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81 Cards in this Set

  • Front
  • Back
  • 3rd side (hint)
Define thermoregulation
The process by which the body compensates for environmental extremes.
35.32
What part of the brain is responsible for temperature control?
The hypothalamus
3.32
What principal does the hypothalamus work off of?
Negative feed back principle. A rise in core body temperatures elicits responses that increase heat loss and shut off normal heat production pathways while a fall in body temperature prompts heat production.
35.5
What is the body temperature of hypothermia?
Starts at 95 degress F or 35 Degrees C
35.5
What is the normal core body temp?
98.6 Degrees F or 37 degrees C
35.5
What is the body temperature for heat stroke?
104 Degrees F or 40 degrees C
35.5
Where is the body's main thermoregulatory center located?
In the hypothalmus. The thermogenic (heat-generating) tissues in the hypothalmus are mediated by the sympathetic nervous system; the thermolytic (heat-liberating) tissues are mediated by the parasympathetic nervous system. The hypothalamus receives signals from the peripheral receptors (located primarily in the skin and muscles) and central receptors (triggered by changes in blood temperature; located in the core).
35.5
What is the recommend caloric intake a day?
2,000 to 2,500 kcal
A good "calorie" is actually a kilocalorie.
35.6
What is thermolysis?
The release of stored heat and energy from the body. The hypothalamus sends signals via the parasympathetic nervous system to cause vasodilation and sweating. Heart rate and stroke volume thus increase.
35.6
What are the four mains ways of thermolysis?
When warmed blood from the core and overheated muscles heads for the peripherally dilated cutaneous vessles it may be cooled in four major ways (in addition to behavioral changes, such as slowing down or seeking shade):
Radiation, Conduction, Convection, and Evaporation.
35.6
Define Radiation
Emmison of heat from an object into surrounding, colder air. Accounts for more than 65% of heat loss in a cooler setting.
35.32 and 35.6
Define Conduction
The transfer of heat from a hotter object to a cooler object by direct physical touch. Water is the greatest conductor.
35.6
Define Convection
The loss of heat that takes place when moving air picks up heat and carries it away. The faster the air the faster it can remove heat. IE. blowing hot food to cool it. Thus why wind chills are dangerous.
35.6
Define Evaporation
The conversion of liquid to a gas, sweating. Accounts for about 30% of cooling.
35.6
What happens with environmental temperature exceeds skin temperature?
The body absorbs heat, and the heat loss diminishes especially with convection and radiation. Thus the increase blood flow to the skin is counter productive. The only way to really dissipate heat at this point is sweat.
35.6
Define thermogensis
The production of heat and energy for the body, is the main method of dealing with cold stressors.
35.7
How does the body produce heat?
In addition to basl metabolic rate (heat produce normally at rest) and physical exertion, the sympathetic nervious system can increase muscle tone and initiate shivering in the short-term and increase thyroid levels in the long term. The hypothalmus also stimulates vasoconstriction, thereby shunting blood to the core. Sweating decreases, the outer shell becomes thicker, and better insulation.
35.7
Risk factors for heat illness:
Older adults
Infants and young children
Increase physicial excerion
Hyperthyroidism
Infection causing fever
Drugs
Obesity
Diabetics
Alcohlosim
35.7
What are heat cramps?
Acute involuntary muscle pains, usually in the lower extremities, the abdomen, or both, that occur because of profuse sweating and subsequent sodium losses in sweat.
35.8
What three factors contribute to heat crapms?
Salt depletion, dehydration, and muscle fatigue. Thus why sodium replacement is important, not just water. (Sports drinks)
35.8
Treatment of heat cramps
Move the pt to a cooler environment.
Pt may drink fluid containing salt if not nauseated, otherwise give fluid via IV.
Consider salty chips or pretzels.
Donot massage the cramping muscles as it actually aggravates pain.
35.8-9
Define heat syncope
An orthostatic syncopal, or near-syncopal, episode that typically occurs in nonacclimated people who may be under heat stress. Pt should recover quickly in supine or trendalenburg position, if not suspect heat exhaustion or heat stroke.
