Enviromental Flashcards
(175 cards)
1
Q
Describe mild (32-35 degrees) hypothermia (6)
A
- thermogenesis still possible
- Shivering
- Apathy
- Ataxia
- Dysarthria
- Tachycardia
2
Q
Describe moderate (28-32 degrees) hypothermia (6)
A
- Progressive failure thermogenesis
- No shivering
- Altered mental state
- Muscular rigidity
- Bradycardia
- Hypotension
3
Q
Describe severe (<28 degrees) hypothermia (6)
A
- Adopt temp of surrounding enviroment
- Signs of life almost undetectable
- Coma
- Fixed/dilated pupils
- Areflexia
- Profound bradycardia and hyptension
4
Q
What is a J wave
A
Deflection at J point
5
Q
Which leads can J waves be seen the best?
A
Lead II
V3-6
6
Q
Describe frostnip (3)
A
- Short lived, superficial freezing
- Rapid response to warming
- No swelling
7
Q
Describe superficial frostbite (3)
A
- Superficial layers only
- Clear blisters 24-48 hours after injury
- Tissue below remains pliable and soft
8
Q
Describe deep frostbite (4)
A
- Full thickness
- Blood filled blisters 1-3 weeks later
- Underlying tissue woody and stony
- Bad prognosis, loss of digits likely
9
Q
How should frostbite be managed immediately? (4)
A
- Splint area and wrap in loose, dry clothing
- Don’t warm unless you can continue to
- Rewarm at 40-42 degrees initially
- Analgesia (re-warming very painful)
10
Q
When should surgery be performed on frostbite?
A
Delayed
11
Q
What is the most useful discriminating factor in the pre-hospital environment for the severity of heat illness?
A
Altered mentation after 30 mins cooling
12
Q
What is:
- exertional heat illness
- non-extertional heat illness
A
- Increased work leads to increased heat production
- Inability to compensate for enviromental change
13
Q
What is the WBGT (heat)?
A
Wet Bulb Globe Temperature - heat stress index
14
Q
When does the American College of Sports Medicine suggest cancelling an event?
A
WBGT > 28 degrees C
15
Q
What is the initial management of heat illness? (3)
A
- Cool first, transfer later
- Immersion in ice water is gold standard
- Aim to cool to 38.5 degrees - 39 degrees C to avoid hypothermia
16
Q
What are the 5 types of heat illness?
A
17
Q
What is the underlying mechanism that makes heat stroke different from heat exhuastion?
A
SIRS response leading to multi-organ failure with encephalopathy predominating
18
Q
What biochemical abnormalities can be seen in heat stroke? (6)
A
19
Q
What the two main groups of snakes?
A
- Vipers
- Elapids
20
Q
Where are vipers found?
A
Americas/Africa/Europe
21
Q
Where are elapids found?
A
SE Asia, Australia, PNG
22
Q
How long should snake bites be observed for?
A
24 hours - can be delayed
23
Q
What type of snake is a cobra?
A
Elapid
24
Q
How do you treat suspected envenomation?
A
- pressure immobilisation (> lymph/venous pressure)
- Anti-venom
- Neostigmine if paralysis due to cobra/death adder and no anti-venom
25
What types of spider are poisonous? (3)
- Lactrodectus (black widow, red back spider)
- Funnel web spider
- Recluse spiders
26
What are the effects of venomous spider bites?
Mainly local but can be systemic
27
What are the effects of scorpion bites in:
- US/OZ
- N. Africa, S + C America and ME
1. Local affects only
2. Can lead to systemic effects resembling a cathecholamine surge
28
What types of jellyfish have systemic effects?
Box and Portuguese Man of War
29
How do you treat Jellyfish envenomation?
1. Box jellyfish - rinse with vinegar + anti-venom
Other jellyfish
2. Wash in sea/saline water to remove remaining nematocysts
3. Then immerse in hot water
30
Describe pressure immobilisation post envenomation? (4)
1. Dont remove trousers as can increase venom through bloodstream
2. Pressure bandage from below wound as high as possible with minimal movement of leg
3. Apply splint to immobilise joint above/below bite
4. Restrict walking
31
What is:
1. Immersion
2. Submersion
1. Airway above water
2. Airway below water
32
Following submersion what occurs initially?
