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cdc yellowbook > Environmental Hazards & Risks 2 > Flashcards

Environmental Hazards & Risks 2 Flashcards

1
Q

what are diving disorders?

A

Barotrauma - ear & sinus, pulmonary;
Decompression illness - arterial gas embolism, decompression sickness;

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1
Q

which population who wish to either begin a dive program or continue diving, should undergo a physical examination to assess their cardiovascular fitness - including ECG, exercise treadmill test, or echocardiogram?

A

People with known risk factors for coronary artery disease, including but not limited to diabetes, elevated blood pressure, family history, an abnormal lipid profile, and smoking history

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2
Q

what is barotrauma?

A

an injury to soft tissues resulting from a pressure differential between an airspace in the body and the ambient pressure. The resultant expansion or contraction of that space can cause injury.

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3
Q

what is the most common injury in divers?

A

ear barotrauma

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4
Q

what are additional risk factors for ear and sinus barotrauma?

A

Use of solid earplugs.

Medication (e.g., overuse or prolonged use of decongestants leading to rebound congestion).

Ear or sinus surgery.

Nasal deformity or polyps.

Chronic nasal and sinus disease that interferes with equilibration during the large barometric pressure changes encountered while diving.

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5
Q

what are the symptoms of ear barotrauma?

A

Decreased hearing
Pain
Sensation of fullness
Sensation of “water in the ear” (serous fluid/blood accumulation in the middle ear)
Tinnitus (ringing in the ears)
Vertigo (dizziness or sensation of spinning)

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6
Q

how do Scuba divers reduce the risk for lung overpressure problems when breathing compressed gas?

A

breathing normally;
ascending slowly

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7
Q

what can happen if the scuba diver ascends without exhaling?

A

overexpansion of the lungs

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8
Q

During ascent, compressed gas trapped in the lung increases in volume until the expansion exceeds the elastic limit of lung tissue, causing damage and allowing gas bubbles to escape into 3 possible locations…?

A

the pleural space;
mediastinum;
pulmonary vasculature

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9
Q

what can gas entering the pleural space cause?

A

lung collapse or pneumothorax

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10
Q

what can gas entering the mediastinum (the space around the heart, trachea, and esophagus) cause?

A

mediastinal emphysema;
subcutaneous emphysema;
change in voice (affect the tissue around the larynx)

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11
Q

where does gas rupturing the alveolar walls into the pulmonary capillaries go?

A

pulmonary veins to the left side of the heart - causing arterial gas embolism (AGE)

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12
Q

what is decompression illness?

A

bubble-related dysbaric injuries - include arterial gas embolism (AGE) and decompression sickness (DCS)

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13
Q

what are clinical symptoms of arterial gas embolism?

A

Ataxia
Blurred vision
Chest pain or bloody sputum
Loss of consciousness
Convulsions
Dizziness
Muscular weakness
Numbness or paresthesia Paralysis
Personality change, difficulty thinking, or confusion

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14
Q

what are symptoms of decompression sickness?

A

Loss of bowel or bladder function
Collapse or unconsciousness
Coughing spasms or shortness of breath
Dizziness
Unusual fatigue
Itching
Joint aches or pain
Mottling or marbling of skin
Numbness or tingling
Paralysis
Personality changes
Staggering, loss of coordination, or tremors
Weakness

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15
Q

if a diver who surfaces unconscious or loses consciousness within 10 minutes after surfacing, what is suspected?

A

Arterial gas embolism

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16
Q

what do you need to do if arterial gas embolism suspected?

A

Initiate basic life support, including administration of the highest fraction of oxygen.

Because relapses can and do occur, divers suffering AGE should be rapidly evacuated to a hyperbaric oxygen treatment facility even if they appear to have recovered fully.

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17
Q

how does decompression sickness develop?

A

excess inert gas (usually nitrogen) dissolves in and saturate body tissues –> depending on the amount of gas dissolved and the rate of ascent, some gas can supersaturate tissues –> gas separates from solution to form bubbles, interfering with blood flow and tissue oxygenation

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18
Q

what is immersion (induced) pulmonary edema?

A

sudden development of fluid in the lungs that typically occurs early during a dive and at depth.

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19
Q

what are the symptoms of immersion pulmonary edema (IPE)?

A

chest pain, dyspnea, wheezing, and productive cough with frothy, sometimes pink-tinged sputum

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20
Q

which are believed to increase Immersion Pulmonary Edema risk in otherwise healthy divers?

