Environmental Emergencies Flashcards
What is the definition of hypothermia?
Drop of core body temp to 35 C (95F) degrees or less
Primary: direct exposure to cold
Secondary: complication of systemic illness/injury
What are some possible findings on exam in a patient who is hypothermic?
- CNS: AMS progressing to coma
- CV: tachycardia –> bradycardia; arrhythmias; reduced BP; eventual asystole
- Respiratory: tachypnea –> hypoventilation –> apnea
- Renal and Endocrine: increased metabolic activity (compensation) –> preservation of core perfusion –> reduced blood flow and globally decreased metabolic activity
What is the treatment for hypothermia in the ED?
- Confirm core temperature and assess for other injuries
- Supplemental O2 (for everyone)
- Administration of IV fluids
- Administer calories
- Correct acid-base disturbances
- Rewarming strategies
What are some external active rewarming techniques?
- Forced hot air (bair hugger)
- Heated blankets
- Radiant heat
- Heated water circulation pads
- Heat packs
What are some core active rewarming?
- Heated IV fluids
- Heated and humidified O2
- Heated GI irrigation
- Thoracic lavage (last resort)
What EKG changes can occur in hypothermia?
Osborne Waves - J waves
Seen best in inferior and precordial leads (V3-V6)
Can also see slow, positive deflection at end of QRS
What lab values can indicate higher rate of mortality in a hypothermic patient?
- Potassium > 10-12 (major cell lysis)
- Core temp < 10-12 degrees (50-54 F)
- pH < 6.5
- Fibrinogen < 0.5 (indicates intravscular thrombosis)
A 35-year-old male presents to the emergency department with confusion, agitation, and muscle rigidity. He is diaphoretic, and his core body temperature is 104°F (40°C). The patient has been working outdoors all day in the summer heat. What is the most likely diagnosis, and what is the immediate treatment?
Heat Stroke
Treatment: core temperature monitoring
* Intubation (ABCs)
* IV fluids and O2 (nitric oxide for hypotension)
* Correct any associated hypoglycemia, electrolytes (Na imabalence)
* Cooling
A 28-year-old female is brought into the ED after a camping trip in a mountainous region. She complains of severe headache, nausea, and dizziness. On examination, her vital signs are stable, but she exhibits ataxia and confusion. What environmental condition should you suspect, and what is the appropriate management?
Altitude Sickness
Management: Self-limited illness
* Rest, NSAIDs, anti-emetics
* Avoid ETOH and narcotics
* Acetazolamide and dexamethasone
What can be given prophylacticly to reduce risk of mountain sickess?
Acetazolamide
What is the treatment for electrical injuries?
Initial: ABCs, address associated injuries
Admit for observation and work-up!
* High voltage
* EKG abnormalities
* Acidosis, myoglobinuria, CK elevations
* Large burns or deep burns
What are the three complications of altitude sickness?
- High Altitude Pulmonary Edema (HAPE)
- High Altitude Cerebral Edema (HACE)
- High Altitude Flatus Expulsion (HAFE)
What is the presentation of HAPE (High Altitude Pulmonary Edema)?
What is the treatment?
- Usually, day 2-4 after ascent
- Pulmonary edema: cough, DOE –> pink frothy sputum
Add O2, PPV, and nifedipine (reduces PA pressure)
What is the presentation for HACE (high altitude cerebral edema)?
- Headache, ataxia, papilledima, encephalopathy
Add O2 and dexamethasone
What is the presentation of near drowning?
Hypoxia can lead to what?
Present with:
* Rales on auscultation
* Cardiac arrhythmias
* AMS
Present with hypoxia, hypercarbia, metabolic acidosis
* +/- associated mechanical trauma
* +/- hypothermia
anoxic brain injury and ARDS