Patient will swallow water preferentially until urge to breath takes over
33
Following submersion how long does
1. Resp movement
2. Cardiac output
COntinue for?
1. 1 min
2. 2 mins
(approx)
34
How cold does water need to be to lead to a 'cold shock response'?
< 15 degrees
35
What is the 'cold shock response?'
Involuntary gasp (2-3L) and uncontrollable hyperventilation for around 90 secs
Therefore decreased time to aspirate lethal amount of water
36
What is the lethal amount of water aspirated in:
1. Sea water
2. Fresh water
1. 1.5L
2. 3 L
37
What is the consequence of submersion in water < 6 degrees C?
- Selective brain cooling from aspiration
- successful resus can increase from after 30mins to 90 mins
38
What are the good prognostic indicators in drowning (9)?
1. Submersion <10mins
2. Tw (water temp) < 10 degrees and patient temp <33-35 degrees
3. Time to BLS < 10 mins
4. Early ROSC
5. Child
6. No aspiration
7. Spontaenously breathing
8. PH > 7.1 and blood glucose < 11.2
9. Neurologically intact at hospital
39
What is the strongest predictor of prognosis in drowning?
Submersion > 10 mins
>25 mins nearly 100% mortality (unless very cold water)
40
Describe the 3 zones in water rescue and the PPE that should be worn
1. Hot = in/on water + full PPE
2. Warm = < 3m from waters edge + full PPE
3. Cold = safe
41
What is the recommendation for non-specialist water rescue options? (3)
Talk
Reach
Throw
42
In drownings what should trigger prolonged resus? (4)
1. Submersion < 30mins (Tw >6 degrees) or <90mins (Tw <6 degrees)
2. Possibility of air pocket
3. Intermittently submerged ie. life jacket
4. Signs of life
43
In prolonged immersion what should the initial management be? (3)
- conscious, encourage patients to continue fighting for survival
- if semi/un conscious then remove horizontal from water to avoid circum-rescue collapse
- prioritise oxygenation ( <10% shockable) how AED not c/i in wet enviroments
44
What should we consider in ALS following a drowning? (5)
1. 5 rescue breaths and ALS if no response
2. I+V
3. OG tube
4. May need high PEEP
5. Consider ECMO
45
What considerations should be made with post drowning patients? (4)
1. Ignore 'foam at mouth; and give oxygen
2. Consider PHEA and PEEP 10-15cmH20
3. Vasopressors and cautious fluids
4. Treat as 'wet head injury' i.e. neuroprotection
46
What 3 criteria need to be met to discharge a drowning from scene?
1. No foam at mouth
2. No resp distress and normal resp exam
3. Safety net
47
What does SCUBA stand for?
Self Contained Underwater Breathing Apparatus
48
What does a SCUBA kit consist of?
Cylinder with up to 300atm compressed gas delivered via a pressure regulator
49
What is Daltons Law?
Total pressure exerted by gaseous mixture is equal to the sum of the partial pressure of each gas
50
What is the real world consequences of Daltons law?
At sea level air subject to 1 atmosphere pressure, however as you descend that pressure increases and therefore so does the partial pressure of the component gases (o2/nitrogen in particular)
Converse true as you ascend
51
What is Boyles Law?
At a constant temperature the volume of gas will vary inversely with pressure
e.g.
0 m = 1atm = 1.0 (volume) x 1 (density)
10m = 2 atm = 1/2 = x 2
20m = 3 atm = 1/3 = x 3
52
How much descent is needed to increase pressure by 1 atmosphere?
10m
53
What is Henrys Law?
Amount of gas dissolved in a liquid is proportional to pressure of gas
54
What is the conequence of Henrys Law in diving?
As partial pressure of each component increases more gas dissolves in divers tissues/blood
Ascent = reverse of this
Slow ascent means bubbles filtered by lungs
55
What is nitrogen narcosis?
