Environmental Injuries Flashcards
Heat cramps- EEti
- Hyponatremia- loss of salt
- Replacement of water to replace lost fluids
Heat cramps- Sx
- Muscle spasms in abdomen, thighs and shoulders
Heat cramps- Tx
- Electrolyte solutions
- Saline
Heat exhaustion- Eti
Dehydration, prolonged exposure
- Hypernatremic- inadequate water replacement
- Hyponatremic- excessive sweating with water replacement
Heat exhaustion- Sx
- HA, N/V
- Not altered, conscious
- Tachypnea
- Malaise
- Cramps
- Tachycardia
- OrthoHTN
- Dizziness
- Diaphoresis
Heat exhaustion- Tx
- Salt tablets, saline
- Rest, cooling measures
- Check for myoglobinuria- Rhabdo, order CK
- Hospitalize with comorbid conditions or severe sx
Heat stroke- Eti
- Dysfunction of heat regulation
- Emergency
Heat stroke- Sx
- Elevated body temp > 41C/ 105.8 F
- AMS!
- Seizures, delirium and coma
- Skin hot and dry- Anhidrosis
- HA, N/V visual disturbances
Heat stroke- Tx
- Rapidly lower core temp
- ABCs, IV fluids
- Evaporative cooing
Heat stroke- Dx
- Dx of exclusion, RO drugs, infection, endocrine emergencies
- Hemoconcentration- loss of fluid
- BUN and CK for rhabdo
Frost bite- Eti
- 2nd degree injury to tissue due to freezing
- Limited to exposed skin
- Classified after rewarming
Frost bite- Sx
- 2nd degree: full thickness freezing
- Erythema, significant edema
- Vesicles, blackened eschar
- Numb, achy and throbbing
- 3rd degree: full skin and sub freezing
- Less pain, violates hemorrhagic blisters
- No sensation progress to shooting pains
- 4th degree: Most severe, full skin, sub, muscle, tendon and bone
- No pain, little edema
- Loss of limb, dry, black and mummified
Frost bite- Tx
- 3-5 weeks to determine extent of injury
- Deep, rapid rewarming until skin pliable
- Narcotics
- ## Debride clear blisters
Frost nip- Eti
- First degree frost bite
- No loss of tissue after rewarming
Frost nip- Sx
- Partial freezing
- Erythema, edema, hyperemia
- Stinging, burning and throbbing
- Desquamation after warming
- Hyperhydrosis
Frost nip- Tx
- Same as frost bite
Hypothermia- Eti
- Capacity to produce heat overwhelmed by external temp
- More common with comorbid- CNS depressants, ETOH
Hypothermia- Sx
- Mild: Retal temp of 90-95
- Normal consciousness and shivering
- Profound: Retal temp below 90
- Marked AMS
- Shivering stops at 87.8
- Hypotension, ventilation, bradycardia
- EKG: Osborne/ J wave- unusual QRS elevations
Hypothermia- Tx
- Hospitalize
- Rewarming- may be dangerous due to vasodilation
- Cardiopulm resus
- Correct fluids and lytes
- Abx if coma
Chilblains- Eti
- Women (15-30), children, PV dz
- Chronic, intermittent exposure to damp, nonfreezing temps
Chilblains- Sx
- Painful, inflamed lesion of hands, ears and lower extremities
- Erythema, edema, vesicles, nodules and ulcerations
- Paresthesias and pruritus
Chilblains- Tx
- Elevate
- Warm at room temp
- Protect from further trauma
Immersion foot- Eti
- Prolonged clod water immersion
- Hours to days to develop
- Alternating vasospasm and dilation
Immersion foot- Sx
- Tingling, numbness with pale mottled appearance
- Hyperemic- burning
- Edema and bullae
- Anesthesia
- Hyperhydrosis, cold sensitivity and gangrene
Immersion foot- Tx
- Change shoes and wet socks
Electrical/ lightening injuries- Eti
- Electrical current on cells
- Heat generated due to resistance of tissues
- Energy greatest at point of contact
Electrical/ lightening injuries- Sx
- Linear, thermal burns
- AMS, dazed or unconscious
- Rhythm disturbances
- MS trauma- crush injuries
- Damage to vessels, muscles and nerves
- Exit wound larger than entrance
Electrical/ lightening injuries- Dx
- UA for myoglobin
- ECG
- CT for head trauma
Electrical/ lightening injuries- Tx
- High flow O2
- ACLS for systole of ventricular dysrhythmia
- Crystalloid fluids
Barotrauma- Eti
- Most common
- Squeeze on descent in air filled body space
Barotrauma- Sx
- Sinus and dental barotrauma
- ## Pulm barotrauma leading to gas
Barotrauma- Tx
-
Decompression sickness- Eti
- Increased Atm pressure increases gas dissolved in plasma
- Due to rapid ascent
- 75% develop sx within 1 hr
- Wait 12-48 hrs before flying
Decompression sickness- Sx
- Type 1: Mild
- MS joint pain, elbow and shoulder
- Pruritus, erythema, cyanosis
- Peau d’orange, adénopathie
- Type II: NS involvement
- Paresthesia, weakness, paraplegia, venous gas embolism
Decompression sickness- Tx
- O2, analgesics, crystalloid fluids
- Hyperbaric chamber
Arterial gas embolism- Eti
- Due to pulmonary barotrauma
Arterial gas embolism- Sx
-
Arterial gas embolism- Tx
-
Acute mountain sickness- Eti
- Rapid ascent over 6600 ft
- Phys changes to resp, circ, hematopoietic, renal sx
- 6-24 hrs after arrival at altitude
Acute mountain sickness- Sx
- HA, N
- Palpitation
- Drowsiness, weakness and fatigue
- Worse on day 2-3, better by day 7
Acute mountain sickness- Tx
- Descent
- Antiemetics, analgesics
- O2
- Dexamethasone if progression
- Prevent with acetazolamide
High altitude pulm edema- Eti
- Severe AMS
- Rapid ascent > 8000 ft
- Young and healthy
- Salt intake, cold, sleeping exposure increase risk
High altitude pulm edema- Sx
- Cough, dyspnea at rest
- Pink, frothy sputum
- Weak and drowsy
High altitude pulm edema- Tx
- Rest and O2
- Postive pressure vent
- Descend
- Acetazolamide
- Nifedipine to lower pulm pressure
High altitude cerebral edema- Eti
- Rapid ascent > 8000 ft
- Hypoxia
High altitude cerebral edema- Sx
- HA
- AMS and coma
- Papilledema
- Global encephalopathy
May lead to brainstem herniation
High altitude cerebral edema- Tx
- O2
- Rapid descent
Drowning/ Near drowning- Eti
- Oregon 10th highest
-
Drowning/ Near drowning- Sx
- Wet drowning- fluid in lungs
- Dry drowning- Laryngospasm due to inhalation of water, no water in lungs
- Resp impairment due to submersion in liquid
- Panic, loss of breathing
- Inspiration reflex
Drowning/ Near drowning- Tx
- Resuscitation in 2 min
- Breaths before compressions
- O2 > 94%
- CPAP
- Hospitalize! Sx within 7 hrs
- C-spine immobilization
