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PC1-2 > Vol.4-Ch.10 "Environmental Trauma" > Flashcards

Vol.4-Ch.10 "Environmental Trauma" Flashcards

1
Q

what are 5 risk factors for an environmental emergency?

A
  • age
  • poor general health
  • fatigue
  • predisposing medical condition
  • certain medications
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2
Q

what are the 2 ways the body gains and looses heat?

A

within the body or contact with the environment

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3
Q

what is the thermal gradient?

A

the difference between the temp in he environment and the human body

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4
Q

what are the 3 ways the body produces heat or Thermogenesis?

A

1) Work Induced Thermogenesis - exercise or shivering
2) Thermoregulatory Thermogenesis - controlled by endocrine system; thyroid gland or epi/norepi from adrenal gland
3) Metabolic Thermogenesis or Diet-Induced Thermogenesis - heat made through the ingestion and digestion process of food

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5
Q

Thermogenesis VS Thermolysis

A

Heat generation vs heat loss

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6
Q

What are the 5 ways the body looses heat (thermolysis)?

A

1) Conduction - direct contact to a colder object
2) Convection - heat loss to air currents passing over body
3) Radiation - heat loss without contact, an unclothed person will loose 60% total body heat at room temp
4) Evaporation - heat loss as water evaporates from the body
5) Respiration - heat loss through release of warm humidified air in the lungs

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7
Q

What is normal body temp?

What is “steady-state metabolism”

A

98.6 degrees

It is a characteristic of mammals that allows them to regulate body temp. A naked person can regulate their body temp with external temps of 55-144 degrees

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8
Q

How can you take peripheral and core body temps?

A

Peripheral - oral or axillary
Core - tympanic or rectal

Core temp is more important to know because it is where the major organs lie

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9
Q

How does the body maintain temp balance?

A

Almost entirely through the NERVOUS SYSTEM and NEGATIVE FEEDBACK mechanisms (ones that can be stopped)

This is done through the HYPOTHALAMUS which acts a thermostat and controls temp w/ neurosecretions

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10
Q

Mechanisms of heat dissipation?

heat conservation?

A

Dissipation:

  • sweating
  • vasodilation

Conservation:

  • shivering
  • vasoconstriction
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11
Q

Where are there thermoreceptors and what do they sense?

A

There are ones in the skin and mucous membranes for Peripheral thermoreceptors and in deep tissues for Central thermoreceptors.

Both sense the cold more than heat b/c there are more numerous cold receptors

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12
Q

Basal metabolic rate vs exertional metabolic rate

A

the metabolic rate at rest vs metabolic rate needed for any extra activity or energy expense

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13
Q

The body uses metabolic rate mainly to manage heat but how does it use its blood and vessels?

A

The body can dilate and constrict certain vessels to shunt blood to peripheral vessels where the heat can be given off through the skin, or adversely it can do Counter-Current Heat Exchange and shunt blood away from the superficial veins

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14
Q

What are your 3 general signs of hyperthermia; what are 2 signs of thermolysis inadeuacy?

A
  • Diaphoresis
  • Increased skin temp
  • flushing
    (the last two are caused by vasodilation of vessels close to skin)
  • AMS
  • Altered LOC
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15
Q

What are the 4 types of heat disorders? (technically caused by inadequate thermolysis)

A
  • Hyperthermia
  • Heat Cramp
  • Heat Exhaustion
  • Heat Stroke
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16
Q

Predisposing factors for heat injuries (7) (also basically the same for cold)

A
  • Age
  • General Health:
    (diabetics develop AUTONOMIC NEUROPATHY which damages the autonomic nervous system and may interfere with the thermoregulatory input)
  • Medications:
    (Diuretics, Beta-Blockers [interfere with vasodilation and the bodies ability to increase heart rate to compensate for volume loss], psychotropics/antihistamines)
  • Level of Acclimatization
  • Length of Exposure
  • Intensity of Exposure
  • Environmental factors (humidity or wind)
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17
Q

3 preventative measures to heat disorders?

4 for cold?

A
  • maintain hydration
  • allow time for acclimatization
  • limit exposure to hot environments
  • dress warm
  • rest in order to replenish energy for heat generating machanisms
  • eat enough at regular intervals to support metabolism
  • limit exposer to cold environments
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18
Q

What are heat cramps?
what are the signs and symptoms?
how do you treat them?

A

They are cramps caused by dehydration and overexertion of muscles. As you sweat you loose water and sodium (electrolytes) which can lead to muscles cramping.