35.9
Define heat exhausion
A clinical syndrome thought to represent a milder form of heat illness on a continuum leading to heat stroke. Hallmarks are volume depletion and heat stress.
35.9
S/s of heat exhaustion
Headache, fatigue, dizziness, nausea, vomiting, and sometimes, abdominal cramping. Pt is usually sweating profusely, and the skin is pale and clammy.May be slightly confused. Tachycardia, respirations fast and shallow, and BP may be decrease.
35.9
Treatment of heat exhaustion
Move to cool environment, and remove excessive clothes.
Place pt supine or trendalenburg.
Sponge or drip water along with a fan over pt, but don't over do it and cause shivering.
Oral rehydration of sports drinks if not nauseated. IV fluid as need for tachycardia and hypotension.
35.9
Define heat stoke
The least common and most deadly heat illness, caused by severe disturbance in thermoregulation, usually characterized by core termperature of more than 104 F or 40 C and altered mental status.
35.10
What are the two heat stroke syndromes?
Classic and Exertional.
Classic effects the very old and very young, or chroinic ill ie diabetes, heart disease, and alcoholism.
Exertional typically effects young and fit people exercising in hot and humid conditions.
35.10
Early onset of heat stroke
May make the patient appear to be experiencing a behavior emergency as they beome confused, aggitated, hallucination, and combative. Behaving strangely in a hot environment.
35.10
Signs of heat stroke
AMS, core temp >104 F or 40 C, tachycardia, hyperventilation with an end-tidal carbon dioxide of less than 20 mm Hg, and lower peripheral vascular resistance from efforts of the body to cool itself with vasodilation. Skin can be dry, red and hot or pale and sweaty. Usually have constricted pupils.
35.10
During the hot months be at increase index of suspicion for:
Heat Stroke
35.10
Treatment of heat stoke
Active recooling, including moving to a cooler environment, removing clothing, and spraying water along with a fan to promore evaporation and conduction. Ice packs to neck groin, and axillae. Control ABCs, intubate as needed. Watch for seizures. Give NS but becareful as pulmonary edema is a known complication of heat stroke.
35.11
Don'ts for treating heat stoke
Cover pt in wet sheets as it impedes heat loss by evaporation.
Massage muscles to combat cutaneous vasoconstriction from cooling too much is not beneficial.
35.11
Define frostbite
An ischemic injury that is classified as superficial or deep depending on whether tissue loss occurs.
35.12
Define frostnip
Early frostbite, characterized by numbness and pallor without significant tissue damage. Not usually painful. Easily treated by placing extremity in a warm area like the armpits.
35.31 &12
Risk factors for frostbite:
Going out into the cold without earmuffs, gloves, scaf, or a hat.
Impeding circulation, tightly fitting clothes, socks, or shoes. Smoking which constricts arteries.
Direct contact with cold object.
Dehydration.
35.12-13
S/s of frostbite
Most common symptom include numbness, tingling, burning and/or pain. Because the skin is frozen it will be firm to palpation but underlying tissues remains soft. Capillary leakage produces edema.
35.13
Treatment of superficial frostbite
If the tissues beneath the skin are soft when you press down than it is probably superficial.
Get the pt out of the cold, so that warm blood can start to flow to the peripherals.
Rewarm the area with firm steady pressure against the area, ie place hands in pt's armpits. Donot try and reheat with radiant or dry heat.
Donot rub or massage the area as it can further damage.
Cover blisters with dry, sterile dressing.
35.13
Deep frostbite
A type of frostbite in which the affect part looks white, yellow-white, or mottled blue-white and is hard, cold, and without sensation. Pain will start as they begin to unthaw.
35.31
Treatment of deep frostbite
Depends on whether the injured extremity has been partially or completely thawed before you arrive and how far the patient is from the hospital.
If still frozen and within an hour of the hospital leave frozen. Proper rewarming is hard to carry out in the field. Pad and cover with dry sterile dressing.