A

age, overhydration, overexertion, negative inspiratory pressure, and left ventricular hypertrophy

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21
Q

Anyone experiencing acute pulmonary edema while diving requires a work-up to rule out which?

A

myocardial ischemia, evaluation of left ventricular function, hypertrophy, and valvular integrity

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22
Q

what is nitrogen narcosis?

A

At increasing depths, generally >100 ft (≈30 m), the partial pressure of nitrogen within the breathing gas increases, causing narcosis in all recreational divers

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23
Q

what is oxygen toxicity?

A

At increasing partial pressures of oxygen, levels in the blood become high enough to cause seizures.

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24
Q

how long do you need to wait to fly after surfacing from a single no-decompression dive?

A

12 hours or more

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25
Q

how long do you need to wait to fly after multiple dives or multiple days of diving?

A

18 hours or more

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26
Q

how long do you need to wait to fly after a dive that required decompression stops?

A

24 to 48 hours

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27
Q

what are risk factors for decompression illness?

A

dive depth, dive time, rates of ascent;

altitude exposure soon after a dive, difficult diving conditions (colder water, currents, decreased visibility, wave action);

dives to depths >60 ft (18 m);

multiple consecutive days of diving or repetitive dives;

overhead situations (diving in underwater caves or wrecks),

strenuous exercise, certain physiologic variables (e.g. dehydration)

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28
Q

what is definitive treatment of decompression illness?

A

recompression and oxygen administration in a hyperbaric chamber

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29
Q

which maintains 24-hour emergency consultation and evacuation assistance for decompression illness?

A

Divers Alert Network (DAN)

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30
Q

Because of either incidental causes, immersion, or DCI itself, which can cause capillary leakage, divers often are dehydrated. In most cases, treatment includes …?

A

administering isotonic glucose-free intravenous fluids. Oral rehydration fluids also can be helpful, provided they can be administered safely

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31
Q

where are typical high-elevation travel destinations?

A

Colorado ski resorts (8000-10000ft, 2440-3050m);
Cusco, Peru (11000ft, 3350m);
La Paz, Bolivia (12000ft, 3650m);
Lhasa, Tibet Autonomous Region (12100ft, 3700m);
Everest base camp, Nepal (17700ft, 5400m);
Mount Kilimanjaro, Tanzania (19341ft, 5900m)

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32
Q

The magnitude and consequences of hypoxic stress depend on which factors?

A

elevation, rate of ascent, and duration of exposure

33
Q

Hypoxemia is greatest during … ?

A

sleep

34
Q

the acute phase (3-5 days) of acclimatization to high elevation is associated with ..?

A

steady increase in ventilation;
improved oxygenation;
changes in cerebral blood flow;
decrease in plasma volume (cause increase hemoglobin concentration)

35
Q

when does altitude illness develop in relation to acute acclimatizaion process?

A

before the acute acclimatization process is complete, but not afterwards

36
Q

if you are at elevation above 3000m (9800ft), what would be the ascending rate for further elevation?

A

500m (1650ft) per night in sleeping elevation, and then extra night every 1000m (3300ft)

37
Q

if you arrive at 8000-9000ft (2450-2750m) how many nights do you need to sleep before going up?

A

min 2-3 nights

38
Q

avoid directly from low elevation to how much sleeping elevation in 1 day ?

A

9000ft (2750m)

39
Q

what do you need to tell about alcohol at high elevation?

A

avoid for the first 48 hours at elevation

40
Q

what do you need to tell about coffee/caffeine users at high elevation?

A

continue using to avoid withdrawal headache that could be confused with an altitude headache

41
Q

what do you need to tell about exercise at high elevation?

A

only mild exercise for first 48 hours

42
Q

what is the high risk category for developing acute mountain sickness (AMS), which acetazolmaide prophylaxis is strongly recommended?

A

People with a history of AMS ascending to >9,200 ft (≈2,800 m) in 1 day;

All people with a prior history of HAPE or HACE;

All people ascending to >11,400 ft (≈3,500 m) in 1 day;

All people ascending >1,600 ft (≈500 m) per day (increase in sleeping elevation) at elevations >9,800 ft (≈3,000 m), without extra days for acclimatization;

People making very rapid ascents (e.g., <7-day ascent of Mount Kilimanjaro)

43
Q

what is the moderate risk category for developing acute mountain sickness (AMS), which acetazolamide prophylaxis would be benenficial and should be considered?

