SPECIAL CIRUMSTANCES Flashcards
(26 cards)
Why is it important for patients who have been immersed to be rescued horizontally?
To prevent positional hypotension, caused by hydrostatic changes from prolonged immersion/hydrostatic squeeze effect.
Why may i-gels be insufficient in patients who have drowned?
Likely regurgitation of stomach contents due to aspiration of water
Poor lung compliance from pulmonary oedema so Higher Ventilation
Chest wall stiffness from hypothermia
Laryngospasm may be present due to irritation from water
May not seal due to hypothermia.
Why are 5 initial rescue breaths recommended in drowning resuscitation?
Hypoxia is very common → cause of the cardiac arrest, restore oxygen levels, reverse effects of respiratory arrest.
Why would signs of life be particularly challenging to detect in drowned patients?
Hypothermia is associated with depression of cerebral blood flow and oxygen requirements, reduced cardiac output and decreased arterial pressure therefore a pulse may be hard to detect, patients may be severely bradycardic due to the body’s reflex to cold water submersion.
What is the difference between submersion and immersion?
Submersion - whole body in the water; immersion - just the head in the water.
How do submersion durations impact outcomes?
Submersion less than 10 minutes is associated with a very high chance of a good outcome; more than 25 minutes is associated with a low chance of good outcome.
How to manage an airway in drowning incidents?
Massive amounts of foam are quite common due to mixing of moving air with water and surfactant to come out of the mouth of the victims. Follow the airway ladder; intubation may be the best option if possible.
When can a role be considered in drowning patients?
Role can be considered at 60 minutes submersion for adults and up to 90 for children when the incident involves icy cold water.
How does hypothermia impact defibrillation?
If core temperature is <30 degrees, defibrillation attempts should be restricted to 3 shocks of 360 joules, ensuring the patient is dry as water can conduct electricity.
How does hypothermia impact drug administration?
Drugs should be withheld for any patient until warmed to >30 degrees. When between 30-35 degrees, the intervals between drug doses should be doubled (every 6-10 minutes instead of 3-5 minutes).
How to effectively warm a hypothermic patient in a pre-hospital setting?
Use a warm environment and blankets. Do not just place a foil blanket on the patient; instead, place a normal blanket on the patient, then a foil blanket, and then another normal blanket.
What are the changes to your patient’s acid-base balance as a result of drowning?
Leads to respiratory and metabolic acidosis due to hypoventilation and reduced metabolic rate.
What are the three types of hypothermia?
ACUTE HYPOTHERMIA - When a Person suddenly loses heat very Rapidly (E.g. Falling into Cold Water)
SUBACUTE HYPOTHERMIA - Typically Occurs in a Hill Walker who is exercising in Moderate Cold who becomes Exhausted and is unable to Generate Enough Heat.
CHRONIC HYPOTHERMIA - Heat Loss Occurs Slowly, often over Days or Longer. Most Common in the Older Population living in an Inadequately heated House or the Homeless.
What are the risk factors of hypothermia?
- Older patients >80 years due to impaired thermoregulation.
- Children due to larger body surface area.
- Some medical conditions (e.g., hypothyroidism, stroke).
- Intoxicated patients.
- Drowning.
- Exhaustion.
- Injury and immobility.
- Decreased level of consciousness.
What are the clinical stages of hypothermia?
Stage 1 - Conscious and Shivering
Stage 2 - Reduced Conscious Levels, may or may not be shivering
Stage 3 - Unconscious, Vital Signs Present
Stage 4 - Apparent Death, Vital Signs Absent.
What are the severity classifications of hypothermia?
Mild: 35-32 Degrees
Moderate: 32-28 Degrees
Severe: <28 Degrees.
What to consider in hypothermic arrest?
- Severely Hypothermic Patients may initially appear to be Dead but Frequently have a very slow and Weak Pulse
- Very Slow and Shallow Respirations
- Fixed Dilated Pupils
- Increased Muscle Tone
- Dilated Pupils can be Seen in Hypothermia and therefore should not be used as a sign of death.
- DO NOT STOP CARDIAC RESUSCITATION IN THE FIELD.
What ECG changes are associated with hypothermia?
- Osborne Waves = J Waves
- Bradyarrhythmias
- Shivering Artefact
- Ventricular Ectopics
- Cardiac Arrest due to VF, VT or Asystole
- Prolonged PR, QRS and QT Interval.
What are the complications of gastric aspiration post drowning?
- Severe Respiratory Distress
- Acidic Fluid can Severely Damage the Upper + Lower Airways
- Aspiration Pneumonia - caused by Foreign Material Entering Lungs and Causing a Severe Infection.
- Sepsis: Occurs after Pneumonia
- Pulmonary Obstruction
- Possible Death due to Hypokalemia/Hyponatremia.
What are the effects of hypothermia on the body?
Decrease in the Level of Consciousness, Brain Dysfunction, Slurring Speech, Muscular Coordination, Slowing Heart Rate, Slowing Respiratory Rate, Cardiac Arrhythmias: AF/VF/Asystole/Sinus Bradycardia
What is the difference between primary and secondary hypothermia?
Primary - Environmental Exposure, with no underlying medical condition causing disruption of Temperature Regulation. Secondary - Results from a Medical Illness Lowering the Temperature Set-Point.
What are the cardiac consequences of hypothermia in trauma patients?
Decreased Cardiac Output and Myocardial Ischaemia, Decreased Cardiovascular Response to Catecholamines (Epinephrine), Impaired Tissue Oxygen Delivery, Arrhythmias such as Atrial and Ventricular Fibrillation
What is the management of respiratory distress post submersion?
Suction/pt position and Adjuncts, Ventilate pts as RR required, IV Access: Fluid Bolus, Warm pt, Remove Clothing, Ventilate the Pt if RR above 30
What cardiac complications can occur when warming someone too quickly?
Arrhythmias and Heart Failure
