environmental emergencies Flashcards by Melissa Ring

How fast does cold water decrease body temperature

4 times faster than cold air

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What stage of frosbite do thrombi form

vascular stasis

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What will superficial frostbite look like

White or yellow skin
Numbness
edema
blisters w/ clear/ milky fluid

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What layer of skin will 4th degree frostbite effect

tissue beyond the dermis

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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

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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

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What is iloprost and when is it used

a vasodilator used in conditions such as Raynaud’s

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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

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Which populations are at higher risk of hypothermia

Extremes of age
dehydration & malnutrition

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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

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What are some external active rewarming startegies

Bair hugger
heated blankets
heated water circulation pad
hot packs

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What are some core active rewarming techniques

Heated IV fluids
Heated/humidified O2
Heated GI irrigation
Thoracic lavage (last resot)

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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

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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)

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What defines heat exhaustion

What accompanies it

Core temp at or above 105F

Dehydration / Na+ depletion

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How does heat exhaustion differ from heat stroke

Heat exhaustion preserves thermoregulation and there will be NO CNS disturbances

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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 ## Footnote When does it occur

High altitude pulmonary edema *think flash pulmonary edema | pink frothy sputum ## Footnote 2-4 days after ascent

How can you treat HAPE

add O2, positive pressure ventilation, nifedipine (reduces PA pressure)

What is HACE | SXS? ## Footnote treatment?

High altitude cerebral edema | ataxia, H/A, Papilledema, Encephalopathy ## Footnote 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 ## Footnote 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