If extremity is partilly thawed or the transport is long discuss rewarming with medical control: you will need a water bath a lerge clean container in which the extrmity can be immersed without tounching the sides or bottom with water at 95 to 104 D. Remove ext and add hot water as needed to maintain this temp. Typically takes 10 to 30 minutes and is complete when the extremity is warm to the touch and deep red or bluish. Do not premit the patient to smoke as it causes vasoconstriction interfering with blood flow to the area. Than cover with dry sterile dressing.
35.14
What is trench foot
A simular process to frostbite but can occur in temperatures as high as 65 degrees F. Caused by prolonged exposure to cool, and wet conditions.
35.14
Water causes heat loss ___ times more than dry condtions.
25
Define hypothermia
A decrease in CBT stating at 95 Degrees F or 35 C owning to inadequate thermogenesis and/or excess environmental cold stress. Any temp below normal body tem can cause hypothermia even in the warm summer ie geriatic with alcoholism with a stroke living home alone in 60 degrees F or a hiker in the summer caught in and the wind and rainstorm.
35.15
Risk factors for cold illness
Cold environment, wet clothes, Impiared judgement by drug or alcohol, vasodilation from alcohol or acute spinal cord injury, diabetics, dehydration, Parkinson's, hypothyroidism. Very young and the very old. TRAUMA.
35.15
What is the most common cause of heat loss in the urban setting?
Alcohol, it predisposes the pt to hypothermia by impairing shivering thermogenesis and promoting cutaneous vasodilation, which hiders the body's attemts to create an insulating shell around the warm core. Liver disease leads to inadequte glycogen stores, and alcohol impairs judgement.
35.15
S/s of hypothermia
"umbles" Stubles, mumbles, fumbles, and grumbles.
Impaired reasoning, speech is slow and may be slurred, coordination is impaied causing ataxia. May resemble stoke, head injury, or alcohol intoxication.
Peripheral vasoconstiction. Cold initially speeds up the heart, then slows the rate and disrupts the electircal system. Initially respiratory rates speeds up but later slows dosen.
Shivering until the CBT falls below 91 degrees F. Thereafter, cold muscles become progressively weaker and stiffer.
May lead to hypoglycemia as the body depletes glucose through shivering.
35.16
Dysrhythmias of hypothermia
Include A-Fib, V-Fib, and Osborn wave may be observed if shivering does not obscure tracing. Osborn waves look like t wave immediately after QRS without going to isometric line first.
35.16
Treatment of hypothermia in the field
Passive rewarming, involving removing wet clothing, drying the patient's skin, and using war blankets or "space" blankets to prevent further heat loss.
Active rewarming occurings in the hospital and includes warm IV fluids, warm humified oxygen, and peritoneal lavage and espoheagea rewarming tubes.
35.17
Witholding and cessation of resuscitative efforts in hypothermia cases
If the airway or chest (to hard for chest compressions) is frozen than consider withholding efforts. It is some what controversial and many believe they are not dead until "warm and dead."
35.19
Define drowning
The process of experiencing respiratory impairment from submersion/immersion in liquid. Pt may live or die.
35.20
What are the risk factors for downing?
Male sex
Younger than 20 years
Preexising conditions, such as seizures
Alcohol use
Ineffective safety barriers
Hyperventilationl
35.20
Table 35-7
Notes on Spinal immobilization in drowing and submersion incidents
The American Heart Association, as part of it 2005 ACLS revisions, suggest that routine cervical spine stabilization is not needed in cases involving drowning or submersion. The exception are patients who have a history of diving or using water slide before the drowning or have obvious traumatic injury signs and when witnesses claim alcohol was involved.
35.20
Treatment of Drowning and Submersion
Assist ventilations as soon as possible even before the patient is removed from the water. Do not perform heimlich maneuver because it may dispalce water from the stomach into the lungs.
ABCs, CPR as needed. Pt is likely to vomit have suction ready. Protect airway from aspiration, secure it.
