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Enviornmental
environmental
| Question | Answer |
|---|---|
| Normal temperature | 37*c (98.6* f) |
| between 55-144*F a naked body | can maintain a constant internal body temp |
| Thermoregulation | regulated by Posterior Hypothalamus-thermostat(-negative feedback system) |
| Posterior hypothalamus recieves input from | 1.Central thermoreceptors (anterior hypothakamus-deep body tissues.-spinal cord,abd viscera,around great veesels 2.Peripheral thermoreceptors-in skin, mucous membranes |
| Cold receptors | stimulated by lower skin surface temp,body warms when stim-more cold receptors than hot in skin and organs |
| Warm receptors | stimulated by higher temp-body cools when stim,more warm than cold in anterior hypothalmus-negative feedback |
| Thermogenesis | internal heat production |
| 1.Work induced thermogenesis | exercise/shivering |
| 2.Thermoregulatory thermogenesis | controlled adrenal/Thyroid |
| 3.Diet induced thermogenesis | processing foods-affected by age,general health,nutritional state |
| (BMR) Basal metabloci rate | rate body consumes energy to maintain stability |
| Exertional Metabolic rate | rate body consumes energy during activity (faster than BMR) |
| Skeletal muscle | largest producer of heat (shivering)-increases heat x400,motor center in hypothalamus is excited-piloerection occurs |
| Vasoconstirction | conserves heat, hypothalamus stimulates SNS-A1 receptor stim |
| Endocrine glands regulate heat | through release of hormones from thyroid and adrenal gland |
| Heat is | recieved from enviornment via thermal gradient |
| Thermal gradient | difference between temp of environment and body.Factors that effect:1.Ambient ai temp,2.infrared radiation,3.relative humidity,4.wind |
| Ambient air temp | determines how conduction occurs-towards body or away |
| Heat loss | by air or water currents passing over body |
| Factors that contribute to cooling effects of convection | velocity and temp of air or water currents |
| Evaporation | evaporation of fluids absorb heat from surrounding objects and air. affected by ambient temp/humidity |
| Respiration | heat is lost in inhailed air and exhaled air, amount lost depends on air temp,rate and depth of respirations |
| Heat Elimination (THERMOLYSIS) | body eliminates heat thru-vasodilation,perspiration, decreasing internal production,increased CO/RR, vasodilation,perspiration |
| Thermolysis | SNS/Thyroid hormones are inhibited |
| Thermogenesis | SNS/Thyroid hormones are stimulated |
| Hyperthermia | when normal mechanisms are overwhelmed by environment,excessive exercise, thermoregulatory mech dails |
| Heat disorders | heat cramps,heat exhaustion, heatstroke |
| Heat cramps | -brief muscle cramps,occurs in fatigued muscles,caused by rapid change in extracellular fluid osmolarity-Na+ and H2o loss-sweats profusely/drinks H2o without enough salt, 1-2 liters can be lost/hr-20-50mEq of Na+-occur in limbs and abd |
| S/S-Tx | diaphoresis,mentally alert,weak,dizzy,tachy,normotensive,normal core temp: remove from heat,replace water/salt,IV,NS,massage cramp,apply moist towel |
| Heat Syncope | orthostatic syncopal-cause:seen in mass gathering in heat,dehydration,peripheral vasodilation |
| Heat exhaustion | hot ambient temp-profuse sweating 1-2l/hr, inadequeate perfusion-osmosis occurs fluid shifts from vessels |
| S/S:Tx | AMS,dizzy,nausea,HA,temp elevation <103*F,tachy,Dilated pupils,decreased urine output-Tx: remove,supine, |
| Heat Stroke | thermoregulator mechanisms break down completely,>104-105*F(41*c),multi system tissue damage-leads to CNS disturbances |
| Classic Heat stroke | high sustained ambient temp/humidity,affects young,old,without ac.med problems-DMI,CAD,alcoholism,schitzo |
| Exertional heat stroke | exercise in hot humid conditions-heat accumalates faster than it can be lost.50% have diaphoretic skin due to SNS |
| S/S | convulsions,hypozia,hypoglycemia, |
| Tx: | lower temp to 102*F,remove from enviroment, rapid cooling, avoid overcooling,2 large bore iv's,monitor,AVOID vasopressorsand anticholinergics |
| Outcomes frrom heat stroke | pulm edema,GI bldg,kidney dysfunction due to hypovolemia,hepatic injury,clotting disorders,electrolyte abnormalities |
