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116 Cards in this Set
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What are neuromuscular signs of hypothermia and at what temperatures do they occur?
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-Amnesia, dysarthria, poor judgement (34 C)
-Loss of coordination appearing drunk (33 C) -Shivering ceases (32 C) -Progressive decrease in LOC (29 C) -Pupils dilated (29 C) -Loss of deep tendon reflexes (27 C) |
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What are respiratory signs of hypothermia?
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-Initial hyperventilation < 34 C
-Progressive decrease in rate and depth of respiration -Noncardiac pulmonary edema (25 C) |
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What are cardiovascular signs of hypothermia?
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-Sinus bradycardia
-Atrial Fibrillation (30 C) -Progressive decrease in BP (29 C) -Progressive decrease in pulse (29 C) -Ventricular irritability (28 C) -Hypotension (24 C) |
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What is frostnip?
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-A very mild form of frostbite which comes on slowly and is generally not painful. The victim may be unaware of its occurrence.
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How can it be treated?
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Easily treated by placing a warm hand firmly over the chilled nose or ear.
The return of warmth to the area is usually accompanied by some redness or tingling. Windmilling forces blood into the cold hand. |
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What is frostbite?
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An ischemic injury that is classified as superficial or deep depending on whether tissue loss occurs.
With a windchill index of -25 C there is a risk of frost bite. At -45 C skin can freeze in minutes |
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What occurs in frostbite?
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The water within cells turns to ice crystals which can damage or destroy cells.
There is also an increase in viscosity and sludging, poor flow leading to thrombus formation and ischemic injury. |
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What are signs of frostbite?
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-Altered sensation
-Numbness, tingling or burning -Skin appears white and waxy -Skin is firm to palpation but underlying tissue is soft |
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What is frostnip?
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-A very mild form of frostbite which comes on slowly and is generally not painful. The victim may be unaware of its occurrence.
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How can it be treated?
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Easily treated by placing a warm hand firmly over the chilled nose or ear.
The return of warmth to the area is usually accompanied by some redness or tingling. Windmilling forces blood into the cold hand. |
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What is frostbite?
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An ischemic injury that is classified as superficial or deep depending on whether tissue loss occurs.
With a windchill index of -25 C there is a risk of frost bite. At -45 C skin can freeze in minutes |
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What occurs in frostbite?
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The water within cells turns to ice crystals which can damage or destroy cells.
There is also an increase in viscosity and sludging, poor flow leading to thrombus formation and ischemic injury. |
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What are signs of frostbite?
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-Altered sensation
-Numbness, tingling or burning -Skin appears white and waxy -Skin is firm to palpation but underlying tissue is soft |
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What is frostnip?
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-A very mild form of frostbite which comes on slowly and is generally not painful. The victim may be unaware of its occurrence.
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How can it be treated?
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Easily treated by placing a warm hand firmly over the chilled nose or ear.
The return of warmth to the area is usually accompanied by some redness or tingling. Windmilling forces blood into the cold hand. |
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What is frostbite?
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An ischemic injury that is classified as superficial or deep depending on whether tissue loss occurs.
With a windchill index of -25 C there is a risk of frost bite. At -45 C skin can freeze in minutes |
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What occurs in frostbite?
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The water within cells turns to ice crystals which can damage or destroy cells.
There is also an increase in viscosity and sludging, poor flow leading to thrombus formation and ischemic injury. |
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What are signs of frostbite?
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-Altered sensation
-Numbness, tingling or burning -Skin appears white and waxy -Skin is firm to palpation but underlying tissue is soft |
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What happens when thawing occurs?
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-The injured area turns cyanotic
-Patient experiences a hot stinging sensation -Capillary leakage produces edema -Dull pain may persist for days or weeks |
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What is it very important to differentiate between superficial and deep frostbite?
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Treatment differs significantly for deep frostbite. It can be difficult to tell.
If the tissues beneath are soft when you push down then likely it is superficial. If not or there is any doubt then treat as deep frostbite. |
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How are mild cold injuries managed?
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A combination of dressing, rest, food and limiting exposure to the cold.
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What are the steps?
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-Get the patient out of the cold
-Rewarm the injured part with body heat -Do not rub or massage the frostbitten area as it will cause further damage -Cover blisters with dry sterile dressings and protect the area from further injury -Transport with the injured area elevated and protected from the cold |
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What is deep frostbite?
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Usually involves the hands or the feets.
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What does a frozen extremity look like?
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It looks white, yellow white or mottled blue-white and is hard, cold and without sensation
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How and why does the major tissue damage occur?