After intubation consider placing an NG tube.
35.20-21
What is PEEP?
Positive end-expiratory pressure. It is used in intubated drowning and submersion pts to force positive pressure during expiratory phase (which usaually has no pressure). This keeps alveoi from collapsing and pushes water out into interstitium or capillaries.
A PEEP comes as a comercial device to connect to a ET and many ventilators have a PEEP setting.
35.21
Pts rescued from submersion are prone to what?
Bronchospasm from the irritation to their airways. If you hear wheezes, administer a beta-2 adrenergic drug, such as albuterol.
35.21
Diving pressure
Every 33 feet of seawater adds 1 atomosphere absolute. So 66 ft of seawater is 3 ATA.
The majority of scuba diving is done at depths between 60 and 120 (fsw) seawater feet.
35.22
Dving pressures effect on the body
Effects hollow or gase filled organs because they are compressible.
Nitrogen found in body normally, causes decompression sickness on ascent becaues of the bubbles that form on reduction of pressure. Thus why professional divers follow strict outlines as to how long it is safe a various depths.
35.22
Boyle's law
At a constant temperature, the volume of a gas is inversely proportional to its pressure, written as PV=K, wher P=Pressure, V=Volume, and K=a constant.
Thus when a diver descends and pressure goes up, gas volume is reduced. As a diver ascends and pressure goes down, gas volume increase.
This law explains the problem that can occur in a gas-filled space in the body.
35.22
Dalton's law
Each gas in mixture exerts the same partial pressure that it would exert if it were alone in the same volume and that total pressure of a mixture of gases is the sum of the partial pressures of all gases in the mixture.
IE fesh air P total=P O2 +P CO2 +P N2
35.22
Henery's law
The amount of gas dissolved in a liquid is directly proportional to the partial pressure of the gas above the liquid.
IE soda bottle is opened and carbon dioxide is release.
35.23
When does decompression sickness usually manifest?
Usually within the first hour of surfacing and certainly within 6 hours.
Symptoms within 10 minutes suggest an air embolism, especially when accomplish by loss of consciousness.
35.23
Special hx to record on a dive
-Onset of symptoms
-Type of diving and type of equipment used
-Type of tank used, compressed air or Nitrox system (color of tank)
-Site of diving and water temperature
-Number of dives made during the past 72 hours, along with depth, bottom time, and surface intervals for eace.
Was a dive computer used?
-Were safety stops used?
-Were there any attemts at in-water decompression (a no-no)?
-Any dive complications
-Predive and postdive activities
35.23
Dive injuries during descent
Most common is barotrauma.
Barotrauma is injury resulting from pressure disequilibrium across body surfaces. Effects gas-filled areas including the ears, sinuses, lungs, and even teeth. Can cause pain, and even an embolism especially with lungs.
35.23-24
How are divers theroretically protected from barotrauma?
By breathing compressed air, which will match the pressure of the surrounding environment. Thus, as long as the air-filled cavities of the body can equilibrate freely barotrauma will not occur.
35.23
What is nitrogen narcosis?
A state of alter mental status casued by breathing compress air (including nitrogen) at depth. The gas dilutes the concentration of oxygen. Typically occurs at 100 ft, and 150ft, and is why sports divers use copressed air only for dives over 120 ft.
35.23
What are some s/s of nitrogen narcosis?
Euphoric feeling, inappropriate behavior at depth, incluiding lack of concern for safety, apparent stupidity or inappropriate laughter, and tingling of lips, gums, and legs.
35.23
Barotrauma on ascent
Divers are taught to constant exhale during ascent as to vent air from their lungs. If they were to hold their breath their lung capacity would double. Thus if a diver panics and holds their breath on ascent they may cause pulmonary overpressurization sydrome or "burst lungs." Could also cause pneumothorax, mediastinal and subcutaneous emphysema, alveolar hemorrhage, and a lethal arterial gas embolism. Increase risk with asthma, or COPD.
35.25
What is decompression sickness?
