Lecture 7: Environmental Emergencies Flashcards
What is good samaritan law?
Not liable when providing emergency care.
Stay within your scope ideally
Must turn over to emergency personnel once they arrive.
What are the 3 stinger type insects with venom?
- Bee
- Hornet
- Wasp
Can only differentiate via allergy testing
How long might it take for insect venom to cause anaphylaxis?
15-30 mins, maybe even more
What is the average epi dose for a child? Cutoff? Adult?
- Child < 33 lbs: 0.1mg
- For a child/person 33-66 lbs: 0.15 mg
- For an adult: 0.3 mg
Anterolateral thigh is main site.
How much epi remains in an autoinjector after injection?
1.7 mL
How does carbon monoxide poisoning present?
- HA
- N/V
- Weakness
- Confusion
- Syncope
- Cherry red skin is pretty rare
Will affect multiple people simultaneously
How do you treat carbon monoxide poisoning?
- 320 minutes of RA
- 74 minutes of 100% O2
- 23 minutes in hyperbaric chamber
What is the spectrum of heat illness?
- Heat Edema
- Heat Syncope
- Heat Cramps
- Heat Exhaustion
- Heat Stroke
Demographics most at risk for heat illness
- Young/elderly
- Obese/thin
- Mental illness
- Drugs/ETOH
- Limited hydration/nutrition
- Depends on if its hypernatremic or hyponatremic
Management of Heat edema
- Mild swelling d/t vasodilation and venous stasis
- Elevate ext + rest
Management of heat syncope
- Vasodilation + intravascular redistribution
- Oftentimes normal Na or hypernatremic
- Treat as heat edema, but consider IVF.
Management of heat cramps
- Painful spasms d/t hyponatremia
- Temp is normal or slightly elevated
- Moist/dry skin
- Cool them and give them 6% carb & electrolyte (gatorade)
- Avoid heat/exertion for 1-3d
Features of heat exhaustion
- Unable to maintain CO
- Muscle cramps + tachy + hypotension + temp of around 104F
- Could have dark urine
- Either hypo or hypernatremic.
Most accurate core temp is via rectal.
What is required to treat heat exhaustion?
Water with electrolytes
What are the additional symptoms of heat stroke over heat exhaustion?
- Dysfunction of heat regulation due to hyperthemia + end organ dmg
- Neural dmg, hepatic dmg, and vascular dmg occur
- CV collapse due to vascular volume loss
Characteristics of a thyroid storm
- Zero TSH, but very higher T3/T4
- Temp > 38C
- N/V/D/Abd pain
- Shaking of hands, anxious
- Tachy, HTN, sweating
High mortality if untreated.
S/S of heat stroke
- HA/dizziness/N/V/AMS
- Hematuria, hematemesis, bruising/petechiae, oozing
- Hot, flushed, Dry
- Tachycardic with bounding pulse
- Hypotensive
Management of Heat Stroke
- Rapid cooling
- Severe shivering = BZD after electrolyte check
- Monitor core temp until safe zone of 101.5-102
- If unresponsive…. internal lavage to cool the brain
- IV NS bolus for hypotension and rhabdo
- Goal Urine output: 50-100 mL/hr
- Supplemental O2
What is ICU criteria for heat stroke?
- Hemodynamic instability
- Rhabdo
- LFTs elevated/severe lyte abnormalities
- Unknown etiology
What are the poor prognostic signs of heat stroke?
- Extreme hyperpyrexia (107F+)
- Hyperkalemia w/ rhabdo
- Coma persists after cooling
- Marked LFT elevation
Hypothermia stages
Under 32C, you cannot rewarm yourself!
You can only recover alone in stage 1
Hypothermia management
- Rewarm in 24C or higher environment
- Horizontal/supine
- If in VFIB, you get 1 shot to defib until core temp is 30C
Overview of acute mountain sickness
- Primarily occurs above 9k feet unless ill
- Decreases in PO2
- HA w/ anorexia, weakness, dizziness, imsomnia, etc
- Untreated => HAPE => HACE
By the time youre at 15k, arterial blood = venous blood at seas level.
Everest PO2 is even lower than fetal umbilical PO2
