Environmental Emergencies Flashcards
Who is at risk of frostbite
anyone with increased/prolonged exposure to cold environments
(military, winter sports, outside workers, elderly/young patinets, homelessness, etc)
What factors increase your risk of frostbite
temp < 20C of <-4F
hight winds
cold, wet, environments
prolonged exposure
high altitude
pre-existing neurovascular susceptibility
what is the progression of frostbite stages
frostnip
frostbite (graded 1-4)
- 1st and 2nd degree = superficial
- 3rd and 4th degree = deep (frostbite)
what is superficial frostbite
involves epidermis and dermis
white or yellowish skin
skin numbness
edema
blisters with clear or milky fluid
what is frostbite
deeper into the dermis
hemorrhagic blisters
tissue necrosis (eschar)
4th degree = involvement of tissues beyond dermis
how is frostbite diagnosed
usually clinical
imaging and labs not typically needed
what is the treatment of frostbite
prevent further injury
dont add heat (graudal rewarming over 20-30 min)
give analgesia
dont rub area
apply topical ointment to blisters
apply loose dressings
elevate and immobilize
assess need for tetanus
consider abx
what are complications of frostbite
persistent pain - CRPS
cold hypersensitivity
persistent numbness
raynauds
loss of limb/digit/appendage
increased susceptibility to frostbite in future
what is Iloprost
vasodilator used in condition such as Raynauds
what is the definition of hypothermia
drop of core body tep to 35C (95F) degrees of less
- primary: direct exposure to cold
- secondary - coplication of systemic illness/injury
How is hypothermia treated
passive external re-warming (cover head, cover and insulate body)
Active rewarming
what is active rewarming
external and core
external: foreced hot hair, heated blankets, radiant heat, hot packs
Core: heated IV fluids, heated/humidified O2, Heated HI irrigation, thoracic lavage (last resort)
what are Osborne waves
“j waves” - seen best in inferior and precordial leads
slow, positive deflection at end of QRS
what medications are considered with hypothermia cardiac arrest
epinepherine ( medications may be ineffective at low temps)
What is heat exhaustion
core temp at or below 40.5C (105F)
usually accompany dehydration or Na+ depletion/dilution
may progress to heat stroke
how does heat exhaustion differentiate from heat stroke
preservation of thermoregulation and NO CNS distrubances
What is the treatment of heat exhaustion
remove from heat, hydrate +/- electrolyte correcton
evaporative cooling
what is heat stroke
medical emergency
types:
- classic: prolonged exposure, older and co-morbidities
- exertional: increased activity/exercise, often higher temps, younger and otherwise health
what is heat stroke
loss of thermoregulatory mechanisms
vasoconstriction to maintain MAP
what is the diagnostic triad for heat stroke
heat exposure
CNS dysfunction
temp > 40.5 degrees C
What is the treatment of heat stroke
ABC/IV/O2/monitor (core temp)
remove from exposure
correct electorolytes
what are the three mechanisms of electrical injuries
direct tissue damage from current
direct tissue injury from thermal burns
mechanical trauma from fall, throws, muscle contraction
how are electrical injuries diagnosed
report from pt /witness
what are Arc burns
thermal burn from indirect electrical current - radiatn heat
what are flash burns
thermal injury caused by combustion of material on contact wtih current
How are electrical injuries treated
ABCS
address associated injuries (expose everything)
admit for observation and workup
how do lightning injuries travel
skin surface, but magnetic field/pressure penetrates throughout
what are associated injuries with lightning injuries
cardiac - asystole
ventricular arrhythmias
CNS disruption
intracranial hemorrhage
peripheral nerve damage
blunt trauma
what are radiation injuries
exposure through transport, storage, occupational exosure, errors in therapeutic dose
high doses - cell death
low dose - interrupt mitosis - CA
what are the radiation safety considerations
time
distance
shielding
what is the presentation of acute whole body exposure to radiation
prodrome: N/V/D, anorexia, hypotension, fever, sweating, HA, fatigue
latent phase: symptom free
Manifests: Hematopoetic, GI, Neurovascular collapse
what is the general treatment of radiation injuries
treat life threatning injuries first
minimize your own exposure
decontamination
at what elevation does altitude sickness occur
elevations higher than 4,800ft within first 24 hours
- usually > 8,000ft and rapid ascent
what is the treatment of altitude sickness
self-limited illness
mild cases - pause ascent and supportive tx (acetazolamide and dexamethasone)
what is HAPE
High Altitude Pulmonary Edema
pink frothy sputum
usually, day 2-4 after ascent
add O2, positive pressure vent, nifedipine
what is HACE
High Altitude Cerebral Edema
HA, ataxia, pailledema, encephalopathy
add O2, and dexamethasone
What is HAFE
High Altitude Flatus Expulsion
increase in both volume and frequency of flatus
not as much an emergency as HAPE and HACE
What occurs with viperidae
hemolytic changes
What is Hymenoptera
bees, wasps, yellow-jackets, fire ants
most symptoms for IgE mediated reactions
what is the initial treatment of hymenoptera
remove stinger
disinfect bite site
apply ice
elevation
analgesics, benadryl, calamine lotion
epinepherine
monitor 4 hours in ER
what is the advanced anaphylaxis treatment
IV, O2 monitor and fluids
albuterol
IV epi
vasopressors for shock (norepi)
what is brown recluse bites
provoking bite
mostly minor injury -edema/erythema in about 3 days
what is the treatment of brown recluse bites
RICE
analgesics and antihistamines
abx and tetanus ppx
consider corticosteroids
debridement of large ulcerations and secondary closure
what is the progression of black widow bites
within 60 min: cramps at bite site - extremity - trunk
later: abdominal rididity, abd pain
even later: excess salivation, lacrimation, urination, defication, emesis
late stages: respiratory arrest, cerebral hemorrhage, cardiac failure
what is the treatment of black window bites
RICE
Mostly supportive, ABC
tetanus
?antivenom
what is the definition of near drowning
suffocation wtih submersion and survival (immediate)
can occur with or without aspiration
results in ventilation-perfusion mistmatch
what is the presentation of near drowning
rales on aucultation, cardiac arrhythmias, AMS
hypoxia, hypercabia, metabolic acidosis
what is the treatment of near drowning
rescue breathing ASAP
CPR as necessary
secure airway
administer O2
monitor BP
correct electrolyte abnormalities