Breathing nitrogen at increased partial pressure (usually >4atm or 30m) leads to symptoms like being drunk. If do not resolve on ascent then alternative diagnosis likely
56
What is oxygen toxicity in diving?
At depth partial pressure of oxygen means free radicals may accumulate in brain
57
What are the symptoms of oxygen toxicity? (7)
1. Tingling
2. Vertgio/tinnitus
3. Personality change
4. n/v
5. tunnel vision
6. Seizure and likely death (underwater)
7. Coma
58
What is management of oxygen toxicity?
Abort dive
59
What is the safe partial pressure of oxygen for recreational dive and what depth is this with compressed air?
1. 1.4 atm
2. 57m
60
What are the 3 parts of decompression illness?
1. DCS
2. AGE
3. Barotrauma
61
How do the nitrogen bubbles in decompression illness cause disease? (4)
Fast reforming expanding nitrogen bubbles damage cells causing:
- mechanical compression
- stretch of blood vessels/nerves
- act as emboli
- activate inflam/coag pathways
62
When does type 1 (mild) DCS normally present?
10-30 mins after surfacing
98% < 24 hours
63
What are the symptoms of type 1 DCS? (3)
1. MSK joint pain (not on movement)
2. Itching/burning sensation +/- faint rash
3. Localised pain lymph nodes and swelling in tributary tissue which can be prolonged
64
When does type 2 (severe) DCS normally present?
Immediately but can be up to 36 hours
65
How often does pain feature with type 2 DCS?
30%
66
What systems does type 2 DCS affect? (4)
1. Neuro
2. Cardiopulmonary
3. Auricular
4. Skin
67
What are the neuro signs of type 2 DCS?
1. Usually affects spine - LBP with progressive SCI symptoms
2. Cerebral - headaches/visual field def/dizziness/poor co-ordination/amnesia/personality change/tremor
68
Whhat are the cardiopulmonary affects of type 2 DCS?
'The chokes'
- pleuritic CP, haemoptysis, dry cough, tachypnoea
69
What is the treatment for 'the chokes' and what is an absolute c/i/
Recompression
Untreated PTX
70
What are the auricular affects of type 2 DCS?
'The staggers'
Vertigo/tinnieus/ataxia/vomiting
71
If a patient developes only 'inner ear' symptoms following a dive what will be the cause?
Baratrauma if no other signs of DCS
72
What are the cutaneous manifestations of type 2 DCS?
Flat raised itchy rash > common shoulders/chest
Will become dark-bluish 'cutis marmorata'
73
What is altitude decompression sickness ?
Flying after diving
74
How long after diving should you avoid flying?
12-48 hours
75
How should altitude decompression sickness be managed and when can recompression be avoided?
Descend to sea level and:
- if pain resolves
- -100% Fi02 for 2 hours available
- 24 hours observation available
then no need for recompression
76
How do arterial gas emboli form?
Leakage of air into pulmonary arterial system following alveoli rupture during ascent
77
At what depth can AGE form?
Any diver any at any depth
78
How can venous gas emboli that are relatively common in recreational dives become dangerous?
PFO/ASD/VSD
79
How long after a dive do symptoms caused by AGE and DCI develop?
10-30mins
80
What are the signs/symptoms of AGE?
Depends on site:
- coronary artery feels like 'direct blow' to chest and causes MI
- cerebral = CVA
etc
81
What are the time goals for treatment following signs/symps of AGE (3)?
< 2 hours better prognosis
>6-8 hours worse prognosis
If neuro/pulmonary/mottled skin then hyperbaric regardless of age
82
What is the initial management of AGE (ie. pre recompression)? (5)
1. 100% Fi02
2. Remove diving gear
3. Keep patient supine and horizontal
4. Take diving gear and ideally buddywith patient (to help with hx of dive)
5. IVI - start 75/ml-100ml per hour and UO 0.5-2.0ml/hr
83
If having to fly a patient following AGE what should be ensured?
