LO1/2 Adverse Environments

Question 1

Thermoregulation

Answer 1

Heat production and excretion

Question 2

Hypothalamus

Answer 2

thermostat of the brain

Question 3

afferent

efferent

Answer 3

Skin to nervous system afferent pathways

Hypothalamus to body efferent pathways

Question 4

Lowest temp a human can survive

Answer 4

is 13.7

Question 5

hypothermia vs hyperthermia

Answer 5

Hyperthermia
Vasodilation (increased HR)
Hairs flat
Sweat – dermal layer of skin

Hypothermia
Vasoconstriction
Piloerection
Shivering

Question 6

Thermolysis

Answer 6

release of stored heat

Mediated by parasympathetic nervous system

Question 7

An increase in core temperature causes

Answer 7

the hypothalamus to send signals via Efarrant pathways in the parasympathetic nervous system causes vasodilation and sweating

Question 8

Body’s reaction to daily production of heat energy and to hot environment

Answer 8

Vasodilation:
The person may have a complete loss of vasomotor control blood pools in the periphery and the patient could experience distributive shock

Question 9

Radiation

Answer 9

body heat is lost to nearby objects without physically touching them (heat waves- sun)

Question 10

Conduction

Answer 10

body heat is loss to nearby objects through direct physical touch (touch)

Question 11

Convection

Answer 11

body heat is lost to surrounding air which becomes warmer, rises abd is replaced with cooler air (air moving over- an object-fan)

Question 12

Evaporation

Answer 12

body heat causes precipitation which is lost from the body surface when changed from liquid to vapor (sweating)

Question 13

Thermogenesis

Answer 13

Production of heat and energy for the body

Mediated by the sympathetic nervous system

Question 14

Main method of dealing with cold stressors

Answer 14

Skin is the body’s thermostat.

Increases muscle tone and initiate shivering in the short term

Increases thyroid levels in the long term

Hypothalamus shunts blood to the core.

Sweating decreases.

Question 15

Heat Illness

Answer 15

Increase in core body temperature

• -Due to inadequate thermolysis
• -Inability to get rid of the heat buildup in the body

Question 16

Heat Cramps

Answer 16

Acute involuntary muscle pains

Usually in the lower extremities, the abdomen, or both

Occur because of profuse sweating and subsequent sodium loss

3 factors contribute: salt depletion, dehydration and muscle fatigue

Question 17

Heat Cramps Treatment

Answer 17

Stop activity

Move the patient to a cool environment.

If the patient is too nauseated to take liquids by mouth, insert an IV catheter and infuse normal saline rapidly.

Do not massage the cramping muscles.

Question 18

Heat Syncope

Answer 18

Typically occurs in nonacclimated people

Can occur with prolonged standing or when standing suddenly from a sitting or lying position

Peripheral vasodilation is thought to be the cause.

Treatment involves placing the patient in a supine position and replacing fluid deficits.

Question 19

Water depleted

Answer 19

This form primarily effects geriatric patients.

Can effect active younger workers and athletes who do not adequately replace fluids in a hot environment

Question 20

Sodium Depleted

Answer 20

May take hours or days to develop

Results from huge sodium losses from sweating but replacing only free water

Question 21

Heat Cramps s/s

Answer 21

Temp < 40

No alt LOC

sweating

Headache, fatigue, dizziness, nausea, vomiting, and, sometimes, abdominal cramping

Skin is pale and clammy.

Fast and shallow respirations

Tachypnea

Question 22

Rhabdomyolysis

Answer 22

muscle breaks down releases potassium which can kill you (brown urine)

Question 23

“Summer flu”

Answer 23

Misdiagnosed

If untreated may progress to heat stroke

Question 24

Heat Exhaustion – TREATMENT

Answer 24

Stop activity

Remove to cool area

Remove clothing

Replace oral fluids - water or electrolyte fluid, no stimulants

If decrease LOC withhold fluid

Monitor ABC and LOC, if changes treat as load and go

Cardiac monitoring, ETCO2

Question 25

GOAL TEMP WHEN YOU ARE COOLING SOMEONE

Answer 25

38.8

Question 26

Heat Stroke

Answer 26

Least common but most deadly Caused by a severe disturbance in the body’s thermoregulation Core temperature more than 40°C (104°F) Altered mental status No sweating

Question 27

classic heatstroke

Answer 27

Passive heat stroke Usually occurs during heat waves

Question 28

exertion heatstroke

Answer 28

Typically an illness of young and fit people exercising in hot and humid conditions Generate heat without any means of excreting that heat

Question 29

Heat Stroke Treatment

Answer 29

Temperature between 37.7 degrees Celsius and 40 degrees Celsius Stop activity and remove from hot environment Remove excess layers of clothing if required If clinically indicated administer oxygen Cool patient by sponging front and back of patient with lukewarm water, allow air conditioning air currents to flow over the patient to promote cooling Stop cooling if temperature drops below 38.8 degrees, or patient starts shivering Apply cardiac monitor Establish vascular access- fluid Transport

Question 30

Frostbite

Answer 30

an ischemic injury that is classified as deep or superficial Occurs when ice crystals form between the cells of the skin, and then expand as they extract fluid from the cells

Question 31

Superficial Frostbite

Answer 31

first layer of skin Frequently involve tips of ears, nose and fingers Presents with loss of sensation and feeling of effected area Commonly feels soft to the touch and pale around area Complains of pain on rewarming Capillary leakage produces edematous skin in the area