Pt will have stable vital, skin moist and warm, possible nausea or dizzy or weak, mentally alert, normal or slightly elevated body temp

Treat w/:

  • remove from environment
  • give water or sports drink (do NOT give salt tablets)
  • educate (if they continue they may have heat stroke or exhaustion)

(salt tablets do not absorb quickly and will cause stomach irritation)

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19
Q

What is heat exhaustion?
signs and symptoms?
treatment?

A

Ultimately the loss of water and sodium in combo with vasodilation (the bodies normal response to try to dissipate heat) will cause a decrease in circulating blood volume, venous pooling, and cardiac output.

Pt will mirror shock, cool/clammy skin, rapid/shallow respirations, weak pulse, may have signs of active thermolysis such as diarrhea or muscle cramps

Treat w/:

  • Remove from environment
  • Put in Supine Position w/ knees elevated
  • Water and sports drink (do NOT give salt tablets)
  • Remove excess clothing and fan pt
  • treat for shock if distributive shock is present
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20
Q

What is heat stroke?
signs and symptoms?
treatment?

A

It is the loss of the regulatory function of the hypothalamus, resulting in uncompensated hypothermia. It is general characterized as a body temp of 105degrees+, CNS disturbances, and the cessation of sweating

Pt will have ceased sweating, hot dry or moist skin (depending on when the sweating stopped), very high core body temp, deep respirations the become more shallow and can start rapid but will later slow, a rapid/full pulse that will later slow, hypotension with low or absent diastolic, confusion/disorientation/unconscious, CNS symptoms (headache, anxiety, paresthesia, impaired judgement, or psychosis), and possibly seizures

Treat w/:

  • remove pt from environment
  • rapid cooling (remove clothing, place cloths soaked in tepid water, fanning, and aim for temp of 102)
  • O2 if pt is hypoxic
  • Fluid therapy if pt is alert and can swallow (oral or iv)
  • Monitor ECG
  • Avoid vassopressors and anticholinergic drugs
  • monitor body temp
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21
Q

Signs and symptoms of dehydration (5)

A

dehydration inhibits vasodilation and therfor thermolysis, it also causes orthostatic hypotension (increased pulse and drop in BP when rising from supine)

  • nausea, vomiting, abdominal distress
  • vision disturbances
  • decreased urine output
  • poor skin turgor
  • signs of hypovolemic shock
22
Q

What is pyrexia?

What are pyrogens?

A

Pyrexia = Fever

A fever develops when pathogens enter the body and stimulate the production of PYROGENS, which are any substances that cause a fever (ex. virus or bacteria), they reset the hypothalamic thermostat to a higher level and increase metabolic activity to increase heat. The purpose of this heat increase is to try to make the internal environment too hot for the pyrogens to live.

23
Q

What is a specific type of pt to watch out for with fevers?

A

A child with history of febrile seizures, b/c the parents will often have extra cloths or blankets on them b/c they feel cold but these NEED TO BE REMOVED down to just a diaper or underwear

24
Q

What should be avoided in the cooling process of pts?

A

Sponge baths, cold water immersion, cold packs or anything that will cause cooling too quickly as this can induce shivering which causes the body temp to rise back up

25
Q

what are 2 good antipyretic meds?

A

Acetaminophen (tylenol): 15mg/kg for kids and 650-1000mg for adults

Ibuprofen (motrin): 10mg/kg for kids and 600-800mg for adults

26
Q

When is Induced Therapeutic Hypothermia used?

A

After a successful cardiac arrest resuscitation

27
Q

When is a pt hypothermic?

A

when they have a core temp below 95degree

28
Q

What are the temp ranges and signs/symptoms of:
Mild hypothermia
Moderate hypothermia
Severe hypothermia

A

Mild Hypothermia: 90-95 body temp

  • tachycardia, vasoconstriction
  • shivering
  • tachypnea
  • fatigue
  • impaired judgement

Moderate Hypothermia: 82-90 body temp

  • cold induced arrhythmia
  • hypotension
  • respiratory depression
  • AMS
  • Loss of shivering

Severe Hypothermia: Less than 82 body temp

  • coma
  • apnea
  • Ventricular arrhythmias or asystole

(In 2 tiered system, above 90 is moderate, below is severe)

29
Q

Treatment plan for hypothermia? (6)

A
  • remove wet garments
  • protect against further heat loss and wind chill; use passive external rewarming (blankets, etc)
  • maintain pt in horizontal position
  • avoid rough handling, this can cause arrhythmias
  • monitor core temp
  • monitor cardiac rhythm
30
Q

What is rewarming shock?

