Chapter 32 Flashcards
five ways the body can lose heat: … … … … ...
conduction convection evaporation radiation respiration
hypothermia:
Core temperature falls below …°F (..°C)
Body loses the ability to regulate its temperature and generate …
Eventually, key organs such as the heart begin to slow down and mental status deteriorates.
Can lead to death
95; 35; body heat
(hypothermia)
Air temperature does not have to be … for it to occur.
People at risk:
Homeless people and those whose homes lack heating
…
Geriatric, pediatric, and ill individuals
assess temp by placing back of hand on patient’s …
below freezing
swimmers
abdomen
Mild hypothermia
Occurs when the core temperature is between … and .. (32°C and 35°C)
More severe hypothermia
Occurs when the core temperature is less than … (32°C)
Never assume that a cold, pulseless patient is dead.
90°F; 95°F; 90°F
Important factors in determining the severity of a local cold injury: ... of the exposure … to which the body part was exposed Wind … during exposure Underlying factors: Exposure to .. conditions Inadequate … from cold or wind
Duration temperature velocity wet insulation
Underlying factors of local cold injuries (cont’d): Restricted .. from tight clothing or shoes or circulatory disease … Poor … … or ...abuse … … … disease Age
circulation; fatigue nutrition alcohol/drug hypothermia diabetes cardiovascular
…: After prolonged exposure to the cold, skin may freeze while deeper tissues are unaffected.
Usually affects the ears, nose, and fingers
Usually not painful, so the patient often is unaware that a cold injury has occurred
Frostnip
…
Occurs after prolonged exposure to cold water
Common in hikers and hunters
Immersion foot
..: most serious local cold injury because the tissues are actually frozen
… requires surgical removal of dead tissue
frostbite; gangrene
frostbite:
the … of skin damage will vary:
with superficial frostbite, only the … is frozen
with deep frostbite, … are frozen
depth; superficial; deeper tissues
… helps warm the patient from the inside out
for patients in these types of conditions palpate for a carotid pulse for up to … seconds
warmed, humidified oxygen; 60
Transport decision
Complications can include … and …abnormalities.
All patients with hypothermia require immediate transport.
Rough handling of a hypothermic patient may cause a cold, slow, weak heart to ….
cardiac dysrhythmias; blood clotting; fibrillate
for history, find out how long your patient has been …. to the cold environment
exposed
vitals for hypothermia:
respirations may be … and …
… blood pressure and … pulse indicate moderate-severe hypo
slow; shallow; low; slow
rewarming patient can lead to …
cardiac dysrhythmias
general management of cold emergencies:
move patient from cold enviro
remove any …
place dry blankets … and … the patient
if available, give the patient arm, humidified oxygen
do not … the extremities and do not allow the patient to … or use any stimulants
wet clothing; over; under; massage; eat
Mild hypothermia
Patient is alert, shivering, and responds appropriately
Place the patient in a warm environment and remove wet clothing.
Apply heat packs or hot water bottles to the …, .., and …regions.
Give … by mouth.
groin; axillary; cervical
warm fluids
Moderate or severe hypothermia
Do not try to actively rewarm the patient.
The goal is to …
Remove the patient from the cold environment.
Remove wet clothing, cover with a blanket, and transport.
prevent further heat loss.
If transport will be delayed, consider active rewarming.
With frostnip, …may be all that is needed.
With immersion foot, remove wet shoes, boots, and socks, and rewarm the foot ….
Do not reexpose the injury to cold.
Never rub or massage injured tissues.
contact with a warm object; gradually
Rewarming in the field
Immerse the frostbitten part in water between …°F and …°F.
Dress the area with dry, sterile dressings.
If blisters have formed, do not break them.
Never attempt rewarming if there is any chance that the part may freeze again.
102; 104
Hyperthermia is a core temperature of …°F (…°C) or higher.
