Environmental Emergencies Flashcards
Factor that cause Heat Related Illnesses
- Humidity above 80%
- Temperature above 95º F
Those at Risk for Heat Related Illness
- Older adults
- Blacks (poverty)
- Construction/Agricultural workers
- Men
- Homeless
- Illicit Drug Users
- Outdoor athletes
- Military personnel in countries w/ hot climates
Prevention of Heat Related Illness
- Avoid alcohol & caffeine
- Rest frequently
- Limit activity at hottest time of day
- Wear light weight & light color clothing
- Check on elderly twice daily
- Stay in air conditioning
- Take cool showers
heat related syndrome due to dehydration caused by heavy perspiration and inadequate fluid intake w/ symptoms of HA, weakness, N&V in which the body temperature is not significantly elevated
Heat Exhaustion
Treatment for Heat Exhaustion
Monitor V/S
Monitor labs (Na+ & K+)
Give cooled IV fluids (NS)
medical emergency in which body temperature exceeds 104º F and heat regulatory systems fail leading to organ dysfunction & death
Heat Stroke
type of heat stroke that is suddenly onset as a result of strenuous activity in hot, humid conditions
Exertional Heat Stroke
type of heat stroke that occurs over a period of time due to exposure to hot, humid conditions generally affecting the ill & elderly
Class Heat Stroke or “Non-exertional” Heat Stroke
Key Features of Heat Stroke
- Temp > 104º F
- hot, dry skin
- may or may not perspire
- mental status change
- V/S change
- electrolyte imbalance
- abnormal clotting
Treatment for Heat Stroke
- Aggressive cooling until rectal temp reads 100º F
- High concentration O2
- cooled IV fluids (NS)
- Foley
Labs Monitored in Heat Stroke
- Electrolytes
- Cardiac Enzymes
- Hepatic Enzymes
- CBC
- UA
Why do we treat shivering in Heat Stroke patients?
because it burns energy and raises body temp…it can also lead to seizures
Pit Vipers include:
rattlesnakes, copperheads, & cottonmouths
traingular headed snakes with two retractable, curved fangs that can regulate the amount of venom in their bite
Pit Vipers
Envenomation results in:
- local & systemic toxic effects
- local tissue necrosis
- massive tissue swelling
- fluid shifts
- pulmonary edema
- DIC
- death
Sequence of Symptoms in Pit Viper Bites
- pain
- bruising
- vesicles/bullae
- weakness/ N&V/ hypotension/ seizures
- chest pain
- anxiety
- minty/ rubbery/ metallic taste
- twitching
Pit Viper Bite vicitims need to be on ________ because _______ may occur.
cardiac monitor; dysrhythmias
Before coming to the hospital, victims of pit viper bites should:
- immobilize the area of body bitten
- maintain that area at level of the heart
- keep calm
Treatment of Pit Viper Bite
- O2
- 2 large-bore IVs
- Cardiac Monitoring
- BP Monitoring
- Tetanus Prophylaxis
- Pain Medication
- Measure & Document bite site q 15-30 min
drug given to snake bite victims made from sheep so that antibody fragments of IgG break down venom toxins
Crotalidae Polyvalent Immune Fab (Crofab)
Type III hypersensitivity reaction to Crofab that occurs 3-21 days after administration resulting in rash, fever, joint pain, pruiritus & urticaria
Serum Sickness
Crofab is contraindicated if the patient is allergic to _______.
papaya
Give Crofab cautiously to patients with:
- prior known allergy to Crofab
- Hypersensitivity to pineapples
- pregnancy
Crofab vials are initially reconstituted with ___ mL of NS.
18
Crofab is further diluted into ___ mL of NS.
250
Initial Crofab dose should be administered over ___ minutes.
60
Initial Crofab administration rate is ___mL/ hour for observation of allergic reaction then increased to _____ mL/hour.
25 - 50; 250
The recommended initial dose of Crofab is __ to ___ vials.
4 - 6
Crofab should be administered within ___ hours of the bite.
6
Careful observation is needed during the infusion and for ___ after treatment.
1 hour
After Crofab administration, measure ___, _____, & _____ once daily in the hospital and immediately if bleeding occurs.
PT, fibrogen, & platelets
After discharge, patients having had Crofab need PT, fibrogen, & platelets measured ___ to ___ days & ____ to ___ days after last dose.
2 - 3; 5 - 7
After discharge after Crofab, avoid NSAIDS for ___ weeks.
2
snake found in the SE & SW part of the US that are non-aggressive & burrow in the ground with small, upright maxillary fangs
coral snakes
coral snakes have _____ & ______ toxins in their venom
nerve & muscle
coral snake venom is spread through the ______ system
lymphatic
coral snake bites are mildly painful because the vecom affects the ____________.
neurotransmission perception of pain
coral snake venom may be delayed ___ to ____ hours
12 -18
In severe cases of coral snake bites, ______ & _______ can occur.
respiratory problems & cardiac collapse
Early Signs of Coral Snake Bite
- N&V
- HA
- abdominal pain
Neurological Symptoms of Coral Snake Bite
- paresthesias
- mental status change
- cranial nerve deficits
- peripheral nerve deficits
Cardiac Symptom of Coral Snake Bite
elevation in CK-Myoglobinuria
Before coming to the hospital, victims of coral snake bites should:
- try to ID & kill snake
- pressure immobilization of bite area
Treatment of Coral Snake Bite
- continuous monitoring
- 2 large-bore IVs
- cross-match for blood products
- airway support
- intubation
For coral snake bite victims, the nurse should contact _______.