A

It is when the use of external heat beyond a blanket like heat packs can cause a vasodilation of the peripheral veins (as is done to dissipate heat) which will in turn create a drop in core body temp and may cause shock because the dilation may drop the blood pressure

(most rewarming pts die from ventricular fibrillation)

31
Q

What are safe means of active rewarming?

A

warm blanket
IV given at 95-100 degrees

(it says maybe heat packs put over areas of high heat transfer: base of neck, axilla, groin; but It also says this can lead to rewarming shock)

32
Q

What is cold diuresis?

What is the best way to prevent rewarming shock and cold diuresis?

A

Cold diuresis is when the body vasoconstricts the core vessels which raises BP, therefore the kidneys get rid of fluid through urine in order to bring the pressure down, thus causing diuresis

Warm IV fluids is the best thing to prevent rewarming shock and cold diuresis

33
Q

What is compensated hypothermia?

A

A pt will have signs and symptoms of hypothermia but still have a normal core body temp. This will end as the glycogen stores in the liver and muscles are used up.

34
Q

What are 2 concerns about giving drugs to a hypothermic pt?

A
  • one the drug metabolism is reduced so the pt may accumulate toxic doses of the drug if too many doses are administered repeatedly
  • two the drugs may remain in the peripheral vascular system, then once the pt is rewarmed and the vessels relax, it could release toxic level boluses to the pt

(**Meds should be avoided if the body temp is below 86 degrees, the ability for the heart to be restarted if it is below 86 degrees is very slim anyways)

35
Q

Frostbite occurs when?

Superficial VS Deep frostbite

A

When the tissues get so cold that ice crystals form which draw water out of the cells, as ice expands it destroys the cells.

Superficial Frostbite (frostnip) :

  • freezing of epidermal layers
  • redness followed by blanching
  • diminished sensation

Deep Frostbite:

  • freezes epidermal and subcutaneous layers
  • white and hard skin
  • loss of sensation
36
Q

Treatment Do’s and Don’ts for frostbite? (8)

A
  • do not thaw if possibility of refreezing is possible
  • do not massage area (this could cause ice crystals to do more damage)
  • administer analgesia prior to thawing
  • transport to hospital for rewarming by immersion
  • cover the thawed part with loosely applied, dry, sterile dressing
  • elevate and immobilize the thawed part
  • do not puncture or drain blisters
  • do not rewarm frozen feet if they are required for walking out of a hazardous situation
37
Q

What is trench foot or immersion foot?
How do you treat?
how do you prevent?

A

It is when you stand in standing cold water for days, it is similar in symptoms to frostbite

Treat with early recognition, warm/dry/aerate/elevate the feet

prevent by avoiding long exposure to standing in water, change wet socks frequently, and never sleep in wet boots or socks

38
Q

What are the 9 steps of drowning between going under water and ending in death?

A

1) involuntary breath hold
2) water swallowed
3) involuntary laryngospasm due to liquid in the oropharynx
4) evolving hypoxia, hypercarbia, and acidosis
5) laryngospasm resolves due to worsening of hypoxia and unconsciousness
6) liquid enters lungs
7) surfactant washout
8) worsening hypoxia and acidosis due to pulmonary hypertension and shunting
9) development of cardiac arrest and electrolyte derangements

(**surfactant is the substance that helps to keep the alveoli open)

39
Q

What are 4 factors that effect survival rates of drowning?

A
  • cleanliness of the water
  • length of time submerged
  • age (children have better prognosis)
  • general health
40
Q

What is the cut off time for when a person should be attempted to resuscitate?

A

If a pt is under for less than 60minutes they should be attempted, especially if it is in near freezing water b/c this can increase time for them to be resuscitate. But if pt is under for longer than 60 minutes they usually cannot be resuscitated

41
Q

What is the mammilian diving reflex?

A

Basically it is a reflex when someone goes into near freezing water where the body goes bradycardic, and vasoconstriction helps tissues resist hypoxia, while the cerebral and cardiac blood flow is maintained, sending the bodies O2 to the heart and brain

“the cold water drowning pt isnt dead until he is warm and dead”

42
Q

What is the main problem with the drowning pt ?

A

Primary insult is anoxic brain injury; the body will eventually use up all the o2 leaving just waste products in the blood, therefore the main goal is to oxygenate the blood and ventilate out the waste

43
Q

Are abdominal thrust, cpap/peep, or cpr compression only CPR good or bad for a drowining pt?

