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Chap 33 Enviro
Environmental
| Question | Answer |
|---|---|
| Dysbarism injuries | Any signs and symptoms caused by the difference between the surrounding atmospheric pressure and the total gas pressure in various tissues, fluids, and cavities of the body |
| Five ways the body can lose heat | Conduction Convection Evaporation Radiation Respiration |
| Conduction | The loss of heat by direct contact when a body part comes in contact with a colder object. however, heat can also be gained if the substance being touched is warm |
| Convection | The loss of body heat caused by air movement such as a breeze blowing across the body. However, heat can also be gained if the air moving across the body is hotter than the temperature of the environment |
| Evaporation | The conversion of water or another fluid from a liquid to a gas. the natural mechanism by which sweating cools the body |
| Radiation | The transfer of heat to colder objects in the environment by radiant energy; for example, heat gained from a fire |
| Respiration | The loss of body heat as warm air in the lungs is exhaled into the atmosphere and cooler air is inhaled. However, if the temp is above body temperature, an individual can gain heat with each breath. |
| Hypothermia | Condition in which the internal body temperature falls below 95F/35C, usually as a result of prolonged exposure to cool or freezing temperatures. The body loses its ability to regulate its temp and generate body heat. |
| Diving reflex | The slowing of the heart rate caused by submersion in cold water. this may cause immediate bradycardia (slow heart rhythm) |
| Turgor | The ability of the skin to resist deformation; tested by gently pinching the skin on the forehead or back of the hand |
| Scuba gear | A system that delivers air to the mouth and lungs at various atmospheric pressures, increasing with the depth of the dive; stands for self-contained underwater breathing apparatus |
| Reverse triage | A triage process used in treating multiple victims of a lightning strike, in which efforts are focused on those who are in respiratory and cardiac arrest. this is different from conventional triage where such patients would be classified as deceased |
| Hyperthermia | A condition in which the body core temperature rises to 101 degrees (F) or more. when heat gain exceeds heat loss. |
| Hymenoptera | A family of insects that includes bees, wasps, ant, and yellow jackets |
| Homeostasis | A balance of all systems in the body |
| Heat stroke | a life threatening condition of severe hyperthermia caused by exposure to excessive heat, with warm, dry skin; severely altered mental status, often irreversible coma. Uncommon but serious illness. If untreated this can always result in death |
| Heat exhaustion | Heat emergency in which a significant amount of fluid and electrolyte loss occurs because of heavy sweating; also called heat prostration or heat collapse. Most common heat emergency. (heat exposure, stress, fatigue, and hypervolemia) |
| Heat cramps | Painful muscle spasms usually associated with vigorous activity in a hot environment. Does not always occur when it is hot outdoors. Dehydration may play a role in the development of muscle cramps. Usually occurs in the leg or abdominal muscles. |
| Frostbite | Damage to tissues as the result of exposure to cold; frozen body parts. Once the extremity is frozen it is considered damaged and cannot be reversed. |
| Drowning | Process of experiencing respiratory impairment from submersion or immersion in liquid. This is often the last cycle of events caused by panic in the water. Can occur in buckets, puddles, bathtubs etc. Young children in as little as 1 inch of water. |
| Decompression sickness | A painful condition seen in divers who ascend too quickly, in which gas especially nitrogen forms bubbles in blood vessels and other tissues; see Bends |
| Core temperature | The temperature of the central part of the body (heart lungs and vital organs) |
| Breath-holding syncope | Loss of consciousness caused by a decreased breathing stimulus. Holding your breathing until you pass out |
| Bends | A common name for decompression sickness |
| Antivenom | A serum that counteracts the effect of venom from an animal or insect |
| Ambient temperature | The temperature of the surrounding environment |
| Air embolism | Air bubbles in the blood vessels |
| Physical condition | Patients who are ill or in poor __________ _________ will not tolerate extreme temperatures well |
| Children and older adults are more likely to experience temperature related illness due to their? | Age |
| Most heat strokes occur when the temperature is? | 80 degrees (F) and the humidity is 80% |
| Cold exposure may cause injury to? | Feet, hands, ears, nose or the whole body in the case of hypothermia |
