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  • Thermogenesis – how the body creates heat Work-induced – includes shivering Endocrine – epi and norepi increase cell metabolism Diet induced – metabolic
  • treatment – remove wet clothing, passive external rewarming, avoid rough handling, active rewarming should wait until in ER, warm IV fuids rewarming shock – reflex reipheral vasodilation, cool blood and acds return from peripheral to core and further worsen core hypothermia, cold diuresis – causes volume depletion, vasoconstriction causes htn, kidneys remove excess fluid
  • drug metabolism reduced, drugs may remain in peripheral system, when rewarmed pt may get toxic bolus
  • Near drowning death within 24 hours Dry, water in mouth stimulates larygospsm
  • Children can live longer. Cold water – can be resucitated up to 30 min in cardiac arrest
  • Adult respiratory distress syndrome – ARDS fluid leaks into alveoli causing inflammation and resp failure Destruction of surfanctant, aspiration pneumonitis, pneumothorax, renal failure,
  • Denity or Water – 62.4 lb/ft3, air at sea level 14.7 lb/sq in one mile up 12.2 Boyle’s law – P = 1/V at constant temperature Dalton’s Law – total = sum partial pressures ex air 760torr= 21% O160 torr, 78%N593torr 1% CO2 4 torr Henry’s Law – amount of gas dissolved in liquid proportional to pressure of gas above – ex pop bottle, as we descend N disolved into tissue, if we ascend to quickly turns into bubbles
  • Barotrauma – “the squeeze” – indury during descent, occurs if diver can not clear middle ear Nitrogen narcosis – state of stupor caused by nitrogen effect on the brain, use helium mixed with oxygen for deep dives. Decompression illness – nitrogen bubbles “bends”, tx decompression chamber Pulmonary overpressure – lung overinflation due to rapid ascent, holding breath air expands causing destruction of alveoli. c/o substernl chest pain, resp distress.
  • Arteial gas emboli – pressure build up in lungs destroying alveoli can release air bubble into circulation. Neurologic deficits after rapid ascent
  • Pneumomediastinum – release of gas into visceral pleura and pericardial sac, decreased BP and pulse pressure, cp, irreg heart beat
  • High altitude illness – decress in ambient pressure causing hypoxia, sob, dizzy, confusion, malaise, anorexia, headache, sleep disturbance, respiraory distress increase with exertion. %O same, partial pressure less. Hypoxic nemtilatory response (HVR) as O decrease resp incease. Decrease in CO2 compensated for by kidneys eliminate more bicarb. Takes 4 to 7 days Cardiovascular changesincreased heart rate to deliver more O to tissues Blood changes – increased red blood cell production – blood dopping
  • High altitude pulmonary edema (HAPE) vascular constriction and increased pulmonary pressure leads to HAPE tx acetazolamide for diuresis and forces out bicarb
  • High Altitude Cerebral edema (HACE) – increased intercranial pressure confusion ataxia poor coordination, coma.
  • Environmental

    1. 1. Environmental Emergencies
    2. 2. Sections Pathophysiology of Heat and Cold Disorders Heat Disorders Cold Disorders Near-Drowning and Drowning Diving Emergencies High-Altitude Illness Nuclear Radiation
    3. 3. Environmental Emergencies Risk Factors  Age  Poor General Health  Fatigue  Predisposing Medical Conditions  Medications Homeostasis  Tendency of the body to maintain a steady and normal internal environment
    4. 4. Pathophysiology of Heat and Cold Disorders Mechanisms of Heat Gain and Loss  Thermal Gradient  Wind  Relative Humidity Thermogenesis  Work-Induced  Thermoregulatory  Diet-Induced
    5. 5. Pathophysiology of Heat and Cold Disorders Thermolysis  Conduction  Convection  Radiation  Evaporation  Respiration
    6. 6. Pathophysiology of Heat and Cold Disorders Thermoregulation  Body Temperature  Core temperature  Peripheral temperature  The Hypothalmus  Heat Dissipation  Sweating, vasodilation  Heat Conservation  Shivering, vasoconstriction
    7. 7. Pathophysiology of Heat and Cold Disorders  Thermoreceptors  Peripheral thermoreceptors  Central thermoreceptors  Metabolic Rate  Basic metabolic rate  Exertional metabolic rate  Core temperature measurement
    8. 8. Heat Disorders Hyperthermia  Signs of Thermolysis  Diaphoresis, increased skin temperature  Signs of Thermolytic Inadequacy  Altered mentation or altered level of consciousness  Manifestations  Heat cramps  Heat exhaustion  Heat stroke
    9. 9. Heat Disorders Predisposing Factors  Age of the Patient  Health of the Patient  Medications  Diuretics, beta-blockers, psychotropics, and antihistamines  Level of Acclimatization  Length and Intensity of Exposure  Environmental Factors
    10. 10. Heat Disorders Preventive Measures  Maintain adequate fluid intake.  Allow time for gradual acclimatization.  Limit exposure to hot environments.