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When the tissues thaw out, particularly if the tissue thaw out gradually.
Partial refreezing of melted water can occur and the new ice crystals tend to be larger causing more tissue damage. |
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What happens as thawing occurs?
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The injured area turns purple and becomes excruciatingly painful.
Gangrene may set in within a few days requiring amputation of all or part of the injured limb. |
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What are the two factors on which prehospital care depends on?
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Whether the injured extremity has been partially or completely thawed prior to arrival
How far the patient is from hospital |
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What if the extremity is still frozen when you find the patient?
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Leave it frozen until the patient reaches the hospital.
-Leave the extremity frozen if you are within an hour of the hospital -Pad the extremity in the ambulance to protect the tissue from further trauma, keep it away from the heater or sources of dry heat -DO NOT massage the extremity -Transport without delay |
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What if the extremity is partially thawed or if the transport is delayed?
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Contact direct medical control to discuss warming in the out of hospital setting.
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What preparations should be made for rewarming the limb?
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-Rewarm the injured extremity before transport, need a large clean container enough to submerge the limb without it touching the side or bottom.
-Heat water in a second container and get the bath to 35-40 C. Patient should have analgesia if possible! need paramedic Patient will experience very severe pain as the limb thaws out. |
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How is the limb rewarmed?
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-Gently immerse the injured extremity
-Keep the temperature within the range -The procedure normally takes 10-30 minutes -It is complete when the frozen area is warm to the touch and is deep red or bluish and remains so when taken out of the bath. -Keep the patient warm while this is happening and do not permit to smoke. |
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How should the extremity be dressed?
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Dry the extremity and apply sterile dressings very gently. Use gauze to separate frostbitten fingers and toes.
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What is hypothermia?
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Defined as a decrease in CBT generally starting at 35 C due to inadequate thermogenesis and/or excess environmental cold stress
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What are risk factors for hypothermia?
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-Increased thermolysis
-Decreased thermogenesis -Impaired thermoregulation -Cold temperatures, fatigue, improper equipment, malnutrition and exposure -Alcohol is the most common cause of heat loss in the urban setting |
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Why does alcohol predispose the patient to hypothermia?
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-Impairs shivering thermogenesis
-Promotes cutaneous vasodilation hindering attempts by the body to create an insulating shell -Inadequate glycogen stores from liver disease impairs metabolic heat generation -Impairment of judgement leading to inappropriate behaviour in cold conditions |
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What are considerations with older people?
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-Reduced muscle mass diminishing shivering response
-Reduced insulation due to atrophy of subcutaneous fat -Medication can interfere with vasoconstriction |
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What about the effects of trauma on hypothermia?
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-Hypotension and hypovolemia can interfere with thermoregulation
-Pts with CNS and shock will not be able to mount a shivering response -Can lead to serious coagulation problems |
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What should you do to protect your patient?
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If you are wearing protective gear make sure the ambulance is toasty and ask the patient if they are cold, ensure you do what you can to preserve the patients body heat.
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What is the clinical definition of mild hypothermia?
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Mild hypothermia is a CBT of not lower than 32.2 C
Below 32.2 is considered severe hypothermia Early stage hypothermia is not lower than 35 C |
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How can time classify hypothermia?
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Acute - Rapidly as in cold water drownings
Sub-acute - short time exposure to cold conditions Chronic - over days in a poorly heated home |
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What can happen with older people?
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May be a more flat effect, slightly more confused or develop symptoms suggestive of a possible stroke
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What is the net effect of hypothermia?
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To slow things down.
Dramatically apparant in the CNS, thinking feeling and speaking Typically apathetic and shows impaired reasoning, speech is slow and may be slurred, condition is impaired |
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What happens in the cardiovascular system?
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Viscosity of the blood is increased impairing circulation and producing a hypovolemic state.
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What can happen to the heart?
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At CBT of 32.2 C the body experiences cardiac arrhythmias.
The Osborn or J wave can become apparant if not obscured by shivering The heart is succeptable to V-Fib at around 28 C |
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What about muscles?
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Shivering ceases at about 32.7 C
Thereafter cold muscles become steadily weaker and stiffer. |
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How can hypothermia affect the metabolism?
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It can lead to hypoglycemia as the bodies glucose stores are depleated.
Insulin levels can also fall so the body switches to metabolizing fat. |
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What is general pre-hospital care for hypothermia?
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Preserving further heat loss and rewarming.
The victim should be stripped of wet clothes and insulated from further heat loss. |
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What is the treatment for patients with a pulse that are about 34 C?
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The treatment is passive rewarming.