A

People with prior history of AMS and ascending to 8,200–9,200 ft (≈2,500–2,800 m) elevation (or above) in 1 day;

People with no history of AMS ascending to >9,200 ft (2,800 m) elevation in 1 day;

All people ascending >1,600 ft (≈500 m) per day (increase in sleeping elevation) at elevations >9,900 ft (3,000 m), but with an extra day for acclimatization every 3,300 ft (1,000 m)

44
Q

what is the low risk category for developing acute mountain sickness (AMS)?

A

People with no prior history of altitude illness ascending to <9,000 ft (2,750 m);

People taking ≥2 days to arrive at 8,200–9,800 ft (≈2,500–3,000 m), with subsequent increases in sleeping elevation <1,600 ft (≈500 m) per day, and an extra day for acclimatization every 3,300 ft (1,000 m) increase in elevation

45
Q

what are 3 syndromes of altitude illness?

A

Acute moutain sickness;
High-altitude cerebral edema;
High-altitude pulmonary edema

46
Q

how to diagnose acute mountain sickness?

A

Hx of recent ascent to high elevation;
occuring 2-12 hours after arrival, ofetn during or after the first night;
presence of subjective symptoms -

cardinal symptom - headache;
usually with one or more symptoms of anorexia, dizziness, fatigue, nausea, vomiting

47
Q

what are the symptoms of AMS in preverbal children?

A

loss of appetite, irritability, pallor

48
Q

how soon does AMS resolve if stop ascening?

A

12-48 hours

49
Q

how to treat AMS?

A

supplemental oxygen at 1-2 L per min - will relieve headaches within about 30 minutes and other symptoms over hours; non-opiate analgesics (ibuprofen 600 or acetaminophen 500mg every 8 hours), antiemetics (ondansetron 4mg)

moderate to severe AMS - dexamethasone;

if symptoms worsen, decent is mandatory

50
Q

what is high-altitude cerebral edema and how to diagnose?

A

‘end stage’ AMS;
neurological findings - altered mental status, ataxia, confusion, drowsiness; coma can ensue within 24 hours of onset

51
Q

how to treat HACE?

A

oxygen, dexamethasone;
descent!

52
Q

what are initial symptoms of HAPE?

A

chest congestion, cough, exaggerated dyspnea on exertion, and decreased exercise performance; progression over 1–2 days - easily recognizable as HAPE

53
Q

how to diagnose HAPE?

A

Rales are detectable in most victims. Pulse oximetry can aid in making the diagnosis; oxygen saturation levels will be at least 10 points lower in HAPE patients than in healthy people at the same elevation. Oxygen saturation values of 50%–70% are common.

54
Q

how to treat HAPE?

A

descent is urgent and mandatory;
oxygen/portable hyperbaric chamber if can’t descent!

nifedipine can be used as an adjunct to descent, oxygen, or portable hyperbaric oxygen therapy.

A phosphodiesterase inhibitor can be used if nifedipine is not available, but concurrent use of multiple pulmonary vasodilators is not recommended.

55
Q

what is the dose of acetazolmaide for AMS and HACE prevention?

A

125mg bid (250mg if >100kg);
pediatric 2.5mg/kg bid upto 125mg

56
Q

what is the treatment dose of acetazolamide for AMS?

A

250mg bid (2 doses taken 8 hours apart);
can be added to dexamethasone

57
Q

what is the prevention dose of dexamethasone for AMS and HACE?

A

2mg qid (every 6 hours) or
4mg bid (every 12 hours)

kids - do not use

58
Q

what is the treatment dose of dexamethasone for AMS?

A

AMS - 4mg qid;
pediatric 0.15mg/kg/dose qid upto 4 mg

59
Q

what is the treatment dose of dexamethasone for HACE?

A

8mg stat, then 4mg qid;
pediatric 0.15mg/kg/dose qid upto 4 mg

60
Q

what is the prevention and treatment dose of nifedipine for HAPE?

A

30mg SR bid or
20mg SR tid

61
Q

what is the prevention dose of salmeterol for HAPE?

A

125 ug bid

62
Q

what is the prevention dose of sildenafil for HAPE?

A

50mg tid

63
Q

what is the prevention dose of tadalafil for HAPE?