| The rate and amount of heat loss or gain by the body can be modified in three ways? 1/3 | INCREASE OR DECREASE in heat production (shivering and increasing movement when cold or decreasing and limiting movement when hot) |
| The rate and amount of heat loss or gain by the body can be modified in three ways? 2/3 | MOVE TO AN AREA where heat loss can be decreased or increased by seeking shelter from the wind in the cold and seeking shade in the heat) |
| The rate and amount of heat loss or gain by the body can be modified in three ways? 3/3 | WEAR THE APPROPRIATE CLOTHING layers of clothing provide good insulation, protective clothing traps perspiration and prevents evaporation and loosen or remove clothing to cool down. |
| Physiology of hypothermia (to prevent heat loss) | The body constricts blood vessels in the skin resulting in blue lips and or fingertips. Shivers to generate heat. Functions begin to slow down and mental status deteriorates. key organs (heart lungs, vital organs) tend to slow down and can lead to death |
| To assess general temperature for hypothermia you should? | Pull back your glove and place the back of your had on the patients abdomen. if the abdomen feels cool, patient is likely experiencing a generalized cold emergency. Have to get a temp rectally with hypothermia thermometer which reads lower body core temps |
| mild hypothermia | temp is between 90 - 95 degrees (F) the patient is usually alert and shivering, pulse rate and respirations are usually rapid and the skin may appear red, pale or cyanotic. the body will shunt to keep the vital organs warm and functioning. |
| medium hypothermia | temp is less that 90 degrees (F) shivering stops, muscular activity decreases and eventually all muscle activity stops and mental status deteriorates. |
| severe hypothermia | temp drops to 85 (F). Patient becomes lethargic and stops fighting the cold. LOC decreases, patient may try to undress, mood changes, impaired judgment, less communication, joint or muscle stiffness has trouble speaking, body appears to be stiff or rigid |
| dangerous hypothermia | temp drops to 80 degrees (F) vital signs slow, pulse becomes weaker and slower, respirations become slow, shallow or absent and cardiac dysrhythmia may occur as the BP decreases or disappears |
| possible fatal hypothermia | the core temp is less that 80 degrees (F) all cardiorespiratory activity may cease, pupillary reaction is slow and the patient may appear dead or in a coma. (never assume that a cold pulseless patient is dead |
| when exposed parts of the body become very cold but not frozen the condition is called? | frostnip, chilblains or immersion foot (trench foot) |
| gangrene | this is known as permanent death or cell death of the tissue and requires surgical removal of dead tissue. the exposed part will become inflamed, tender to the touch and unable to tolerate exposure to cold. |
| signs/symptoms of frostnip | type of condition the skin is pale (blanched) and cold to the touch. normal color does not return after palpation of the skin. the foot may be wrinkled but can also remain soft and the patient reports loss of feeling and sensation in the injured area |
| signs/symptoms of frostbite | with this type of condition most parts are hard and waxy. the injured part feels firm to frozen as you gently touch it. blisters and swelling may be present and in light skinned |
| individuals with a deep injury that has thawed or partially thawed the skin may appear? | red with purple and white or it may be mottled and cyanotic. |
| superficial frostbite | with this type of condition only the skin is frozen |
| deep frostbite | with this type of condition deeper tissues are frozen |
| true or false rough handling of a patient with hypothermia may cause a cold slow weak heart to fibrillate and the patient to lose any pulse | true |
| true or false do not massage the extremities of the patient with cold exposure as they may become septic | true |
| when you apply heat packs or hot water bottles to the groin, axillary (under armpits) and cervical regions while giving warm fluids by mouth (if patient can swallow) this is know as? | active rewarming (mild hypothermia) |
| true or false do not try to actively rewarm the patient with moderate to severe hypothermia as it may cause a fatal cardiac dysrhythmia | true |
| risk factors of heat illness | this occurs when high air temperature (reduces radiation) high humidity (reduces evaporation) lack of acclimation to the heat and vigorous exercise (loss of fluid and electrolytes) |
| persons at great risk for heat illnesses are? | children (especially newborns and infants) geriatric patients, patients with heart disease, COPD, diabetes, dehydration and obesity. patients with limited mobility, alcohol and certain drugs/medications make a person more susceptible to heat illnesses |
