Environmental Flashcards

1
Q

What part of the brain regulates body temperature

A

Hypothalamus

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2
Q

What is considered hypothermic

A

Core temp <35 C or <95F

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3
Q

EKG changes seen in hypothermia

A

Osborn Wave
Notched wave just after the S wave

Usually happens in patients less then 86 degrees (30C)

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4
Q

Things to look out for in the mildly hypothermic patient

A

Osborn wave or V-fib
Pupils can be minimally responsive and mimic brain death at 82-88 degrees
Should warm to 94 before pronouncing them dead
Gingerly handle the patient to avoid arrhythmias
Monitor acid-base because they will become acidotic
Do not attempt to resuscitate the patient with a frozen chest where compressions are not possible

Treat with warm blankets, warm fluids (PO or IV)

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5
Q

Treatment of patients with extreme hypothermia

A

Handle the patient gently to avoid V-fib
IVF should be warmed to 105 degrees
Continual temp monitoring through core temp
Watch for acidosis - IVF will help prevent this
Examine pt for frostbite

In very severe cases:
-Place chest tubes and instill with warm saline
-Peritoneal lavage with warmed saline
-ECMO

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6
Q

Clinical management of frostbite

A

Rewarm the frostbitten area
-Place area in tub of warm water (98.6-102 F)
—If tub not available can use warm wet towels

Do not massage the area because this will cause tissue damage

Thawing usually takes 20-40 minutes and is complete when the distal tip of the affected area flushes and tissue is soft and pliable and takes on a reddish-purple color

Once thawed, keep body part in sterile sheets, elevated and splinted when possible

Administer analgesics

No role for antibiotics in frostbite

Tetanus prophylaxis in those that are due

Consult burn specialist and consider tPA administration within 24 hours if tissue damage is very deep

Takes 1-3 months to determine need for amputation

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7
Q

Treatment for trench foot

A

Washing and keeping feet dry - no lotions
Elevation for several weeks

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8
Q

Symptoms of heat stroke

A

Occurs when body temperature is increasing above 104 degrees

Presents with:
-Fatigue
-Vomiting
-Dehydration
-Profuse sweating that sometimes progresses to anhidrosis
-AMS

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9
Q

Treatment of heat stroke

A

Generous IVF
Spray patient down with tepid water and put a fan on them
Stop this when core temp reaches 101

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10
Q

Care of a marathon runner

A

Marathon runners who seize with heat stroke often have exertional hyponatremia
—Overly enthusiastic about drinking water and have lost a lot of sodium due to sweating
—Because this happened very rapidly, you want to fix this very rapidly - give hypertonic saline

Cool the patient down with evaporation

Treatment:
-3% saline 100cc IV plus D5NS 1-2L over 1 hour

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11
Q

Thermal burns - rule of 9’s

A

Anterior trunk - 18%
Posterior trunk - 18%
Each arm 9%
Each leg - 18%
Anterior head - 4.5%
Posterior head - 4.5%
Genitals - 1%

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12
Q

Worrisome exam features in burns

A

Circumferential burns can cause compartment syndrome

If singed nose hairs, intubate early because there is often delayed laryngospasm and airway edema
–Also intubate if soot in mouth, nose or posterior pharynx

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13
Q

Treatment of burns

A

Expose the patient completely to exam for burns
Brush off any soot to assess burn
If burned with oil or grease - remove with dish soap and cool water

If burned with tar, use petrolium based product

Stop the burn by applying cool water
–For large open areas, apply soaked, cold sterile towel or ice on top of a sterile towel (never direct ice)

Administer analgesics and update tetanus

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14
Q

Parkland formula for IV hydration

A

Used to treat thermal burns of greater than 25%

4 X %BSA burned x weight (kg) = total volume of LR to be given in the first 24 hours

Give half of the volume in the first 8 hours and the other half over 16 hours

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15
Q

Management of acidic chemical burns

A

Remove the patient’s clothes
Brush off any dry chemicals from the patient using any suitable instrument
Irrigation of the burn, starting at the face and head with water - almost all chemicals can be irrigated with water
—-Do not try to neutralize an acid with a base or vice versa as it will make a thermal burn

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16
Q

Chemicals that cannot be irrigated with water

A

Dry lime: Brush off

Elemental metals: Use mineral oil to remove

Phenol (used in disinfectants and plastic manufacturing): Use polyethylene glycol solution

Tar and asphalt: wipe off any that is loose and use bacitracin or vaseline to remove it completely

17
Q

Injury and management of patients from radiation

A

Injury to the skin and mucous membranes
Injury to deep structures
Radiation sickness

Delayed effects include neoplastic disease and birth defects

Anyone exposed to radioactive fallout should have their clothes removed and showered and scrubbed to remove any radioactive material

Should obtain CBC to assess for lymphocytic death

Can give potassium iodine to overwhelm the thyroid

Blood and platelet transfusions to treat any cytopenias

18
Q

Anaphylaxis treatment for bee stings

A

If the symptoms are skin and respiratory:
-Benadryl 50mg IV
-Pepcid 40mg IV
-Consider steroids - methyprednisolone 125mg IV

If the symptoms include cardiovascular:
-Give all of the above plus epinephrine

19
Q

Treatment of mammal bites

A

Concern is infection (Pasturella most common in dogs and cats) or rabies

-Treatment of Pasturella is with Augmentin 850mg PO BID x7 days

-Treatment for rabies is Rabies vaccine given on days 0, 3, 7 and 14 and Rabies immune globulin given IM on day 0

Cleanse wound carefully with copious amounts of water

Debride any devitalized tissue

If feline or other sharp toothed animal bit the pt:
—Use a #11 blade and cut along tooth marks and irrigate along with a blunt tip needle

Close only wounds that absolutely need it.
—Others can be closed loosely with sutures or steri strips

20
Q

Electrolytes to be concerned about in burns

A

Metabolic acidosis expected during early resuscitation phase
Monitor for hyperkalemia during the first 24-48 hours and then hypokalemia as you give them more fluids over the course of the next few days