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Clinical Decision Making Exam 1 > Ross - Environmental Injury > Flashcards

Ross - Environmental Injury Flashcards

1
Q

what do you need for initial eval and continued monitoring of hypothermia

A

core temp

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2
Q

2 types of core temp

A

rectal

bladder

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3
Q

typical triage thermometers only go down to

A

95F

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4
Q

Swiss Hybrid Classification of Hypothermia

A
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5
Q

HT1 - mild hypothermia criteria

A

sx: conscious, shivering

core temp: 35-32C (90-95F)

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6
Q

tx for HT1

A

warm environment

warm, sweet drinks

active movement

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7
Q

HT2 - moderate hypothermia criteria

A

impaired consciousness

core temp: 28-32C (80-90F)

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8
Q

tx for HT2

A

active external and minimally invasive rewarming:

warm environment, heating blanket, warm parenteral fluids

core temp monitoring

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9
Q

HT3 - severe hypothermia criteria

A

unconscious, vitals present

core temp: <28C (80F)

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10
Q

tx for HT3

A

same as HT2

treat in ECMO center dt high risk of cardiac arrest

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11
Q

HT4 criteria

A

vitals absent, cardiac arrest possible

core temp: <32F

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12
Q

tx for HT4

A

cpr

3 doses of epi w. defib

HT2 tx and transport to ECMO

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13
Q

what stage of hypothermia is shivering reflex lost

A

HT2

core temp 80-90F (28-35C)

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14
Q

beginning at what stage of hypothermia might you see dilated pupils (+/- fixed), bradycardia, afib

A

HT2

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15
Q

ventricular arrhythmias can occur below what temp

A

86F

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16
Q

what stage of hypothermia involves areflexia, hypotn, pulmonary edema

A

HT3

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17
Q

cardiac arrest is very likely beginning at what stage of hypothermia

A

HT3

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18
Q

what should you order at HT4 to assess if pt is alive

A

potassium

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19
Q

indications that a person is dead and can not be resuscitated following drowning (5)

A

core temp > 32F (hypothermia is not the case)

K+ > 12

cardiac arrest prior to cooling

chest not compressible → frozen

asystole

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20
Q

if core temp is < 32 AND K+ < 12, consider

A

ECMO

OR

warm up 5 degrees or to 32 and check for spontaneous return of vitals

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21
Q

what tx are indicated for HT4 until death is determined

A

epi

cpr

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22
Q

ekg findings in hypothermia

A

atrial arrhythmias: afib, first degree block

J wave

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23
Q

electrolyte findings in hypothermia may include (3)

A

hyperkalemia

hypophosphatemia

hypomagnesemia

dehydration

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24
Q

core temp > 32F PLUS no response

A

likely dead

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25
Q

process resulting in respiratory impairment from submersion in liquid

A

drowning

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26
Q

submersion in water without respiratory complications

A

water rescue

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27
Q

if you are on the scene of a drowning and the person is conscious, what should you do (5)

A

get to land

initiate bls

give O2

keep warm

call for EMS

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28
Q

if you see an unconscious person in the water, what should you do (3)

A

keep vertical

get to land

if no pulse, give rescue breaths or use ambubag

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29
Q

tx for unconscious drowning victim with no pulse

A

ABC not CBA → 5 initial breaths

continue CPR until ems brings to ED

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30
Q

tx for unconscious drowning victim in ED

A

if core temp > 95 → terminate resuscitation efforts

if core temp < 95 and it was cold water → consider rewarming

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31
Q

mc complication of resuscitation

A

regurgitation of stomach contents → aspiration

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32
Q

what is immersion

A

head above water → have cardiac arrest → drown

33
Q

what is submersion

A

head under water → drown → cardiac arrest

34
Q

immersions have cardiac arrest due to

A

hypothermia

35
Q

submersions have cardiac arrest due to

A

hypoxia

36
Q

who can go home after a drowning incident

A

no significant sx at scene: cough, difficulty breathing, abnormal vitals

37
Q

who needs to go to ED after drowning incident

A

any symptoms at all

young children

38
Q

work up for pt’s in previous card

A

CXR

VBG

pulse ox

obs x 6 hr

39
Q

injury that involves hand or foot immersed in non-freezing water and causes arterial spasm

