Environmental Emergencies Flashcards
This Occurs most often in non acclimated individuals typically during the first couple of days to heat exposure. Is associated with mild swelling of the hands and feet.
Heat edema
Describe the treatment for heat edema.
Does it include diuretics? Why or why not?
Treatment includes rest, elevation of the lower extremities, and use of support or compression hose. It is
Considered a minor heat disorder and resolves spontaneously.
Diuretics are not recommended because they may delay heat acclimation and cause dehydration or electrolyte imbalance.
What causes heat cramps?
caused by sweat induced electrolyte depletion
A patient with heat cramps may also have what else?
appearance
a flushed appearance.
what does the treatment of heat cramps and discharge instructions entail
Treatment includes removal from heat, rest, and oral or IV fluid electrolytes replacement
Discharge with instructions to drink sports drinks with outdoor activity and avoid strenuous activity for several hours after cramps subside
This is caused by prolonged heat exposure, usually over hours or days
If left untreated can progress to heatstroke
Heat exhaustion
what are the S/S of Heat exhaustion? (11)
excessive sweating,
pale skin,
Rapid onset of extreme thirst, general weakness,
headache, N/V,
anxiety,
tachycardia which may lead to syncope and collapse
Mild to moderate elevated core body temperature of
98.6 to 104F (37-40C)
Treatment of heat exhaustion may include hints; - clothing -ice -fluids -lab results
move to a cool, quiet environment, remove constrictive clothing,
Immersion of hands and forearms into cold water and use ice packs in the neck, groin, and axillae
When there is hyperthermia, the patient should be sprayed or sponges with tepid water and then fanned
Begin fluid and electrolyte replacement, IV if patient is nauseated
1 L NSS over 30 minutes
Lab results anticipate electrolytes, phosphorus, hematocrit, BUN and creatinine
when would you consider admission for heat exhaustion?
If a patient does not respond to fluid and electrolyte replacement within 3 to 4 hours, consider admission
Heatstroke, which can be life- threatening, characterized by a core temperature of
105F (40.5C)
Classic heatstroke commonly affects who?
geriatric patients, chronically ill, those who live in poorly ventilated homes without air conditioning, kids in cars
Risk factors for heat stroke include (8)
cardiovascular disease, autonomic neuropathies, previous CVA or nervous system lesions, obesity, cystic fibrosis, low fitness, skin disorders such as burn scars
Prescription drugs classes such as these can increase the risk for heat stroke (13)
anticholinergics, phenothiazines, butyrophenones, tricyclic antidepressants, antihistamines, antispasmodics, diuretics, antiparkinson drugs, beta blockers, adrenergics, benzodiazepines, laxatives, thyroid agonists
Street drugs such as these can increase the risk for heat stroke
LSD, jimson weed, amphetamines, PCP, alcohol
S/S of heatstroke May present with Neurologic changes such as;
explain
anxiety, confusion, hallucinations, loss of muscle coordination, combativeness, coma
- Direct thermal damage to the brain combined with decreased central blood flow can lead to cerebral edema and hemorrhage.
- The brain, particularly the cerebellum, is extremely sensitive to thermal injury, therefore, the range of neurologic S/S is broad.
Immediate treatment of heatstroke may include what?
Reduce the core temperature as rapidly as possible,
Treat subsequent complications
Prevent shivering from cold treatments, may increase body temperature
Tepid water with fanning, ice packs
Describe the use of fluids in the treatment of heat stroke
1 to 2 L of NSS during the first 4 hours
Lactated ringers is not recommended because of the livers inability to metabolize the lactate.
when treating heat stroke, keep in mind that Water is __ times more effective for heat exchange then air
25
why is it important to keep a heat stroke victim on a cardiac monitor?
Because hyperthermia decreases pulmonary capillary wedge pressure and cerebral vascular conductance, causing an inotropic shift in the Frank-Starling curve, it is important to place the patient on a cardiac monitor to observe for signs of high output cardiac failure, which may develop in heatstroke
After a hyperthermic event, tissue injury continues to occur. Be alert for signs of AMS like delirium and seizures. What causes this?
In severe cases, coma can result as a direct consequence of heat on the central nervous system.
