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NUR 202 Week 13 > Environmental Emergencies > Flashcards

Environmental Emergencies Flashcards

1
Q

Environmental emergencies may include

  • Poisoning
  • Hypothermia
  • Hyperthermia
  • Snakebites
  • Spider bites
  • Drowning
A

Heat Exhaustion

  • Prolonged exposure to heat over hrs or days

> Leads to heat exhaustion

☞ Thermoregulatory mechanisms like sweating, vasodilation, & incr resp cannot compensate for exposure to incr ambient temps

☞ Usually occurs in individuals engaged in strenuous activity in hot, humid weather, but also in sedentary indiv

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2
Q

Clinical synd characterized by

☞ Fatigue
☞ Light-headedness
☞ n/v
☞ Diarrhea
☞ Feelings of impending doom
☞ Tachypnea

A

☞ Tachycardia
☞ Dilated pupils
☞ Mild confusion
☞ Ashen color
☞ Profuse diaphoresis
☞ Hypotension & mild to severe temp elevation (99.6°-104°F d/t dehydration)

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3
Q

♥ Place pt in cool area & remove constrictive clothing

♥ Place moist sheet over pt to decr core temp

♥ Provide oral fluids

♥ Replace electrolytes

♥ Initiate NS IV solution if oral solutions not tolerated

A

♥ Monitor ABCs incl cardiac dysrhythmias (d/t electrolyte imbalances)

♥ Consider hosp admission for the elderly, the chronically ill, or those who don’t improve within 3-4 hrs

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4
Q

?

☞ Is the most serious form of heat stress; failure of the hypothalamic regulatory process

☞ Vasodilation, incr sweating & RR deplete fluids & electrolytes, spec sodium
- Sweat glands stop functioning & core temp incr (>104°F)

☞ Skin hot, dry, & ashen; cerebral edema & hemorrhage may occur as a result of direct thermal inj to the brain & decr cerebral blood flow

A

Heat stroke

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5
Q

✓ Treatment: stabilize pt’s ABCs & rapidly reduce temp

✓ Admin of 100% O2 compensates for the pt’s hypermetabolic state

✓ Ventilation w/a BVM or intubation & mech vent may be req’d

A

✓ Cooling methods
- Remove clothing
- Cover w/wet sheets
- Place pt in front of large fan
- Immerse in ice water bath
- Admin cool fluids or lavage w/cool fluids

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6
Q

The muscle breakdown leads to ___, which places the kidneys @ risk for acute failure

A

myoglobinuria

Excretion of myoglobin in the urine; results from muscle degradation, which releases myoglobin into the blood; occurs in certain types of trauma (crush synd), adv or protracted ischemia of muscle, or as a paroxysmal process of unk etiology

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7
Q

💫 Shivering: increases core temp, complicates cooling efforts, treated w/IV chlorpromazine

💫 Aggressive temp reduction until core temp reaches 102°F

A

💫 Monitor for signs of rhabdomyolysis, myoglobinuria, & DIC

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8
Q

?

Is a synd c/b inj to skeletal muscle & involves leakage of large quantities of potentially toxic intracellular contents into plasma; its final common pathway may be a dist in myocyte calcium homeostasis

  • Myoglobin is an important myocyte compound released into plasma
A

Rhabdomyolysis

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9
Q

After muscle inj, massive plasma myoglobin lvls exceed protein binding (of haptoglobin) & can precipitate in glomerular filtrate

A

Excess myoglobin may thus cause renal tubular obstruction, direct nephrotoxicity (ischemia & tubular inj), intrarenal vasoconstriction, & AKI

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10
Q

Hypothermia

Core temp < ___°F

Risk factors
- Elderly
- Certain drugs
- Alcohol
- Diabetes

Core temp < ___°F is potentially life-threatening

A

95

86

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11
Q

___ hypothermia (<86° F)

Makes the person appear dead

☞ Bradycardia
☞ Asystole
☞ Ventricular fibrillation

A

Severe

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12
Q

___ hypothermia (93.2-96.8°F)

☞ Shivering
☞ Lethargy
☞ Confusion
☞ Rational to irrational behavior
☞ Minor HR changes