-Remove wet clothing -Drying the patients skin -Move patient into a warm ambulance -Use warm blankets to prevent further heat loss -Depending on location promote heat generation by feeding the pt, warm fluids and getting patient to move about |
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What is the treatment for moderate hypothermia?
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Passive rewarming and active external warming of the truncal areas.
-heating blankets or radiant heat from hot packs in the neck, groin or axillae, forced hot air and warm IV fluid. -500 ml bolus unless otherwise indicated to counteract the hypovolemia encountered in hypothermia -Keep monitoring patient for hemodynamic changes as active external warming can cause "afterdrop" |
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What is afterdrop?
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The continued lowering of CBT after the patient has been removed from the cold environment due to a shift of cold blood from the extremities.
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What is rewarming shock?
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Peripheral vasodilation in response to active external rewarming may cause venous pooling and “rewarming shock.” Because of these complications, patients may deteriorate briefly before they begin to improve.
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What is rewarming acidosis?
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“rewarming acidosis” may occur as pooled lactic acid from the periphery joins the central circulation.
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What is the treatment for severe cases of less than 30 C?
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The active internal rewarming sequence is accomplished in hospital.
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What about patients with no pulse or not breathing?
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You may need to look, listen and feel for a good 60 seconds to determine whether breathing and a pulse are present.
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What do patients in cardiac arrest require?
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-High quality CPR (hard and fast with full recoil)
-Single shock if advised -Establish IV access and infuse warmed NS -Attempt advanced airway and ventilate with warm humidified O2 |
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What is drowning or submersion?
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The process of experiencing respiratory impairment from submersion / immersion in liquid.
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What is a dry drowning?
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The patient dies during the laryngospasm phase of drowning essentially death from suffocation.
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What is the difference between salt water and fresh water?
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Both can lead to pulmonary injuries. Salt water can cause blood problems and electrolyte imbalances
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What happens when water enters the lungs?
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It decreases the compliance of the lungs (they become stiff)
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What happens in the decompensation stage of drowning?
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The victim gasps for air taking in more water which mixes with air and chemicals to form froth in the lungs.
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What happens next?
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The process of hypoxic brain damage begins and cardiac arrest occurs.
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What is the management of drowning and submersion?
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-Ensure basic life support measures are being carried out with an emphasis on airway and oxygenation
-Anticipate vomiting -Administer supp O2 and get advanced airway if needed -Establish IV access -Measure core temp and prevent / treat hypothermia -Treat for wheezing with B2 adrenergic. -Monitory end tidal CO2 and pulse oximitry Transport ALL patients to hospital even those that recover on scene. |
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What are post resuscitation problems?
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-Adult respiratory distress syndrome
-Chemical or bacterial pneumonitis -Renal failure Can occur hours to days after a submersion. Symptoms can be subtle (slight cough, mild tachypnea) or they may be asymptomatic |
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What are factors affecting survival from drowning?
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-Cleanliness of Water
-Length of Time Submerged -Victim’s Age and General Health -Water Temperature -Cold-water drowning. -Mammalian diving reflex. The cold-water drowning patient is not dead until he is warm and dead. |
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What is Boyles law?
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The volume of a gas is inversely proportional to its pressure if the temperature is kept constant.
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What is Daltons law?
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The total pressure of a mixture of gases is equal to the sum of the partial pressures of the individual gases.
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What is Henrys law?
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The amount of gas dissolved in a given volume of liquid is proportional to the pressure of the gas above it.
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What happens with a too rapid ascent from diving?
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A rapid ascent causes gases to come out of solution quickly, forming gas bubbles in the blood, brain, spinal cord, skin, inner ear, muscles, and joints.
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What is barotrauma?
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Occurs when the diver ascends or descends due to the decrease or increase of ambient pressures.
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How can barotrauma occur during descent?
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A diver can usually equalize pressures such as in the middle ear. If not able to do so the tympanic membrane can rupture leading to nausea vomiting and vertigo and a panicked ascent with all the problems that this entails.
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What injuries can occur at depth?
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Nitrogen narcosis is an altered mental state caused by breathing compressed air at depth. The nitrogen in the compressed air dilutes the O2.
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What can result?
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Euphoria, Lack of concern for safety, stupidity or laughter. Divers can become panicked and surface too quickly.
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How can barotrauma occur during ascent?
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Trapped air expands and if the diver is unable to equalize the pressures then air may be trapped in sinuses or ears. This can happen when diving with a cold and using decongestants.
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What happens if the diver panics and holds their breath during ascent?
