EMER 199 Medical 3 Flashcards
Thermoregulation
Heat production and excretion
Hypothalamus
thermostat of the brain
afferentefferent
Skin to nervous system afferent pathways Hypothalamus to body efferent pathways
Lowest temp a human can survive
is 13.7
hypothermia vs hyperthermia
Hyperthermia Vasodilation (increased HR) Hairs flat Sweat – dermal layer of skin Hypothermia Vasoconstriction Piloerection Shivering
Thermolysis
release of stored heat Mediated by parasympathetic nervous system
An increase in core temperature causes
the hypothalamus to send signals via Efarrant pathways in the parasympathetic nervous system causes vasodilation and sweating
Body’s reaction to daily production of heat energy and to hot environment
Vasodilation: The person may have a complete loss of vasomotor control blood pools in the periphery and the patient could experience distributive shock
Radiation
body heat is lost to nearby objects without physically touching them (heat waves- sun)
Conduction
body heat is loss to nearby objects through direct physical touch (touch)
Convection
body heat is lost to surrounding air which becomes warmer, rises abd is replaced with cooler air (air moving over- an object-fan)
Evaporation
body heat causes precipitation which is lost from the body surface when changed from liquid to vapor (sweating)
Thermogenesis
Production of heat and energy for the body Mediated by the sympathetic nervous system
Main method of dealing with cold stressors
Skin is the body’s thermostat. Increases muscle tone and initiate shivering in the short term Increases thyroid levels in the long term Hypothalamus shunts blood to the core. Sweating decreases.
Heat Illness
Increase in core body temperature –Due to inadequate thermolysis –Inability to get rid of the heat buildup in the body
Heat Cramps
Acute involuntary muscle pains Usually in the lower extremities, the abdomen, or both Occur because of profuse sweating and subsequent sodium loss 3 factors contribute: salt depletion, dehydration and muscle fatigue
Heat Cramps Treatment
Stop activity Move the patient to a cool environment. If the patient is too nauseated to take liquids by mouth, insert an IV catheter and infuse normal saline rapidly. Do not massage the cramping muscles.
Heat Syncope
Typically occurs in nonacclimated people Can occur with prolonged standing or when standing suddenly from a sitting or lying position Peripheral vasodilation is thought to be the cause. Treatment involves placing the patient in a supine position and replacing fluid deficits.
Water depleted
This form primarily effects geriatric patients. Can effect active younger workers and athletes who do not adequately replace fluids in a hot environment
Sodium Depleted
May take hours or days to develop Results from huge sodium losses from sweating but replacing only free water
Heat Cramps s/s
Temp < 40 No alt LOC sweating Headache, fatigue, dizziness, nausea, vomiting, and, sometimes, abdominal cramping Skin is pale and clammy. Fast and shallow respirations Tachypnea
Rhabdomyolysis
muscle breaks down releases potassium which can kill you (brown urine)
“Summer flu”
Misdiagnosed If untreated may progress to heat stroke
Heat Exhaustion – TREATMENT
Stop activity Remove to cool area Remove clothing Replace oral fluids - water or electrolyte fluid, no stimulants If decrease LOC withhold fluid Monitor ABC and LOC, if changes treat as load and go Cardiac monitoring, ETCO2
GOAL TEMP WHEN YOU ARE COOLING SOMEONE
38.8
Heat Stroke
Least common but most deadly Caused by a severe disturbance in the body’s thermoregulation Core temperature more than 40°C (104°F) Altered mental status No sweating
classic heatstroke
Passive heat stroke Usually occurs during heat waves
exertion heatstroke
Typically an illness of young and fit people exercising in hot and humid conditions Generate heat without any means of excreting that heat
Heat Stroke Treatment
Temperature between 37.7 degrees Celsius and 40 degrees Celsius Stop activity and remove from hot environment Remove excess layers of clothing if required If clinically indicated administer oxygen Cool patient by sponging front and back of patient with lukewarm water, allow air conditioning air currents to flow over the patient to promote cooling Stop cooling if temperature drops below 38.8 degrees, or patient starts shivering Apply cardiac monitor Establish vascular access- fluid Transport
Frostbite
an ischemic injury that is classified as deep or superficialOccurs when ice crystals form between the cells of the skin, and then expand as they extract fluid from the cells
Superficial Frostbite
first layer of skin Frequently involve tips of ears, nose and fingers Presents with loss of sensation and feeling of effected area Commonly feels soft to the touch and pale around area Complains of pain on rewarming Capillary leakage produces edematous skin in the area
Deep Frostbite
all layers of skin Usually involves the hands or feet Looks like wax, white, yellow-white, or mottled blue-white Hard, cold, and without sensation Major tissue damage from thawing Partial refreezing of melted water may occur. As thawing occurs, the injured area turns purple, bluish, mottled and becomes excruciatingly painful Gangrene
Frostbite Care
Remove patient from cold source Do not allow patient to use injured limb Remove coverings from area Rewarm area unless danger of refreezing - body heat, warm environment, warm water Do not rub or massage (ice crystals) Watch for hypothermia Fully frozen limb don’t do anything just transport
