

• get water into the back of your throat and have a laryngeospasm — no volume of water into the lungs
• retrograde blood flow causes “dry drowning” via profound pulmonary edema

Question 10

Acute Mountain Sickness

Question 11

HAPE

Question 12

HACE