Environmental Emergencies Flashcards

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1
Q

Environment

A

All of the surrounding external factors that affect the development and functioning of a living organism

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2
Q

Thermogenesis

A

Production of heat and energy for the body and main method of dealing with cold stressors

Vasoconstriction and shivering

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3
Q

Thermolysis

A

Release of stored heat and energy, and body’s main reaction to heat

Vasodilation and sweating
Main mechanisms are radiation, conduction, convection, evaporation

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4
Q

Thermoreceptors

A
  1. Peripheral - skin and certain mucous membranes that mostly respond to cold
  2. Central - deep tissues, spinal cord, abdominal viscera, and great veins that mostly respond to cold
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5
Q

Basal metabolic rate (BMR)

A

Energy at which the body consumes energy just to maintain stability

Core temperature reflects internal energy production and consumption

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6
Q

Hypothermia

A

Low core temperature attributed to:

  1. Inadequate thermogenesis
  2. Excessive cold stress
  3. A combination of both
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7
Q

Pathophysiology of hypothermia

A

Compensation = shivering, vasoconstriction, increased BMR

Decompensation = decreased cardiac output, increased viscosity of hemoglobin (viscosity increases 2% for every centigrade decrease)

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8
Q

Affects of alcohol on heat loss in urban setting

A
  1. Impairs shivering thermogenesis
  2. Promotes cutaneous vasodilation
  3. Liver disease create inadequate glycogen stores and poor nutrition
  4. Impair judgment
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9
Q

Degrees of hypothermia

A

Mild = core temperature > 32 with symptoms
- Shivering, lethargic, stiff/uncoordinated muscles

Severe = core temperature < 32 with symptoms
- No shivering, disoriented to confused, rigid/stiff muscles, dysrhythmias, increased risk of vfib <30 degrees

Compensated = normal core temperature with symptoms

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10
Q

Rewarding shock

A

Reflex vasodilation that causes cold/acidic blood from the periphery to return to the core

Afterdrop - further decreased core body temperature

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11
Q

Frostbite

A

Environmentally induced freezing of body tissues

Ice crystals form and water is drawn out of cells; the crystals expand causing destruction of the cells, and damage to the blood vessels causes loss of vascular integrity

Tissue swelling and loss of nutritional flow

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12
Q

Types of frostbite

A
  1. Superficial - freezing of epidural tissue, redness followed by blanching and diminished sensation
    Altered sensation, white/waxy skin, skin firm on palpation but underlying tissue is soft, appears cyanotic upon thawing, capillary leakage causing edema in area
  2. Deep - freezing of epidural and subcutaneous layers with a white frozen appearance
    White/white-yellow/blue mottled skin, hard and cold with no sensation, major tissue damage from thawing, turns purple as it thaws and causes excruciating pain, potential for gangrene
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13
Q

Hyperthermia

A

Unusually high core body temperature

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14
Q

Heat cramps

A

Muscle cramps caused by overexertion and dehydration, and due to sodium loss from sweating

Slightly elevated body temperature, skin moist and warm

Remove from environment and give oral saline solution

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15
Q

Heat exhaustion

A

Mild heat illness caused by dehydration and sodium loss
- decreased circulating blood volume, venous pooling, reduced CO output

Increased body temperature, cool clammy skin, heavy perspiration, diarrhea, N/V, muscle cramps, headache, CNS changes, tachypnea, rhabdomyolysis

Place supine, remove from environment, saline, cool patient, treat for shock

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16
Q

Heat stroke

A

Least common but most deadly heat illness caused by a severe disturbance in the body’s thermoregulation; core temp > 40

Incoherent hx, irritability, combativeness, hallucinations, possible stroke like symptoms, hot skin with no sweating, deep/shallow respirations, rapid pulse, hypotension, confusion, disorientation, possible unconsciousness, seizures

Active cooling, oxygen, fluids, cardiac monitoring, avoid vasodepressors/anticholinergics

17
Q

Affect of dehydration

A

Inhibits vasodilation and thermolysis

Orthostatic hypotension, decreased urine output, skin turger, signs of hypovolemic shock

18
Q

Fever

A

Pyrexia- elevation of body temperature above normal

Pathogens enter body and stimulate production of pyrogens (release of prostaglandin E2), resetting hypothalamic thermostat

19
Q

Boyle’s Law

A

At a constant temperature, the volume of gas is inversely proportional to its pressure

Increased pressure = decreased volume and vice versa

20
Q

Dalton’s Law

A

Each gas in mixture exerts the same partial pressure that it would exert if it were alone in the same volume and that the total pressure of a mixture of gases is the sum of the partial pressure of all gases in the mixture

21
Q

Henry’s Law

A

The amount of gas dissolved in a liquid is directly proportional to the partial pressure of the gas above liquid

22
Q

Barotrauma (the squeeze)

A

Pressure imbalance between gas filled spaces inside the body and external atmosphere (eg., inability to equalize)

Compression of gases with the body spaces on descent, or expansion of gases on ascent

Use valsalva maneuver to equalize

23
Q

Nitrogen narcosis

A

Altered mental status caused by breathing compressed air at depth; nitrogen dilutes concentration of oxygen

Euphoria, inappropriate behaviour, lack of safety concern, tingling of lips, gums, legs

24
Q

Arterial gas embolism (AGE)

A

Air bubbles from ruptured alveoli enter pulmonary capillaries, then into cardiac circulation (cardiac arrest) or cerebral circulation

ALOC, paralysis, seizures, chest pain, dyspnea, sudden death

25
Q

Decompression sickness

A

Nitrogen bubbles interfere with tissue perfusion and trigger chemical changes in the body

CNS and spinal cord most affected

26
Q

Acute mountain sickness (AMS)

A

Three criteria: recent gain in altitude, several hours at new altitude, and headache with on of:

  1. Fatigue/weakness
  2. GI symptoms
  3. Dizziness/lightheadedness
  4. Difficulty sleeping

HA usually throbbing and worse in temporal and occipital areas made worse by valsalva maneuver

27
Q

High altitude pulmonary edema (HAPE)

A

At least two of:

  1. Dyspnea at rest
  2. Cough
  3. Weakness
  4. Decreased exercise performance
  5. Chest tightness/congestion

AND at least two of:

  1. Central cyanosis
  2. Audible rales/wheezing in at least one lung field
  3. Tachypnea
  4. Tachycardia
28
Q

High altitude cerebral edema (HACE)

A

Change in mental status and/or ataxia in a person with AMS
OR
Change in mental status AND ataxia in person with AMS

Acetazolamide (Diamox) for prevention/treatment