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One of the worst forms of barotrauma (POPS) pulmonary overpressurization syndrome. Also known as burst lung. It can cause pneumothorax, mediastinal and subcutaneous emphysema, alveolar hemorrhage and a lethal arterial gas embolism (AGE)
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Where is the greatest danger?
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In the last two meters of the ascent. Here are the greatest pressure changes. Breath holding here can be enough to rupture alveoli.
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Who is at greatest risk?
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People with COPD and asthma.
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What happens when alveoli rupture?
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The signs and symptoms depend on where the leaking air ends up.
Most commonly it leaks into the mediastinum and under the skin causing SE. There is also potential for a Pneumothorax. |
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What is the most dangerous complication of POPS?
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AGE, which is second only to drowning in terms of deaths.
Air bubbles from ruptured alveoli enter the pulmonary capillaries and coalesce into larger bubbles as they travel through the veins to the left side of the heart. |
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What happens when the reach the left ventricle?
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The bubbles can enter the coronary arteries producing all of the effects of an AMI including cardiac arrest.
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Where do the majority of emboli go?
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The head as this is usually the highest point.
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What are symptoms and when do they appear?
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Usually appear within seconds or minutes (within 10 minutes)
They can involve just about any cerebral function. Patient can experience weakness paralysis of one or more extremity, seizure activity or unresponsiveness. |
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What is treatment for the patient?
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They need transporting to a hyperbaric chamber for treatment.
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What is decompression sickness?
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Refers to a broad range of signs and symptoms caused by nitrogen bubbles in blood and tissues coming out of solution during ascent.
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How does this cause damage?
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They interfere mechanically with tissue perfusion and they trigger chemical changes within the body. The ensuing multisystem trama can potentially affect almost every organ in the body.
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What is general assessment of Diving Emergencies?
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-Time at Which Signs and Symptoms Appeared
-Type of Breathing Apparatus Used -Type of Hypothermia-Protective Garment Worn -Parameters of the Dive -Number of dives, depth, and duration -Aircraft Travel following a Dive |
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What are Factors to Assess with diving emergencies?
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-Rate of Ascent
-Associated with panic forcing a rapid ascent -Inexperience of the Diver -Improper Functioning of Depth Gauge -Previous Medical Diseases -Old Injuries -Previous Episodes of Decompression Illness -Use of Alcohol or Medications |
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What are signs and symptoms of decompression sickness?
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-Signs & Symptoms
-Occurs within 36 hours -Joint/abdominal pain -Fatigue, paresthesias, and CNS disturbances |
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What is treatment for decompression sickness?
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-Assess ABCs and begin CPR if required.
-Administer high-flow oxygen. -Maintain supine position. -Protect the patient from heat, cold, wetness, or noxious fumes. -Transport and establish IV access. -If aeromedical evacuation is used, maintain cabin pressure at sea level or fly at the lowest possible altitude. -Send diving equipment with the patient for analysis if possible. |
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What are signs and symptoms of a Pneumomediastinum?
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Substernal chest pain, irregular pulse, abnormal heart sounds, hypotension with a narrow pulse pressure, and a change in voice (hoarse and brassy)
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What are Types of High-Altitude Illness?
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-Acute Mountain Sickness
-Mild cases include lightheadedness, breathlessness, weakness, headache, nausea, and vomiting. -Severe cases include weakness, severe vomiting, decreased urine output, shortness of breath, and an altered level of consciousness. -Treatment includes halting of ascent or descent, use of supplemental oxygen. |
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What is High-Altitude Pulmonary Edema?
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-Mild symptoms include dry cough, shortness of breath, and slight crackles in the lungs.
-Severe cases develop cyanosis, dyspnea, frothy sputum, weakness, and possibly coma or death. -Treatment includes descent and supplemental oxygen, or portable hyperbaric bag |
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What is High-Altitude Cerebral Edema?
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-Usually occurs as progression of AMS or HAPE.
-Symptoms include altered mental status, ataxia, decreased level of consciousness, and coma. -Treatment includes descent and supplemental oxygen, or portable hyperbaric bag. |
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What is heat illness?
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An increase in CBT due to lack of thermolysis. The main problem is an inability to get rid of the heat buildup in the body often due to hot and humid conditions.
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Why are old people more at risk of heat illness?
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Older people are particularly at risk. They acclimatize more slowly and feel thirst less readily.
They may be on medications or have chronic conditions that interfere with normal heat excretion. Beta blockers for example prevent the heart from initiating a tachycardic response. |
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Who else is at risk?
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Infants and young children as they have a higher metabolism causing greater heat production.
