Environmental Emergencies and Trauma Flashcards
Although environmental emergencies can affect anyone, what are some predisposing risk factors for environmental trauma and emergencies?
Age - Especially the very young and very old do not tolerate environmental extremes very well
Poor general health
Fatigue
Predisposing medical conditions
Medications - both prescription and over the counter (Beta blockers and diuretics in particular)
What age groups are particularly vulnerable to environmental extremes?
Very young and the very old
Define environmental emergency
Medical condition caused or exacerbated by environmental factors
Define homeostasis
Process of maintaining constant suitable conditions within the body
Define thermogenesis
the body creating heat
Define thermolysis
The body losing heat
Define conduction
transfer of temperature from one source to another through direct contact
Define convection
Temperature carried away by currents of air or water
Define radiation
In the absence of convection and conduction, the body naturally radiates its temperature outward
Define evaporation
Perspiration evaporating from the body which causes a cooling effect
Define respiration and how it relates with environmental emergencies
Body breaths air out and replaces it with the ambient temperature air around it
What is the normal range for body temperature?
96 to 100 degrees
What is a mild hypothermia temperature for the body?
90 to 95 degrees
What is considered severe hypothermia for the body temperature?
below 90 degrees
How does the body combat heat loss?
Shivering
Sweat reduction
Reduction of circulation to the skin
Increases metabolism
Define hypothermia
state of low body temperature, in particular low core temperature
How does alcohol affect the body in relation to environmental emergencies
Vasodilates
People tend to feel warm while intoxicated and therefore wear less clothing
What body temp is considered mild heat exhaustion?
over 100 degrees
What body temperature is considered heat stroke and high fever?
105 degrees and up
What is the temperature at the upper limit of survival for the body?
114 degrees
What is considered the lower limit survival temperature for the body?
66 degrees
Core body temperature is best assessed where in/on the body?
Axially or rectally
Define negative feedback
Homeostatic mechanism in which a change in variable will ultimately lead to an inhibition of the process that caused the shift.
What are some signs and symptoms of mild hypothermia?
Increased pulse and respires
vasoconstriction
Fatigue
Mental status degradation
Shivering
What cardiac arrhythmia is common in hypothermia?
Atrial Fibrillation
What treatments can we give for a hypothermic patient with atrial fibrillation?
Cardizem
Possibly cardioversion
What are some signs and symptoms of moderate hypothermia
Cardiac arrhythmias
Decreased pulse and respires
hypotension
Shivering will cease
continued altered mental status
What are some signs and symptoms that are associated with severe hypothermia
unresponsive
cardiac arrest
What are Osborne waves?
Also known as “J Waves”
Appears similar to ST elevation
Most commonly seen in hypothermic patients
Most commonly seen in leads II and V6
All victims of hypothermia should receive what kinds of treatments?
Remove wet garments
Protect from further heat loss and wind chill, apply passive rewarming such as blankets, insulating materials, and moisture barriers
Maintaining patient in a horizontal position
Avoid rough handling that may cause an arrhythmia
Monitor core temperature
Monitor cardiac rhythm
Active rewarming may be used in what type of hypothermic patient and should be avoided in what kind of hypothermic patient?
Mild hypothermia patients may receive active rewarming (warm blankets, heat packs around the axilla, base of the neck, and groin. Remember to insulate heat packs to avoid burning the patient)
Severe hypothermia patients are best actively rewarmed in a hospital environment.
What kind of hypothermic patients may receive warm liquids orally?
Conscious and alert patients that are able to do it themselves.
Unresponsive patients in hypothermic emergencies may appear to be what?
Dead
When assessing pulse in a patient in a hypothermic emergency how long should you assess pulse and why?
30 - 45 seconds because of bradycardia may make pulse harder to assess
A patient is not dead until they are ______ and dead.
Warm
You have a patient that is hypothermic (<86 degrees faherneheit) pulseless and apneic.
What is your treatment?