Cardiovascular failure can also result from heat stroke due to what?
dehydration, cutaneous vasodilation, and heat induced myocardial depression.
True of false
Liver dysfunction and coagulopathies can also occur as a consequence of thermal breakdown
True
Because myoglobinuria and poor renal perfusion put the kidneys at risk for renal failure, carefully monitor the following urine characteristics
(4)
Color
Amount
pH
Myoglobin level
To increase renal blood flow, be prepared to administer ____ to a patient whose urine output is less than what?
mannitol (osmitrol)
50 mL/hr.
Expect to administer various pharmacological agents to treat the thermoregulatory response of shivering/ reduce the shivering reflex, name a few (6)
RSI premedications
Sedatives
Analgesics
Neuromuscular blocking agents
Mannitol to reduce intracerebral swelling
Chlorpromazine (thorazine) or benzodiazepines to reduce shivering
What are Some predisposing factors for cold related emergencies?
illicit drug use, myxedema, hepatic failure, renal failure, malnutrition, alcohol, dermal dysfunction (burns), sepsis, bronchopneumonia
Localized cold emergencies include ____ the painful inflammation of small blood vessels in the skin that occur as a result of sudden warming from cold temperatures. What are the S/S?
Chilblains
They can cause localized areas of itching, redness, and recurrent edema on exposed or poorly insulated body parts, such as ears, fingers, and toes. Occurs in cool, damp climates with temperatures above freezing. ransient numbness and tingling, initial pallor or redness of the nose, digits, or ears
The eventual development of plaques and small, superficial ulcerations in chronically exposed areas
Clilblains; Lesions usually resolve how, and in what timeframe?
spontaneously in 1 to 3 weeks. Instruct patient to avoid further exposure.
Treatments for Chilblains include what?
warming and elevation to reduce edema
Avoid rubbing, massaging, direct heat, and scratching
Nonfreezing cold injuries (immersion foot)
this is the most common injury related to extreme cold, causing ruptured membranes, interrupting enzymatic activity, altering metabolic processes
Frostbite
Describe the damage from frostbite
Damage is irreversible, may take several days until able to estimate the depth and severity of the damage.
S/S of superficial frostbite include
tingling, numbness, burning sensation, white, waxy color
After the tissue affected by frostbite thaws, the patient may feel a ____, ____ sensation. The areas may become ____, and ____develop within a few hours.
A gray-black mottling eventually progresses to ____.
Edema of the entire extremity occurs and may persist for how long?
hot, stinging mottled blisters gangrene months
Treatment of frostbite includes;
Injured tissue is____, and optimal recovery requires very ____ handling
(Do/ do not) rewarm the area if refreezing is possible
____ areas that have thawed
Place the patient on____ until the extent of the injury can be estimated
Avoid ____ blankets
___ within 24 hours of deep frostbite injury to prevent thrombosis, shown to reduce amputation rates
Admission to ____ unit
Surgical intervention
friable, gentle Do Immobilize bedrest heavy tPA burn
Hypothermia is defined by a Core temperature of less than what?
Mild __F to __F (__ - __C)
Moderate __ - __F (__ - __C)
Severe less than __ (__C)
95F (35.0C)
Mild 89.6F to 95F (32 - 35C)
Moderate 82.4 - 89.6F (28 - 32C)
Severe less than 82.4 (28C)
Hypothermia
The body’s metabolic responses depend on a normal body temperature. The basal metabolic rate decreases by __% for each __C drop.
5% for each 1C drop.
Death typically occurs when the core body temperature plummets below __F (__C)
78F (25.6C)
Early symptoms of hypothermia include (6)
shivering, fatigue, loss of coordination, confusion, and disorientation
tachycardia
Late symptoms of hypothermia include no ____, ____ or ____ skin, ____ pupils, ____ pulse and respirations, LOC, and what EKG changes?
no shivering, blue or dusky skin, dilated pupils, slowed pulse and respirations, and LOC
Bradycardia, EKG about one third of hypothermic patients exhibit the Osborne or J wave
Neurologic effects of hypothermia include
apathy, weakness, easy fatigability, impaired reasoning, slow or slurred speech, paradoxical undressing
Renal effects of hypothermia include
- cold induced diuresis results from the relative central hypervolemia (caused by vasoconstriction) and the inhibition of ADH release.
