environmental emergencies Flashcards
How fast does cold water decrease body temperature
4 times faster than cold air
What stage of frosbite do thrombi form
vascular stasis
What will superficial frostbite look like
White or yellow skin
Numbness
edema
blisters w/ clear/ milky fluid
What layer of skin will 4th degree frostbite effect
tissue beyond the dermis
When and how do you treat someone with frostbite
gradual rewarming over 2-3 minutes only when there is NO risk of refreezing
**No dry heat
What are some complications associated with frostbite
Complex regional pain syndrome
Cold hypersensitivity
Persistent numbness
Raynaud’s
Loss of limb etc
increased susceptibility of future frostbite
What is iloprost and when is it used
a vasodilator used in conditions such as Raynaud’s
What is hypothermia
What are the types
Drop in core body temperature to 35C (95F) or less
Primary (direct exposure) & secondary (complications of systemic illness
Which populations are at higher risk of hypothermia
Extremes of age
dehydration & malnutrition
What exam findings are there with hypothermia
CNS: AMS progressing to coma
CV: Tachy–> brady & eventually asystole
Resp: tachypnea–> hypoventilation
Renal: Increased metabolic activity
Neuromuscular: Shivering –> hyporeflexia
What are some external active rewarming startegies
Bair hugger
heated blankets
heated water circulation pad
hot packs
What are some core active rewarming techniques
Heated IV fluids
Heated/humidified O2
Heated GI irrigation
Thoracic lavage (last resot)
What are Osborne waves and when are they seen
What do you need to be careful with when these waves are present
- J waves seen best in the inferior and precordial leads
- Positive deflection at the end of QRS
- Seen in hypothermia
Positioning/moving the patient
What will be seen on labs in those with hypothermia indicating high mortality
- K+ >10-12 (massive cell lysis)
- core temp <10-12 degrees
- pH <6.5
- Fibrinogen <.5 (intravascular thrombosis present)
What defines heat exhaustion
What accompanies it
Core temp at or above 105F
Dehydration / Na+ depletion
How does heat exhaustion differ from heat stroke
Heat exhaustion preserves thermoregulation and there will be NO CNS disturbances
Over what time frame should people with heat exhaustion be rehydrated
Why
over 24-48 hours
Prevents further Na dilution
What are the 2 primary types of heat stroke
Classic –> older patients
Exertional –> Younger/healthy
What sxs will someone have with heat stroke
Tachycardia, tachypnea, hypotension, widened pulse pressure
What is the diagnostic triad for heat stroke
Heat exposure
CNS dysfunction
Temp >40.5 degrees
At what temperature is someone at risk for irreversible damage
What will be seen
Temp of 107.6F
Hepatic failure, renal failure, DIC. multisystem organ failure
What shoud vasopressors never be given to someone in heat stroke even if they are hypotensive
It causes vasoconstriction leading to even less heat loss from the patient
What population are electrical injuries mostly seen in
Kiddos < 6 and adults with occupational exposure
What are the mechanisms for electrical injuries
Direct tissue damage from current
Direct tissue injury from thermal burn
Mechanical trauma from fall/ spasms etc
What are the types of thermal burns seen with electrical injuries
Arc burns: Burns from indirect electrical current
Flash burns: Thermal injury caused by combustion of material on contact w/ current
What tissues are better conductions and more prone to injury
Nerve> blood> muscle> skin> tendon> fat> bone
What is the prodrome for radiation injuries
How about the latent phase
n/v, anorexia, diarrhea, hypotension, fever, sweating, H/A, fatigue
Symptom free interval
Where does altitude sickness occur
Elevations > 4800ft within the first 24 hours
*generally >8000ft & rapid ascent
What can altitude sickness lead to if ignored
Cerebral/pulmonary edema
GI distress
Which patients CANNOT take acetazolamide
Athletes
What is HAPE
What are the sxs
When does it occur
High altitude pulmonary edema
*think flash pulmonary edema
pink frothy sputum
2-4 days after ascent
How can you treat HAPE
add O2, positive pressure ventilation, nifedipine (reduces PA pressure)
What is HACE
SXS?
treatment?
High altitude cerebral edema
ataxia, H/A, Papilledema, Encephalopathy
immediate descent, O2, dexamethason
What is HAFE
High altitude flatus expulsion
*increases both in volume and frequency of flatus
What is the difference between poison and venom
Poison= secreted toxin (you bite it)
Venom= injected toxin (it bites you)
What is the mechanism of drowning for kiddos <1y/o
bathrubs or buckets of water
What is the drowning mechanism for kiddos 1-4y/o
pools
What is the drowning mechanism for school aged kids and older
large bodies of water
What is near drowning
Suffocation with submersion WITH survival
*can occur w/ and w/o water aspiration
Will get a VQ mismatch
What are primary injuries assocaited with drowning
Anoxic brain injury (hypoxia)
ARDS (inhalation)
How will someone with near drowning present
rales on auscultation
AMS
secondary arrhythmias
How do you treat near drowning
rescue breathing ASAP
