Flashcards in Environmental Emergencies Deck (52):
What is CHILBLAINS?
Cold tissue injury without frozen tissues
What are the signs and symptoms of chilblains?
Red pruitic lesions where exposed to cold. Lymphocytic vasculitis common
Edema and blistering that is aggrevated by warmth
How do we treat chilblains?
• Elevated on a soft surface, like a pillow
• Allow to warm at room temperature
• DO NOT massage or apply heat
When do we know the damage accrued by frostbite?
Degree determined once area is warmed because all look the same at first
What are the signs and symptoms of frost bite?
Skin is white or blue–white, firm or hard (frozen), cool, and insensitive
Mild frostbite sx: numbness, paresthesias, pruritus, and lack of fine motor control
More severe sx: ↓ ROM, blister formation, and prominent swelling
May not show sx until rewarmed → tenderness/throbbing pn, discolored, loses elasticity, immobile
What are the classifications of frostbite?
First Degree = Freezing w/o blistering; peeling is occasionally present.
Second Degree = Freezing w/ clear blistering.
Third Degree = Freezing w/ death of skin, hemorrhagic blisters, and subcutaneous involvement.
Fourth Degree = Freezing w/ full-thickness involvement (including bone); ultimate loss/deformity of body part
How do we treat frostbite?
Superficial: rewarm by remove wet clothing and apply constant warmth
Full thickness: rewarm in waterbath w/ abx in it; must be 40°C–42°C (104°F–107.6°F). DO NOT begin this unless the threat of refreezing is gone
Protect body part, clean well, give PCN prophylaxis
What is an example of immersion syndrome? What is immersion syndrome?
trench foot; prolonged immersion in cold water causing alternating arterial vasospasm and vasodilatation
What are the signs and symptoms of immersion syndrome?
first = cold and anesthetic
Hyperemia (excessive blood flow to an area) after 24–48 hrs = parts become warm, w/ intense burning and tingling pain, blistering, swelling, redness, ecchymoses, ulceration
Post-hyperemic phase: after 2–6 wks, limbs are cyanotic, w/ ↑ sensitivity to cold
What are the complications of immersion syndrome?
Complications include lymphangitis, cellulitis, thrombophlebitis, and wet gangrene
How do we treat immersion syndrome?
Best before hyperemia stage: Protect from trauma or infection and Rewarm gradually by air exposure (not ice or hot); do not soak or massage skin.
Prevent ulcers by elevation, protection of site
Hospitalize and bed rest until ulcers are healed
What are the signs and symptoms of heat edema?
swelling of feet and ankles due to vasodilatation and venous stasis
Usually in nonacclimatized ppl (elderly), assoc w/ sitting/standing for long time
How do we treat heat edema?
support hose, elevation, NOT diuretics
What is heat syncope?
fainting after exertion in heat. Vasodilation of muscular and cutaneous veins
What are the signs and symptoms of heat syncope?
skin is cool and moist, weak pulse, and transient hypoTN
core temp is normal or mild ↑
How do we treat heat syncope?
rest in recumbent position, cooling, rehydration; eval elderly for other causes of syncope
What are heat cramps?
Spasms of the voluntary muscles of the abdomen and extremities, Due to salt depletion
What are the signs and symptoms of heat cramps?
skin cool or warm, moist or dry. The core temp is normal or mild ↑ while the Serum Na may be norm or low
How do we treat heat cramps?
GATORADE!!!! I swear this is what the book says!!
oral fluid and salt replacement with 0.1–0.2% salt solution OR IV NS; rest for 1-3 days
What is heat exhaustion?
prolonged heat exposure (hours to days) and is due to sodium depletion, dehydration, accumulation of metabolites, or a combination of these factors. Rapidly leads to heat stroke
What are the signs and symptoms of heat exhaustion?
dehydration sx, headache, nausea, vomiting, malaise, muscle cramps, and dizziness.
Core temp <104F, 40C
What are the types of heat exhaustion?
Types: (usually a combo of both)
• Hypernatremic = primary water loss; person in hot environment does not have enough water
• Hyponatremic = primary salt loss; person sweats excessively and replaces w/ pure water
How do we treat heat exhaustion?
put in cool place, rehydration, IV fluids NS or LR
Serum Na may be very low
What is heat stroke?
A dysfunction of the heat-regulating mechanism
What are the signs and symptoms of a heat stroke?
altered mental status (can be coma), skin is hot, flushed, dry (may be sweaty)
The core temp >105.8, 41C
• early- HTN, tachycardia
• late- HypoTN
• liver damage with elevated enzymes, oliguria
• Rhabdomyolysis and multiorgan dysfunction.