| signs/symptoms of heat exhaustion 1/2 | dizziness, weakness, syncope, muscle cramps, cold clammy skin with ashen pallor, dry tongue and thirst, normal vital signs, although the pulse is often rapid and weak and the diastolic blood pressure may be low. |
| signs/symptoms of heat exhaustion 2/2 | normal or slightly elevated body temperature; on rare occasions as high as 104 degrees (F) |
| signs/symptoms of heat stroke 1/2 | hot, dry, flushed skin. skin may be moist or wet due to exertion by the patient. quickly rising body temp of 106 degrees (F) or higher, falling LOC leading to unconsciousness, change in behavior, unresponsiveness, seizures |
| signs/symptoms of heat stroke 2/2 | strong, rapid pulse at first, becoming weaker with falling BP, increasing respiratory rate and lack of perspiration (body has lost its thermoregulatory mechanisms) |
| if the patient is tachycardia, tachypneic, has falling BP which indicates going into shock this person is? | hyperthermic |
| if you have excessive fluid and salt loss your skin will be? | moist, pale cool skin |
| if your body is unable to regulate core temperature your skin will be? | hot, dry skin |
| if your body is unable to regulate core temperature your skin will be? | hot, moist skin |
| the basic rules of water rescue is? | reach, throw, row and only then go Reach from shore, throw an object, row to them, swim to them (last resort) |
| descent emergencies | diving emergency is caused by the sudden increase in pressure on the body as the person dives deeper into the water. (effected areas are lungs, sinus cavities, middle ear, teeth and area surrounded by the diving mask) |
| emergencies at the bottom of a descent | diving emergency rarely occurs caused by faulty connections in the diving gear inadequate mixing of oxygen and Co2 in the air the diver breaths accidental poisonous carbon monoxide in the breathing apparatus can cause drowning or rapid ascent. |
| ascent emergencies | they type of diving emergency is the most serious and usually requires aggressive resuscitation an can cause an air embolism (obstruction) |
| this is caused when air enters the space within the thorax that contains the heart and great vessels causing a condition called? | pneumomediastinum |
| Breath holding syncope | this occurs when a person swimming in shallow water experiences a loss of consciousness caused by a decreased stimulus for breathing |
| altitude illness | this occurs when an unacclimated person is exposed to diminished oxygen pressure in the air at high altitudes. this can effect the central nervous system and pulmonary system |
| acute mountain sickness (above 5k feet) | this is caused by ascending too high, too fast or not being acclimatized to high altitudes. diminished oxygen in the blood (hypoxia) |
| high-altitude pulmonary (lung)edema (HAPE) above 8k feet | this is cause when fluid collects in the lungs hindering the passage of oxygen into the bloodstream. |
| high-altitude cerebral (brain) edema (HACE) above 12k feet | this may accompany HAPE an can quickly become life threatening |
| splash effect | this happens when you are indirectly struck when standing near an object that has been struck by lightning such as a tree |
| mild symptoms of lightning injuries | this type of lightning injury causes LOC, amnesia, confusion, tingling, other non-specific signs/symptoms. burns if present are typically superficial. |
| moderate symptoms of lightning injuries | this type of lightning injury causes seizures, respiratory arrest, dysrhythmias that spontaneously resolve, and superficial burns |
| severe symptoms of lightning injuries | this type of lightning injury causes cardiopulmonary arrest. most patients do not survive |
| black widow spider | this spider measures approximately 2 inches with its legs extended. it has a distinctive bright red orange marking in the shape of an hourglass on it's abdomen |
| brown recluse spider | this spider is a dull brown in color and is 1 inch long it has a violin shaped mark brown to yellow in color on it's back the venom is cytotoxic and causes severe local tissue damage an ice-pack can help control bleeding |
| Hymenoptera stings | these stings are caused by bees, wasps, yellow jackets and red ants. they are painful but are not a medical emergency. |
| urticaria | this is also known as hives (allergic reaction) |
| venomous snakes | these types of snakes are native to the US have hollow fangs in the roof of the mouth that inject the poison from two sacs at the back of the head |
| rattlesnakes, copperheads and cottonmouth are all referred to as____________ they have small pits that contain poison located just behind each nostril and in front of each eye. | pit vipers |
| rattlesnake | this type of snake is the most common pit viper. it has many patterns of color often with a diamond patter and can grow to 6' or more in length. |
| copperheads | this type of snake is usually 2-4 fee long has red copper color crossed with brown or red bands. typically inhabits woodpiles and abandoned dwellings |