Hypothermia
Is an imbalance between heat loss and heat production Some common issues leading to the development of hypothermia are: Cold temperatures Fatigue Improper gear for temperature Wetness Dehydration Malnutrition Length of exposure Intensity of weather conditions
Immersion Hypothermia
Is the result of immersion in cool or cold water which results in a loss of body heat. Outcome may be better Mammalian Diving reflex Not dead till you’re warm and dead
Mild Hypothermia
Below 36 degrees Increased metabolic rate Maximum shivering Thermogenesis
Below 34 degrees
Impaired judgment Slurred speech Passive re warming
Moderate Hypothermia
To 30 - 34 degrees Respiratory depression –Slowing down to save energy Myocardial irritability Bradycardia –Slowing down to save energy Atrial fibrillation Osborn waves or j wave Shivering stops at 32.2 degrees Warm IV fluid After drop is defined as the continued lowering of core body temp even after the patient is removed from the cold environment due to a shift of cold blood from the extremities during re-warming
Severe Hypothermia
Below 30 degrees Half the metabolic rate Loss of reflexes Fixed and dilated pupils VFib Call hypothermia Drugs will not work normally
Hypothermia Treatment
History and Assessment Maintain airway Handle with care Remove wet clothing Retain heat and place in warm environment Warmed oxygen if possible Warmed IV fluids If transport over 1 hour rewarm hot packs on pulse sites, not extremities No resp or pulse, cardiac monitor – CPRALS
Pathophysiology of Drowning and Submersion
Breath holding Water enters the mouth and nose A small amount of water is aspirated into the posterior pharynx and perhaps the trachea. Sets off spasms of the laryngeal muscles that seal off and protect the airway Water begins to enter the lungs.
Laryngospasm
Leads to asphyxia and the patient may lose consciousness ‘ “Dry drowning” – cant get air in Only happens in cold water
Drowning and Submersion Management
Resuscitation ABCs –Assist ventilation as soon as possible with BVM and oxygen –If there are weasels administer bronchodilators Trauma considerations —Immersion episode of unknown etiology warrants trauma management Post-resuscitation complications –Adult respiratory distress syndrome (ARDS) or renal failure often occur post-resuscitation –Symptoms may not appear for 24 hours or more post- resuscitation Fresh versus saltwater considerations -No difference in prehospital treatment
2 mechanisms Barotrauma
Pressure imbalance between gas-filled spaces in the body and the external atmosphere Compression of gases within body spaces during descent Expansion of gases within those spaces during ascent
Barotrauma
Nitrogen in tissue not blood can cause gas embolism very painful As the diver ascends, the ambient pressure decreases and gases expand. Trained to exhale constantly as they are ascending
Barotrauma results
Results in pulmonary over pressurization syndrome (“burst lung”) Can cause pneumothorax, mediastinal and subcutaneous emphysema, alveolar hemorrhage, and a lethal arterial gas embolism (AGE) Relative pressure and volume changes are greater near the surface of water
Nitrogen narcosis
State of altered mental status caused by breathing compressed air at depth
Injuries at Depth
Signs and symptoms Euphoric feeling Inappropriate behavior at depth Lack of concern for safety Apparent stupidity or inappropriate laughter Tingling of lips, gums, and legs
Decompression Sickness
Rapid ascent Nitrogen bubbles form in blood “The Bends” Multisystem disorder Can potentially affect almost every organ in the body As a diver descends As a diver ascends
The Bends
Is a diving complication that occurs when more Nitrogen is dissolved in blood when the gas is pressurized Because of the water pressure, body tissues absorbs nitrogen gas more rapidly as a diver descends than when ascending If a diver ascends to rapidly nitrogen gas bubbles will form in body tissue rather than being exhaled.
Dirty bombs
Any container designed to disperse radioactive material; intended to injure with both the radioactive material and explosive material Nuclear weapons Nuclear bombs/missiles Special atomic demolition munitions Small suitcase like weapon design to destroy individual targets
Radioactive Exposure Signs and Symptoms Vary depending on:
Amount of radiation Route of exposure
Low exposureModerate exposureSevere exposure:
Low exposure: nausea, vomiting, diarrhea Moderate exposure: first-degree burns, hair loss, depletion of immune system, cancer Severe exposure: Second/third-degree burns, cancer, death
Snakebite Management
ABC support as needed O2 as needed Keep patient calm and motionless to decrease venom spread and absorption Immobilize the Extremity in a neutral position DO NOT apply constricting bands or ice Immediate transport
Glaucoma
Increased pressure with the eye due to an obstruction of the outflow of aqueous humor Swelling on the optic nerve
Glaucoma Signs and Symptoms:
Intense ocular pain Blurred vision or cloudy vision Dilated pupil Colored halo around lights Nausea and vomiting Loss of peripheral vision *Acute angle-closure glaucoma is an emergency that require immediate ophthalmologic consultation – transport promptlyCauses -Hypertension -Diabetes
Retinal Detachment
The separation of the inner (neuronal) layer of the retina from outer (pigment) layer.