Treatments for hypothermia include
Remove what?
O2 delivery should be what?
For patients with core temperatures below 86F (30C),
avoid ____ medications as they will have minimal effects
Limit defibrillation to ____ shock until body is warmed above __F
Administer warmed IV fluids (up to __F or __C)
Rewarm patient at a rate of __ to __F per hour
Name three rewarming methods
Terminate active external rewarming at __F or __C
cold and wet clothing, volume resuscitation,
Heated and humidified
For patients with core temperatures below 86F (30C),
avoid IV medications
one initial shock until warmed above 86F
Administer warmed IV fluids (up to __F or __C)
Rewarm rate of 1 to 4F per hour
Heat lamps, Bair hugger, water immersion
Terminate rewarming at 96.8F or 36C
Hypothermia
Afterdrop - Rewarming too fast can cause Afterdrop, which is what?
Afterdrop - Rewarming too fast can cause Afterdrop, which happens when cold peripheral blood returns to the central circulation, causing ventricular irritability and fibrillation.
Drowning
Neurologic outcome depends on what three things?
Greater than __ minutes is usually associated with severe neurological damage
the duration of submersion, water temp, and amount of time before BLS
5
Drowning Other factors include (that increase chances of survival) Water colder than \_\_F \_\_\_\_ struggle \_\_\_\_ water
Water colder than 70F
Less struggle
Cleaner water
Diving Emergencies
Boyle’s Law - describe
The most common medical problem among divers is ____
a gas is inversely related to the pressure at a constant temperature
barotrauma
What happens If the diver ascends but does not exhale,
the water in the lungs expands and increases the pressure in the lungs, to the point of alveolar rupture, causing pneumothoraces
A diver ascends, how can this cause air embolism?
High pressure air is forced across the alveolar-capillary membrane into the circulatory system, causing air embolism, the bubbles enter the pulmonary vein and are carried to the heart and systemic circulation
What is the leading cause of death among divers second to drowning
Air gas embolism
Diving emergencies, Air embolism
Classic presentation is what?
If the bubbles enter the coronary arteries, __ can occur
If the bubbles enter the the cerebral circulation, can result in what?
____ ____ ____ to the spinal cord can lead to paralysis or weakness
sudden LOC within minutes of reaching the surface
MI
blindness, generalized seizures
Blocked vascular flow
Treatment for air embolism includes
-Immediately ____ an unconscious patient
-____
Place patient in the left lateral position to avoid what?
If air transport is necessary, ensure cabin altitude does not exceed __ ft
… and one more thing
- Immediately intubate an unconscious patient
- thoracentesis
- Place patient in the left lateral position to avoid cerebral embolism
- 1000 ft
- Hyperbaric O2 therapy
Nitrogen Narcosis- what is it?
Dissolved nitrogen has a neuro ____ effect similar to ____
Martini rule, for every __ feet of decent, the effects are comparable to drinking one martini
Loss of consciousness occurs at __ feet
Increased pressure with depth causes more nitrogen to dissolve in the blood
depressant effect similar to alcohol
50
300
what is The most common divers emergency?
It has 4 names, what are they?
S/S begin within __ minutes of surfacing
Bubbles can occur in ____ tissue
Decompression sickness
The bends, dysbarism, caisson disease, divers paralysis
60
any
Divers emergencies, Decompression sickness
treatments include
(3)
100% O2
Aspirin prophylactically for antiplatelet therapy
Treat N/V/HA symptoms
Divers emergencies; The Squeeze
What is it?
Can cause ____ to rupture
People should avoid diving when these chambers are what?
Descend too fast, air inside the mask, lungs, ears, intestinal tract, and teeth can cause severe pain
eardrums
congested from a cold
Divers emergencies
Barotrauma of ascent is The opposite of what?
the squeeze
2 types of poisonous snakes live in the US, what are they?