Begin CPR
Preform quick look, if VF or pulseless V-Tach present defibrillate
INtuabte
Initiate IV with warm fluid
Assess core temperature
If core temperature continues to be below 86 degrees fahrenheit then continue CPR but DO NOT ADMINISTER MEDICATIONS OR DEFIBRILLATION
If core temperature is above 86 degrees fahrenheit then continue with normal ACLS algorithm
Define frostbite
Environmental freezing of skin that causes cell death
What are the two types of frostbite?
Superficial Frostbite (Frost nip)
And Deep Frostbite
What is the treatment of superficial frostbite?
Remove from the area
Warm affected body part
DO NOT MASSAGE THE BODY PART
Splint if possible
What is the treatment of deep frostbite?
Rapid transport
Gentle handling, splinting. Treat as if it were a fracture
Rewarm according to protocol
Contact medical direction
Treat associated symptoms
Define trench foot
Similar to frostbite but occurs at temperatures above freezing
May result in tissue sloughing and gangrene
Also known as immersion foot
Define heat stroke
Patient loses ability to thermoregulate combined with fluid and electrolyte loss
What are signs and symptoms of heat stroke
Increased respires
rapid pulse
low blood pressure
lack of perspiration
hot dry skin
seizure
What are febrile seizures
Seizure caused by drastic change in temperature, usually seen in pediatrics
How should patients with hypothermia and hyperthermia be transferred to your cot?
Carried
DO NOT WALK THESE PATIENTS to the cot
Define drowning
Process of experiencing respiratory impairment from submersion/immersion in liquid which may result in mortality, morbidity or no morbidity
Drowning can happen _________ in only a ____ inches of liquid
Anywhere, few
True or false
Drownings are loud events
False
Drownings are silent
Define Atelectasis
Complete or partial collapse of a lung or lobe of the lung resulting from alveoli
_____% of drowning victims have water in their lungs
Why?
10%
When water contacts the vocal cords a coughing reflex is triggered.
Which type of drowning is preferable and why
Cold water or warm water drownings?
Cold water drownings are preferable because water below 70 degrees fahrenheit can slow the onset of death due to the bodies response to hypothermia
What is the treatment of drownings?
Remove patient from water without compromising your own safety
C-spine precautions on all victims
Rescue breaths should be initiated ASAP and the airway controlled
CPR if pulseless
Main concern is hypoxia to the brain
How will salt water and fresh water drownings be different?
Patient drowning in fresh water is more likely to develop sepsis due to the increased presence of microbes and germs in fresh water.
How can water be removed from the lungs?
Positive pressure ventilations
Osmosis
Define Air Embolus
Air bubble in the blood stream
What are signs and symptoms associated with air embolus?
Localized chest pain
Numbness/tingling in extremities
Blood in the airway
Sudden LOC
Cardio/Respiratory arrest
Define Boyles Law
Volume of gas is inversely proportional to its pressure if temperature is kept constant
Define Daltons Law
The total pressure of a mixture of gases is equal to the sum of all the partial pressure of the individual gases
Define Henrys Law
The amount of gas dissolved into a given volume of fluid is proportional to the pressure of the gas above it
Define the bends (decompression sickness)
Nitrogen concentration in tissues and joints as a result of resurfacing too quickly
What are signs and symptoms associated with the bends?
Altered LOC
Muscle/joint pain
Blotchiness on skin
Difficulty breathing
LOC
What are the 4 steps of water rescue?
Reach
Throw
Row
Go
Define altitude illness
Caused by rapid ascension to high altitudes
May include Acute Mountain Sickness, High Altitude Cerebral Edema, High Altitude Pulmonary Edema
What is the criteria for Acute Mountain Sickness?
Rapid increase in altitude with headache and AT LEAST ONE of the following:
Fatigue and or weakness
Dizziness or light headedness
GI Problems
Difficulty sleeping
What is the treatment of high altitude sickness?
Remove to lower altitude if possible
High flow oxygen
Hyperbaric bags
If pulmonary edema is present provide CPAP and Furosemide
Treat associated signs and symptoms