| Dehydration in Heat disorders | lead to orthostatic hypotensionS/S-n/v,abd distress,vison dist, |
| Water intoxification | when drinking water > loss of water, water intake >1 liter per hour.Sodium levels drop leading to N/V,HA,AMS,polyuria,diluted urine.TX:encourage eating foods high in sodium |
| Fever (pyrexia) | resetting of hypothalamic thermostat,pathogens enter,neutrophils and monocytes arrive,WBC's release PYROGENS=resent of thermosts.TX:if temp is >105*F,ams or seizure-tylenol 650mg,ibuprophen 600-800 mg |
| Neuroleptic Malignant syndrome | caused by antipsychotic drugs and antimemetic med,S/S hyperthermia,muscle rigidity,ams, |
| Hypothermia | when core tempis <95*F,caused by < heat production,>heat loss,excessive cold stress |
| . | . |
| Drugs that impair thermoregulator mech. | alcohol,antidepressants(vistaril),antipyretics(ASA,phenothiazines(thorazine),sedatives,antiseizure meds, |
| Mild hypothermia | temp 93.2-97*F,increased metabolic rate,vasocoonstriction+increased CO,shivering, |
| Moderate hypothermia | temp 86-93.2*F,slurred speech,apathetic,amnesia,uncoordinated,decreased shivering,dilated pupils,a-fib,CO<33%,bld becomes acidotic,hypovolemia develops |
| @ 86*F shivering stops due to | glucose/glycogen depletion or insulin not available for transfer |
| Severe Hypothermia | <86*F,Shivering stops,BMR <50%,ascess pulse n resp for 30sec |
| S/S | disoriented,confused,supor,coma,stiff,rigid,loss of deep reflexes,Fixed dilated pupils,prolonged PR,QRS,QT,Osborn wave,A-fib(most common),brady |
| Mild/Mod Tx | passive/active rewarming,no acess activity,warm drinks and sugar sources,warm iv fluid |
| Afterdrop phenomenon | rewarming shock leads to V-fib |
| Severe w/pulse | remove cloth,warmed o2,warm to 102-104*, no meds |
| Severe w/no pulse | asscess pulse for 1-2 min,rectal temp,cpr,IV meds longer interval-lidocaine/procainamide,mag, only 1 shock |
| Frost Nip | mildest form of cold injury,involves extremities,localized injury-fingers n hands less common |
| Frostbite | ice crystals form in the extracellular tissue,intracellular water is drawn to ext t cellular,Intracellular lytes reach toxic levels-w/in mins bld flow declines |
| Superficial frostbite | some loss of sensation-S/S:cold,numb,skin red, white or gray.extreme pain w/rewarming-post warming:edema in 3 hrs, blisters 3-24 hrs,skin blackens |
| Deep frostbite | disrupted nutritional cap flow.cold, mottled blue or gray skin,edema develops slowly |
| TX | analgesic,place in hot H2o,warm to 102-104*f,cover with dry dressing,elevate thawed part |
| Trench Foot | emersion foot,exposure to cold/wet-H2o temp >32*F,tissue sloughing or gangrene-TX-warm, dry,elevate feet |
| Drowning | asphyxiation resulting from submersion in liquid, death within 24 hrs post sub |
| Dry drowing | Laryngospasm drowning 10% |
| Fresh water | washes away surfactant,alveoli collapse-V-fib occurs-leads to hyperkalemia and anemia |
| Salt water | draws fluids from bloodstrea,.pulmonary edema occurs |
| Mammalian diving reflex | trigeminal nerve (V) takes message to brainstem=breathing inhibited,brady,decreased metabolic rate,vasoconstriction |
| Factors affecting outcome | 1.Water temp 70*F or below,2.length of submersion3.cleanliness of H2o,4.age/health-younger is better |
| Drowing TX | safety,c-spine,rescue breathing,ALS.IV @75 ml/hr |
| ARDS | due to water in lungs-lungs leak fluid into alveoli,fluid loaded with chemicals causing inflammation of tissue-can cause:pulm parenchymal injury,destruction of surfactant,pneumothorax |
| water rescues | reach,throw and tow,row,go |
| 33 ft of water | 2 atmosphere (14lbs)per square inch |
| Boyles Law | POPS-pulmonary overpressurization syndrome:volume of gas inversly proportional to its pressure-cause of barotrauma |
| Daltons law | high altitudes: |
| Henry's law | Decompression illness: |
| Descent problems (squeeze) | barotrauma, results from compression of gas-usually from blocked eustachian tubes |
| S/S | pain,HA,disorientaiton,vertigo,nausea, bleeding from ears/nose, ringing in ears |
| Nitrogen Narcosis (bottom injury) | dissolved nitrogen crosses BBB-S/S evident @70-100 ft,>200ft becomes impaired,300-350ft unconsious-S/S: impaired judgement, sensation of alcohol intox,euphoria,TX: ascent,helium,O2 |