Also athletes and military personnel engaging in heavy exertion. |
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What are heat cramps?
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Acute and involuntary muscle pains usually in the lower extremities, the abdomen or both due to profuse sweating and subsequent sodium losses.
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What are the signs and symptoms of heat cramps?
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-Start suddenly during strenuous and or prolonged physical activity
-Can be severe incapacitating pain in the extremities and abdomen. -Patient can become hypotensive and nauseated but remains alert. |
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What is treatment for heat cramps?
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Eliminate the exposure and restore the lost salt and water to the body.
-Move the patient to a cool environment, have the patient lie down if they feel faint. -If the patient is not nauseated then give one or two glasses of a salt containing solution (lemonade with teaspoon of salt or a commercial sports drink) -Instruct to drink slowly and eat salty chips or pretzels. -If to nauseated to drink then IV and normal saline -Do not massage cramping muscles -Once the balance is restored the pt may want to resume activity, consult medical control. |
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What is heat syncope?
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It is thought to be due to peripheral vasodilation exacerbated by some degree of dehydration.
Place patient supine and replace fluid deficits. If no quick recovery then suspect heat exhaustion or heat stroke. |
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What is heat exhaustion?
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A clinical syndrome thought to represent a milder form of heat illness on a continuum leading to heat stroke.
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What are the two forms of heat exhaustion?
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Water depleted and sodium depleted
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What are symptoms of heat exhaustion?
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-Headache
-Fatigue -Dizziness -Nausea -Vomiting -Abdominal Cramping -Usually profuse sweating -Skin pale and clammy -Possible slight disorientation -Temp normal or slightly elevated -Tachycardia present - can be blunted by beta blockers -Respirations are fast and shallow |
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What can the tachypnea produce?
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Symptoms of hyperventilation
-carpopedal spasm -perioral numbness -and low ETCO2 |
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What about blood pressure?
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Can be decreased due to peripheral pooling of blood volume or volume depletion
Patients blood pressure will almost certainly drop when trying to sit or stand. |
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What about brown urine?
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Rhabdomyolysis - destruction of muscle tissue leading to a release of potassium and myoglobin
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What is the treatment for heat exhaustion?
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The treatment is aimed at removing the patient from exposure to heat and repairing the derangement in fluid and electrolyte balance.
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What are the steps for treatment of heat exhaustion?
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-Move the patient to a cool environment
-Remove excess clothing and place supine with legs elevated -If patients temperature is elevated sponge spray or drip with tepid water and fan gently but do not overdo! -Oral hydration with sports drinks may be appropriate. -If nausea then start an IV use the BP and HR for a guide to fluids to administer -Monitor cardiac rhythm, vital signs, temperature and end tidal CO2 |
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What if you cannot determine that the patient has heat exhaustion?
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Treat for heat stroke!!!
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What is heat stroke?
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Caused by a severe disturbance in the bodys thermoregulation and is a profound emergency.
Diagnosed by core temp of higher than 40 C and altered mental status |
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What are the two catagories of heat stroke?
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Classic heat stroke: occurs usually during heat waves affecting the very young, old or bedridden people
Exertational heat stroke: typical of young and fit people exercising in hot and humid conditions. RH above 75% makes cooling by evapouration ineffective. |
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What should you do at the scene?
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Suspect heat stroke and check a core temperature in any person behaving strangely in a hot environment
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What are the earliest signs of heat stroke?
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-Changes in behaviour, irritability, combativeness, signs patient is halucinating
-Older patients may present with signs resembling that of stroke -CNS disturbances including tremors constricted pupils and posturing can be prominent features of heat stroke |
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What are the diagnostic vitals signs for heat stroke?
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-Elevated temperature >40 C
-Usually tachycardia (unless meds) -hyperventilation with ETCO2 less than 20mmHg |
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What is skin condition like in heat stroke?
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In classic it is hot dry and red with exertational it is pale and sweaty.
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What can mimic heat stroke?
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Fever and sepsis. Look to the history to rule out other causes.
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What is treatment of heat stroke?
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-Evaluate ABC's administer supplemental O2
-Move to cool environment and strip to underclothing, monitor the rectal temperature every 10 minutes -Cool as rapidly as possible by the most expeditious means available, spray patient while fanning constantly. -Apply ICE packs to neck groin and axillae -Cooling with ice water soaked blankets -Start an IV line and give normal saline, check the blood glucose level -Be careful with fluids as pulmonary edema is a known complication of heat stroke -Monitor cardiac rhythm as rhabdomyolysis can occur causing hyperkalemia -Be prepared to treat seizures |