Retinal Detachment Signs and Symptoms:
Painless (retina does not contain sensory nerves) Visual disturbances —Shadowing, Floating spots, Blindness
Retinal Detachment Management:
True emergency requiring immediate ophthalmologic intervention. Transport promptly. Keep in mind the visual impairment of the patient.
Corneal injury
Patients complaining of an ocular “foreign body” sensation will generally have either a corneal abrasion or a foreign body.
Corneal injury Signs and Symptoms:
Significant eye pain Foreign body sensation Photophobia Tearing Eyelid edema
Conjunctivas
almost immediately and the eyes begin to predict tears in an attempt to flush out the object Irritation of the cornea or conjunctiva cause intense pain Blunt eye injuries
Hyphemia
is bleeding into the anterior chamber of the eye that scares vision partially or completely
An orbital blowout fracture
is the fragments of a fractured bone can entrap some of the muscles that control movement causing double vision especially with upward gaze
physical examination of the eyes
Orbital rim: for swelling, lacerations, and tenderness Eyelids: for swelling, and lacerations Corneas: for foreign bodies Conjuncativae: for redness, pass, inflammation in foreign bodies Globes: the redness, abnormal pigmentation and lacerations Pupils: for size, shape, equality and action to light Eye movement in all directions: for paralysis of gays or discord nation between the movement of the two eyes (deconjugate gaze) Visual acuity: make a rough assessment by asking the patient to read a newspaper handheld visual acuity chart
Anisocoria
condition in which the pupils are not of equal size
Eye Injury Management
Cover the injured eye to protect from external elements. Both eyes may have to be covered to prevent irritation caused by excessive eye movement. Transport to appropriate health care facility.
Cataract
Cataract is defined as an abnormal progressive condition of the lens of the eye, characterized by the loss of transparency. The cataract is the only common abnormality of the lens. Cataracts usually occur after the age of 50, and they are also inherited. Most cataracts are centrally located; however, peripheral cataracts do occur
Otitis Media
Infection of the middle ear cannal common in children 6-36 months old usually preceded by an upper respiratory infection
Otitis Media Signs and Symptoms:
Pain Fever Sense of fullness in the ear Diminished hearing Usually only one ear is affected
Otitis Externa
aka “swimmers ear” Inflammation or infection of the external canal or the auricle Major causes include allergy, bacteria, fungi, viruses, and trauma abrasions of the ear canal may become infected and excessive swimming may wash out the protective waxy substance (cerumen) and lead to secondary infection
Otitis Externa signs and symptoms
Pain Pus in the ear canal Swelling of the ear canal Pain increased by touching the tragus or the ear canal
Vertigo-”dizziness”
Most cases of vertigo can be attributed to illness or injury involving the ear. Loses sense of balance
Vertigo-”dizziness” Management:
Supportive care. Assess pulse oximetry. Assess blood sugar level. Administer oxygen if required. Gravol Transport to appropriate health care facility.
Ruptured ear drum
Perforation of the tympanic membrane can result from foreign bodies in the ear or from pressure related injuries such as blast injuries or diving related injuries
Ruptured ear drum Signs and symptoms
perforated tympanic membrane include loss of hearing and blood drainage from ear
Dental Abscess
Abscess that forms in the bone or soft tissue of the jaw. Results of an infection that follows dental caries or injury to a tooth.
Dental Abscess signs and symptoms
Fever (severe infection) Visual ‘sore’ on the gum line Flu-like symptoms (severe infection) Pain and pressure feeling at the site of infection
Tetanus
Develop after a traumatic event causes a break in the skin or as a complication of a chronic skin wound or lesion
Tetanus Signs and Symptoms:
Prolonged tonic spasm of the masseter muscles (Trismus) Excessive and uncontrolled muscle activity Irritability Weakness Hydrophobia Autonomic nervous system instability –Tachycardia –Hypertension –Hyperthermia
Sinusitis
Swelling of the nasal mucosa and blockage of the sinus result in an acute inflammatory reaction within the sinuses
Sinusitis Signs and Symptoms:
Nasal discharge or congestion Cough that worsens at night Sinus pain Headache Tooth or palate pain Low-grade fever
Peritonsillar Abscess (PTA)
Dx primarily on physical examination and usually results from tonsillitis. Large abscesses may displace the uvula laterally and lead to respiratory compromise if not treated
Peritonsillar Abscess (PTA)Signs and Symptoms:
History of recent tonsillitis Pain while swallowing Sore throat Drooling Fever Voice change Uvular deviation Pain in the ear
Retropharyngeal Abscess (RPA)
Primarily in children less than 6 years of age. The diagnosis is suspected in a patient with sore throat and difficulty swallowing.
