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Clinical Care > Enviromental Emergencies > Flashcards

Enviromental Emergencies Flashcards

1
Q

Who is at risk of heat illnesses and why

A

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

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2
Q

What are heat cramps

A

Acute involuntary muscle pains

Occurs because of sweating and sodium loss

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3
Q

Treatment of heat cramps

A

1) move to cool are
2) drinks fluid or give saline

Do not massage muscle

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4
Q

What is heat syncope

A

It can be called orthostatic syncopal episode - can occur with prolonged standing or from sitting/ lying to standing
Occurs because of peripheral vasodilation

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5
Q

Treatment for heat syncope

A

Place in supine position and replace fluids

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6
Q

What is heat exhaustion?

A

Volume depletion and heat stress

There is two forms

Water depleted
Sodium depleted

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7
Q

Sodium depleted in heat exhaustion what is it

A

Exertional hyponatremia

  • loss of sodium through sweating

Can cause nausea, vomiting, mental status change and convulsions

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8
Q

Heat exhaustion symptoms

A 
Headache 
Nausea 
Fatigue 
Vomiting 
Dizziness 
Abdo cramps 
Pale/clammy
Respiratory rate fast and shallow 
Tachypneoa
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9
Q

What can heat exhaustion progress to

A

Heat stroke

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10
Q

Treatment for heat exhaustion

A

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

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11
Q

What is heat stroke

A

Severe disturbance in body’s regulation have core body temperature greater than 40
Altered mental status

Can be classic or exertional

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12
Q

Clinical features of heat stroke

A 
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
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13
Q

Treatment for heat stroke

A

Rapid cooling
Spray water on patient
Ice pack on neck, groin, axillae

IV fluids, glucose, may seize
May need to intubate

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14
Q

What is hypothermia

A

Decrease in core body temperature below 35c

Caused by inadequate thermogenesis or cold environment

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15
Q

Risk factors for hypothermia

A 
Body factors 
Trauma 
Issue with development 
Alcohol 
Older people
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16
Q

Clinical features of hypothermia

A

Umbles

Stumbles
Mumbles
Fumbles
Grumbles

As it is affecting cerebral and cognitive function

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17
Q

Tempeture ranges for hypothermia

A

Mild 35-32
Moderate 32-28
Severe - below 28

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18
Q

Happens to cvs in hypothermia

A

Blood shunted to core, increased viscosity of blood, impairs circulation, hypovolaemia.

Initially speeds up then slows rate = disrupted electrical conduction

Arrhythmias

19
Q

Happens to resp in hypothermia

A

Speed up then decreases
Minute volume decreases

Secretions increase, increased bronchospasm

20
Q

Happens to msk in hypothermia

A

Slow in response to cold
Start to shiver
Shivering stops when to low below 32
Cold muscles = weaker and stiffer

21
Q

Happens to metabolism in hypothermia

A

Shivering decreases glucose
Insulin levels falls body changes to metabolism of fat
Liver metabolism of drugs is slowed

22
Q

Stages of hypothermia

A

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

23
Q

Treatment for hypothermia

A 
Prevent further heat loss and rewarm 
Take off wet clothes 
Passive rewarming 
Promote heat generation 
People only dead if warm and dead
24
Q

Sequence of Drowning

A

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

25
Q

What is a light ring strike most likely to result in

A

Hypoxic arrest

As respiratory effort doesn’t kick back in

26
Q

When assessing lightning stroke victims

A

Go to dead looking people first rather than awake ones
Opposite to normal

Must go to medical facility

27
Q

How many metres up will the body begin to have physiological changes

A

2500m

28
Q

What can u get from ascending too quickly

A

Hypobaric hypoxia

29
Q

Illnesses associated with altitude

A

AMS (acute mountain sickness)

HAPE (High altitude pulmonary edema )

HACE (high altitude cerebral edema)

30
Q

What happens in AMS

A

Acute mountain sickness

Headache plus one of: fatigue, weakness, gi symptoms, dizzy, lightheaded.
Headache usually temporal and occipital
Worse by valsalva manoeuvre

31
Q

What happens in HAPE

A

High altitude pulmonary edema

Dyspnoea, cough, weakness, chest tightness, congestion

Central cyanosis, crackles, tachypnoea, tachycardia

May have AMS then HAPE

32
Q

What is HACE

A

High altitude cerebral edema

Require presence of mental status change = can progress to coma

33
Q

Management of altitude illness

A

Oxygen and decent

Drug used - acetazolamide
Carbonic anhydrase inhibitor causes kidneys to secret bicarbonate leads to metabolic acidosis, will cause body to adjust

34
Q

Treatment for AMS

A

Paracetamol / aspirin

Antiemetics

Oxygen

Descent

35
Q

Treatment for HAPE

A

Desecent

Oxygen

Nifedipine or dexamethasone

36
Q

treatment for HACE

A

Oxygen
Descent
Dexamethasone (8mg followed by 4 very 6 hours )

37
Q

Details need for diving

A 
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
38
Q

Injuries that can occur in diving

A

Barotrauma
Pulmonary over pressurisation syndrome (POPS)
Arterial gas embolism
Decompression sickness (DCS)

39
Q

What is barotrauma

A

Tissue damage due to changes in pressure altering the volume within gas filled spaces e.g. sinus, lungs, gut

40
Q

What is pulmonary over pressurisation syndrome

A

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

41
Q

What is arterial gas embolism

A

Air bubbles from ruptured alveoli enter pulmonary capillaries and form large air bubbles

Can cause blockage e.g. STEMI, stroke

42
Q

What is decompression sickness

A

Gas that dissolved within the body tissue under pressure when re-emerge become bigger

Usually nitrogen and can cause emboli

43
Q

Management of dcs

A

Oxygen
IV fluids
Do not use Entonox
Hyperbaric therapy

Clinical Care (18 decks)

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