A

Mild

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13
Q

___ hypothermia (86-93.2°F)

☞ Rigidity
☞ Bradycardia, bradypnea
☞ BP by Doppler
☞ Metabolic & resp acidosis
☞ Hypovolemia
☞ Shivering disappears @ temp 86°F

A

Moderate

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14
Q

✔️ Warm pt to @ least 90°F before pronouncing dead
> Cause of death - refractory ventricular fibrillation

A

Treatment of hypothermia

✔️ Manage & maintain ABCs
✔️ Rewarm pt
✔️ Correct dehydration & acidosis
✔️ Treat cardiac dysrhythmias

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15
Q

Mild hypothermia: passive or active external rewarming

✓ Passive external rewarming: move pt to warm, dry place; remove damp clothing; place warm blankets on pt

✓ Active external rewarming: body-to-body contact; fluid or air-filled warming blankets, radiant heat lamps

A

Moderate to severe hypothermia: active core rewarming

✓ Use of heated, humidified O2
✓ Warmed IV fluids
✓ Peritoneal, gastric, or colonic lavage w/warmed fluids

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16
Q

! Risks of rewarming
- Afterdrop, a further drop in core temp (occurs when cold peripheral blood returns to the central circulation)
- Hypotension
- Dysrhythmias

A

! Rewarming should be discontinued once the core temp reaches 95°F

17
Q

?

Is somewhat like burns in that the inj can be superficial, partial, or full thickness

1st - 4th degrees

A

Frostbite

18
Q

?

Occurs usually on superficially exposed areas such as nose, face, fingers, toes

Causes pain, numbness, pallor; left untreated, can be a precursor to frostbite

A

Frost nip

19
Q

1°
☞ Increases circulation to the area

2°
☞ Large, fluid-filled blisters form w/partial thickness skin necrosis

A

3°
☞ Small blisters appear w/dark fluid & the affected body part is cool numb, blue, or red & does not blanch
☞ Full thickness & SC tissue necrosis occurs & req debridement

4°
☞ Most severe; are no blisters or edema; part is cold, numb, & bloodless
☞ Full thickness then extends into the muscle & bone
☞ Gangrene develops which may req amputation

20
Q

?

Results when person becomes hypoxic d/t submersion in substance, usually water

R/t inability to swim, use of alcohol or drugs, trauma, seizures, hypothermia, stroke, & child neglect

A

Submersion injury

21
Q

Drowning: death from suffocation after submersion in fluid

☞ Immersion syndrome occurs w/immersion in cold water, which leads to stimulation of the vagus nerve & potentially fatal dysrhythmias

☞ Near-drowning: survival from potential drowning

A

Pathophysiology of Submersion Injury

22
Q

✦ Treatment of submersion injuries

☞ Correct hypoxia
☞ Correct acid-base & fluid imbalances
☞ Support basic physiologic functions
☞ Rewarm if hypothermia present

A

✦ Initial evaluation: ABCD

✦ Mechanical vent w/PEEP or CPAP to improve gas exchange when pulm edema is present

☞ Mannitol or furosemide is used to decr free water & treat cerebral edema

23
Q

✦ Deterioration in neurologic status: cerebral edema, worsening hypoxia, profound acidosis

✦ Observe for min of 4-6 hrs

A

✦ Secondary drowning is a concern w/pts who are essentially sx free - refers to delayed death from drowning d/t pulm comp

24
Q

Proper tick removal

A

Bees & Wasps

☞ Potential for anaphylactic reaction
☞ Emergency care to remove stinger & apply ice pack
☞ Advanced emergency hosp care to ensure ABC
☞ EpiPen admin esp vulnerable for allergic pts