• Illness and death result from destruction of cerebral, cardiovascular, hepatic, and renal tissue
How do we treat a heat stroke?
ABCs, cooling is priority (cooling blankets, ice packs, fans, etc), monitor urine output.
Ice packs to axilla, post neck and inguinal regions
How do we get injured by lightning?
Injury from direct strike, splash (i.e. from trees, buildings, fences), step voltage (spreading on ground), upward leaders, and blunt trauma from concussive shockwaves
Injuries include burns, CNS (spinal, cerebral bleeds, seizures, ect), musculoskeletal (fx, blunt trauma), eye injury, and ear injury including hearing loss
What are the signs and symptoms of a lightning burn?
initially pulseless with mottled extremities, AMS
Blown pupil does not equal dead!!! Death from resp arrest (#1), V fib, asystole
How do we treat a lightning injury?
Treat like a trauma (c-spine precaution, internal injury). EKG, and laboratory tests including CK, cardiac enzymes, electrolytes, urinalysis with myoglobin, lactate, and hemogram. CT of the head
What are the types of electrical burns?
AC (found in houses) is more dangerous than DC
What are the signs and symptoms of electrical burns?
Shock- V fib, ectopic beats, sinus tachycardia or bradycardia, atrial fibrillation, and asystole. Seizures, deafness, blindness, aphasia, and neuropathy
Burns- small burns may mask extensive internal injury with 3rd spacing and rhabdomylosis • Remove from electric source by turning it off or pulling the victim away with a nonconductive material
How do we treat electrical burns?
Treat circulatory shock and burns as usual
What are the signs and symptoms of snake bites?
edema, hemorrhage, necrosis around site; systemic = hemolysis, thrombocytopenia, coagulopathy, vomiting, and, rarely resp failure
How do we treat snake bites?
1st Aid: none of that tourniquet, suck it out stuff; just immobilize site and hold below heart and transport
Hospital: ABCs, labs, IV access, antivenom
What are the signs and symptoms of bee and wasp stings?
How do we treat bee and wasp stings?
Oral pain control, tetanus prophylaxis, and diphenhydramine, unless anaphylaxis (then tx that)
What are the signs and symptoms of black widow bites?
severe pain in the bitten extremity and muscle spasms of the abdomen and trunk, Severe HTN/↑ HR can occur.
How do we treat black widow bites?
narcotic analgesics and antivenom in the seriously ill
What are the signs and symptoms of brown recluse bites?
local tissue destruction, initial pustule to a bull's eye like lesion to a larger craterlike ulcer
How do we treat brown recluse bites?
tetanus prophylaxis and local wound care
What are the signs and symptoms of scorpion stings?
local reactions including a painful sting site with or without erythema (most are harmless)
How do we treat scorpion stings?
ice for pain; unless it is this certain kind that is not in FL which produces systemic sx then put them in ICU
What are the signs and symptoms of stingray stings?
intense local pain, then 30 min later N/V, weakness, tachycardia, muscle cramps
Severe cases: syncope, paralysis, hypotension, cardiac arrhythmias, and death → RIP Steve Irwin ☹
How do we treat stingray stings?
wound care (irrigate, anesthetize, explore, etc), abx and tetanus
What are the signs and symptoms of sea snake bites?
initial bite is painless, but limb and respiratory paralysis as well as myolysis can occur
How do we treat
same as for land snakes and includes sea snake antivenom if paralysis or myolysis is present
What are the deadly jellies?
The deadly ones: Box Jellyfish, Irukandji, Portugese Man-o-war
What are the signs and symptoms of jelly stings?
extreme pain (local and distant), inflammatory rxn (most are not life threatening)
Systemic sx = bad (nausea and vomiting, autonomic changes, and paralysis)
How do we treat jelly stings?
Box: basic life support, vinegar, compression bandages, antivenom, pain control
Irukandji: supportive care and monitoring for complications
Portugese: remove tentacles, rinse with sea water, cold packs, pain meds
What are the signs and symptoms of near drowning?
unconscious, semiconscious, or awake and apprehensive. Cyanosis, trismus, apnea, tachypnea, and wheezing. A pink froth @ mouth = pulmonary edema. Tachycardia, arrhythmias, hypotension, shock, and cardiac arrest. Decerebrate or decorticate posturing