Environmental Trauma Flashcards
Heat Cramps
Etiology
- hot environments with inadequate volume
- deficient in K+, Na & Mg
Presentation
- cramps/spasm of muscle
Management
- fluid and salt replacement in cool space
Heat Exhaustion (heat Stress)
Etiology
- hot enironment and inadequte volume replacement
- water depleted: think eldery and workers
- sodium depleted: those who are only replacing with water, not with electroyltes
Symptoms
- HA
- N/V
- dizzy
- malaise
- cramps
- tachydarida, ortho. hypotension
- normal or elevated temperauter
- normal mental status
Diagnosis
- if you think you need to : get labs for electrolytes or to assess for rhabdomylosis)
Management
- fluids to replace (oral hydration with electroyltes) or IV fluids (LR or NS)
- cooler environment will help them; if they need you can active cooling with fan and water spritzing
Heat Stroke
worst of the heat pathologies: can be fatal!
Etiology
- life-threatening if not treated
- cerebellum doesnt like to get hot: ataxia, neuro findings
- can lead to end organ damange
Symptoms
- the heat exhastion symptoms PLUS
- hyperthermia of 104+ (40)
- altered mental status
- hallucinations, confusion, odd behavior,etc.
Diagnosis
- can be simialr to sepsis: get a good history
- labs: glucose, CMP, CBC, CK, EKG; can get head CT or culutres if sepsis, etc.
Treatment
- IV fluids 1-2 L LR or NS
- remove clothing = cool environment
- goal cooling: get them to 39C (102.2) but prevent shivering
- ice packs to the places
- evaporative cooling with fan and water
- immersion cooling in a tub
- invascive cooling: ECMO, gastric/bladder lavage
- admit them
Frostbite
Etiology
Degrees (1st-4th) & Presentation
Etiology
- cold expsoure prolonged = tissue freezing/injured = thawing causes additional injury
- head,hands and feet
Presentation by Degree
1st degree: :”nip”
- NO BLISTERS
- numbness, stinging, dryness, mild edema
2nd Degree:
- full thickness freeze
- edema
- BLISTERS
3rd degree
- damange extends deeper to subdermal plexus (fat)
- development of hemorrhagic blisters: due to vessel involvement
4th Degree
- damage that can get to the bone
- darker, black echar color
Frostbite
management
management
- prevent further injury, remove from the cold and remove wet clothing
- rewarm without refreezing
- use warm circualting WARM water: not hot: 37-39C water
- leave blisters in place
- severe could be amputated
Hypothermia
etiology
Mild
moderate
severe
Etiology
- dropping of core temperature before 35C/95F
- can lead to cardaic arrest
- can be due to environment but also could be impaired thermoreg.
Mild Hypothermia
temp
symptoms
treatment
Mild : core temp 35-32
- awake, alert, shivering
Treatment
- warm environment, clothing & blankets
Moderate Hypothermia
temp
symptoms
treatment
Moderate: core temp 32-28
- some impaired consciousness
- shivering Moderate Hypothermia
Treatment
- active rewarming
- bear hugger blankets
- warm IV fluids
- shivering is good
- monitor their cardaic and respiratory function
Severe Hypothermia
temp
symptoms
treatment
Severe: core temp < 28
- unconscious but has vital signs
- high risk of cardiac arrest
Treatment
- active rewarming with warm IV fluids, bear hugger blankets
- airway mangement + intubation if needed with warm air ventiliation
- bladder lavage or gastric lavage
- thraocic lavage with chest tubes
- ECMO if failure to improve with other methods
- watch arrythmias, hypotensions and respitroay failure with refractor acidosis
Hypothermic Cardiac Arrest: what to do
when to pronounce dead in hypothermic
Hypothermic Cardiac Arrest
- hypotension or cardiac arrest?
- eitehr way = CPR
- 3 cycles of defibrillation + epinephrine
- airway management with intubation and warm air
- bladd/gastric lavage
- thoracic lavage chest tubes
- ECLS if able
Prounoucement of Death
- not dead until warm and dead
- if serum potassium > 12 = dead
- core temp > 32 with no return of spontaneous circulation = dead
Acute Mountian Sickness (AMS)
where does this occur & why
symptoms
treatment
Where and Why
- elevations > 8000 ft. = hypoxic environment (the PP of oxygens decreases)
- body attempts to increase ventilation: respiratory alkalosis
- renal excretion of bicarb to comp. for alkalosis
- EPO levels increase for Hgb carrying
- Increase HR
- vasodilation
- takes 4-7days to weeks to acclamate
Clinical Presentation : Lake Lousie AMS questions
- HA
- GI symptoms
- Fatigue/weakness
- dizzy/lightheaded
- difficulty sleeping
- mild = 2-4, moderate 5-9 severe = 10-15
Treatment
- dont go any higher, go back down if you can
- hault ascent: gets better 12-36 hours
- decend 300-1000 m (gamow bag)
Medications
acetazolamide (CAI) causes a metablic acidosis to reduce renal bicarb reabsorpbtion, stimulating ventilation
symptomatic: ibuprofen, ondansetron
dextamethasone taper or + acetazolamide
High Altitude Pulmonary Edema (HAPE)
etiology
symptoms
Etiology
- an increase in pulmonary vascualr resistance (without any change to the heart)
- due to a rapid ascent, heavy exersion, prior experience, “stong and fit dude” climbing mountian too quick
Symptoms
Early
- dry cough, crackles/rails
- SOB
- decreased pulse Ox. more than what you would expect at that altitude
Later
- tachycardia, tachypena, SOB
- fatigue, weakness, producitve cough
Treatment
- immediate decent
- supplemental oxygen : consider hyperbarid bag
- nifedipine, tadafinil, inhaled salmeterol etc. to vasodilate
High Altitude Cerebral Edema (HACE)
etiology
symptoms
management
Etiology
- high altitude = neurologic decline + ataxia due to increased intracrainal pressure
Symptoms
- AMS/confusion
- ataxia
- focal neruologic deficts
- coma
Management
- immediate decent
- oyxgen!!!
- dextamethasne + acetazolamide can help
Barotrauma of Decent (Diving)
volume of gas/air in the cavities decreases with decent = vacuum created
Symptoms
- pain in the ears, sinuses
- sensation of pain or pressure within the face
Management
- “pop” ears with Valsalava
- ascend
Barotrauma of Ascent: plane
decreasing pressure in the outside: volume of air increases in side
- can injury surrouidng strucutres: ears, sinuses or lungs
Symptoms
- pain
- inner ear = vertigo
- Lungs = PTX or pneumomediastium! (if significant enough)
Management
- symotomatic
- wathc for other signs of decompression sickness or air embolsims
