WEEK 9 - Environmental Issues

Question 1

For mild hypothermia (35-32oC), signs and symptoms include:

Answer 1

pale and cool to touch
numbness in the extremities
sluggish responses, drowsiness or lethargic
shivering
tachycardia and tachypnoea

Question 2

For moderate hypothermia (32-28oC), signs and symptoms include:

Answer 2

decreasing conscious state
may have been incontinent of urine as a result of an increased workload on the kidneys related to blood being shunted to the major organs
no longer shivering
bradycardia, bradypnoea, hypotension

Question 3

For severe hypothermia (below 28oC), signs and symptoms include:

Answer 3

unconsciousness/unresponsiveness
severe bradycardia and irregular rhythm, with possible asystole
no response to light in the pupil of the eye
rigid muscles – the person might feel like they are in rigor mortis
pulses and respiratory effort may be present but diffcult to detect

Question 4

Treatment for hypothermia follows these principles:

Answer 4

• prevent further heat loss (remove wet clothes, cover patient)
• passively rewarm the patient (warm blankets, space blanket, heating)
• gently move any patient less than 32oC (risk of arrhythmias with sudden/jerky movements)
• minimise IV fluids (can cause further drop in temperature)
• active internal rewarming (warm fluids and irrigation) is done in the hospital setting
• alter ABC and resuscitation management as required (e.g. abandon defibrillation)

Question 5

Signs and symptoms of heat cramps/heat stress include:

Answer 5

muscle pains/spasms (depletion of salt and water)
diaphoresis
heat rash from excessive sweating
red, very warm skin

Question 6

Signs and symptoms of heat exhaustion (<40.5oC) include:

Answer 6

excessive diaphoresis
pallor
tachycardia
widespread muscle cramps
nausea and vomiting
dizziness/syncope
headache

Question 7

Signs and symptoms of heat stroke (>40.5oC) include:

Answer 7

severe headache
tachycardia and tachypnoea
altered GCS (confusion/coma)
possible seizures
red, hot, dry skin
muscle breakdown - rhabdomyolysis and kidney failure

Question 8

Treatment for hyperthermia follows these principles:

Answer 8

moving the patient to a cool area (air conditioning)
removing clothing to expose body and promote heat loss
promoting fluid intake if conscious in mild hyperthermia
externally wetting skin with cool water
cold packs in axilla/groin/head
IV fluid resuscitation
Monitor ABCs, dysrhythmias and BGL

Question 9

Some individuals with underlying diseases are more susceptible to allergic reactions as a result of elevated IgE levels. These include:

Answer 9

infection states (HIV, tuberculosis)
inflammatory conditions
malignancies
cystic fibrosis
immunodeficiency diseases

Question 10

Signs and symptoms of allergies include:

Answer 10

itchy eyes
rhinitis/rhinorrhoea
wheezing/asthma
eczema/urticaria
hives/welts
anaphylaxis!

Question 11

Treatment of allergies

Answer 11

Treatment for allergic responses predominantly involves managing symptoms and preventing exposure. If symptoms are very mild, no treatment may be required. If these symptoms are irritating or continuing however, patients can take an antihistamine. Other patients may require a ventolin puffer or nebuliser should they experience moderate respiratory symptoms, or even adrenaline and IV fluid if anaphylaxis is present

Question 12

Signs and symptoms of envenomation include:

Answer 12

pain at site of bite/sting
local tissue damage
hypotension
headache
blurred vision
nausea and vomiting
abdominal pain
lymphadenopathy
coagulation issues
muscle weakness/paralysis
rhabdomyolysis

Question 13

Management principles of envenomation include:

Answer 13

• monitor ABCs at all times
• minimise movement of patient
• transport to hospital
• consider contacting toxicology services for specific management

insect sting:
- scrap out sting of bee
- apply ice to site
- consider analgesia

spider bite:
- cold pack to site for pain relief
- analgesia (red back)
- antihistamines if required
- antivenom administration (in hospital - funnel web)

snake bite:
- apply a pressure immobilisation bandage for all Australian snake bites (see ARC guideline below)
- antivenom administration (in hospital)

Question 14

Symptoms of funnel web spider bites

Answer 14

• tingling around the mouth and tongue
• increased salivation
• nausea and vomiting Or headache
• SOB
• Altered conscious state
• hypertension

Question 15

Prehospital management focus for a blue ringed octopus bite

Answer 15

Airway and ventilations due to paralysing effects of the venom