Question 32

Deep Frostbite

Answer 32

all layers of skin Usually involves the hands or feet Looks like wax, white, yellow-white, or mottled blue-white Hard, cold, and without sensation Major tissue damage from thawing Partial refreezing of melted water may occur. As thawing occurs, the injured area turns purple, bluish, mottled and becomes excruciatingly painful Gangrene

Question 33

Frostbite Care

Answer 33

Remove patient from cold source Do not allow patient to use injured limb Remove coverings from area Rewarm area unless danger of refreezing - body heat, warm environment, warm water Do not rub or massage (ice crystals) Watch for hypothermia Fully frozen limb don’t do anything just transport

Question 34

Hypothermia

Answer 34

Is an imbalance between heat loss and heat production Some common issues leading to the development of hypothermia are: Cold temperatures Fatigue Improper gear for temperature Wetness Dehydration Malnutrition Length of exposure Intensity of weather conditions

Question 35

Immersion Hypothermia

Answer 35

Is the result of immersion in cool or cold water which results in a loss of body heat. Outcome may be better Mammalian Diving reflex Not dead till you’re warm and dead

Question 36

Mild Hypothermia

Answer 36

Below 36 degrees Increased metabolic rate Maximum shivering Thermogenesis

Question 37

Below 34 degrees

Answer 37

Impaired judgment Slurred speech Passive re warming

Question 38

Moderate Hypothermia

Answer 38

To 30 - 34 degrees Respiratory depression --Slowing down to save energy Myocardial irritability Bradycardia --Slowing down to save energy Atrial fibrillation Osborn waves or j wave Shivering stops at 32.2 degrees Warm IV fluid After drop is defined as the continued lowering of core body temp even after the patient is removed from the cold environment due to a shift of cold blood from the extremities during re-warming

Question 39

Severe Hypothermia

Answer 39

Below 30 degrees Half the metabolic rate Loss of reflexes Fixed and dilated pupils VFib Call hypothermia Drugs will not work normally

Question 40

Hypothermia Treatment

Answer 40

History and Assessment Maintain airway Handle with care Remove wet clothing Retain heat and place in warm environment Warmed oxygen if possible Warmed IV fluids If transport over 1 hour rewarm hot packs on pulse sites, not extremities No resp or pulse, cardiac monitor – CPR ALS

Question 41

Pathophysiology of Drowning and Submersion

Answer 41

Breath holding Water enters the mouth and nose A small amount of water is aspirated into the posterior pharynx and perhaps the trachea. Sets off spasms of the laryngeal muscles that seal off and protect the airway Water begins to enter the lungs.

Question 42

Laryngospasm

Answer 42

Leads to asphyxia and the patient may lose consciousness ‘ “Dry drowning” – cant get air in Only happens in cold water

Question 43

Drowning and Submersion Management

Answer 43

Resuscitation ABCs - -Assist ventilation as soon as possible with BVM and oxygen - -If there are weasels administer bronchodilators Trauma considerations ---Immersion episode of unknown etiology warrants trauma management Post-resuscitation complications - -Adult respiratory distress syndrome (ARDS) or renal failure often occur post-resuscitation - -Symptoms may not appear for 24 hours or more post- resuscitation Fresh versus saltwater considerations -No difference in prehospital treatment

Question 44

2 mechanisms Barotrauma

Answer 44

Pressure imbalance between gas-filled spaces in the body and the external atmosphere Compression of gases within body spaces during descent Expansion of gases within those spaces during ascent

Question 45

Barotrauma

Answer 45

Nitrogen in tissue not blood can cause gas embolism very painful As the diver ascends, the ambient pressure decreases and gases expand. Trained to exhale constantly as they are ascending

Question 46

Barotrauma results

Answer 46

Results in pulmonary over pressurization syndrome (“burst lung”) Can cause pneumothorax, mediastinal and subcutaneous emphysema, alveolar hemorrhage, and a lethal arterial gas embolism (AGE) Relative pressure and volume changes are greater near the surface of water

Question 47

Nitrogen narcosis

Answer 47

State of altered mental status caused by breathing compressed air at depth

Question 48

Injuries at Depth

Answer 48

Signs and symptoms Euphoric feeling Inappropriate behavior at depth Lack of concern for safety Apparent stupidity or inappropriate laughter Tingling of lips, gums, and legs

Question 49

Decompression Sickness

Answer 49

Rapid ascent Nitrogen bubbles form in blood “The Bends” Multisystem disorder Can potentially affect almost every organ in the body As a diver descends As a diver ascends

Question 50

The Bends

Answer 50

Is a diving complication that occurs when more Nitrogen is dissolved in blood when the gas is pressurized Because of the water pressure, body tissues absorbs nitrogen gas more rapidly as a diver descends than when ascending If a diver ascends to rapidly nitrogen gas bubbles will form in body tissue rather than being exhaled.

Question 51

Dirty bombs

Answer 51

Any container designed to disperse radioactive material; intended to injure with both the radioactive material and explosive material Nuclear weapons Nuclear bombs/missiles Special atomic demolition munitions Small suitcase like weapon design to destroy individual targets

Question 52

Radioactive Exposure Signs and Symptoms | Vary depending on:

Answer 52

Amount of radiation | Route of exposure

Question 53

Low exposure Moderate exposure Severe exposure:

Answer 53

Low exposure: nausea, vomiting, diarrhea Moderate exposure: first-degree burns, hair loss, depletion of immune system, cancer Severe exposure: Second/third-degree burns, cancer, death

Question 54

Snakebite Management

Answer 54

ABC support as needed O2 as needed Keep patient calm and motionless to decrease venom spread and absorption Immobilize the Extremity in a neutral position DO NOT apply constricting bands or ice Immediate transport