    11. 11. Heat Disorders
    12. 12. Heat Cramps
    13. 13. Heat Exhaustion
    14. 14. Heatstroke
    15. 15. Role of Dehydration in Heat Disorders Close Relationship to Heat Disorders  Dehydration prevents thermolysis. Signs & Symptoms  Nausea, vomiting, and abdominal distress  Vision disturbances, decreased urine output  Poor skin turgor and signs of hypovolemic shock Treatment  Oral fluids if the patient is alert and oriented  IV fluids if the patient has an altered mental status or is nauseated
    16. 16. Fever (Pyrexia) Pyrogens Differentiating Fever from Heatstroke Cooling the Fever Patient  Consider antipyretic medication.  Acetaminophen or ibuprofen  Avoid sponge baths.
    17. 17. Cold Disorders Hypothermia Mechanisms of Heat Conservation and Loss Predisposing Factors  Age of the Patient  Health of the Patient  Medications  Prolonged or Intense Exposure  Coexisting Weather Conditions
    18. 18. Cold Disorders Preventative Measures  Dress warmly and ensure plenty of rest.  Eat appropriately or at regular intervals.  Limit exposure to cold environments. Degrees of Hypothermia  Mild  Severe  Compensated Hypothermia  Acute, Subacute, and Chronic Exposure
    19. 19. ColdDisorders
    20. 20. Hypothermia Signs & Symptoms  Mild  Severe
    21. 21. Hypothermia ECG  Pathognomonic J waves (Osborn waves).  Eventual onset of bradycardia.  Ventricular fibrillation probable below 86º F.
    22. 22. Hypothermia
    23. 23. Hypothermia Treatment  Active Rewarming  Active external rewarming  Active internal rewarming  Rewarming Shock  Cold Diuresis
    24. 24. Hypothermia Resuscitation  BCLS  Perform pulse and respiration checks for longer periods.  Administer up to 3 shocks with the AED.  Follow with CPR, rewarming, and rapid transport.  ACLS  Intubate and administer up to 3 shocks and initial medications.  Establish IV access, begin rewarming, and transport rapidly.  Avoid further resuscitation until the core temperature is above 86º F.
    25. 25. Frostbite Superficial Frostbite  Freezing of epidermal tissue  Redness followed by blanching and diminshed sensation Deep Frostbite  Freezing of epidermal and subcutaneous layers  White, frozen appearance
    26. 26. Frostbite Treatment  Do not thaw the affected area if there is the possibility of refreezing.  Do not massage the affected area.  Administer analgesia prior to thawing.  Transport; rewarm by immersion only if transport is lengthy or delayed.  Cover the thawed part with a loose, sterile dressing.  Elevate and immobilize the thawed part.  Do not puncture or drain blisters.  Do not rewarm feet if walking will be required.
    27. 27. Trench Foot Trench Foot  Occurs above freezing.  Typically occurs from standing in cold water.  Symptoms are similar to frostbite.  Pain may be present, and blisters may form with spontaneous rewarming.  Treatment:  Warm, dry, and aerate the feet.  Prevention is the best treatment.
    28. 28. Near-Drowning and Drowning Near-Drowning vs. Drowning Pathophysiology of Drowning and Near-Drowning  Dry vs. Wet Drowning  Fresh-Water vs. Saltwater Drowning  Fresh water causes the alveoli to collapse from a lack of surfactant.  Salt water causes pulmonary edema and eventual hypoxemia due to its hypertonic nature.
    29. 29. Near-Drowning and Drowning
    30. 30. Near-Drowning and Drowning Factors Affecting Survival  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.
    31. 31. Near-Drowning and Drowning Treatment for Near-Drowning  Remove the patient from the water.  Attempt rescue only if properly trained and equipped.  Initiate ventilation while the patient is still in the water.  Suspect head and neck injury if the patient experienced a fall or was diving. Place the victim on a long spine board and use c-spine precautions throughout care.  Protect the patient from heat loss.  Evaluate ABCs. Begin CPR and defibrillation if indicated.
    32. 32. Near-Drowning and Drowning  Manage the airway using proper suctioning and airway adjuncts.  Administer oxygen at 100% concentration.  Use respiratory rewarming, if available.  Establish IV of lactated Ringer’s or normal saline at 75 mL/hr.  Follow ACLS protocols if the patient is normothermic. Treat hypothermic patients according to hypothermia guidelines. Adult Respiratory Distress Syndrome
    33. 33. Diving Emergencies Scuba The Effects of Air Pressure on Gases  Boyle’s Law  The volume of a gas is inversely proportional to its pressure if the temperature is kept constant.  Dalton’s Law  The total pressure of a mixture of gases is equal to the sum of the partial pressures of the individual gases.  Henry’s Law  The amount of gas dissolved in a given volume of liquid is proportional to the pressure of the gas above it.