poison control
spiders known as fiddleback or violin spiders that hide in dark areas whose bite is either painless or sharply painful and can produce skin ulcers (classic “red, white & blue sign”)…some victims show no reaction while others develop necrotic wound in 1-3 days
Brown Recluse Spider
First Aid for Brown Recluse Spider bite
- apply ice during 1st 4 days
- elevate affected extremity
- local wound care
- rest
Treatment for Brown Recluse Spider Bite
- topical antiseptic & dressing
- pain medication
- antihistamines
- antibiotics
- tetanus prophylaxis
- skin grafting
spider that is shiny black with red hourglass pattern on the abdomen (female) or black with gray & white markings (male) who bite in self-defense with neurotoxic venom who bite is painless or sharply painful leaving tiny red puncture marks with usually no progression besides local reaction
Black Widow Spider
Symptoms of Reaction to Black Widow Spider Bite
- severe abdominal pain***
- muscle rigidity/ spasm
- HTN
- N&V
- facial edema
- eyelid drooping
- twitching
Treatment for Black Widow Spider Bites
- monitor V/S especially BP
- monitor for seizures
- give O2
- pain medication
- muscle relaxers
- tetanus prophylaxis
insect found in most states that injects venom through their tail producing mild symptoms of pain & inflammation
scorpion
Treatment of scorpion bite
- pain medication
- wound care
scorpion whose bite can produce a potentially fatal systemic response that are found in trees & woodpiles or personal items left on the ground like shoes or clothes
bark scorpion
Symptoms of Bark Scorpion Bite
- pain at site upon gentle tapping***
- cranial nerve deficits
- skeletal muscle deficits
- high fever
- HTN
- GI disorders
- pulmonary edema
- cardian dysrhythmias
- death (rarely)
Treatment for Bark Scorpion Bite
- monitor V/S
- give O2
- IV fluids
- ice compress
- tetanus prophylaxis
- pain medication
- wound care
- contact poison control
- intubation
Systemic effects from bee/wasp stings develop based on _________ & __________.
venom load & patient’s sensitivity
Symptoms of Systemic Response to Bee/Wasp Sting
- Nausea/Vomiting
- Diarrhea
- Destruction of red/white blood cells and platelets
If the patient has an allergy to bee or wasp, the sting will result in:
- Itching
- Hives
- Swelling of lips/tongue rapidly leading to ANAPHYLAXIS!
First Aid for Bee/Wasp Stings
- Quick removal of stinger by tweezers but also by gently scraping it off with edge of knife blade, credit card, or needle
- Apply ice
Treatment for Bee/Wasp Stings
- Large bore IV
- Oxygen support
- Benadryl
- Epi pen
- Protonix
- Steroids- Solu-medrol
For Animal or Human Bites, the Nurse must:
Notify Authorities
Most lighting strikes occur during:
summer afternoons/evenings
First Aid for Lightning Strikes:
- A, B, C’s
- CPR if in cardiac arrest
- Spinal Immobilization
Prevention of Hypothermia & Frostbite:
- Layer clothing
- Wear synthetic instead of cotton
- Sunscreen
- Sunglasses
- Hat
core temperature of below 95º F
Hypothermia
Conditions that promote hypothermia:
- Cold water immersion (drowning)
- Acute illness
- Advanced age
- Medications
- Malnutrition
- Inadequate shelter
First Aid for Hypothermia:
- Remove wet clothing
- Apply warm, dry clothes
- Heating blankets
- High carb drinks
- No alcohol or caffeine
Treatment for Hypothermia
- Monitor ABC’s
- Warm IV fluids
- Internal rewarming methods (warm fluids in all ways)
- Oxygen
- Heated bladder lavage
In patient with hypothermia, do not give any drugs until core body temp is above _____ ºF
86
least severe type of frostbite consisting of increased blood flow & edema
1st Degree Frostbite
type of frostbite consisting of arge fluid filled blisters with skin necrosis
2nd Degree Frostbite
type of frostbite with small blisters containing dark fluid affecting body part that is numb, blue or red and does not blanch and necrosis occurs
3rd Degree Frostbite
Most severe type of frostbite with no blisters or edema & affected body is numb, cold and bloodless. Necrosis extends to muscle and bone. Gangrene develops and amputation may occur.
4th Degree Frostbite
First sign of frostbite that means you must get inside and get warm:
white, waxy appearance on nose, cheeks, & ears
Treatment of Frostbite:
- Rapid rewarming in a water bath of 104 to 108 degrees
- IV fluids
- IV opiates
- Keep affected extremity above heart level
- Assess hourly for compartment syndrome
- Tetanus prophylaxis
syndrome occuring at high elevations resulting in hypoxia
High Altitude Disease (HAD)= Altitude Sickness
Supplemental O2 is needed at elevations over _________ feet to prevent illnesses including death.
18,000
Risk Factors for High Altitude Disease
- Obesity
- Chronic illnesses
- Cardiovascular disease
- Alcohol use
- Dehydration
High Altitude Disease becomes common above _______ feet.
8,200
Altitude related illness that is the most common cause of death
High Altitude Pulmonary Edema (HAPE)
Altitude related illness that is rare but life threatening & has occurred at altitudes as low as 8200 feet
High Altitude Cerebral Edema (HACE)
In high altitudes, early recognition of __________ or __________ is crucial for quick descent to lower levels.
ataxia or change in LOC
occurs when water washes out alveolar surfactant leading to alveolar collapse and shunting, shunting leads to hypoxemia & acidosis…air replaced by water
Drowning
In drowning, death occurs from ___________ & ___________.
bronchospasm and cerebral edema
Questions to ask about drowning victim:
- How long were they under?
- Fresh or salt water?
- Any injuries?
- Were they drinking alcohol?
- Temperature of water?
First Aid for Drowning
- Spine stabilization
- Airway clearance
- Ventilatory support
- CPR if needed
Treatment for Drowning
- ABCs
- NG tube
- PICC line
