Enviro-Aquatic Emergencies

Question 1

What is a normal body temperature?

Answer 1

35-38 C, with optimal function at 37.0 C

Question 2

What are heat cramps?

Answer 2

-Muscle cramps generally in legs of abdomen as a result of significant sodium loss through sweating from physical exertion
-Will present with sudden onset of mild to incapacitating muscle cramps, in the extremities and/or abdo. Small increase in CBT, tachycardia, and hypotension.
-Treatment involves simple things such as moving the pt to a cooler area, if there is no NV and
pt is conscious have them drink salted beverages or sports drinks

Question 3

What is heat exhaustion?

Answer 3

-Involves depletion of either water or sodium generally from exertion
-Symptoms may include headache, fatigue, NV, dizziness, altered LOA, Abdo cramping, maybe an inc in temp but < 40C, Tachycardia, Fast/shallow resps, Orthostatic hypotension, sweating and possibly even rhabdomyolysis
-Treatment should include moving the pt to cooler area, removing as much clothing as possible, consider patch for NaCl bolus if normotensive or have them drink water/electrolyte drinks if able

Question 4

What is heat stroke?

Answer 4

-The two key findings are altered mental status (possibly unconscious) and high temp generally > 40.0C. as well as tachycardia, hyperventilation, ETCO2 < 20mmHg, dry/red/hot skin (possibly pale/sweaty) and Hypotension
-Treatment includes moving the pt to cooler area, removing clothing, nothing by mouth, cover w wet sheets, cold packs to groin, axillae, neck and head.
-D/C active cooling if pt begins to shiver, skin temp or mentation normalizes

Question 5

What is frost bite?

Answer 5

Frost bite is an ischemic injury that can either be superficial or deep typically affecting, tip of nose/ ears, upper part of the cheek and fingers/toes

Question 6

What is frost nip?

Answer 6

Frostnip is a much less severe issues and can even go unnoticed. It can be alleviated by simply placing a warm hand on the affected area

Question 7

How does superficial frost bite present?

Answer 7

numbness/tingling, white/waxy/firm skin with underlying tissues remaining thawed and soft.

Question 8

How do you treat superficial frost bite?

Answer 8

remove pt from the cold, if hands affected have them place in axillae, for other areas press and hold a firm hand on the cheek, ear etc, cover blisters with dry dressing. Do not rub or massage affected areas.

Question 9

How does deep frost bite present?

Answer 9

generally affects the hands and feet and presents with hard, cold wooden feeling skin with loss of sensation and can be white, yellow or blue

Question 10

How do you treat deep frost bite?

Answer 10

-Wrap the affected body part and protect it from further trauma and active rewarming.
-Do not rub or massage and leave/dress blisters w dry dressings
-Remember to wrap digits separately on hands/feet

Question 11

What is hypothermia?

Answer 11

Defined as a core body temp under 35 C

Question 12

What is mild hypothermia?

Answer 12

34-35 C

Question 13

What is moderate hypothermia?

Answer 13

32-34 C

Question 14

What is severe hypothermia?

Answer 14

< 32 C

Question 15

What are the findings of hypothermia?

Answer 15

-Everything slows down
-Speech becomes slow and slurred, confusion sets in and coordination is impaired with unsteady gait similar to ETOH use or head injury
-Peripheral vasoconstriction shunts blood to the core which is sensed as an increase in volume and urine production increases
-An initial inc in HR is followed by bradycardia. A-fib is common, and these patients are susceptible to VF (vigorous movement or suction) and resistant to defibrillation
-Initially RR is increased followed by profound hypoventilation (O2 consumption cut in half) with an inability to protect a/w and the possibility of bronchospasm

Question 16

How do you treat hypothermia?

Answer 16

-Remove wet clothing regardless of severity of hypothermia.
-Remove jewelry or the constrictive accessories if not frozen
Mild/moderate:
-with shivering present move the patient into warm ambulance, wrap in blanket or rescue blanket and rewarm using hot packs or water bottles in the groin, axillae, head and/or neck areas
Severe:
-if not shivering and temp < 30, unconscious, stiff limbs and slow absent pulse use blankets only and be gentle with extrication and oral suctioning if required. Note SpO2 may be untraceable due to cold extremities

Question 17

How long should a bite be irrigated?

Answer 17

5 mins

Question 18

What are the 2 venomous spiders native to Ontario?

Answer 18

black widow spider and brown recluse spider

Question 19

How many feet of sea water is it atmospheric change/level?

Answer 19

For every 33 feet of seawater the pressure increases by 1 atmosphere with most scuba diving done between 60-120FSW

Question 20

What assessment questions should be used in scuba injuries?

Answer 20

water temp, depth of dive, symptoms as time of descent or ascent, did they use safety stops, other recent dives, how long at depth, dive complications and pre/post dive activities

Question 21

What is barotrauma/”the squeeze”?

Answer 21

-as a result of pressure difference in gas filled spaces in the body and external pressure generally on descent.
-Can be as a result of compression of those gases during descent or expansion of them during ascent.
-Can occur in middle/inner ear, sinuses or teeth.
-Severe ear pain without correction can result in tympanic membrane rupture leading to NV, dizziness, pain and vertigo

Question 22

What is nitrogen narcosis?

Answer 22

-An altered mental status caused by breathing compressed air including N generally around 100FSW
-pt. May present with euphoric or intoxicated appearance, uncontrolled laughter, disregard for safety leading to removal of regulator or ascent to quickly and tingling in lips, gums or legs

Question 23

What is decompression sickness/the bends?

Answer 23

-Broad range of signs and symptoms relating to nitrogen bubbles going out of blood and tissues during ascent.
-Interferes with tissue perfusion and can cause chemical changes
-Increased risk of the bends to divers with several recent dives, recent flights, obesity, a patent foraman ovale, dehydration or fatigue.
-Most common symptom is joint pain but can have more serious affects like spinal cord pain. Generally, the unconscious patient is more likely suffering from an AGE
-Treatment for the bends and AGE is hyperbaric chamber to dissolve N bubbles and restore oxygen to deprived tissues sooner rather than later