25
Q

Lightning Injuries

☞ Cardiopulmonary & central nervous systems profoundly affected
☞ Asystole is most lethal initial effect on cardiopulmonary system

A

☞ Treatment is immediate CPR
☞ No danger to rescuer from contact w/victim

26
Q

Animal Bites

A

☞ Children @ greatest risk

☞ Animal bites from dogs & cats are most common, followed by bites from wild or domestic rodents

Complications
☞ Infection
☞ Mech destruction of skin, muscle, tendons, blood vessels, bone
☞ Bite may cause a simple laceration or be assoc w/crush inj, puncture wound, or tearing of mult layers of tissue

27
Q

Dog bites
☞ Usually occur on extremities
☞ May involve sig tissue damage
> Deaths are reported, usually children

☞ Facial bites common in small children

A

Cat bites
☞ Deep puncture wounds that can involve tendons & joint capsules
> Greater incidence of infection
- Septic arthritis
- Osteomyelitis
- Tenosynovitis

28
Q

Human bites
☞ Result in puncture wounds or lacerations
☞ High risk of infection
☞ Oral bacteria flora (Staphylococcus aureus, Streptococcus, hepatitis virus)
☞ Sites: hands, fingers, ears, nose, vagina

A
29
Q

Animal & Human Bites

☞ Initial treatment: clean w/copious irrigation, debridement, tetanus prophylaxis, & analgesics
> Prophylactic abx for bites @ risk for infection
- Wounds over joints
- Wounds less than 6-12 hrs old
- Puncture wounds
- Bites on hand or foot

A

☞ Puncture wounds left open

☞ Lacerations loosely sutured

☞ Wounds over joints splinted

@ greatest risk are infants, older adults, immunocompromised pts, alcoholics, diabetics, & people taking corticosteroids
> Incr incidence of cellulitis, osteomyelitis, & septic arthritis in these pts

30
Q

☞ Rabies prophylaxis essential in management of animal bites
- Initial injection: rabies immune globulin

  • Series of 5 injections of human diploid cell vaccine: days 0, 3, 7, 14, & 28
A
31
Q

Poisonings

A

☞ Chemicals that harm the body accidentally, occupationally, recreationally, or intentionally

☞ Severity depends on type, conc, & route of exposure

32
Q

Management
☞ Decr absorption

☞ Enhance elimination

☞ Implement toxin-spec interventions per poison control center

A

Decreasing absorption
☞ Gastric lavage
> Intubate before lavage if altered LOC or diminished gag reflex

> Perform lavage within 2 hrs of ingestion of most poisons

! Contraindicated
- Caustic agents
- Co-ingested sharp objects
- Ingested nontoxic substances

33
Q

☞ Activated charcoal
> Most effective intervention: administer orally or via gastric tube within 60 min of poison ingestion

! Contraindications
- Diminished bowel sounds
- Paralytic ileus
- Ingestion of substance poorly absorbed by charcoal

A

> Charcoal can absorb & neutralize antidotes: do not give immediately before, with, or shortly after charcoal

34
Q

☞ Dermal cleansing/eye irrigation
> Skin & ocular decontamination: removal of toxins from skin & eyes using water or saline

> W/the exception of mustard gas, toxins can be removed w/water or saline
! Water mixes w/mustard gas & releases chlorine gas

A

> Decontamination takes priority over all interventions except BLS measures

35
Q

☆ Enhance elimination

☞ Cathartics (e.g., sorbitol)
> Give w/1st dose of charcoal to stimulate intestinal motility/incr elimination

☞ Whole bowel irrigation
> For swallowed objects like cocaine-filled balloons or condoms, lead, mercury

A

☞ Hemodialysis/hemoperfusion
> Reserved for severe acidosis from ingest of toxic subst (e.g., asa)
> Urine alkalinization
> Chelating agents
> Antidotes
- Calcium EDTA for lead poisoning

  • Vit C added to IVFs to enhance excretion of amphetamines & quinidine

NUR 202 Week 13 (4 decks)

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