Retropharyngeal Abscess (RPA) Signs and Symptoms
Fever Neck swelling Neck stiffness Poor oral intake Sore throat Drooling Painful swallowing Stridor
Tonsillitis Signs and Symptoms:
Sore throat Fever Headache Malaise Earache Difficulty swallowing Enlarged and tender lymph nodes of the neck
Conductive deafness
is a usually curable temporary condition caused by an injury to the eardrum, and infection or simply a buildup of earwax in the external auditory canal
Sensorineural deafness
which is permanent may be caused by a lesion or damage to the inner ear or a damage to the eighth cranial nerve
Dysarthria
the inability to make speech sounds correctly Results from a lack of muscle control and coordination of the larynx, tongue, mouth and lips
Language disorders
stroke, traumatic head/brain injury, brain tumor, delayed development, hearing loss, lack of stimulation or emotional disturbance may cause damage to the language center of the brain and lead to aphasia
Aphasia
is loss of ability to communicate in speech, writing or signs primarily affect the single aspect of language used such as ability to recall names of objects
Fluency disorders
person speech pattern is broken interrupted or repetitious
Voice production disorders
refer to the way the voice sounds these may be slightly easier to understand than other speech impairments
Paraplegia/Quadriplegia
Process is the inability to voluntarily move one or more body parts it may be caused by a head trauma, cerebrovascular accident, spinal cord injury, malignancy, neuromuscular disease, trauma, or birth defects
Hemiplegia
paralysis of one side of the body, possibly from Stroke or head injury
Parapeligia
paralysis of the lower part of the body possibly from thoracic or lumbar spinal injury or spina bifida
Quadriplegia
process of all four extremities in the trunk, possibly from a cervical spine injury
Dysphagia
caused by a partial paralysis of the esophagus is the inability to swallow
Integrate care for the mentally impaired patient
Mental illness is a generic term for a variety of illnesses that result in emotional, cognitive, or behavioral dysfunction Developmental disability is a permanent condition that means a person develops slower and differently than others do
Assessment specific to the mentally impaired patient
Speak to the patient as well as family members or caregivers, to determine the patients level of understanding and interaction. Change or a break in routine may be overwhelming for the patient. Be compassionate and try to reduce any anxiety. Treatment should be based on the chief complaint, unless related to their mental disability.
Down Syndrome Features:
Eyes slope upward at outer corners Folds of skin on either side of the nose that cover the inner corners of the eyes A small face and small facial features Large, protruding tongue Flattening on back of head Short, broad hands
Cerebral Palsy
Is a developmental condition that causes damage to the brain, typically the frontal lobe It is a self limiting condition and doesn’t worsen over time Begins in infancy, milestones like walking, crawling and talking maybe delayed 70-80% of CP cases are “spastic” (near constant state of contraction)
Multiple Sclerosis (MS)
Autoimmune condition that attacks the myelin sheath of neurons in the brain and spinal cord MS presentation usually follows a pattern of attacks and remissions The initial attack double vision and blurred vision or common reports other symptoms include muscle weakness impairment of pain, temperature and touch, tremors, speech disturbances, vertigo, bladder or bowel dysfunction, depression, euphoria, cognitive abnormalities and fatigue
Muscular Dystrophy (MD)
A non neurological condition of genetic origin marked by degeneration of muscular tissue Many forms of MD exist May affect all types of muscles including respiratory and cardiac muscles Mostly males Diagnosed before 5 years old Life expectancy not past 20 years
Poliomyelitis
Viral infection In children Fecal oral route Multiplies in intestine and moves to neuro system Through vaccinations this disease has been almost eradicated from the world
Poliomyelitis
s/s NV Sore throat Diarrhea Stiff neck Weakness or paralysis
Spina bifida
Developmental condition resulting from a neural tube defect Because the neural tube does not close a portion of the spinal cord remains outside its normal location In most severe forms the defect interferes with normal movement of CSF pressure builds within the brain causing increased ICP and seizures Be aware that many of these patients have latex allergies
Cystic fibrosis
Is a chronic disfunction of the endocrine system that targets multiple body systems but primarily the respiratory and digestive system Usually fatal don’t live past their teens Is caused by defective recessive gene which makes it difficult for chloride to move through the cells this causes unusually high sodium loss and abnormally thick mucus secretions no nothing