Crotalidea or pit vipers; rattles snakes, copperheads, and cottonmouths
Elapidae such as coral snakes
Crotalidea or pit vipers; name three
rattles snakes, copperheads, and cottonmouths
Elapidae, name three
what is found in the US?
such as coral snakes Cobras and mambas belong to the Elapidae family but do not live in the US
Snake venom can be \_\_\_\_otoxic \_\_\_\_otoxic \_\_\_\_otoxic Any combination of these
Cardiotoxic
Neurotoxic
Hemotoxic
Poor timing by a pit viper may result in a ____ bite
If the patient has no effects in __ to __ hours, the patient may be cleared for discharge
dry
8 to 12
S/S - local reactions from a snakebite might include
edema around the site 1 to 36 hours after the bite, pain, petechiae, ecchymosis, loss of limb function, necrosis 16 to 36 hours after the bite
Systemic reactions from a snake bite include (17)
N/V, diaphoresis, syncope, metallic or rubber taste, excessive salivation, epistaxis, blood in the stool, vomitus, or sputum, pupil dilation, difficulty speaking, vision disturbances, ptosis, paralysis, muscle twitching, parestesia, seizures
Life threatening reactions from a snake bite include
severe hemorrhage, renal failure, hypovolemic shock
Treatment of snakebites
Hypovolemia; begin aggressive fluid resuscitation. If organ perfusion is inadequate after __L in adults, begin a trial infusion of ____, because why?
2L in adults, begin a trial infusion of albumin, because vascular permeability occurs rapidly, especially after a significant pit viper envenomation
after a snake bite, Immobilize the limb ___ ___ ___ the heart
at or below
after a snake bite, Clean the wound and mark the leading edges with the time every __ minutes
15
Do NOT use any of these methods to treat a snake bite
Avoid incision, suction, electric shock, and tourniquet, ice, or alcohol, these are not recommended treatments
How should pain be managed in the treatment of a snake bite?
Manage pain with opioids, avoid NSAIDS because they might aggravate coagulopathy
Treatment of a snake bite should include what prophylaxis
Administer tetanus prophylaxis
When treating a snake bite, Suspect ____ ____ if the extremity becomes increasingly tense due to edema or third spacing
compartment syndrome
Snake bites Antivenom
the primary indication for antivenin is the progression of venom effects which include
____ and ____ effects, Systemic manifestations such as ____/____, ____
Local effects
Significant ____ abnormality
Most therapeutic when given __ to __ hours after the bite and has a limited value after __ hours
Neurologic and cardiac effects N/V, parenthesis coagulation 4 6 12
Lizard bites
Can cause (6)
Treatment
No antivenin is currently available for this lizard
Wound care, ____, analgesics
Avoid the use of ____ as they can complicate coagulopathies
____ has reduced the need for analgesics
Provide ____ care for systemic effects
N/V, weakness, hypotension, syncope, shock, anaphylaxis Gila monster tetanus NSAIDS Diazepam (valium) supportive
General treatment for animal bites include (5)
__ minutes of direct pressure for bleeding
Consider ____ prophylaxis in certain circumstances, such as raccoon or an ____ attack by an animal
Ice and elevation, wound cleansing, copious high-pressure irrigation, tetanus prophylaxis, analgesic administration
10
rabies
unprovoked
Dog bites; treatment
Copious ____
Leave puncture wound ____, expect lacerations to be ____ ____.
Splint, immobilize, and elevate the extremity
Consider ____ prophylaxis
ABx
In many states, laws require dogs to be quarantined for __ days if the immunization history is unknown or if ____ is suspected
__% of all dog bites become infected
irrigation open, loosely sutured tetanus 10 rabies 18%
Cat bites and scratches have a Higher risk for infection, __%
80
Treatment; clean a cat bite with what?
Irrigate the wound with what?
Administer ____
antiseptic solution or soap and water
copious amounts of NSS or water
antibiotics
Cat scratch disease; ____ ____ may be in the claws or in the mouth of the offending cat Can cause fever, chills, but Usually resolves on its own in how long?
