Environmental Emergencies

Question 1

Pathophysiology of Hypothermia
31-32
28-31
<28

Answer 1

31-32 : loss of shivering
28-31 : afib, low HR & BP, flipped T, dilated pupils
<28 : pulseless, Vfib, coma, nonreactive pupils

Question 2

Hypothermia tx

• General principles for ABCs
• Below which temp do interventions work less?

Answer 2

O2
Intubation if needed (gently)
Ventilate 1/2 normal rate
CPR for asystoly (any HR <28C is better than your CPR)
Vfib - defib X 3 and stop until >30
RISK Arrhythmia <30
Drugs work less <30

Question 3

Rewarming techniques

> 34
30-34
<30

Answer 3

if you can shiver - passive
30-34C : active to trunk and passive
<30 : internal &amp; external
warm humid O2 (42-46)
warm IVF (43C)
Invasive (Peritoneal lavage, ECMO, esophageal/rectal)

Question 4

Hypothermia

• ECG changes (4)
• at which temp

Answer 4

sinus brady
1st degree AV block
Osborn/J waves
long QT

<32C

Question 5

Frostbite tx

Answer 5

Avoid rewarming if you can't maintain it to definitive care
Water bath (42)
No debridement

Question 6

Hyperthermia

-Which patients are at high risk (4)

Answer 6

cystic fibrosis
absent sweat glands
infants in cars
young athletes

Question 7

Difference between:
heat cramps
heat exhaustion
heat stroke

Answer 7

cramps: pain (salt + water)
exhaustion: “flu-like”, lousy feeling (water>salt)
stroke: core temp >41, disorientation/coma, rhabdo, end-organ dysfunction, hypoNa, sz, DIC (salt)

Question 8

Submersion Injuries

-Risk factors (5)

Answer 8

Not supervised
Alcohol use
PMHx
Not able to swim
no life jacket

Question 9

Submersion Px factors
Good (3)
Bad (2)

Answer 9

CPR (most imp)
ROSC < 10 min
Submersion <5min
NSR at scene

Bad
ROSC >25min
Submersion >10 min

Question 10

Name one serious complication of low voltage oral injury in children

Answer 10

labial artery bleed (1-3 wks later)

Question 11

Complications of high voltage (AC)

3

Answer 11

small outer wound
can be worse inner wounds
- muscles: compartment syndrome, rhabdo (follow K)
-cardiac : VF, arrest
-Monitor UA

Question 12

Lightning

Features on P/E
Types of injuries ** to finish)

Answer 12

• feathering