Fly under 300m and with cabin pressure 1atm
84
What should be avoided in AGE? (5)
1. Trendelenburg
2. High flow oxygen over 12 hours (toxicity)
3. Entonox (can increase bubble size)
4. Steroids/aspirin/lidocaine (no evidence)
5. 5% dextrose can increase cerebral oedema
85
What is the physiology involved in acclimatisation?
As you ascend partial pressure oxygen decreases leading to lower SATs and exercise tolerance.
You adjust to this by initially increase plasma volume then gradual increasing red cell mass and so increase Hb concentration
86
What percentage of people will develop AMS?
60% over 4000m
87
What are the signs/symptoms of AMS?
Hangover like symptoms worse at night
88
How should AMS be managed?
No further ascent until symptoms improve
89
What is the prophx dose of acetazolamide?
125mg BD day before ascent until descending
90
What is the mechanism by which acetazolamide prevents altitude sickness?
Carbonic anhydrase inhibor which increases excretion of HCO3- leading to metabolic acidosis and therefore increases RR.
91
How much does acetazolamide reduced AMS by in percentage terms?
48%
92
What are the common side effects of acetazolamide? (3)
1. Polyuria
2. Parasthesia
3. Altered taste
93
Describe te pathophysiology of High Altitude Cerebral Oedema (HACE)
Cerebral blood flow increases with altitude - combination of capillary leakage and decreased cerebral autoregulation on acute exposure to hypoxia
94
What are the signs/symptoms of HACE? (3)
1. Progressive personality change/confusion
2. Worsening co-ordination (test heel/toe and sharpened Rombergs)
3. Coma/death within 12 hours
95
How should HACE be treated? (3)
1. Descend/portable altitude chamber (head up slope)
2. If unable to descend dexamethasone can by time by decreasing cerebral oedema
3. High flow oxygen
96
What is the dose of dexamethasone used to tx HACE?
8mg STAT PO followed by 4mg TDS
97
What is the pathophysiology involved in HAPE?
Non cardiogenic pulmonary oedema caused by exaggerated hypoxic pulmonary artery vasoconstriction.
Lead to increased pulmonary artery pressure which causes a transudative capillary leak and mild alveolar haemorrhage + mild SIRS
98
What is the treatment of HAPE? (4)
1. Descend
2. Nifedipine SR 20-30mg QDS (sildenafil if not available)
3. Acetazolamide 250mg QDS
4. CPAP
99
How do calcium channel blockers tx HAPE?
Decrease pulmonary artery pressure by increasing NO levels in pulmonary vasculature causing smooth muscle relaxation
100
To what pressure is a portable altitude chamber pressurised?
2 psi = 2000m
101
What should be considered when using portable altitude chambers? (2)
1. Will need to keep pumping
2. Think what they will need in chamber as can't leave ie. PU, warmth, meds, pen and paper to communicate
102
How common is HAPE?
2% >4000M
103
What is the main cause of decompression sickness?
Ascending too quickly
104
What does the FPHC define exertional heat illness as?
A syndrome associated with a raised core temperature and disordered thermoregulation which occurs on a spectrum of severity, during or immediately after physical activity
105
What does FPHC require alongside a raised temperature during or immediately after exercise to diagnose EHI?
Symptoms
106
What does FPHC define as mild EHI?
core body temperature from 38.5°C to 40°C associated with signs or symptoms of heat illness other than CNS during or immediately after exercise
107
What does FPHC define as severe EHI?
A life-threatening condition of disordered
thermoregulation with central nervous system dysfunction, associated with a core body temperature above 40°C during or immediately after physical activity
108
What are the signs/symptoms of severe EHI? (12)
Temp > 40 degrees + CNS dysfunction (less than A on AVPU) +/-
1. Confusion
2. Agitation or aggression
3. Behavioural changes
4. Stumbling gait/ataxia
5. Seizures
6. LOC + coma
7. Vomiting
8. Urinary/faecal incontinence
9. Flushed/pale skin
10. Collapse
11. Hypotension
12. Arrhythmias
109
What does FPHC recommend with regards to temperature measurement in EHI? (5)
1. Core temperature should be measured with flexible rectal probe (rigid can cause injury)
2. Oesophageal temp probe acceptable if I+V
3. Core body temperature measurement should not be delayed, priority
4. Peripheral temprature measurement is unreliable and may lead to false reassurance, not recommended
5. Cooling recommended if not able to measure core body temp if EHI suspected until core temp can be measured
110
What does FPHC state about transfer before cooling in EHI?
