Ross - Environmental Injury Flashcards by Alice Richards

what do you need for initial eval and continued monitoring of hypothermia

core temp

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2 types of core temp

rectal

bladder

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typical triage thermometers only go down to

95F

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Swiss Hybrid Classification of Hypothermia

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HT1 - mild hypothermia criteria

sx: conscious, shivering

core temp: 35-32C (90-95F)

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tx for HT1

warm environment

warm, sweet drinks

active movement

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HT2 - moderate hypothermia criteria

impaired consciousness

core temp: 28-32C (80-90F)

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tx for HT2

active external and minimally invasive rewarming:

warm environment, heating blanket, warm parenteral fluids

core temp monitoring

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HT3 - severe hypothermia criteria

unconscious, vitals present

core temp: <28C (80F)

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tx for HT3

same as HT2

treat in ECMO center dt high risk of cardiac arrest

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HT4 criteria

vitals absent, cardiac arrest possible

core temp: <32F

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tx for HT4

cpr

3 doses of epi w. defib

HT2 tx and transport to ECMO

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what stage of hypothermia is shivering reflex lost

HT2

core temp 80-90F (28-35C)

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beginning at what stage of hypothermia might you see dilated pupils (+/- fixed), bradycardia, afib

HT2

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ventricular arrhythmias can occur below what temp

86F

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what stage of hypothermia involves areflexia, hypotn, pulmonary edema

HT3

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cardiac arrest is very likely beginning at what stage of hypothermia

HT3

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what should you order at HT4 to assess if pt is alive

potassium

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indications that a person is dead and can not be resuscitated following drowning (5)

core temp > 32F (hypothermia is not the case)

K+ > 12

cardiac arrest prior to cooling

chest not compressible → frozen

asystole

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if core temp is < 32 AND K+ < 12, consider

ECMO

warm up 5 degrees or to 32 and check for spontaneous return of vitals

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what tx are indicated for HT4 until death is determined

epi

cpr

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ekg findings in hypothermia

atrial arrhythmias: afib, first degree block

J wave

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electrolyte findings in hypothermia may include (3)

hyperkalemia

hypophosphatemia

hypomagnesemia

dehydration

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core temp > 32F PLUS no response

likely dead

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process resulting in respiratory impairment from submersion in liquid

drowning

submersion in water without respiratory complications

water rescue

if you are on the scene of a drowning and the person is conscious, what should you do (5)

get to land initiate bls give O2 keep warm call for EMS

if you see an unconscious person in the water, what should you do (3)

keep vertical get to land if no pulse, give rescue breaths or use ambubag

tx for unconscious drowning victim with no pulse

ABC not CBA → 5 initial breaths continue CPR until ems brings to ED

tx for unconscious drowning victim in ED

if core temp \> 95 → terminate resuscitation efforts if core temp \< 95 and it was cold water → consider rewarming

mc complication of resuscitation

regurgitation of stomach contents → aspiration

what is immersion

head above water → have cardiac arrest → drown

what is submersion

head under water → drown → cardiac arrest

immersions have cardiac arrest due to

hypothermia

submersions have cardiac arrest due to

hypoxia

who can go home after a drowning incident

no significant sx at scene: cough, difficulty breathing, abnormal vitals

who needs to go to ED after drowning incident

any symptoms at all young children

work up for pt's in previous card

CXR VBG pulse ox obs x 6 hr

injury that involves hand or foot immersed in non-freezing water and causes arterial spasm

trenchfoot

sx of trenchfoot (3)

hyperemia blistering redness/ulceration hand/foot is cold/anesthetic

complications of trenchfoot (3)

permanently increased sensitivity to cold hyperhidrosis Raynaud's

pathology of cold extremity injury

vasoconstriction → endothelial damage → extracellular to intracellular ice formation → cell death

4 stages of extreme cold injury

pre-freeze freeze-thaw progressive microvascular collapse ischemic

what stage of freezing injury does ice begin to form

freeze-thaw → extracellular ice

non freezing injury with excellent prognosis that typically occurs in non-freezing temps

frostnip

tx for frostnip

warm, dry environment

who is esp at risk for complications w. frostnip

pt's w. PVD

classifications of frost bite

like burns → 1st degree-4th degree

what stage of frost bite has sub q involvement

stage 3

what stage of frostbite involves muscle and bone

4th

zones of injury in frostbite

1. neurons 2. muscle 3. endothelial cells

t/f: in frostbite, zones of injury are irreversibly damaged

F! they may come back

tx for frostbite

rapidly warm extremity → water bath of 102 F preferred avoid slow defrost splint and pad to avoid further injury **do not let refreeze**

in frostbite, should you rewarm even if there is a chance it will refreeze again

no! only rewarm once you can keep it warm

what is this showing

frostnip

what is this showing

2nd degree frostbite

what is this showing

3rd degree frostbite

what is this showing

4th degree frostbite

what is this showing

thawed trenchfoot

what is this showing

chillblain/pernio

blue discolored sub q tender vesicles no long term damage first 3-6 hr

chillblain

swelling pain, ache, desquamation no long term damage 6-12 hr

gray zone

all damaged skin sloughs off eschars form chronic pain/inability to walk 12 hr -3 days

pernio

at what altitude do you experience increased ventilation

4921 ft

normal physiologic response to acclimatize

peripheral vasoconstriction → triggers baroreceptors → suppresses ADH/aldo → diuresis

normal sx of altitude (5)

exertional dyspnea spontaneous diuresis → decreased stroke volume nocturnal periodic breathing frequent night awakening weird dreams

4 high altitude syndromes

acute hypoxia acute mountain sickness HACE (high altitude cerebral edema) HAPE (high altitude pulmonary edema)

3 at risk pops for altitude syndrome

decreased pulmonary reserve rate of ascent previous AMS

sx of acute mt sickness

AMS → HA GI dizziness sleep disturbance

can you have acute mtn sickness w.o ascent

no!

4 tx for acute mtn sickness

stop ascent acetazolamide O2 +/- pressure bag

ataxia, AMS, extreme weakness, +/- personality changes

HACE

tx for HACE (5)

stop ascent acetazolamiode O2 dexamethasone hyperbaric therapy

non cardiogenic edema, dry cough, decreased exercise tolerance

HAPE

what altitude does HAPE start at

8202

what is this showing

pulmonary edema

tx for HAPE (6)

descent minimize cold/exertion O2 nifedipine/acetazolamide/viagra CPAP hyperbaric therapy

exposure to altitude not recommended in what disease states (5)

CHF uncompensated pHTN HTN severe COPD sickle cell

tx for all AMS in altitude disorders

steroids