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SU-18 ER > Altitude Emergencies > Flashcards

Altitude Emergencies Flashcards

(59 cards)

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1
Q

at what altitude do we start to see issues?

A

> 8000 ft

can occur at > 5000 ft

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2
Q

altitude emergencies are influenced by

A

rate of ascent
final altitude
sleeping altitude
duration of altitude

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3
Q

RF of altitude emergencies

A

young males
PHYSICAL FITNESS FOES NOT PROCTECT

smoking, alcohol, overexertion, previous incident

asymptomatic hypoxia (COPD, CHF)

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4
Q

hypoxia

A

inability to reach tissue

decrease in barometric pressure causes less arterial oxygen tension and less diffusion of inspired air

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5
Q

hypoxemia

A

low oxygenation of blood

low arterial oxygen in blood due to decreased O2 in air

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6
Q

acclimatization in altitude emergencies

A

ventilation (increase)
increased CO and pulmonary perfusion
increased cerebral blood flow
increase in HG and erythropoietin (weeks)

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7
Q

acute mountain signess

A

HA + 1 or more of:

anorexia, N/v, fatigue, difficulty sleeping, light headedness

6-10 hrs after ascent

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8
Q

tx of AMS

A

slow/halt ascent
analgesics
Diamox prophylaxis (1-2 days earlier)
Dex if unable to descend

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9
Q

diamox and AMS

A

speeds up acclimatization

1-2 days before

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10
Q

HACE

A

severe AMS with ATAXIA or altered mental status

may progress to coma or death

typically occurs at >12,000 feet

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11
Q

first sign of HACE

A

ataxia

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12
Q

tx of HACE

A

immediate descent or evacuation
oxygen
dexamethasone

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13
Q

HAPE

A

non-cardiogenic pulmonary edema 2-4 days after ascent above 8000 ft

MC cause of altitude emergencies death

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14
Q

HAPE clinical features

A

persistent dry cough –> tachycardia and tachypnea at rest + cyanosis –> nocturnal ones and worsening symptoms at night –> dyspnea at rest and crackles in chest

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15
Q

pharm tx HAPE

A

nifedipine (should still descent)

Gamow bag

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16
Q

altitude emergencies summary of tx

A

medications + supplemental o2

stop ascent and attempt acclimatization

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17
Q

acetazolamide/diamox altitude emergencies

A

acclimatization 1-2 days before

little benefit in acute tx and NO HAPE

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18
Q

dexamethasone altitude emergencies

A

AMS and HACE

no HAPE

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19
Q

HAPE pharm

A

B-agonists

nifedipine

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20
Q

hyperbaric oxygen and altitude emergencies

A

BEST in HAVE

beneficial in HAPE

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21
Q

submersion injuries

A

common in toddlers and children, adolescents, elderly

second leading COD <15

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22
Q

wet drowning

A

atelectasis
v/q mismatch
breath holding and swallowing water
breathing water

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23
Q

dry drowingin

A

laryngospasm and glottis closure causing hypoxia

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24
Q

final common pathway of submersion injury

25
fresh water drowning
hypotonic solution inactivates surfactant = hemodilution and hemolysis of cells hyopnatremia + hyperkalemia
26
salt water drowning
osmotic gradients pulls fluid into alveoli from cells suffocates after 8-10 minutes due to inability to exchange O2
27
drowning pts are at risk for
ARDS and PNA
28
categories of submersion injury
Asymptomatic Symptomatic cardiopulmonary arrest obviously dead
29
tx of drowning
CPR intubation and rewarming antibiotics
30
Boyle's law
pressure and volume inversely proportional pressure increase = volume decrease (diving)
31
henry's law
gas enters liquid in proportion to partial pressure descent = increased partial pressure boddy tissue absorbs N faster and diver descends ascend too quick = nitrogen gas bubble in body tissue = severe pain
32
descent barotrauma
middle ear squeeze hemorrhage and edema influx of water may cause extreme vertigo and disaster MC medical problem associated with diving
33
grade of descent barotrauma
0 = pain only 2= erthemia and mild hemorrhage 4= free blood 5= free blood + perforation
34
sinus barotrauma
air trapped in sinuses can cause epistaxis tx with decongestants
35
mask squeeze
descend without equalizing pressure - negative air pressure in mask and rupture of capillary beds = conjunctival hemorrhage and skin ecchymosis
36
nitrogen narcosis
increased nitrogen solubility causes intoxication at high partial pressure
37
DESCENT dz list
1. barotrauma 2. sinus squeeze 3. mask squeeze 4. nitrogen narcosis
38
ascent injury
gas expansion 1. barodontalgia 2. GI barotrauma 3. pulmonary/AGE 4. decompression sickness
39
barodontalgia
when descending air fills cavities then ascent causes air to expand and can't escape = pain
40
GI barotrauma
air trapped in GI tract limited to when you resurface and release air
41
pulmonary barotrauma
air not released = expand in rupture to surrounding tissue can have AGE
42
AGE
air gets into pulmonary veins = gets into left heart = systemic cirulcatoin CAN CAUSE STROKE immediate decompression and oxygenation
43
decompression sickness
nitrogen forms bubbles I ascent too rapid direct and indirect effect
44
direct effect DCS indirect effect net effect
bubbles in joints, SC, pulmonary and vascular system indirect: inflammatory response, clotting, inflammatory cascade net: decreased tissue perfusion, ischemic injury
45
type 1 DCS
nigges skin bends lymphatic involvement the bands - shoulder joint MC affected
46
type 2 DCS
staggers - N gets in spinal cord sheath the chokes
47
differentiating AGS and DCS
time of onset AGE -- rapid DCS - over hours
48
Lightning injuries clinical symptoms
cardiac arrhythmia, nruologic abnormalities, cardiopulmonary arrest tympanic membrane rupture cataracts DIC feathering burns
49
pathognomonic lighting injury sign
featuring burns due to electron showers
50
pearls of Lightning injuries
damage to exterior does not predict interior damage respiratory arrest is prolonged, ventilate
51
HoTN and Lightning injuries
not an expected finding if seen, look for hemorrhage
52
cardiac manifestations Lightning injuries
spontaneous circulation, HTN, tachycardia specific tx not nee. bc BP and pulse spontaneously return MI unusual and prolonged rescucitative effort often successful
53
neuro injury Lightning injuries
victims are unconscious and have temporary paralysis seizure due to injury or hypoxia ALWAYS CT
54
Lethal neuro injuries Lightning injuries
heat induced coagulation of cerebral cortex development of epidural or subdural hematoma hemorrhage
55
ocular injury
opthalmic injuries common in lightening strike victims common to get cataracts
56
MSK manifestations of Lightning injuries
shoulder dislocation spinal fracture RHABDO uncommon
57
cutaneous injuries Lightning injuries list (6)
1. Lichtenberg figures 2. flat burns 3. punctuate burns 4. contact burns 5. superficial erythma 6. contact wound
58
lichtenberg figures
pathognomonic superficial feathering or fern pattern burns disappear within 24 hrs
59
contact burns
occur when metal close to skin is heated from lightening current

SU-18 ER (11 decks)

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