Enviornmental Emergencies Flashcards
Electrical Burns:
-Mechanism of injury with low voltage AC current?
high voltage AC/DC current?
-low voltage AC currents tend to cause what arrhythmias? High voltage AC/DC?
MOI:
-low voltage AC current will cause muscular tetany, causing the person to continually grasp the source.
High voltage AC/DC currents cause a single muscular contraction which tend to throw the victim from the source, increasing the risk of blunt trauma and blast injuries.
Low voltage AC currents tend to cause v-fib.
High voltage AC/DC currents cause asystole and resp arrest.
Electrical Burns:
- PE
- signs and sx
- -CNS
- -Spinal cord
- -Cutaneous
PE:
-primary, secondary survey
Signs and sx: CNS: -transient LOC -agitation, confusion -coma -visual disturbances(fixed/dilated/asymmetric pupils) -ruptured eardrums
Spinal cord injuries:
- Fx
- ascending paralysis
Cutaneous wounds:
- burns (look for entrance and exit wounds & degree of burns)
- look for compartment syndrome
O
Burns:
-tx
Tx:
- dysrhytmias = ACLS protocol
- fluid replacement = isotonic crystalloid
- wound care
- watch urine for myoglobinurea (can cause renal failure and if persistent and compartment syndrome has been excluded amputation may be necessary.
- tetanus ppx
Lightning Strikes:
- what type of current?
- SE?
- tx
Current: DC
SE:
- asystole
- resp arrest
- confusion, amnesia
- short term memory problems
- HA
- muscle pain
- paresthesias
- temporary visual or auditory problems
- most minor injuries improve with no long term sequelae.
- ruptured TM
- fern-like erythematous skin markings
Tx:
- aggressive resuscitation
- ACLS and CPR
- treat cutaneous burns, ocular involvement, auditory involvement, and MSK fxs
- tetanus
Drowning:
- leading cause of death in who?
- MOA
- End organ effects
- -pulm
- -neuro
- -CV
- -acid/base and electrolytes
leading cause of death in children under 5 YO.
MOA:
- panic, loss of normal breathing pattern, breath holding, air hunger, struggle to stay above water.
- aspiration, reflex laryngospasm = hypoxemia
End organ effects
- Pulm
- -fluid aspiration
- -washes out surfactant
- -produces noncardiogenic edema and acute resp distress syndrome (ARDS)
- -ARDS=SOB, rales, wheezing
- Neuro
- -hypoxemia and ischemia cause neuronal damage
- -cerebral edema and elevated ICP
- CV
- -arrhythmias secondary to hypothermia and hypoxemia often occur
- -sinus bradycardia and fibrillation
- Acid/base
- -metabolic and or resp acidosis often occur
- -significant electrolyte imbalances do not generally occur
Drowning
- management
- factors associated with a poor prognosis
Management
-pre-hospital: rescue breathing, rewarm them, possible CPR
- GCS greater than or equal to 13:
- -O2
- -observation for 4-6 hours
- GCS less than 13:
- -O2, vent support if needed, possible intubation
- -CXR
- -ABGs, CBC, CMP, PT/PTT, UA, CK, urine myoglobin, urine drug screen
- -prevent secondary neuro injury (from cerebral edema, hypoxemia, acidosis, etc)
- -if bronchospasm, give beta agonist
Factors associated with a poor prognosis
- duration of submersion more than 10 min
- resuscitation duration greater than 25 min
- hypothermia with core temp less than 33C
- age less than 3
- arterial blood pH less than 7.1
Define:
- mild hypothermia
- moderate hypothermia
- severe hypothermia
Presentation of each
How is heat preserved?
- mild hypothermia: core temp 90-95F
- -tachypnea, tachycardia, hyperventilation
- -ataxia, dysarthria, impaired judgement
- -shivering and cold diuresis
- moderate hypothermia: core temp 82-90F
- -reduction in pulse rate and CO…hypoventilation…a fib…junctional bradycardia and other arrhythmias
- -CNS depression, hyporeflexia
- -decreased renal blood flow and loss of shivering
- -paradoxical undressing
- severe hypothermia: core temp less than 82F
- -pulm edema, oliguria, areflexia, coma
- -hypotension, bradycardia, ventricular arrhythmias and asystole
Heat is preserved by
- peripheral vasoconstriction
- shivering
- non-shivering thermogenesis
- -increase in metabolic rate from thyroid and adrenal glands
Hypothermia
- dx
- tx
Dx
- must use low reading thermometer
- electrolytes, hematocrit, coag studies, ABGs
- EKG: elevation of the j point (j or osborne wave)
Tx
- ABCs
- passive external rewarming
- active external rewarming (warm blankets, radiant heat, forced warm air)
- -risk is core temp afterdrop (occurs when trunk and extremities warmed simultaneously). Warm trunk first!
-active internal rewarming (pleural and peritoneal irrigation with warm saline, hemodialysis, warm humidified oxygen, warm IV fluids)
Frostbite
- pathophys
- describe the classification
- dx
- tx
Pathophys
- tissue destruction due to:
- -immediate cold-induced cell death
- -more gradual development of localized inflammation and tissue ischemia
- -made worse in the setting of thawing and refreezing
Classification
first degree
-central area of pallor and anesthesia of the skin surrounded by edema (superficial)
second degree
-blisters form containing clear of milky fluid surrounded by edema/erythema within 24 hours (superficial)
Third degree
-injury deeper than second degree and blisters are hemorrhagic, progressing to black eschar over several weeks (deep)
fourth degree
-extends to muscle and bone, involves tissue necrosis (deep)
dx
- clinical
- technetium (tc)-99 scintigraphy is used to predict long term viability of affected tissue
Tx
- remove wet clothing
- avoid walking of frostbitten feet
- do not rub
- rapid rewarming
- -waterbath heated to 40-42C
- bulky dressing, elevation, splinting
- drain, debride, and bandage large nonhemorrhagic bullae
- drain but do not debride hemorrhagic bullae
- tetanus prophylaxis
- topical aloe and ibuprofen
- possible tPa, look it up though
- surgial consult
Heat Exhaustion
- describe water depletion
- describe salt depletion
- sx and signs
- tx
Water depletion
- inadequate fluid replacement by individuals working in a hot environment, can progress to heatstroke
- hypovolemia
Salt depletion
- large volumes of thermal sweat are replaced by water with too little salt
- hyponatremia, hypochloremia
Sx
- weakness, malaise, fatigue
- HA, lightheadedness, dizziness
- n/v
- hypotension
- tachycardia, tachypnea
- diaphoresis
- syncope
Tx
- cool environment
- volume and electrolyte replacement
- oral of 1-2 L saline
Heat Stroke
- definition
- sx
- tx
Definition
-body temp more than 40.5C (105F)
Sx
- Ataxia, irritability, confusion, bizarre behavior, combativeness (CNS dysfunction with cerebral edema)
- dry, hot skin, but sweating may persist
- marked elevation of liver transaminases
- arrhythmia
- kidney failure
Tx
- ABCs
- Cooling is the immediate goal
- -evaporative cooling (mist them in front of fans)
- -cold water immersion (ice bath)
- -ice packing
- -cold gastric lavage (NG tube)
- -cold peritoneal lavage
- cooling should be discontinued when rectal temp reaches 104F/40C
- treat hypotension with fluid (NS at 250ml/hr)
- treat sz with benzos
- admit to higher level of care if necessary
