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)
