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Flashcards in Environmental Emergencies Deck (101)
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61

Diagnosing Hypothermia

Low-reading thermometer
Labs
EKG: Osborne or J waves

62

Labs in Diagnosing Hypothermia

Electrolytes
Hematocrit
Coagulation studies
ABGs

63

Management of Hypothermia

ABCs
Passive external rewarming
Active external rewarming
Active internal rewarming
Treat arrhythmias

64

Methods of Active External Rewarming

Warm blankets
Radiant heat
Warm baths
Forced warm air
CORE FIRST

65

Methods of Active Internal Rewarming

Pleural and peritoneal irrigation
Hemodialysis
Cardiopulmonary bypass
Warm humidified oxygen
Warm IV fluids
Bladder or GI irrigation

66

What arrhythmias occur with hypothermia?

A fib
A flutter
V fib
Asystole

67

Define Frostbit

Freezing of tissue

68

Pathophysiology of Frostbite

Immediate cold-induced cell death
Gradual development of localized inflammation and tissue ischemia
Worse in thawing and refreezing

69

Describe 1st Degree Frostbite

Central area of pallor and anesthesia of skin surrounded by edema
Superficial

70

Describe 2nd Degree Frostbite

Blister formation containing clear or milky fluid surrounded by edema/erythema within 24 hours
Superficial

71

Describe 3rd Degree Frostbite

Injury deeper than 2nd degree
Hemorrhagic blisters
Progress to black eschar over several weeks
Deep

72

Describe 4th Degree Frostbit

Extends to muscle and bone
Involves complete tissue necrosis
Deep

73

Presentation of Frostbite

Cold, numbness, and clumsiness of affected area
Insensate, white or grayish-yellow skin
Hard to waxy to touch
Possible bullae
Eschars or tissue necrosis

74

Diagnosis

Clinically
Technetium-99 scintigraphy

75

Prehospital Treatment of Frostbite

Remove wet clothing
Avoid walking on frostbitten feet
Don't rewarm if possibility of refreezing
Do not rub frostbitten areas
Avoid stove or fires to rewarm

76

Prognostic Factors in Frostbit

Temperature and wind velocity?
How long extremity frozen?
Refreezing occur?
Self-treatment?
Recreational drugs or alcohol used?
Predisposing medical conditions

77

Treatment of Frostbite in Hospital

Water bath heated to 40-42 C
Dry heat difficult to regulate
Thawing (15-30 minutes usually)
Bulky dressing
Elevation
Splinting
Tetanus prophylaxis
Topical aloe and ibuprofen
Possible tPA use
Surgical consultation

78

Managing Blisters in Frostbit

Drain, debride, and bandage non-hemorrhagic bullae that interfere with movement
Hemorrhagic bullae drained by aspiration
Minor bullae should be left alone

79

Reasons for Surgical Consult in Frostbite

Long term wound care
Daily hydrotherapy
Repeated debridement
Escharotomy
Possible delayed amputation

80

Short Term Complications of Frostbite

Infection
Gangrene
Autoamputation

81

Long Term Complications of Frostbite

Hypersensitivity to the cold
Increased risk of developing frostbite again
Chronic parasthesias to affected area
Decreased sensation to touch

82

2 Types of Heat Exhaustion

Water depletion
Salt depletion

83

Define Water Depletion Heat Exhaustion

Inadequate fluid replacement by individuals working in a hot environment

84

Define Salt Depletion Heat Exhaustion

Large volumes of thermal sweat are replaced by water with too little salt

85

Signs and Symptoms of Heat Exhaustion

Weakness
Malaise
Fatigue
Headache
Lightheadedness
Dizziness
N/V
Hypotension
Tachycardia
Tachypnea
Diaphoresis
Syncope

86

Treatment of Heat Exhaustion

Cool environment
Volume and electrolyte replacement
Mild: oral replacement
Moderate: 1-2 L saline, guided by electrolytes

87

Define Heatstroke

Life-threatening emergency that occurs when homeostatic thermoregulatory mechanisms fail
Body temp 105+

88

4 Factors Tissue Damage is Affected by

Body temp
Exposure time
Work load
Tissue perfusion

89

Signs and Symptoms of Heatstroke

CNS dysfunction
Cerebral edema
Ataxia
Irritability
Confusion
Bizarre behavior
Combativeness

90

Pathophysiology of Heatstroke

Functional hypovolemia compensated by vasoconstriction of splanchnic and renal vasculature