Enviromental Emergencies Flashcards
Who is at risk of heat illnesses and why
Older people - do not adjust well, acclimatise slowly, likely to have chronic conditions and be on medications which can disrupt mechanisms
Children - have high heat production, do not dissipate heat well, thermoregulatory centres not fully developed
What are heat cramps
Acute involuntary muscle pains
Occurs because of sweating and sodium loss
Treatment of heat cramps
1) move to cool are
2) drinks fluid or give saline
Do not massage muscle
What is heat syncope
It can be called orthostatic syncopal episode - can occur with prolonged standing or from sitting/ lying to standing
Occurs because of peripheral vasodilation
Treatment for heat syncope
Place in supine position and replace fluids
What is heat exhaustion?
Volume depletion and heat stress
There is two forms
Water depleted
Sodium depleted
Sodium depleted in heat exhaustion what is it
Exertional hyponatremia
- loss of sodium through sweating
Can cause nausea, vomiting, mental status change and convulsions
Heat exhaustion symptoms
Headache Nausea Fatigue Vomiting Dizziness Abdo cramps Pale/clammy Respiratory rate fast and shallow Tachypneoa
What can heat exhaustion progress to
Heat stroke
Treatment for heat exhaustion
Move patient out of hot environment
Cool patient - sponge, spray, fan
Rehydration - water, IV fluids, replace electrolytes
If it is exertional hypontraemia do not give fluids by mouth do IV
Monitor observation
What is heat stroke
Severe disturbance in body’s regulation have core body temperature greater than 40
Altered mental status
Can be classic or exertional
Clinical features of heat stroke
Not be able to give coherent history Changes in behaviour Older patient may look as though stroke CNS disturbance e.g tremors posturing Elevated temperature Degree of dehydration
Treatment for heat stroke
Rapid cooling
Spray water on patient
Ice pack on neck, groin, axillae
IV fluids, glucose, may seize
May need to intubate
What is hypothermia
Decrease in core body temperature below 35c
Caused by inadequate thermogenesis or cold environment
Risk factors for hypothermia
Body factors Trauma Issue with development Alcohol Older people
Clinical features of hypothermia
Umbles
Stumbles
Mumbles
Fumbles
Grumbles
As it is affecting cerebral and cognitive function
Tempeture ranges for hypothermia
Mild 35-32
Moderate 32-28
Severe - below 28
Happens to cvs in hypothermia
Blood shunted to core, increased viscosity of blood, impairs circulation, hypovolaemia.
Initially speeds up then slows rate = disrupted electrical conduction
Arrhythmias
Happens to resp in hypothermia
Speed up then decreases
Minute volume decreases
Secretions increase, increased bronchospasm
Happens to msk in hypothermia
Slow in response to cold
Start to shiver
Shivering stops when to low below 32
Cold muscles = weaker and stiffer
Happens to metabolism in hypothermia
Shivering decreases glucose
Insulin levels falls body changes to metabolism of fat
Liver metabolism of drugs is slowed
Stages of hypothermia
1- conscious and shivering
2- reduced conscious level may or may not be shivering
3- unconscious vital signs present
4 - apparent death, vital signs absent
Treatment for hypothermia
Prevent further heat loss and rewarm Take off wet clothes Passive rewarming Promote heat generation People only dead if warm and dead
Sequence of Drowning
Breath holding
Small amount enter mouth nose = coughing, gasping, sets off spasms
Laryngospasms - leads to asphyxia and may lose conscious dry drowning
Water enters lungs = wet drowning
Decompensation = gasps for air allowing more water in
What is a light ring strike most likely to result in
Hypoxic arrest
As respiratory effort doesn’t kick back in
When assessing lightning stroke victims
Go to dead looking people first rather than awake ones
Opposite to normal
Must go to medical facility
How many metres up will the body begin to have physiological changes
2500m
What can u get from ascending too quickly
Hypobaric hypoxia
Illnesses associated with altitude
AMS (acute mountain sickness)
HAPE (High altitude pulmonary edema )
HACE (high altitude cerebral edema)
What happens in AMS
Acute mountain sickness
Headache plus one of: fatigue, weakness, gi symptoms, dizzy, lightheaded.
Headache usually temporal and occipital
Worse by valsalva manoeuvre
What happens in HAPE
High altitude pulmonary edema
Dyspnoea, cough, weakness, chest tightness, congestion
Central cyanosis, crackles, tachypnoea, tachycardia
May have AMS then HAPE
What is HACE
High altitude cerebral edema
Require presence of mental status change = can progress to coma
Management of altitude illness
Oxygen and decent
Drug used - acetazolamide
Carbonic anhydrase inhibitor causes kidneys to secret bicarbonate leads to metabolic acidosis, will cause body to adjust
Treatment for AMS
Paracetamol / aspirin
Antiemetics
Oxygen
Descent
Treatment for HAPE
Desecent
Oxygen
Nifedipine or dexamethasone
treatment for HACE
Oxygen
Descent
Dexamethasone (8mg followed by 4 very 6 hours )
Details need for diving
Type of dive Type of equipment Where was diving site Water temperature How many dives in 72 hours? Depth? Bottom time ? Surface interval Dive computer used Safety stops used Any complications
Injuries that can occur in diving
Barotrauma
Pulmonary over pressurisation syndrome (POPS)
Arterial gas embolism
Decompression sickness (DCS)
What is barotrauma
Tissue damage due to changes in pressure altering the volume within gas filled spaces e.g. sinus, lungs, gut
What is pulmonary over pressurisation syndrome
Dangerous form of barotrauma
Do not exhale during ascent so pressure in lungs increases
Likely to happen in emergency ascent as panic and hold breath
Cause pneumothorax, mediastinal subcutaneous emphysema
What is arterial gas embolism
Air bubbles from ruptured alveoli enter pulmonary capillaries and form large air bubbles
Can cause blockage e.g. STEMI, stroke
What is decompression sickness
Gas that dissolved within the body tissue under pressure when re-emerge become bigger
Usually nitrogen and can cause emboli
Management of dcs
Oxygen
IV fluids
Do not use Entonox
Hyperbaric therapy
