Environmental Flashcards
Causes of hypothermia
Cold exposure
Hypothyroidism
Anorexia
Hypopituitarism
Multi-systems trauma
CVA
Shock
ETOH
Hypothermia presentation
Mild
Moderate
Severe
Mild >35 deg
Shivering, normal mental status, difficulty caring for self
Mod 28-35 deg
Impaired mental status, +/- shivering, slurred speech, hyporeflexia
Severe <28 deg
Hallucinations, LOC, no shivering, loss of vital signs, oliguria, dilated pupils, hypotension, pulmonary oedema
Localised hypothermic tissue injury
First degree:
Partial thickness skin freezing
Erythema, oedema, hyperaemia
No blisters or necrosis
Occasional desquamation at day 5-10
Second degree:
Full thickness skin freezing
Erythema, substantial oedema
Vesicles, desquamation, eschar
Third degree:
Full thickness skin + subcutaneous tissue freezing
Violaceous + haemorrhagic blisters
Skin necrosis
Blue-grey discolouration
Fourth degree:
Full thickness skin, subcut tissue, muscle/tendon/bone freezing
Little oedema
Initially mottled + deep red/cyanotic
Eventually dry, black, mummified
Treatment of hypothermia
32-35 deg
Passive warming - clothing, warm environment, encourage movement
Remove cold and wet clothing
Warm, high carb food and fluids
Transport to hospital if unsuccessful
28-32 deg
Maintain horizontal, minimal movement, gentle handling - risk of arrhythmia
Full body insulation, active rewarming (external, minimally invasive)
<28 deg
ABCs
Invasive warming techniques - extracorporeal membrane oxygenation, cardiopulmonary bypass
<24 deg
As above
CRP, defibrillation
Risk factors for near drowning
Children with inadequate adult supervision
Inability to swim/overestimation of ability
Risk-taking behaviours
ETOH
Drugs
Hypothermia
Concomitant medical event
Seizure/developmental/behavioural disorder in children
Process for near drowning
2 different types
Panic
Loss of normal breathing pattern/breath holding
Air hunger, struggle to stay above water
Reflex inspiratory effort > laryngospasm or aspiration
Hypoxaemia, cerebral hypoxia
Wet near drowning from aspiration of water or liquid in lung
Dry near drowning from asphyxia from laryngospasm
Presentation of near drowning
Unconscious patient in or near water
Suspect cervical injury if diving in shallow water
Gastric distension
Hypoxia
Hypothermia
4 main types electrical injury
Flash - Arc flash > superficial burns
Flame - Arc flash igniting clothing
Lightning - Short, extremely high voltage
True - patient part of electrical circuit, entry and exit wounds
Complications of electrical injury
Arrhythmia - most common cardiac complication
Skin damage, infection
Rhabdomyolysis
Compartment syndrome
Secondary injury - fall, trauma
Fracture/dislocation
Seizure
Peripheral nerve injury
Discharge criteria for electrical injury
Low voltage <100V
No LOC/seizure/arrest
No severe burn/trauma requiring admission
Normal ECG
Heat stroke
vs
Heat exhaustion
vs
Heat cramp
Heat stroke:
- Temp >40
- Altered mental state/seizures
Heat exhaustion
- Dehydration, dizziness, syncope, weakness, discomfort, anxiety
- Normal or raised temp
Heat cramps
- Exercise induced painful involuntary muscle contraction, peripheral oedema
+/- fluid, electrolyte disturbance
Medication contributing to heat illness
ETOH
Drugs - cocaine, amphetamines
Anticholinergics, antipsychotics, antihistamines
Neuroleptics, Benzos
B blockers, CCB
Clopidogrel
Diuretics, laxatives
Phenothiazines, alpha-adrenergic
Management of heat illness
Heat stroke
- Remove from heat source, cold water immersion, whole body conductive cooling
- ABCs
- IV rehydration
Heat exhaustion
- Remove from heat
- Evaporative, convective, conductive cooling
- PO/IV isotonic/hypertonic fluid
Heat cramps
- PO isotonic/hypertonic fluid
- Elevate, compression
Symptoms of decompression illness
Fatigue, joint ache, headache, irritability
Rash
Poor balance and coordination
Speech, hearing, vision disturbance
Paraesthesia, weakness, paralysis
Pulmonary barotrauma complications
Pneumothorax
Subcutaneous emphysema
Mediastinal emphysema
Cerebral artery gas embolism
Sinus and middle ear damage