Risk factors of heat illness include:
High air temperature (reduces radiation)
High … (reduces evaporation)
Lack of … to the heat
Vigorous exercise (loss of fluid and electrolytes)
101; 38.3
humidity
acclimation
Persons at greatest risk for heat illnesses:
Children (especially newborns and infants)
Geriatric patients
Patients with …, …, …, …, and …
Patients with …
heart disease; COPD; diabetes; dehydration; obesity; limited mobility
….: Painful muscle spasms that occur after vigorous exercise
Do not occur only when it is hot outdoors
Exact cause is not well understood
Usually occur in the leg or abdominal muscles
heat cramps
…: most common illness caused by heat
heat exhaustion
…: Least common but most serious illness caused by heat exposure
Occurs when the body is subjected to more heat than it can handle and normal mechanisms are overwhelmed
Untreated always results in death.
heat stroke
Typical onset situations of heat stroke:
During vigorous physical activity
Outdoors or in a closed, poorly …, humid space
During …without sufficient air conditioning or poor ventilation
Children left unattended in a locked car on a hot day
ventilated
heat waves
for heat related conditions:
Physical examinations
Assess the patient for …or …
Examine the patient’s mental status and skin temperature and moisture.
Pay special attention to skin temperature, turgor, and level of moisture.
Perform a careful neurologic examination.
muscle cramps; confusion
Vital signs
Patients who are hyperthermic will be …and …
Falling blood pressure indicates that the patient is going into shock.
In heat exhaustion, the skin temperature may be normal or ….
In heat stroke, the skin is ….
tachycardic; tachypneic; cool and clammy; hot
Heat cramps
Remove the patient from the hot environment.
Administer high-flow oxygen if indicated.
Have the patient …or ….
Replace fluids by mouth.
Cool the patient with … or …
sit; lie down; water spray; mist
Heat stroke
Move the patient out of the hot environment and into the ambulance.
Set air conditioning to maximum cooling.
Remove the patient’s …
Administer high-flow oxygen if indicated.
Assist ventilations as needed.
Cover the patient with … or …
Aggressively … the patient.
Exclude other causes of altered mental status.
Check … level if possible.
Transport immediately to the hospital.
clothing
wet towels; sheets
fan
blood glucose
…:Process of experiencing respiratory impairment from submersion/immersion in liquid
Risk factors:
Alcohol consumption
Preexisting … disorders
Geriatric patients with cardiovascular disease
Unsupervised access to water
drowning
seizure
Submersion incidents may be complicated by spinal fractures and spinal cord injuries.
Assume spinal injury if:
Submersion has resulted from a …mishap or …
The patient is ….
The patient complains of …, …, or …
Stabilize the suspected injury …
diving; long fall
unconscious
weakness; paralysis; numbness
in the water
Never give up on resuscitating a cold-water drowning victim.
Hypothermia can protect vital organs from the …
The …may cause immediate bradycardia –>Slowing of the heart rate caused by submersion in cold water
lack of oxygen; diving reflex
descent emergencies:
Caused by the sudden increase in …as the person dives deeper into the water
The pain forces the diver to return to the surface to equalize the pressures, and the problem clears up by itself.
Divers with continued .. (particularly in the ear) should be transported to the hospital.
pressure; pain
emergencies at the bottom–>
Rarely occur
Caused by faulty connections in the diving gear
Inadequate mixing of …and … in the air the diver breathes
Accidental feeding of … into the breathing apparatus
Can cause drowning or rapid ascent
oxygen; CO2; poisonous carbon monoxide
ascent emergencies:
Usually requires aggressive resuscitation
…:
Most dangerous and most common scuba diving emergency
Bubbles of air in the blood vessels
Air pressure in the lungs remains at a high level while pressure on the …decreases.
Air embolism; chest
ascent emergencies: Decompression sickness “The bends” Bubbles of gas, especially nitrogen, ... Conditions that can cause the bends: Too rapid an ascent from a dive Too long of a dive at too deep of a depth Repeated dives within a short period
obstruct the blood vessels
You may find it difficult to distinguish between air embolism and decompression sickness.
Air embolism generally occurs …on return to the surface.
Symptoms of decompression sickness may not occur for…
treatment is the same for both: BLS and recompression in a hyperbaric chamber
immediately; several hours.
decompression sickness and air embolism must be treated in a
recompression chamber
SAMPLE history
Determine the …of the dive, length of time the patient was …, time of onset of symptoms, and previous diving activity.
depth; underwater
Physical examinations–> secondary:
Examine lungs and breath sounds.
