Environmental emergencies Flashcards
If too hot, body will
vasodilate Increase perspiration Decrease heat production Increase cardiac output Increase resp rate
If too cold, body will
Vasoconstrict Decrease perspiration Increase heat production Decrease cardiac output Decrease resp rate
Mild hypothermia
89.6 - 95 F Shivering Tachypnea, tachycardia, HTN Ataxia, dysarthria Loss of fine motor coordination Confusion, lethargy
Moderate hypothermia
82.4-89.6 F Shivering stops Bradycardia J waves on ECG Altered mental status Slowed reflexes Cold diuresis Pupillary dilation
Severe hypothermia
< 82.4 F Unresponsive, coma Hypotension v-fib/asystole Acidemia Loss of reflexes
Describe the two types of frostbite
Superficial and Deep
Heat emergencies
Heat edema Heat rash Heat syncope Heat cramp Heat exhaustion Heat stroke
Sequence of drowning
Sequence
Submersion → breath holding → panic → swallowing water and emesis → breathing in water → exhaustion → cardiopulmonary arrest
End result = hypoxemia
Drowning
Death within 24 hours of submersion
Heat edema
Cutaneous vasodilation and orthostatic pooling
Resolved spontaneously if treatment started → remove from heat, elevate legs
Heat rash
Pruritic maculopapular rash
Treatment: avoid heat exposure; wear light loose fitting clothes, minimize sweating
Heat syncope
Due to peripheral vasodilation, decreased vasomotor tone, and/or volume loss
Treatment: remove from heat, oral fluids and rest
Heat cramp
Usuaully due to electrolyte imbalance from sweating
Treatment: remove from heat, oral hydration with electrolyte containing fluids
Heat exhaustion
s/sx fatigue/weakness/dizziness/syncope n/v Headaches Muscle cramps Tachycardia Piloerection Profuse sweating Treatment: remove from heat and minimize activity, cool with fans, ice pack to neck/groin/axillae, oral hydration w/ electrolyte containing fluids, monitor VS
Heat stroke
s/sx
Tachycardia, tachypnea, increased SBP and Pulse pressure
CNS dysfunction: seizure, delirium, cerebellar dysfunction, coma, hallucinations
Oliguria (decrease urine output)
Anhydrosis (not always)
Absence of sweating
Descent barotrauma
Ear squeeze
Sinus squeeze
Mask squeeze
gas pockets are compressed
Ascent barotrauma
Essentially reverse of squeeze
Instead of gas being compressed, it expands w/o anyway to escape
Tooth squeeze when descending, air expanding when ascending → PAIN!
Air trapped in GI tract
Pulmonary barotrauma
Pneumomediastinum and subcutaneous air common but usually self-limiting
Possible pneumothorax and arterial gas embolism
Nitrogen narcosis
Increased solubility at increased partial pressure
Essentially, the deeper you go, more nitrogen is dissolved in your blood → causes intoxication effect akin to alcohol
Effects reversed when you ascend
Decompression sickness
Nitrogen bubble formation as a result of rapid ascension
Results in decreased tissue perfusion, ischemic injury
Type I
“Niggles” - mild pain
“Skin bends” = pruritis (itchy skin)
Skin rash
Peripheral edema
“The bends” - aching pain usually in joints/muscles
Type II
Nervous system
Spinal cord most commonly affected
Bladder dysfunction
Pulmonary decompression sickness
Nitrogen emboli in the venous system
s/sx: CP, cough, dyspnea, pulmonary edema, hemoptysis
Treatment of decompression sickness
Remove from water, immoblize if trauma
Supp O2
CPR if indicated
Avoid trendenlenburg
Contribuatory factors cold emergencies
Inappropriate clothing Being wet/immersed Prolonged exposure Very old/very young EtOH/drugs/poison
“Hunting Response of Lewis”
Alternating cycles of vasodilation and vasoconstriction at < 100 C (500 F)
Deep frostbite
3rd degree: hemorrhagic blisters w/ eschar
4th degree: necrosis (involves muscle/tendon/bone)
Superficial frostbite
1st degree: non-sensate white area with surrounding erythema
2nd degree: vesicles with surrounding erythema
Erythema
superficial reddening of the skin, usually in patches, as a result of injury or irritation causing dilatation of the blood capillaries.
Treatment for frosbite
Remove the patient from further exposure to the cold. Handle the injured part gently. Administer oxygen. Remove any wet or restrictive clothing. Never rub the area. Do not break blisters. Transport.
Temperature regulation is controlled by the ____
Hypothalmus
Impaired heat dispersion may be due to:
Cardiovascular disease-impaired circulation and compensation
Obesity
Clothing
Skin alterations
Medications-anticholinergics, cardiovascular drugs,diuretics, sympathomemitics, phenothiazines, alchohal/drugs
Extremes of age
Dehydration
For hyperthermia, what type of cooling is preferred?
Evaporative cooling