Shown increase mortality, transfer should be delayed until cooling
111
How quickly should we aim to cool patients with EHI? (FPHC)
0.15 degrees C / min
112
What does FPHC recommend for cooling in EHI?
Cold Water Immersion (CWI) up to neck with continous core temp monitoring
113
What are the main relative contraindications to cold water immersion in EHI? (2)
1. Hypotension
2. Arrhythmia
114
If cold water immersion is c/i or not available in severe EHI what does FPHC recommend?
Shade, strip and spray
115
What temperature should we aim for in cold water immersion post EHI and why?
38.5 to 39 degrees to prevent hypothermia
116
How long should patients core temp be measured following cold water immersion ?
30 mins
117
What should be done if patients become hypothermic post cold water immersion?
Gentle rewarming with coretemp measurement
118
What patients with EHI should be 1. conveyed and 2. who can be discharged?
1. Anyone with severe EHI (will need bloods)
2. Mild EHI with resolution of symptoms post cooling wth robust safety netting
119
How and to what temp should patients with mild EHI be cooled?
1. Shade, strip and spray
2. 37.5 degrees as low risk of hypothermia post cooling
120
What does FPHC not recommend in management of EHI in pre-hospital setting? (6)
1. Anti-pyretics
2. Dantrolene
3. Steroids
4. Depolarising neuromuscular blockers
5. Abx
6. IV fluids unless clinically indicated (caution with ? hyponatreamia)
121
What are the 4 Original Swiss Stages of hypothermia?
1. 35-32 degrees
Conscious and shivering
2. 32-28 degrees
Impaired GCS and loss of shivering
3. 28-24 degrees
Unconscious
4. <24 degrees
Apnoeic
122
What ECG changes are found in hypothermia? (5)
1. Osborn J Waves (most specific)
2. Prolonged PR and QT interval
3. Sinus bradycardia
4. AF
5. VF
123
What is the first priority for first aid following a snake bite?
Immobilisation
124
What is immersion pulmonary oedema?
Increased hydrostatic pressure causes redistribution of blood from peripheries to thorax, increasing pre-load and SV
This leads to a trasudative oedema secondary to increased alveolar capillary resistance leading to SOB and pink, frothy sputum
125
Who is more at risk of immersion pulmonary oedema?
People with high LV end diastolic pressures e.g. HTN/IHD
126
What does Ohms law state and how is this relevant to electrical injury
The higher to voltage or the lower the resistance, the greater the current and therefore the damage
127
What will the following voltages cause in terms of symptoms/damage?
1. 1mA
2. 10-15mA
3. 20-50mA
4. > 50mA
1. Tingling
2. Muscle contraction 'can't let go affect'
3. Respiratory arrest
4. VF arrest
128
What is slurry?
Animal waste and other unusable organic matter e.g. hay
129
What toxic gases are produced by the breakdown of slurry (4) and what does it cause?
1. Methane
2. C02
3. Ammonia
4. Hydrogen sulphide
All create an irrespirable atmosphere
130
How can people die in slurry pits? (3)
1. Drowning
2. Suffocation
3. It is flammable
131
What is:
1. Primary hypothermia
2. Secondary hypothermia
1. Result of excessive transfer of energy to a cold environment through conduction, convection, evaporation, or radiation
2. caused by conditions that impair thermogenesis or thermoregulation
132
In hypothermia, what is thought to explain 'rescue collapse' ie. arrest once being rescued?
Multifactoral but most likely due to movement of patient
133
What is 'afterdrop' in terms of hypothermic rescue?
