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Clinical Science > Environmental Trauma > Flashcards

Environmental Trauma Flashcards

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1
Q

Hyperthermia is

A

warming of body temp greater than 38 degrees

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2
Q

The body’s mechanisms for heat loss are:

A 
radiation
conduction
convection
evaporation
vasodilation
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3
Q

Causes of hyperthermia

A

external heat source
exercise
infection
seizures

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4
Q

Risk factors of hyperthermia

A 
long period of warm weather
high humidity 
athletes
military
labourers 
elderly 
infants and children
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5
Q

Patho of hyperthermia

A

excessive heat denatures proteins and stabilises lipids leading to failure of vital energy producing processes and loss of cell membrane function.
redistribution of blood flow and loss of fluids and electrolytes

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6
Q

Heat stress or cramps

A

muscular cramps as a result of water and sodium loss

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7
Q

presentation of heat stress

A 
alert
pale, sweaty
tachycardia
weakness
nausea
painful cramps
history of vigorous activity
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8
Q

treatment of heat stress

A 
gently stretch muscles, dont massage 
move to cooler place
oral fluids (500ml)
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9
Q

Heat exhaustion

A

water and electrolyte loss and peripheral blood pooling

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10
Q

presentation of heat exhaustion

A 
anxious, restless, disorientated 
headache
thirst/dehydration 
nausea and vomiting 
pale and sweaty
tachycardia
orthostatic hypotension
tachypnoea
dizziness
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11
Q

treatment of heat exhaustion

A

move to cool place
auto infuse
fluid replacement
passive cooling until temp less than 38

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12
Q

Heat stroke

A

body unable to regulate temp through hypothalamic thermostat

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13
Q

presentation of heat stroke

A 
elevated temp greater than 40 
hot, flushed, dry
neuro dysfunction - anxious, restless, disorientated, seizures, coma 
vomiting and dirrhoea 
rapid bounding pulse 
tachypnoea/hyperventilation 
hypotension
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14
Q

Hypothermia

A

core body temp less than 35 degrees

mild: 32-35
mod: 28-32
severe: less than 28

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15
Q

Risk factors for hypothermia

A 
elderly
dementia
neonates
children
sedatives and TCA
trauma
alcohol
immersion
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16
Q

Patho of hypothermia

A

exposure to cold stimulus leads to peripheral vasoconstriction and increase catecholamine release
Overall increase in BMR
Shivering mechanisms designed to increased CBT
Increased HR, BP, RR
Initial increase in temp then continued decrease
Reduced HR, BP, RR and tidal volume
FLuid shift from intravascular space to intersitial space

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17
Q

Signs and symptoms of hypothermia

A 
mild: ACS
increased HR and BP 
shivering 
lethargy
hungry 
Mod: ACS/confusion
no shivering
uncoordinated movement 
myocardial irritability and potential for arrhythmias 
severe: usually unconscious
absent vital signs
hypercapnic 
may be cyanosed
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18
Q

Paradoxical undressing

A

pts remove their clothing due to disruption of hypothalamus temp control ability
Due to loss of peripheral vasomotor tone and rush of warm blood back to extremities, creates sense of overheating

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19
Q

Terminal Burrowing

A

Hide and die, pts crawl into a small enclosed space

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20
Q

Osborne/J Wave

A

positive deflection occurring at the junction between QRS segment and T wave

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21
Q

Passive External rewarming techniques

A

pts own body heat
dry clothing
warm, dry, wind free environment

22
Q

Active external rewarming techniques

A

apply warm devices such as warm forced air blankets
hot bath immersion
heat packs/water bottles

23
Q

Active core rewarming techniques

A

warmed IV fluids
irrigation of body cavities with warmed fluids
warmed humidified inhaled air
extracorporeal rewarming

24
Q

Frostbite

A

when an isolated part of the body is exposed to intense cold for prolonged period of time

