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Flashcards in Environmental Emergencies Deck (52)
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31

Drowning Management—ER
3

1. Prehospital resuscitative efforts should be continued
2. Head and spinal cord injuries should be sought: often precipitate near-drowning
3. Re-warming initiated in hypothermic patients

32

Drowning: How should you go about rewarming? 4

1. Blankets
2. Bair hugger
3. Overhead warmers
4. Resuscitative efforts should be continued until the patient’s temperature is 32-35C (90-95F)

33

Drowning Management—ER
Patients with GCS > or = to 13 4

1. O2
2. Observation for 4-6 hours
3. If pulmonary exam and room air SA02 remain normal….discharge home with someone to watch
4. If not better….. reassess and admit

34

Drowning Management—ER

Patients with GCS less than 13? 3

1. O2 – ventilation support if needed
2. Chest xray
3. Labs

35

Drowning: Which labs for Patients with GCS less than 13?
9

1. ABG’s
2. CBC,
3. CMP
4. Could develop dilutional hyponatramia and have seizures
5. PT/PTT,
6. UA,
7. CK,
8. urine myoglobin,
9. urine drug screen

36

Management--Inpatient
Neurologic - major determinants of neurologic outcome are:
3

1. Duration of LOC
2. Neurologic state of the patient at presentation
3. Goal of management…..prevent secondary injury

37

Management--Inpatient

Goal of management…..prevent secondary injury such as? 5

1. Cerebral edema
2. Hypoxemia
3. Fluid and electrolyte imbalances
4. Acidosis
5. Seizure activity

38

Management—Inpatient
Pulmonary? 4

1. May need intubation for PEEP delivery: ARDS
2. CXR's should be performed only when indicated
3. Bronchospasm is often seen and responds to beta agonists
4. Glucocorticoids or prophylatic antibiotics are not helpful

39

Factors Associated with a Poor Prognosis
9

1. Duration of submersion > 10 min
2. Time to effective basic life support > 10 min
3. Resuscitation duration > 25 min
4. Hypothermia w/ core temp less than 33C (92F)
5. Glasgow coma scale of 5 (comatose)
6. Age less than 3YO
7. Persistent apnea and requirement of CPR in the ER
8. Arterial blood pH 10C (50F)‏

40

Hypothermia
1. Defined as?
2. Mild?
3. Moderate?
4. Severe?

1. Defined as a core temperature of less than 35C (95F).

2. Mild hypothermia - core temp 90-95F
3. Mod hypothermia - core temp 82-90F
4. Severe Hypothermia - core temp less than 82F

While mostly seem in cold climates, can develop without exposure to extreme environmental conditions.


41

Hypothermia at risk population? 4

1. Elderly lose their ability to sense cold.
2. Neonates have large surface-to-volume ratio.
3. Both groups have limited ability to increase heat production and conserve body heat.
4. Individuals with an altered sensorium.

42

PP of hypothermia:
1. Heat is generated by cellular metabolism (prominently what? 2)

2. Loss by the skin and lungs though?
4

1. (heart & liver)‏

2.
-Evaporation
-Radiation
-Conduction
-Convection

43

Hypothermia
Heat is preserved by? 3

1. Peripheral vasoconstriction
2. Shivering
3. Non-shivering thermogenesis

44

What is non-shivering thermogenesis?

Increase in metabolic rate from thyroid and adrenal glands

45

Presentation of Hypothermia

-Mild? 7

-Moderate? 9

Mild:
1. Tachypnea,
2. tachycardia,
3. hyperventilation
4. Ataxia,
5. dysarthria,
6. impaired judgement
7. Shivering and “cold diuresis”

Moderate:
1. Reductions in pulse rate & cardiac output…
2. hypoventilation…
3. A fib….
4. junctional bradycardia & other arrhythmias can occur
5. CNS depression,
6. hyporeflexia
7. Decreased renal blood flow and
8. loss of shivering
9. Paradoxical undressing

46

Hypothermia Presentation
Severe? 7

1. Pulmonary edema
2. Oliguria
3. Areflexia
4. Coma
5. Hypotension,
6. bradycardia,
7. ventricular arrhythmias and asytole

47

Dx of Hypothermia
1. Must use what kind of thermometer?
2. Labs to ID potential complications? 5

1. Must use low-reading thermometer.

2. Labs to ID potential complications:
-Electrolytes
-Hematocrit
-Coagulation studies
-ABGs
-EKG: elevation of the J point—J or Osborne wave

48

EKG reading for hypothermia?

J waves

49

Managment of ABC’s
Initiation of rewarming
2

1. Passive external rewarming
2. Active external rewarming

50

Active external rewarming:
1. Ways to do this? 4
2. Risk is what?
3. Warm what part of the body first?

1. Combination of
-warm blankets,
-radiant heat,
-warm baths or
-forced warm air.

2. Risk is core temperature afterdrop—occurs when trunk and extremities warmed simultaneously.

3. Warm trunk 1st and minimize use of peripheral muscles .

51

Active internal rewarming:
Can be used alone or with active external rewarming.

Ways you can do this? 4

1. Pleural and peritoneal irrigation with warm saline.

2. Hemodialysis and cardiopulmonary bypass.

3. Warm humidified oxygen.

4. Warm IV fluids and bladder or GI irrigation with warm saline may be used.

52

Treatment of Arrhythmias

1. Hypothermic heart very sensitive to what?

2. Which usually resolve with rewarming? 2

3. Management of V-fib and asystole can be difficult—they may be refractory to therapy until the patient has been what?

1. movement & rough handling of the patient may precipitate arrhythmias.

2. A fib and flutter

3. rewarmed (core temp of 86-90F).