    34. 34. Diving Emergencies Pathophysiology of Diving Emergencies  Increased dissolution of gases during descent due to Henry’s law.  Boyle’s law dictates that these gases have a smaller volume.  In a controlled ascent, the process is reversed and the gases escape through respiration.  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.
    35. 35. Diving Emergencies Classification of Diving Emergencies  Injuries on the Surface  Injuries During Descent  Barotrauma  Injuries on the Bottom  Nitrogen narcosis  Injuries During Ascent  Decompression illness  Pulmonary overpressure and subsequent arterial gas embolism, pneumomediastinum, or pneumothorax
    36. 36. Diving Emergencies General Assessment of Diving Emergencies  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
    37. 37. Diving Emergencies Factors to Assess  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
    38. 38. Pressure Disorders Decompression Illness  May occur with dives of 33’ or more.  Signs & Symptoms  Occur within 36 hours.  Joint/abdominal pain.  Fatigue, paresthesias, and CNS disturbances.  Treatment  Recompression.
    39. 39. Pressure Disorders Treatment  Assess ABCs and begin CPR if required.  Administer high-flow oxygen and intubate if indicated.  Maintain supine position.  Protect the patient from heat, cold, wetness, or noxious fumes.  Transport and establish IV access.  Consult with medical direction regarding administration of dexamethasone, heparin, or diazepam if CNS is involved.  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.
    40. 40. Pressure Disorders Pulmonary Overpressure Accidents  Can occur in depths as shallow as 6’.  Signs & Symptoms  Substernal chest pain with associated respiratory distress and diminished breath sounds  Treatment  Treat as a pneumothorax.  Provide rest and supplemental oxygen.
    41. 41. Pressure Disorders Arterial Gas Embolism  Signs & Symptoms  Onset is within 2–10 minutes of ascent .  There is dramatic onset of sharp, tearing pain.  Common presentation mimics a stroke; suspect AGE in any patient with neurological deficits immediately after ascent.  Treatment  Assess ABCs, provide high-flow oxygen.  Maintain a supine position; monitor vital signs frequently.  Establish IV access and consider administering corticosteroids.  Rapidly transport to a recompression chamber.
    42. 42. Pressure Disorders Pneumomediastinum  Signs & Symptoms  Substernal chest pain, irregular pulse, abnormal heart sounds, hypotension with a narrow pulse pressure, and a change in voice  Treatment  Provide high-flow oxygen.  Establish IV access.  Transport for further evaluation.
    43. 43. Pressure Disorders Nitrogen Narcosis  Occurs during a dive.  Can contribute to accidents during the dive.  Signs & Symptoms  Altered levels of consciousness and impaired judgment.  Treatment  Return to shallow depth.  Use oxygen/helium mix during dive.
    44. 44. Diving Emergencies Other Diving-Related Emergencies  Oxygen Toxicity  Hypercapnia Diver’s Alert Network  Consultation and Referrals  (919) 684-8111
    45. 45. High-Altitude Illness Manifestation  Altitudes above 8,000’ Prevention  Ascend gradually.  Limit exertion.  Descend for sleep.  Eat a high-carbohydrate diet.  Medications  Acetazolamide and nifedipine
    46. 46. High-Altitude Illness Types of High-Altitude Illness  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 acetazolamide and antinausea drugs and supplemental oxygen.
    47. 47. High-Altitude Illness High-Altitude Pulmonary Edema  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; medications such as acetazolamide, nifedipine, and lasix may be useful also.
    48. 48. High-Altitude Illness High-Altitude Cerebral Edema  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.
    49. 49. Nuclear Radiation Personal Safety  Only appropriately trained and equipped personnel should handle radiation emergencies. Basic Nuclear Physics  Atoms  Protons, neutrons, and electrons  Isotopes and Half-Life  Ionizing radiation
    50. 50. Nuclear Radiation  Ionizing Radiation  Alpha particles  Beta particles  Gamma rays  Neutrons Effects of Radiation on the Body  Detection of Radiation  RAD and REM  Acute and Long-Term Effects
    51. 51. Nuclear Radiation
    52. 52. Nuclear Radiation Principles of Safety  Time  Distance  Shielding  Clean Accidents  Patient is exposed but not contaminated.  Dirty Accidents  Patient is contaminated by radioactive particles, liquids, gases ,or smoke.
    53. 53. Nuclear Radiation Management  Park upwind.  Look for signs of radioactive exposure.  Use portable instruments to detect radioactivity.  Normal emergency care principles should be applied.  Externally radiated and internally contaminated patients pose little danger.  Externally contaminated patients require decontamination.
    54. 54. Environmental Emergencies Pathophysiology of Heat and Cold Disorders Heat Disorders Cold Disorders Near-Drowning and Drowning Diving Emergencies High-Altitude Illness Nuclear Radiation