25
Q

presentation of frostbite

A 
cold
grey
mottled
inflammed
waxlike 
hardening
26
Q

Frost nip

A

usually only ear, nose etc

unaware until skin appears white

27
Q

Superficial frostbite

A

cold and numbness, followed by extreme pain during warming

Oedema after rewarming which them becomes blistered and hard scar

28
Q

Depp frostbite

A

medical emergency
solid to touch, but oedema slow to develop
do NOT rewarm

29
Q

Altitude

A 
the body can adapt to hypoxic environment: 
hyperventilate 
increased production of RBC
increased capacity of lungs to diffuse 
increase vascularity of tissues
30
Q

Acute mountain syndrome

A

6-24 hours after arrival

31
Q

Early/mid signs of AMS

A 
similar to hangover
headache
nausea and vomiting
weakness
normally self limiting
32
Q

late/severe signs of AMS

A 
dyspnoea
vomiting
ACS
 headache 
ataxia
retinal haemorrhage
may progress to HACE or HAPE
33
Q

high altitude cerebral oedema patho

A

increased ICP causes decreased CPP and death
vasogenic oedema
hypoxia = increased ECF and microvascular permeability

34
Q

signs and symptoms of high altitude cerebral oedema

A

progressive decline in mental status
truncal ataxia
cranial nerve palsies

35
Q

Treatment of HACE

A

stop climbing, rapid descent
analgesic and antiemetics
dexamethasone to reduce capillary permeability and reduce ICP
oxygen 2-4l/m

36
Q

High altitude pulmonary oedema

A

non cardiac pulmonary oedema due to increased pulmonary artery pressure
Increased pressure due to hydrostatic overcomes oncotic pressure therefore fluid shift into intersitial space

37
Q

early signs of HAPE

A

fluid is interstitial

dry cough and reduced exercise tolerance

38
Q

late signs of HAPE

A 
tachycardia
increased dyspnoea 
marked weakness 
productive cough and frothy sputum 
cyanosis
39
Q

Barotrauma

A

develops secondary to breathing gases at higher than normal atmospheric pressure

40
Q

Boyle’s law

A

volume of gas inversely proportional to pressue

41
Q

Dalton’s law

A

total sum of the mixture of gases is equal to the sum of the partial pressures of each gas

42
Q

Henry’s law

A

at a constant temp the amount of gas that will dissolve into a liquid is proportional to the partial pressure of the gas

43
Q

Decompression illness (DCI)

A

ambient pressure increase as diver ascends, increases the partial pressure of nitrogen which is dissolved into body fluids

44
Q

signs and symptoms of DCI

A

musculoskeletal pain
itching
resp complaint
neurological changes

45
Q

Specific diving history

A 
number of dives performed
surface interval between dives
type of ascent
depth of dive
breathing gas mixes used
levels of exertion before and after dive
46
Q

Submersion

A

process of experiencing resp impairment from submersion/immersion in liquid

47
Q

Indicators of good outcomes after submersion

A

less than 5min submersion
higher GCS post drowning
initiation of good quality CPR within 10m
first spontaneous breath within 30 m

48
Q

What happens during submersion:

A

voluntary apnoea, increased BP and HR
effects of hypercapnia and hypoxia lead to involuntary breath and sudden increase in airway pressure
Secondary apnoea, LOC, involuntary gasping
Hypoxia leads to bradycardia, hypotension and irreversible brain injury

49
Q

Factors suggesting aspiration

A 
prolonged immersion time
any LOC
mouth to mouth
cough
CPR required
cyanosis
tachycardia
wheeze/crackles
pink, frothy sputum 
altered conscious state 
reduced Spo2 readings
50
Q

Diving reflex

A

caused by cooling of the forehead

51
Q

Diving reflex results in:

A

bradycardia
peripheral vasoconstriction
bradypnoea
movement of blood to the core helps maintain higher core temps longer and initiates a bolus of oxygenated blood to vital organs prior to cardiac arrest

52
Q

History of drowning

A 
underlying medical conditons
how long before pt was discovered
submersion time
why was pt in water
how was pt found
type of water and temp
did the pt ingest water
any LOC before during or after
any witnessed headstrike 
CPR/mechanical ventilations
seizure activity

Clinical Science (13 decks)

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