A

CPAP and PEEP are almost always going to be used because the drowning Pt usually has atelectasis (collapsed alveoli) from the surfactant washout phase

Compression-only CPR and abdominal thrusts are bad b/c the pt is hypoxic based arrest so they need O2 not just compressions and ab thrusts just delay o2 and vents and risk aspiration

44
Q

Why should all drowning pts go to the hospital for continuous care?

A

B/c of the risk of ADULT RESPIRATORY DISTRESS SYNDROME (ARDS) which is caused by stress to the lungs during drowning that can lead to fluids leaking into alveoli, causing inflammation; also risks like destruction of surfactant, pneumothorax, aspiration pneumonia, etc.

45
Q

Boyle’s Law VS Dalton’s Law VS Henry’s Law

A

Boyle’s:
Volume of gas is inversely proportional to its pressure if the temp is kept constant

Dalton’s:
Total pressure of a mixture of gases is equal to the sum of partial pressures of the individual gases

Henry’s:
Amount of gas dissolved in a given volume of fluid is proportional to the pressure of the gas above it

46
Q

What is the pressure of the air at sea level?

A

760mmHg

47
Q

What is the gas that causes problems when diving and how does it work?

A

When a person dives, it increases the pressure on the O2 and nitrogen in the body, pushing it into the blood plasma. The O2 gets used up but the nitrogen does not, so the deeper you go the more nitrogen is pushed into and stored in the blood. Thus when you rise to quickly it is releasing too much nitrogen too fast and creating bubbles. Similar to when you decompress a soda can by opening it and the stored gas bubbles get released causing fizz

48
Q

What are the 4 stages of a dive and what injuries can occur at those stages?

(pay attention to caps terms)

A

1) On the Surface:
- things like boat injuries, entanglement, cold water shivering/blackouts

2) During Decent:
- this is caused by Barotrauma or injuries caused by changes in pressure. During the decent the increase in pressure is called “The Squeeze” and if a diver cannot equilibriate the pressure between the nasopharynx and the middle ear (through the eustachian tube) they can get middle ear pain, ringing in the ears, dizzy, or hearing loss.

3) On the Bottom:
- commonly involve NITROGEN NARCOSIS which is when the nitrogen messes with cerebral function and causes AMS

4) During Ascent:
- decents over 33 ft often involve staged ascents to prevent DECOMPRESSION SICKNESS (the bends or Dysbarism) which is when ascent is too fast and causes a release of Nitrogen in the form of bubbles causing a lot of pain in the abdomen and joints
- PULMONARY OVERPRESSURE occurs when a pt holds their breath during ascent, the compressed air in the lungs at the bottom will expand as the pt rises and that must be released through exhaling or it can cause:
- ARTERIAL GAS EMBOLISM
- pneumothorax
- PNEUMOMEDIASTINUM (air released from damaged lung that goes into mediastinum and can get through the visceral pleura of the heart

49
Q

What signs and symptoms separate decompression sickness type I and type II?

What are the main 2 things to do to help?

A

Type I:
joint pain
rash
swollen or painful lymph nodes

Type II:
neurological problems
inner ear problems
cardiopulmonary problem

Mainly giving O2 or possibly putting them in a hyperbaric O2 chamber (obviously done in a hospital)

50
Q

What is the specific name of a network you can call in regards to diving emergencies?

A

DAN - Divers Alert Network

51
Q

What are 5 ways to help prevent high altitude sickness?

A
  • Gradual Ascent
  • Limited Excertion
  • Sleeping Altitude
  • High Carb diet
  • Medications :
    - Acetazolamide (a diuretic that helps force out bicarbonate from the kidneys; this helps the hypoxic ventilatory response that improves ventilation and O2 transport with less alkalosis)
     - Nifedipine (treats high blood pressure; causes vessels to dilate, preventing the increase in pulmonary overpressure that causes pulmonary edema)
52
Q

What are the 3 types of high altitude sickness?

A

1) Acute Mountain Sickness:
- 2,000m or more ascent
- includes a head ache with at least on of the following symptoms as well: GI problems, fatigue, dizzy, difficulty sleeping)

2) High Altitude Cerebral Edema (HACE):
- change in mental status or ataxia and AMS
- both mental status change and ataxia w/out AMS

3) High Altitude Pulmonary Edema (HAPE):
- result of increased pulmonary pressure and hypertension caused by changes in blood flow at high altitude, children are more susceptible and women least susceptible
- at least 2 symptoms: dyspnea at rest, cough, weakness, chest tightness
- at least 2 signs: crackles/wheezing, central cyanosis, tachypnea, tachycardia

PC1-2 (23 decks)

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