Wilderness Med Flashcards
Our baseline metabolism raises our body heat ___ every hour
1.1 degrees celsius
Fortunately we transfer heat into the environment via
- Conduction: direct contact
- Convection: air currents
- Radiation: being in space that is cooler than our own body
- Evaporation (most effective way we lose heat)
Physiologic changes under heat stress
- HR increases
- peripheral vasodilation
- sweating
Risk factors for heat illness
- young and old
- Meds (anticholinergic, BB, lithium)
- alcohol
- Obesity
- CHF
- mental illness
- athletes, laborers, military
- low socioeconomic position
Tx of heat cramps
electrolyte repletion, NS IV
*often after exercise
Tx of heat syncope
Horizontal positioning
Tx of heat edema
leg elevation, compression hose, acclimatization
Tx of heat rash
chlorhexidine cream
*usually under clothed areas (macular-papular rash)
Definition
Volume depletion in the setting of heat stress
heat exhaustion
signs and sx of heat exhaustion
- Fatigue
- Nausea/vomiting, anorexia
- Heat cramps
- LOC: dizzy/syncope
- HR and RR increased
- Skin: pale, cool, clammy, flushed
heat illnesses
- minor heat illnesses
- heat exhaustion
- heat stroke
tx of heat exhaustion
- Rest
- Cool environment
- CBC and chemistry (Cr)
- IV fluids
- Consider admission for elderly patients or those with significant electrolyte abnormalities
Life-threatening rise in internal temperature
Classic and exertion
heat stroke
signs and sx of heat stroke
- LOC: Disoriented, irritable, combative, unresponsive
- Altered mental status*** (Helps differentiate from heat exhaustion), hallucinations, seizures
- Ataxia
- Increased HR and RR
- Skin: Hot, wet or dry, flushed
- Core temp > 104 degrees
- Elevated Transaminases in liver function and Cr
How does humidity effect our cooling mechansim
more difficult to cool off
Tx of heat stroke
- Aggressive cooling*** (evaporative or immersive)
- Ice packs, cooling blankets, lavage
- Airway monitoring and management
- Avoid antipyretics ie. NSAIDs (DONT HELP–> too hot)
- IV fluids if hypotensive after cooling
- Admission
what is drowning definition
Respiratory impairment from submersion in a liquid
Describe the physiology of drowning
Submersion - panic - breath holding - struggle - hypoxia - loss of consciousness - respiratory arrest - cardiac arrest
What factors affect drowning survivability (these factors lead to better outcomes)
- Shorter
- Colder (lowers metabolic needs)
- Cleaner
- Younger
- Calmer
- BLS sooner
Management/work up of drowning
- ECG to evaluate heart rhythm
- Chest XR
- Pulse ox, capnography, ABG
- CBC and chemistry
- ABCs and rewarming
- Monitor for respiratory signs and symptoms
- watch for 4-6 hrs
common bites and stings
- Venomous Snakes
- Spiders
- Bed Bugs
- Hymenoptera
Signs and sx of crotalid envenomations
- Fang marks
- Swelling and pain
- Bruising, blistering, necrosis
- Weakness, sweating, chills
- Nausea, vomiting
- Numbness, lymph node swelling
Signs and sx of Elapid envenomations
- Local swelling
- Nausea, vomiting
- Dizziness
- Respiratory difficulty
Snake bite initial management
Do not need the snake, pictures preferred
- Keep patient calm
- Immobilize the limb (prevent if from dispersing in blood more)
- Monitor degree of symptoms
- Avoid tourniquets (can overly concentrate in 1 area), ice, electricity, suction
- Clean wounds
- Close monitor of ABCs– need cardiac monitoring
Supportive care for pain, nausea - Possibly use Antivenin
- *reassess every 30 min for systemic sx
- *use wound/skin pen to outline rednesses
When do we consider Antivenin?
- rapid swelling
- hypotension
- coagulopathy
25% of snake bites are dry w/o venom
Reassess wound every 30 minutes– look for systemic sx (SOB, increased INR, fever)–> systemic symptoms then administer antivenin
Snake bite lab management
- CBC (platelets),
- Chemistry,
- Coagulation studies,
- LFTs,
- D-dimer,
- CPK
late management of snake bite management
- Updated tetanus
- Contact CDC/toxicology
- Extended monitoring (8-12 hours)
- Disposition depending on severity
signs and sx of widow spider bite
- Initially red, itchy, painless
- Progressive pain and anxiety
- Target lesion
- Muscular cramping in the back and abdomen
- Burning, numbness in the feet
- Headache, dizziness
- N/V
Tx of widow spider bite
- Wound care
- Opioids and Benzos
- IV fluids
- Tetanus
- Antivenin
- Monitor for respiratory symptoms and hypotension
Signs and sx of Recluse spider bite
- Red blister with painless bite
- Progression to a non-healing wound
- Chills, fever, generalized rash, weakness
* *more localized
* *Not found in CO
Lab studies for Recluse spider bite
- CBC,
- Chemistry,
- Coagulation studies
Management of Recluse spider bite
- labs
- Update teatnus
- wound care and monitoring
- Infection management with antibiotics
- Outpatient follow up, may need surgical debridement
Bed bugs are about the size of ____ and are usually found ___
- About the size of an apple seed
- Hide on mattresses, clothing, along baseboards, under light switches
Signs and sx of bed bugs
- Red bite, darker in the center
- Itchy
- Linear or clustered appearance
- “breakfast, lunch and dinner bit– 3 bites in a row” - Face, neck, arms, hands, back
- Severity varies, with systemic allergic symptoms of urticaria and itching possible
Tx of bed bugs
- Topical steroid cream and antihistamine cream
- Diphenhydramine for systemic symptoms
- Monitor for infection, antibiotics as needed (secondary infection from scratch)
- need to wash and dry everything on HIGH heat
What electrolyte abnormality might you expect with heat stroke?
Hypovolemic hypoatremic–> risk for cerebral pontine myelinolysis w/ rapid IV fluids
Signs and sx of Hymenoptera (stings)
- Immediate pain**
- Swelling and redness
- Itching
- Localized urticaria
- Anaphylaxis
Tx of Hymenoptera (stings)
- Remove the stinger**
- Wound care
- Supportive care (itch and pain)
- Antihistamines
Signs and sx of anaphylaxis
- Urticarial rash
- Swelling of lips, tongue, hands, feet
- Dysphagia
- Dyspnea
Tx of anaphylaxis
- Epinephrine
- Diphenydramine
- Famotadine
- Prednisone
- 6 hours of monitoring
- Swelling of deeper tissues
- May be seen with allergic reactions
Angioedema
*due to bradykinin
Tx of angioedema
- epi
- antihistamines
- steroids
* * might have to support the airway - Icatiband (new med that helps with angioedema complications)
- +/- FFP
*4 and 5 are for ACEI angioedema
Coral snakes:
Snake colors: “red on yellow, ____”
“red touches black, __”
- red on yellow, kill a fellow
- red touches back, safe for jack”
What are side effects of antivenin
Monitor for anaphylaxis and serum sickness (can be days after)
In general for spider bites management includes
-most the time its wound care and have pt monitor for systemic sx and reassurance
Describe the organ system involvement with anaphylaxis
4 organ systems involved:
- Skin: urticaria, flushing
- Resp.: stridor, wheezing, tachypnea
- CV: decreased BP, syncope,
- GI: N/V, diarrhea
*If they have 2 or more of these sx (from diff. symptoms) they are having anaphylaxis and use epi!
Angioedema is a SE of what medication
ACEI