| Ascent injuries (boyles law) | air in spaces expand as pressure decreases. if released to fast POP occurs=alveolar rupture |
| other Ascent injuries | *Systemic arterial gas embolism (AGE)-enters circulatory system from damaged lungs,*pneumomediastinum:release of air thu visceral pleura into mediastinum,*pneumopericardium,pneumothorax,pneumoperitoneum |
| POPS S/S | increasing CP,hoarsness,neck fullness,dyspnea,dysphagia(impaired swalling),subcutaneous emphysema |
| Decompression Illness(sickness) (henrys law) AKA the bends | development of nitrogen bubbbles within tissues due to a rapid reduction of air pressure when returning to surface, or exposure to compressed air. Severe pain in abd and joints-effects most cpmmpn in joints and spinal cord |
| Direct effects of nitrogen | ischemia,infarct due to hypoperfusion,tissue displacement,vertigo,platelet aggregation,intravascular coagulation due to air emboli,edema,electrolyte imbalance, lopid emboli are released |
| Decompression S/S-TX | SOB,itch/rash,crepitus,fatigue,vertigo, paresthesias,paralysis,seizures,unconsiousness: develop within 24hrs-ABC's,supine position,dexamethasone,heparin,valium |
| Recompression (hyperbaric O2 chamber) | treats barotrauma,O2 under greater tan atmopspheric pressure,forces nitrogen to redissolve into tissue,when recompressed nitrogen escapes without forming bubbles |
| Arterial gas embolism (boyles law) | alveolar membranes rupture caused by rapid ascent or holding breath during ascent=hemorrhage,cap/alv inflammation,pneumo,sub Q emphysema-onset 2-10min after ascent |
| S/S-TX | neuro def,LOC,sharp,tearing pain,parylysis,unequeal- pupils,blindness,wide pulse pressure,aphasia,confusion,dizzy,vertigo,abd pain,convulsions,arrest-TX:LLR thorax elevate 15*,hyperbaric chamber |
| Pneumomediastinum | result of POPS-air released thru visceral pleura to mediastinum-S/S=substernal CP,abn heart sounds,narrow PP,change in voice, |
| High altitude Ilness (daltons law) | high altitude low O2 environment,barometric pressure decreases,starts at >8,000 ft above sea level-S/S= malaise,anorexia,HA,sleep disturb,resp distress |
| Acclimatization | gradual ascent,days to weeks.within 2 hrs RBC prod increased,>aldosterone and ADH=retained fluid |
| Prevention of altitude effects | 1.limit exertion.2.sleeping.3.high carb diet-Meds-Acetazolamide (Diamox)-diuretic, forces bicarb out.Nifedipine (procardia,adalat) blood vessel dilation, helps prevent pulm HTN and edema |
| (AMS)Acute Mountain Sickness | occurs in unacclimated person that ascends rapidly to 6,600 ft- |
| S/S-TX | mild:light head,breathless,weak,HA,N/V,disturbed sleep 6-24hrs after ascent:mod:weak,severe vomit,SOB,Altered LOC, |
| (HAPE) High altitude pulmonary Edema | result of increased pulmonary pressure and HTN.arterioles become permeable-kids and men more suseptible |
| S/S-TX | dry cough,mild SOB on exertion,slight crackles,lethargy,disorientation then cyanosis,frothy sputum,coma and death-TX:descent,o2,portable hyperbaric bag,Diamox,procardia,lasix,morphine |
| (HACE) High altitude Cerebral Edema | cause unknown,starts with HAPE or acut mont sickness. Increased ICP develops due to edema |
| S/S-TX | AMS,poor judgement,ataxia,HA(common sign), |
| Radionuclide/radioisotope | radioactive substance that emits ionizing radiation |
| Protons | + charged particles,located in nucleus |
| Neutrons | subatomic particles-not charged, avg life <17 mins |
| Electrons | minute particles with a negative charge,called beta particles when emitted |
| Alpha particles | slow moving, large,travel only few mm, stopped by paper, clothes and skin-least dangerous unless internally exposed, most dangerous form of exposure |
| Beta particles | penetrate subcuatneous tissue, enter thru damaged skin,ingestion and inhalation-causes less local damage than alpha, stopped by aluminim |
| Gamma | 100x's penetrating power of beta,only lead protects, produces localized burns and ext internal damage. Causes internal tissue to release alpha and beta particles from electrons |
Created by:
rebeccabelleth
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