Temperature continuing to drop even once warming has started. Likely due to reperfusion of cold body parts during rewarming, but conductive heat transfer between colder and warmer body regions may also play a role.
134
What makes hypothermic arrest less likely?
Consciousness
135
What is the affect of 'rescue collapse' on hypothermic patients mortality?
Doubles it
136
What is the most accurate way to measure temperature and the best way pre-hospital?
Pulmonary artery catheter most accurate
Oesophageal most practical if I+V
137
Why do non-vascular temperature measurements become inaccurate particularly in rapid drops of temp?
During rapid temperature changes, nonvascular central thermometers readings lag behind true core temperature because they are influenced by the surrounding tissue and body contents, such as air, urine, and stool, that have thermal inertia
138
If no way to measure tempeature, what is the next best way to attempt to classify hypothermia?
Swiss system
139
If hypothermic patients are found horizontal, what should be done and why?
Should not be allowed to walk until after they have been consumed calories and been allowed to shiver for at about 30 min because walking will increase heat production but also afterdrop
140
What temp should warmed fluids be?
38-42 degrees
141
What is the priority pre-hospitally with hypothermic patients? (3)
1. Extricate
2. Prevent further heat loss
3. Rapidly move to hospital
142
In terms of hypothermic patients, what is the most important initial measure to prevent heat loss?
Blizzard blanket
143
When should wet clothes be cut off and when should they be kept on in hypothermic patients?
Should be only done if can be done in protected space and have dry clothes available
144
In hypothermia - how should low BP/bradycaria/arrhythmias be managed?
Re-warming usually only measure needed
145
Why should I+V usually be delayed until patient in warmer enviroment? (3)
1. IV lines can freeze
2. Most IV meds won't work
3. ETT tube becomes harder and less pliable
146
What makes I+V more difficult in hypothermic patients? (2)
1. Trismus and rigidity makes more challening
2. ETC02 unreliable
147
How should severely hypothermic patients be ventilated?1
Weight based target - ETC02 unreliable. Hyperventilation better than hypoventilation
148
How long should vital signs be checked for in hypothermia and what else should be used to help? (3)
60 secs
1. ETC02 (any means that signs of life)
2. US
3. ECG
149
In hypothermic patients when should CPR not be started? (4)
1. DNACPR
2. fixed dependent lividity (livor mortis),
3. danger to or exhaustion of the rescuers
4. or avalanche burial longer than 60 min with asystole and a completely obstructed airwayW
150
What are the criteria for direct transfer to ECLS in hypothermia? (4)
1. Cardiac arrest
2. Core temp <30 degrees
3. SBP <90mmg
4. Ventricular dysrhythmia
151
During hypothermic arrest and rescue, if continous CPR is not possible, what should be done if temp?:
1. >28 degrees C
2. < 28 degrees C/ unknown but unequivicle hypothermia arrest
3. <20 degrees
1. Strong consider HEMS or waiting for mechanical CPR
2. Intermittent CPR - 5 mins CPR, up to 5 mins no CPR
3. 5 mins CPR, up to 10 mins no CPR
152
What is the HOPE score and what are the constituent parts? (6)
Score used to predict outcome of patients undergoing ECLS for hypothermic arrest
he HOPE Score is calculated based on the following inputs:
1. Sex (male = 1, female = 0).
2. Hypothermia with asphyxia (yes = 1, no = 0).
3. Age, years.
4. Potassium, mmol/L.
5. CPR duration, min.
6. Temperature, °C.
153
What is a:
1. conditional rescue
2. true rescue
1. Relies upon the victim doing something to assist in their
rescue, e.g. a throw line rescue.
2. Requires no assistance from the victim in their rescue, e.g.
unconscious or injured victims.
154
Following a snake bite, what is the first action?
Immobilise limb
155
How do the following snakes causes toxicity and death?
