Environmental Flashcards
What are predictors of a poor outcome in drowning?
immersion over 10 minutes
delay to CPR
come on arrival to ED
time to first breath
cardiac arrest on scene
temp of water -cold is neuroprotective
Post drowning what is of relevance here?
What ventilation strategies would you use?
bilateral coalescing pulmonary infiltrates - ARDS
low volume ventilation
What are the post intubation priorities in drowning
- protective lung ventilation and oxygenation - VQ mismatch likely, prevetion of secondary brain injury from hypoxia or hypercarbia
- cardiovascular support and fluid as likely cold diuresis and arthymias
- rewarm to 34 and prevent shivering to prevent organ dysfunction from hypothermia
- disposition planning or retrieval
what is the pathophysiology of acute mountain sickness/high altitude cerebal oedema?
vasogenic cerebral oedema as hypoxia causes cerebral vasodilation and increased blood flow
Leaky BBB due to loss of autoregulation and increased permiability
What is the pathophysiology of acute pulmonary oedema?
What are the risk factors?
What is the treatment?
non cardiogenic, hydrostatic oedema
pulmonary vasoconstriction which is widepsread but patchy. this heterogeneity causes diversion to less constricted areas and therefore leaky
Risk factors:
* rapid ascent
* genetics
* exertion
* cold
* pre existing pulmonary hypertension
* sleeping medication
Treatment
* immediate descent
* oxygen
* minimise exertion
* CPAP
* nifidine
What are the clinical features of acute mountain sickness?
- headache worse on bending over
- anorexia/nausea/vomiting
- weakness and irritability
- fluid retention
- retinal haemorrhages
what is the toxin and mechanism of action of the blue ringed octopus?
What are the early and late signs of toxidrome?
What is the definitive management?
**Tetrodotoxin **- Sodium channel blockade causing neurotoxicity
Toxidrome signs
Early
* peri oral parasthesia
* ptosis, blurred vision, doplopia
Late
* progressive descending flaccid paralysis
* respiratory failure and arrest
management
intubation and mechanical ventilation for 24 hours - no antivenom
list three marine creatures and mechanism of collapse
- blue ringed octopus - descendingflaccid paralysis
- box jellyfish - sudden collapse and death from dysryhtmia
- sea snake - descending flaccid paralysis
What is parklands formula?
estimates fluids to be given over first 24 hours in burns in ml
%TBSA x 4 x kg
What is the rule of 9 for burns
what are the key features of an examination post drowning
- evidence of other injuries eg c spine
- temp
- signs of lung injury/aspiration
- neurological deficit
- signs of poor perfusion
how would you prepare the department for a paeds drowing?
- assemble adequate staff, give handover/what is known to team
- prepare resus bay with paeds equipment including wamer, IO, paeds cannulas etc
- clearly defined team roles
- notify anesthetics/paeds
- prepare drugs eg 20ml/kg fluid, adrenaline 0.1ml kg of 1:10000
when should resus caese following drowning?
serum K over 11
one hour of asystole/apnoe most becoming normothermic
What are the phases of drowning?
- voluntary breath holding then involunary laryngospasm due to liquid in oropharynx and may swallow large volumes of water
- hypoxia, hypercarbia and acidosis
- active respiratory movements but no gas exchange
- worsening hypoxia stops laryngospasm and active water ingestion
- electrolyte imbalance, acid base disturbance
- washout of surfactant, pulmonary htn and worse hypoxia
- multi organ failure and death
what is the conn and modell classification for neurological dysfunction in drowning?
A- Awake
B - conscious but obtunded
C - Comatose and can be C1-C3 flex to pain/extend to pain/flaccid
what are two differentials for rash post diving?
contact dermatitis from wetsuit
Cutis marmorata - cutaneous decompression illness