A

10mg bid

64
Q

how does acetazolamide work?

A

fasten acclimatization to high-elevation hypoxia;
induce bicarbonate diuresis and metabolic acidosis –> stimulate ventilation and increase alveolar and arterial oxygenation

65
Q

how long does it take for body to acclimatize at high elevation when using acetazolamide?

A

1 day - normally 3-5 days without

66
Q

what else is acetazolamide good for at high elevation?

A

eliminate central sleep apnea, or periodic breathing, which is common in high elevations

67
Q

what is the common side effect of acetazolamide?

A

increased urination and paresthesia of the fingers and toes

68
Q

what is the dose of acetazolamide?

A

125mg bid beginning the day before ascent and continuing the first 2 days at elevation, and longer if ascent continues

69
Q

what is the allergic reaction concern for acetazolamide?

A

allergic reaction are uncommon;
but sulfonamide derivative - so cross-sensitivity between acetazolmaide, sulfonamides, and other sulfonamide derivatives is possible

70
Q

what is the concern of dexamethasone for use in preventing altitude sickness?

A

mild rebound can occur if discontinued at elevation before acclimatization

71
Q

what else can you use for AMS prevention?

A

ibuprofent 600mg q8hours

72
Q

what is the advantage of using phosphodiesterase-5 inhibitors?

A

selectively lower pulmonary artery pressure, with less effect on systemic blood pressure than nifedipine

73
Q

Travelers can adhere to 3 rules to help prevent death or serious consequences from altitude illness:

A

Know the early symptoms of altitude illness and be willing to acknowledge when symptoms are present.

Never ascend to sleep at a higher elevation when experiencing symptoms of altitude illness, no matter how minor the symptoms seem.

Descend if the symptoms become worse while resting at the same elevation.

74
Q

what is the contraindication of ascent?

A

Angina (unstable)
Asthma (unstable, poorly controlled)

Cerebral space–occupying lesions
Cerebral vascular aneurysms or arteriovenous malformations (untreated, high-risk)

Chronic obstructive pulmonary disease (severe/very severe)
Cystic fibrosis (FEV1 <30% predicted)
Heart failure (decompensated)
Myocardial infarction or stroke (<90 days before ascent)
Pregnancy (high-risk)
Pulmonary hypertension (pulmonary artery systolic pressure >60 mm Hg)
Sickle cell anemia

75
Q

what are the ‘caution required’ medical conditions for ascent?

A

Angina (stable)
Arrhythmias (poorly controlled)
Chronic obstructive pulmonary disease (moderate)
Cirrhosis
Coronary artery disease (nonrevascularized)
Cystic fibrosis (FEV1 30%–50% predicted)
Heart failure (compensated)
Hypertension (poorly controlled)
Infants <6 weeks old
Obesity (Class 3)3
Obstructive sleep apnea (severe)
Pulmonary hypertension (mild)
Radial keratotomy surgery
Seizure disorder (poorly controlled)
Sickle cell trait

76
Q

what are ‘likely no extra risk’ group for ascent?

A

Asthma (well-controlled)
Children and adolescents
Chronic obstructive pulmonary disease (mild)
Coronary artery disease (following revascularization)
Diabetes mellitus
Elderly
Hypertension (controlled)
Neoplastic diseases
Obesity (Class 1/Class 2)2
Obstructive sleep apnea (mild/ moderate)
Pregnancy (low-risk)
Psychiatric disorders (stable)
Sedentary
Seizure disorder (controlled)

77
Q

Travelers with diabetes can travel safely to high elevations, but what are some advices you can give?

A

they must be accustomed to exercise if participating in strenuous activities at elevation and carefully monitor their blood glucose.

Diabetic ketoacidosis can be triggered by altitude illness and can be more difficult to treat in people taking acetazolamide.

Not all glucose meters read accurately at high elevations.

78
Q

Travelers with sleep disordered breathing who are planning high-elevation travel should receive which preventive treatment?

A

acetazolamide

79
Q

what is the recommendation for pregnant people for ascent?

A

do not stay at sleeping elevations >10,000 ft (≈3,050 m)

Advise pregnant travelers of the dangers of having a pregnancy complication in remote, mountainous terrain.

80
Q

At very high elevations, some people who have had radial keratotomy procedures might develop what symptoms?

A

acute farsightedness

81
Q
A

cdc yellowbook (26 decks)

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