| cottonmouths | snake can grow to about 4' in length also called a water moccasin is olive or brown with black cross-bands and a yellow undersurface water snakes with aggressive pattern of behavior tissue destruction may be severe from the venom |
| coral snakes | this type of snake is a small reptile with a series of bright red, yellow and black bands completely encircling the body (red on yellow will kill a fellow - red on black, venom will lack) can cause paralysis of the nervous system |
| scorpion stings | arachnid has eight legs with a venom gland and a stinger at the end of their tail the sting is usually very painful but not dangerous and causes localized swelling and discoloration (exception is centauroids sculpturatus) |
| tick bites | insect usually attaches themselves directly to the skin are found most often on brush, shrubs, trees, sand dunes or other animals only a fraction of an inch in length they can be easily mistaken for a freckle (rocky mountain fever or lyme disease) |
| the stinging cells of a coelenterate are called? (jellyfish) | nematocysts |
| alcohol | will also change the body's ability to regulate temperature |
| Frostbitten parts are usually? | Hard and waxy to the touch |
| Gangrene (necrosis) is? | Permanent cell death from freezing or destructive chemical changes |
| Primary Assessment: Chief Complaint | May only be that they are cold or "cold" may be an additional complaint to their chief complaint |
| Primary Assessment: Do this to determine if life threats exist after hearing Chief Complaint | Rapid exam Check limbs and perfusion Assess temperature Place back of hand on abdomen Check Mental Status (AVPU) |
| In severe cold and you cannot feel the radial pulse, what should you do? | Palpate the carotid for up to 60sec. Even a pulse of 1-2 beats is cardiac activity and may recover once warmed. CPR may be needed |
| How does the body normally balance heat production/elimination? | Normal core temp 98 F (36.7C) Elimination must balance production Sweating+evaporation Blood vessel dilation Removing restrictive clothing Find cool areas/shade |
| What factors can decrease the body's ability to eliminate excess heat? | Air temp is high (reduced radiation) High humidity (reduced evaporation) Vigorous exercise (fluid loss) Inadequate water intake Children/older adults poor thermoreg Med conditions (heart disease, diabetes, obesity, etc) |
| What risk factors does this patient have? May be a heat emergency Sitting under a tree, refused a water break Flushed Conscious/confused Increased respirations Weak/rapid radial Hot/moist skin | Several Significant: prolonged exposure to hot, humid environment Not drinking water Profuse sweating Diabetic history Hypertension (diuretics often prescribed) |
| What type of heat emergency could this be? Sitting under a tree, refused a water break Flushed Conscious/confused Increased respirations Weak/rapid radial Hot/moist skin | Serious heat illness: Heat Stroke Main sign: Altered Mental Status: Confusion |
| What treatment is required? Heat emergency In ambulance w/AC on 24 breaths/min adequate 130bpm weak/regular Skin hot, flushed, moist BP 88/66 mmHg Spo2 95% on o2 | Move patient to cool environment, give oxygen Cooling+O2 is the main treatment Rapid Transport + Rapid cooling ALS can give IV solution |
| What is the most likely explanations for these vitals? Heat emergency In ambulance w/AC on 24 breaths/min adequate 130bpm weak/regular Skin hot, flushed, moist BP 88/66 mmHg Spo2 95% on o2 | Tachypnea (rapid breathing) Tachycardia (rapid pulse) Hypotension (low BP) Indications of shock Because of excessive sweating, not drinking water = Hypovolemic shock + heat stroke (altered mental) |
| Patient is in shock. How should you adjust treatment? Heat emergency LOC: pain response R: 26/min shallow P: 126 weak, regular Skin: flushed, hot, moist Spo2: 89% on o2 | LOC has deteriorated Not breathing adequately = decrease heat removal from respiration Need assisted breathing (BVM) + NPA because semi-conscious |
| How will you know you have adequately cooled the patient who has gone into shock? Heat emergency | Monitor CBT (core body temp) likely from rectal temp CBT can rise quickly, but decreases slowly even with aggressive cooling Can still take normal temp (but will be less accurate) Reassess skin temp often Do not cool to the point of shivering |
| What other conditions should you consider for the Altered Mental? Patients LOC improved, now on NBMask, skin less hot/flushed, still moist LOC: conscious/combative R: 22/min P: 120/min regular BP: 98/58mmHg Spo2: 95% on o2 | Altered mental status is a sign of stroke, but also a sign of hypoglycemia. Patient is diabetic, this increases the risk. Could also be due to both Patient may have fainted, consider head injury |
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cmoney833
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