Environmental Emergencies Flashcards by shawn wilde

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

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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.

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What causes heat cramps?

caused by sweat induced electrolyte depletion

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A patient with heat cramps may also have what else?

appearance

a flushed appearance.

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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

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This is caused by prolonged heat exposure, usually over hours or days
If left untreated can progress to heatstroke

Heat exhaustion

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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

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Mild to moderate elevated core body temperature of

98.6 to 104F (37-40C)

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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

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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

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Heatstroke, which can be life- threatening, characterized by a core temperature of

105F (40.5C)

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Classic heatstroke commonly affects who?

geriatric patients, chronically ill, those who live in poorly ventilated homes without air conditioning, kids in cars

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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

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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

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Street drugs such as these can increase the risk for heat stroke

LSD, jimson weed, amphetamines, PCP, alcohol

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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.

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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

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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.

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when treating heat stroke, keep in mind that Water is __ times more effective for heat exchange then air

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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

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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.

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Cardiovascular failure can also result from heat stroke due to what?

dehydration, cutaneous vasodilation, and heat induced myocardial depression.

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True of false

Liver dysfunction and coagulopathies can also occur as a consequence of thermal breakdown

True

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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

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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

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, __%

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 as what? (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