____ may be prescribed to patients with severe or very prolonged disease.
Complications may include (4)
Bartonella henselae
weeks to months
antibiotics
encephalitis, seizures, osteomyelitis, splenic abscess
Human bites; infection rate of about __%
Can cause what? (3)
10
staph, strep, and hepatitis virus
Spider bites
Most dangerous is the ____ ____; bites can cause local and systemic reactions, including signs and symptoms of ____
black widow
neurotoxicity
Spiders rarely bite more than once
Systemic symptoms develop within __ hour and include;
1
N/V, hypertension, interactive DTR’s, elevated temperatures, respiratory difficulty, syncope, weakness, seizures, shock
spider bites
S/S of envenomation peak within __ to __ hours but can last for several days
2 to 3
Black widow bites are ____toxic and cause pain in local muscle groups or cause severe muscle cramps that extend throughout the ____
neuro
body
spider bites
____ muscle cramps are frequently the most severe, mimicking these conditions (3)
Other S/S include (5)
Abdominal
appendicitis, colic, or food poisoning
Other S/S include HA, restlessness, anxiety, fatigue, insomnia
A spider antivenin produced in ____ is available and is effective no matter the species of ____ that bit the victim
After the antivenin, expect the patient to recover in 1 to 2 days, but eh fatigue, weakness, and other nonspecific symptoms may persist for 7 to 10 days
horses
Latrodectus
Brown recluse
The bite is both ____toxic and ____lytic
The bite is usually ____ and a central papule and erythema may not appear for __ to __ hours
Patients who will have a severe reaction will have key signs such as bullae formation, cyanosis, and hyperesthesia with __ to __ hours
The bite is both cytotoxic and hemolytic
painless, 6 to 12 hours
6 to 12 hours
Brown recluse
Wounds destined for necrosis usually show signs of progression within __ to __ hours, cause significant pain, and may take months to resolve
Bites of the recluse spider can cause what?
Bites in areas of increased ____ tissue are more likely to develop severe necrosis
48 to 72 hours
necrotic arachnidism, which is followed by necrosis an skin sloughing
adipose
Brown recluse
There is no ____ for brown recluse spider bites
Treatment includes (4) If tissue breakdown occurs, use prophylactic ABx such as \_\_\_\_ or a \_\_\_\_ to prevent cellulitis
Tetanus
A necrotic lesion may be removed by a ____ after __ to __ weeks of wound care
antivenin
Analgesics, cold compress, elevation, and cleanse the site
erythromycin or a cephalosporin
Tetanus
A necrotic lesion may be removed by a surgeon after 6 to 8 weeks of wound care
Scorpions
Contain a neuro toxin in the tip of the tail
How is a sting treated?
Pain and numbness resolve without treatment in a few hours
Hymenopteran
Name 4 members of the family
Treatment involves
Remove the stinger as quickly as possible; it can actively inject venom for up to ___minute
Prepare to administer medications such as
(4)
Homey bees, wasps, hornets, fire ants
One
Epinephrine
Benadryl
Solu-medrol
Histamine 2 (H2) blockers, including Zantac and pepcid (famotidine)
Tick bites
Can cause what? (3)
Remove the tick by doing what?
Do not squeeze or crush the tick because why?
Rocky mountain spotted fever
Incubation of about __ to __ days
Mortality of __%
Treated with ____, recovery takes about __ days
Rocky mountain spotted fever, Lyme, Tick paralysis
grasping the mouthparts with forceps
it can force the body fluids into the wound
Incubation of about 2 to 14 days
Mortality of 25%
doxycycline, about 20 days
Lymes disease - deer ticks
Incubation of about __ to __ days
Three stages
Stage one, describe
3 to 32 days
Incubation of about 3 to 32 days
Stage one expanding circular area and flu like symptoms for up to 2 months
Lymes disease - deer ticks
Stage 2 symptoms affect these 3 body systems, complications such aswhat? (6)
Meningitis, facial nerve paralysis, cardiomyopathies, hepatitis, atrioventricular blocks, arthralgia
Treatment for acute neurologic complications, third degree heart block, lymes arthritis include ____
A patient with first or second degree heart block needs treatment with ____
neurologic, cardiac, and musculoskeletal
Meningitis, facial nerve paralysis, cardiomyopathies, hepatitis, atrioventricular blocks, arthralgia
rocephin
Doxycycline
Lymes disease - deer ticks
Stage 3 the third and final stage may last how long?
Symptoms include
years or months
Chronic arthritis
Peripheral radiculoneuropathy
