Environmental Emergencies: Signs, symptoms, and Treatments Flashcards
Hyperthermia
Diaphoresis Increased Skin Temp Flushing Later stages: Altered Mentation Altered LOC
Heat Cramps
Intermittent cramping of skeletal muscle: Signs and symptoms: Cramps in the rings, arms, legs, and abdominal muscles. Mentally allert Weakness Normal Vitals Treatment: Remove PT from environment Oral Saline (if not altered)
Heat Exhaustion
A mild heat illness, acute reaction to heat exposure Signs and Symptoms: Body temp over 100 F Skin cool, clammy w/ heavy perspiration Rapid shallow breathing Weak pulse Active thermolysis (diarrhea and muscle cramps) Feels weak May lose conciseness headache, anxiety, paresthesia, and impaired judgment or psychosis Treatment: Remove from environment Lay Supine Oral Saline (NO SALT TABLETS) Remove clothing and fan PT Threat for shock is suspected
Heatstroke
Acute, dangerous reaction to heat exposure, characterized by a body them of above 105 F and central nervous system disturbances. Signs and symptoms: Temp >105 F No sweating CNS disturbances Skin: Hot- may be wet from earlier exertion but will not be actively sweating Deep Respirations Tachycardia Hypotension Confusion Seizures Treatment: Remove from environment Active cooling (remove clothing, place wet sheet, fanning- no cold water) Oxygen Oral saline/ IV fluid (1-2 L) wide open ECK monitoring No vosopressors or anticholinergics Monitor Body temp
Dehydration
Thirst not a good indicator Signs and symptoms: Nausea, vomiting Visual Disturbances Decreased urination Poor skin turgor Signs of hypovolemic shock Treatment 2-3 L IV fluids
Fever
Treatment:
Remove extra clothing/ blankets
Acetaminophen-15 mg/kg in pediatric; 650 mg in adults
Ibuprofen- 10 mg/kg in pediatric; 600-800 in adults
Hypothermia
Mild- Core temp over 90° F Severe- Core temp under 90° F Signs and symptoms: Shivering Increased muscle tone Peripheral Vasoconstriction Lethargic Sever Cases: Disoriented/Confused J waves A- fib- most common dysrhythmia in these PTs Bradycardia V-fib more probable after core temp <86° F Treatment: Remove wet clothes Protect from further heat loss Maintain PT in horizontal position Avoid rough handling Monitor Core temp ECG Monitoring
Mild Hypothermia Rewarming Measures
Warm IV fluid
Warm water immersion (water between 102° and 104°)
Sever Cases: Do not attempt unless transport time is over 15 minutes- if attempted
Warm, humidified oxygen
Warm IV fluids- 150-200 mL/hour
NO heat packs
Warm blankets
Intubation if needed
No procainamide, lidocaine, or epi because if circulation is restored, it will be derived in toxic levels.
Magnesium sulfate and Bretylium are still useful.
Frostbite
Signs and symptoms: Minor: Red skin followed by blanching Sever: Hard, white skin Treatment: Do not thaw if there is a possibility of re-freezing Do not massage frozen area Give analgesia prior to thawing Transport to hospital Cover thawed area w/ loosely applied dry, strike dressing Elevate and immobilize the thawed part DO NOT puncture of drain blisters DO NOT rewarm frozen feet if they are required for walking
Drowning
Signs and symptoms: Bradycardia Vasoconstriction Treatment: Remove PT from water Suspect head and neck injury Protect PT from heat loss- remove we clothing ABC NO abdominal thrusts Establish IV at 75 mL/hr
Decompression Illness
Treatment:
Keep PT spine
Maintain good body temp
Give PT juices or oral balanced salt solution
IV fluid replacement of electrolyte solution for unconscious or seriously injured PT.
If CNS involvement, give dexamethasone, heparin, or Valium
Maintain Cabin pressure if Air Evacuation
Send equipment with PT
Arterial Gas Embolism
Signs and symptoms: Acute onset of sharp, tearing pain Confusion Vertigo Visual Disturbances Loss of Consciousness Treatment: Maintain ABC's O2 at 100% Place PT in supine position Vital Monitoring IV Fluids at TKO Corticosteriods Transport
Nitrogen Narcosis
Signs and symptoms:
Altered LOC
Treatment:
Helium/oxygen mix
Acute Mountain Sickness
Signs and Symptoms: Lightheadedness Breathlessness Weakness Headache Nausea and vomiting Sever Cases: Vomiting Decreased Urine Output Shortness of breath Altered LOC Treatment: Acetaxolamine (Diamox) and antinauseants like prochlorperazine (Compazine) if needed. Oxygen if needed
High Altitude Pulmonary Edema
Signs and symptoms: Dry cough Mild Shortness of breath on exertion Slight crackles in lungs Treatment: Oxygen Acetazolmiden Maybe morphine, nifedipine (procardia) and furosemide (Lasix)- be aware of side effects.