A broad range of signs and symptoms caused by nitrogen bubbles in the blood and tissues coming out of solution during ascent. May interfer with tissue perfusion and/or by triggering chemical changes within the body.
35.25
Explain how decompression sickness happens
As a diver descends, increasing quantities of nitrogen and oxygen become dissolved in the body (per Henry's law) and are then carried to the tissues. As the diver ascends and ambient pressure decrease, the reveres process occurs and nitrogen begins to diffuse out of the tissue. If the ascent is slow enought the nitrogen will equilibrate in the alveoli. With rapid ascent nitrogen can not be removed, and the tissues begin to bubble.
35.25-26
Classifications of decompression sickness
Type I or II
Type I refers to a mild form that involves only skin, lymphatic system, and musculoskeletal system. Common s/s include joint pain causing the pt to bend over in pain.
Type II includes all the other organs and is regarded as more serious.
35.26
Decompression Sickness vs Arterial Gas Embolism
Hard to distinguish in the field. Typically symptoms produced by air embolism usually reflect cerebral dysfuncion whereas the spinal cord is more like to be involved in decompression sickness. A loss of consciousness points to AGE.
Either way treatment is supportive in the field, they need a hyperbaric chamber.
35.26
How does a hyperbaric chamber work?
Involves intermittient inhalation of pure oxgen under a pressure greater than 1 atm. The treatment mechanically reduces bubble size, reduces nitrogen content, and increases oxygen delivery to ischmic tissues.
35.26
divers and oxygen toxicity
Rarely divers may develop oxygen toxicity after breathing mixtures of compressed air for long period of times. S/s include dizziness, lack of coordination, confusion, twitching or paresthesia symptioms, and underwater seizures.
35.26
What are shallow water blackout?
A condition that may be seen by paramedics in any part of the country. A diving emergency that occurs a person hyperventilates just before submerging underwater and loses consciousness befor resufacing due to hypoxemia and cerebral vasoconstriction.

Decrease P CO2 and causes cerebral vasoconstriction, meanwhile as they descend the Pa O2 increase. Because P CO2 is depressed respiratory drive is depressed while the oxygen is used up, all causing a blackout before reaching the surface.
35.26 and 32
Hypoxemia (or Hypoxaemia) is generally defined as decreased partial pressure of oxygen in blood. Wikipedia
What is altitude illness?
Illnesses caused by effects of hypobaric (low atmospheric pressure) hypoxia on the CNS and pulmonary system as a result of unacclimatized people ascending to altitude. Typically occurs in people who ascend heights above 8,000 feet but can occur as low as 6,500 feet.
35.27
Symptoms of altitude illness
Occur within 6 to 10 hours, and present with the same symptoms as hypoxia.
35.27
Risk factors for altitude illness
Physical exertion, presence of chronic obstructive pulmonary disease, and sleeping above 8,000' increase the risk of developing altitude illness. Physical fitness in not a factor. Older people are at higher risk.
35.27
Lower oxygen levels at altitudes may cause what?
Hypoxic ventilatory drive whenere the brain senses lowered levels of oxygen and responds by increasing ventilations.
35.27
Acute mountain sickness
A type of altitude illness in which headache plus at least one of the following: fatigue or weakness, gastrointestinal symptoms (N/V or loss of appetite), dizziness or lightheadedness, or difficulty sleeping.
35.27
High-altitude pulmonary edema
Altitude illness with at least two of the following symptoms: dyspnea at rest, cough, weakness, or chest tightness or congestion. Along with two of the following: central cyanosis, audible rales or wheezing in at least one lung field, tachypnea, or tachycardia.
35.27
High-altitude cerebral edema
Altitude illness with the presence of changes in the mental status and/or ataxia in a person with AMS or presence of mental stauts changes and ataxia in a person without AMS.
35.27
Treatment of altitude illness
Mild cases requre rest and acclimatation , consider descending.
More severe cases require descending, oxygen, treat symptoms, and hyperbaric chamber.
35.28