Look for hidden life threats and trauma, indications of the ..or …, and signs of …
Assess for peripheral pulses, skin color and discoloration, itching, pain, and numbness and tingling
bends ; air embolism; hypothermia
Drowning patients may deteriorate rapidly due to:
Pulmonary injury
Fluid shifts in the body
Cerebral hypoxia
Hypothermia
Pneumothorax, air embolism, or decompression sickness patients may decompensate quickly.
pulmonary fluid cerebral hypoxia hypothermia pneumothorax; air embolism; decompression sickness
Document:
Circumstances of drowning and extrication
Time submerged
…and … of the water
Possible spinal injury
Bring a … or dive computer.
Bring all dive equipment to the hospital.
Temperature; clarity; dive log
For air embolism or decompression sickness in a conscious patient:
Remove the patient from the water.
Try to keep the patient calm.
Administer ….
Consider the possibility of …and monitor breath sounds.
Provide prompt transport.
oxygen; pneumothorax
Pay close attention to the … of a person who is rescued from cold water.
…:
A person swimming in shallow water may experience a loss of consciousness caused by a decreased stimulus for breathing.
Treatment is the same as a drowning patient.
body temperature;
Breath-holding syncope
… injuries
Caused by the difference between the surrounding atmospheric pressure and the total gas pressure in the body
…
Caused by diminished oxygen in the air at high altitudes
Affects the central nervous system and pulmonary system
Dysbarism; altitude illness
…: Diminished oxygen in the blood Caused by ascending too high too fast or not being acclimatized to high altitudes Signs and symptoms Treatment
Acute mountain sickness
…:
Fluid collects in the lungs, hindering the passage of oxygen into the bloodstream.
…:
May accompany HAPE and can quickly become life threatening
Symptoms of HACE and HAPE may overlap.
Treatment of HAPE and/or HACE
High-altitude pulmonary edema (HAPE)
High-altitude cerebral edema (HACE)
Targets of direct lightning strikes:
People engaged in outdoor activities (boaters, swimmers, golfers)
Anyone in a…area
Many individuals are …struck when standing near an object that has been struck by lightning, such as a tree.
large, open; indirectly
lightning:
The …and … systems are most commonly injured.
Respiratory or cardiac arrest is the most common cause of lightning-related deaths.
Categories of lightning injuries:
…
…
…
cardiovascular; nervous;
mild
moderate
severe
black widow bites:
most cause … and symptoms including agonizing…
main danger is the venom which is …
localized pain; muscle spasms; neurotoxic
brown recluse spider:
venom is …–> causes severe … damage
typically, bite is not painful at first but becomes so within hours
area becomes … and …, developing a …, …, … center
cytotoxic; local tissue; swollen; tender; pale; mottled; cyanotic
Snakes usually do not bite unless provoked, angered, or accidentally injured.
Protect yourself from getting bitten.
Use extreme caution and wear proper PPE.
The classic appearance of the poisonous snakebite is two small …wounds, with …, …, and pain.
puncture; discoloration; swelling
Rattlesnakes, copperheads, and cottonmouths are all pit vipers, with triangular-shaped, flat heads.
Small pits that contain poison located just behind each …and in front of each …
copperhead bites are almost never fatal but the venom can cause significant damage to tissues in the …
nostril; eye; extremities
… from cottonmouths may be severe
tissue destruction
Signs of envenomation include:
Severe … at the site of injury
… and … discoloration
If the patient has no local signs … after being bitten, assume that envenomation did not take place.
burning pain; swelling; bluish; an hour
coral snakes: injects venom with its … and tiny fangs by a chewing motion; usually bites victim on finger/toe
venom is a powerful toxin that causes paralysis of the …–> within a few hours of being bitten, a patient will exhibit bizarre behavior, followed by progressive paralysis of … and …
antivenin is available, but most hospitals do not stock it
emergency care is the same as for a pit viper
teeth; nervous system; eye movements; respiration
ticks can spread …, which occurs within 7-10 days after bite
can also spread … disease: first symptoms are generally fever and flulike symptoms, sometimes associated with a bull’s eye rash that may spread to several parts of the body; painful swelling of joints occurs
rocky mountain spotted fever; lyme
Tick bites occur most commonly during the summer months.
If transport will be delayed, remove the tick by using fine tweezers to grasp the ..and pull it straight out of the skin.
Once the tick is removed, cleanse the area with …and save the tick for identification.
head; antiseptic
…are responsible for more envenomations than any other marine animals.
Fire coral, Portuguese man-of-war, sea wasp, sea nettles, true jellyfish, sea anemones, true coral, and soft coral
Coelenterates