1. Elapids
2. Vipers
1. Systemic absorption occurs through venous channels and result in neurotoxic symptoms - paralysis of respiratory muscles and upper airway lead to death
2. Vasculotoxic - slows systemic absorption and leads to coagulopathy
156
What percentage of snakes are venomous and how common are 'dry bites'
30% venomous
50% 'dry bites'
157
What signs may point to severe envenomation? (6)
1. Snake identified is a very venomous one
2. Rapid early extension of local swelling from the site of the bite
3. Early tender enlargement of local lymph nodes, indicating spread of venom in the lymphatic system
4. Early systemic symptoms
5. Early spontaneous systemic bleeding (especially bleeding from the gums)
6. Passage of dark brown urine
158
What percentage of people have adverse affects from anti-venom?
20%
159
What are the initial signs/symptoms/treatment of an adder bite?
Anaphalactoid - IM adrenaline
160
Following an adder bite, what signs of symptoms define systemic envenoming? (5)
1. Hypotension
2. ECG abnormalities
3. Vomiting
4. Haemostatic abnormalities
5. Marked local envenoming (bites on the hand or foot, swelling extends beyond the wrist or ankle within 4 hours)
161
What is the treatment for systemic envenoming from an adder bite?
European viper snake venom antiserum
162
What water temperature should trigger consideration of prolonged recovery?
6 degrees or less
163
What is Charles Law?
Volume occupied by a fixed amount of gas is directly proportional to its absolute temperature, if the pressure remains constant
164
What are the key impacts of:
1. Boyles Law
2. Charles Law
3. Daltons Law
4. Henrys Law
1. From 10 metres below the surface to the water surface the pressure halves. As a result if you breath hold when you ascend your lungs will double in volume and possibly rupture (pneumothorax). Conversely when you descend the increase pressure can squeeze sinus/ear/mask which can cause bleeding.
2. No significant physiological effects, but logistically may have lower gas volume in cylinder at a lower water temperature.
3. Leads to NITROGEN NARCOSIS, as depth increases more inert nitrogen is absorbed into the body
4. Leads to DECOMPRESSION SICKNESS (BENDS) which is causes by excessive nitrogen absorption at depth and insufficient washout of nitrogen during ascent.
165
What are the Contact High Consequence Infectious Diseases (HCID) (category 4 pathogens) (8)
1. Argentine Haemorrhagic Fever (Junin Virus)
2. Bolivian Haemorrhagic Fever (Machupo virus)
3. Crimean Congo Haemorrhagic Fever (CCHF)
4. Ebola Virus Disease (EVD)
5. Marbug Virus Disease (MVD)
6. Lassa Fever
7. Lujo Virus Disease
8. Severe Fever with Thrombocytopaenia Syndrome (SFTS).
166
What are the Airborne HCIDs? (8)
(high consequence infectious diseases)
1. Andes Virus Infection (Hantavirus)
2. Avian Influenza A (H7N9 & H5N1)
3. Avian Influenza A H5N6 and N7N7
4. Middle East Respiratory Syndrome (MERS)
5. Severe Acute Respiratory Syndrome (SARS).
6. Monkeypox (Mpox)
7. Nipah Virus Infection
8. Pneumonic Plague (Yersinia Pestis)
167
What voltage is likely to lead to respiratory arrest?
20-50 mA
168
In terms or rewarming - what is the order of precedence body area?
1. Chest + head
2. Axilla
3. Back
169
What are the 3 methods of rewarming a patient?
1. passive external rewarming (allow patients thermeogenesis to warm themselves)
2. active external rewarming (provide heat source)
3. active internal rewarming
170
What method of rewarming should mildly hypothermic patients undergo?
Passive rewarming
171
Which patients should have active rewarming?
1. Moderate hypothermia
2. Severe hypothermia
3. Mild hypothermia that has not responded to passive rewarming
172
How can we limit the chance of 'afterdrop'?
Head head/thorax and not limbs
173
What defines cold water?
< 15 degrees C
174
How many drowning deaths are there in the UK per year?
600 approx
175
What are the most common factors in incidence of drowning? (3) (RCUK)
1. Men 20-30 yrs
2. Inland waters (lakes, rivers)
3. During the summer months