A

trenchfoot

40
Q

sx of trenchfoot (3)

A

hyperemia

blistering redness/ulceration

hand/foot is cold/anesthetic

41
Q

complications of trenchfoot (3)

A

permanently increased sensitivity to cold

hyperhidrosis

Raynaud’s

42
Q

pathology of cold extremity injury

A

vasoconstriction → endothelial damage → extracellular to intracellular ice formation → cell death

43
Q

4 stages of extreme cold injury

A

pre-freeze

freeze-thaw

progressive microvascular collapse

ischemic

44
Q

what stage of freezing injury does ice begin to form

A

freeze-thaw → extracellular ice

45
Q

non freezing injury with excellent prognosis that typically occurs in non-freezing temps

A

frostnip

46
Q

tx for frostnip

A

warm, dry environment

47
Q

who is esp at risk for complications w. frostnip

A

pt’s w. PVD

48
Q

classifications of frost bite

A

like burns → 1st degree-4th degree

49
Q

what stage of frost bite has sub q involvement

A

stage 3

50
Q

what stage of frostbite involves muscle and bone

A

4th

51
Q

zones of injury in frostbite

A
  1. neurons
  2. muscle
  3. endothelial cells
52
Q

t/f: in frostbite, zones of injury are irreversibly damaged

A

F!

they may come back

53
Q

tx for frostbite

A

rapidly warm extremity → water bath of 102 F preferred

avoid slow defrost

splint and pad to avoid further injury

do not let refreeze

54
Q

in frostbite, should you rewarm even if there is a chance it will refreeze again

A

no! only rewarm once you can keep it warm

55
Q

what is this showing

A

frostnip

56
Q

what is this showing

A

2nd degree frostbite

57
Q

what is this showing

A

3rd degree frostbite

58
Q

what is this showing

A

4th degree frostbite

59
Q

what is this showing

A

thawed trenchfoot

60
Q

what is this showing

A

chillblain/pernio

61
Q

blue discolored sub q tender vesicles

no long term damage

first 3-6 hr

A

chillblain

62
Q

swelling pain, ache, desquamation

no long term damage

6-12 hr

A

gray zone

63
Q

all damaged skin sloughs off

eschars form

chronic pain/inability to walk

12 hr -3 days

A

pernio

64
Q

at what altitude do you experience increased ventilation

A

4921 ft

65
Q

normal physiologic response to acclimatize

A

peripheral vasoconstriction → triggers baroreceptors → suppresses ADH/aldo → diuresis

66
Q

normal sx of altitude (5)

A

exertional dyspnea

spontaneous diuresis → decreased stroke volume

nocturnal periodic breathing

frequent night awakening

weird dreams

67
Q

4 high altitude syndromes

A

acute hypoxia

acute mountain sickness

HACE (high altitude cerebral edema)

HAPE (high altitude pulmonary edema)

68
Q

3 at risk pops for altitude syndrome

A

decreased pulmonary reserve

rate of ascent

previous AMS

69
Q

sx of acute mt sickness

A

AMS → HA

GI

dizziness

sleep disturbance

70
Q

can you have acute mtn sickness w.o ascent

A

no!

71
Q

4 tx for acute mtn sickness

A

stop ascent

acetazolamide

O2

+/- pressure bag

72
Q

ataxia, AMS, extreme weakness, +/- personality changes

A

HACE

73
Q

tx for HACE (5)

A

stop ascent

acetazolamiode

O2

dexamethasone

hyperbaric therapy

74
Q

non cardiogenic edema, dry cough, decreased exercise tolerance

A

HAPE

75
Q

what altitude does HAPE start at

A

8202

76
Q

what is this showing

A

pulmonary edema

77
Q

tx for HAPE (6)

A

descent

minimize cold/exertion

O2

nifedipine/acetazolamide/viagra

CPAP

hyperbaric therapy

78
Q

exposure to altitude not recommended in what disease states (5)

A

CHF

uncompensated pHTN

HTN

severe COPD

sickle cell

79
Q

tx for all AMS in altitude disorders

A

steroids

Clinical Decision Making Exam 1 (22 decks)

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