More Related Content
What's hot
What's hot (20)
Similar to Environmental nc
Similar to Environmental nc (20)
More from djorgenmorris
More from djorgenmorris (20)
Recently uploaded
Recently uploaded (20)
Environmental nc
- 2. Environmental Emergencies • Weather • Terrain • Altitude • Water
- 3. Risk Factors • Diuretics • Beta Blockers • Psych Meds • ETOH • Diabetes • Coronary Artery Disease • Old People • Young People • Thyroid Diseases • Psychiatric Diseases • Floridians (altitude) • Non-Floridians (football season)
- 4. Terms you need to know • Thermolysis- release of stored heat from the body • Thermogenesis • Homeostasis • Thermoregulation • Hypothalamus • Core body temperature • Basal Metabolic Rate (BMR) • Calorie
- 6. Can lose 1 L/hr in sweat
- 7. Heat Emergencies • Heat Illness • Heat Cramps • Heat Syncope • Heat Exhaustion • Heat Stroke
- 8. Heat Cramps • Salt depletion • Dehydration • Muscle fatigue • Military • Sporting events • Fire fighting
- 10. If they can drink, let them drink! Otherwise, start IV.
- 11. Heat Syncope
- 12. Heat Exhaustion • Water depleted • Sodium depleted
- 13. Exercise-Associated Hyponatremia • Seen in athletes encouraged to pre-hydrate • Fluid shifting to interstitial and intracellular spaces • Can lead to o pulmonary edema (bad) o cerebral edema (bad bad)
- 15. Treatment • Drink when you are thirsty • Don’t overhydrate • People with known hyponatremia or encephalopathy should be treated with hypertonic saline… not D5, not ½ NS, not NS, not LR. • ISTAT?
- 16. Heat Exhaustion • Move patient ! • Check for orthostatic hypotension • Cool with tepid water.. don’t overdo it. • PO fluids- not too many carbs though.
- 18. Heat Stroke • Core temp over 104 (40 C) • Not actively sweating • BP normal or low • Classic- old, young, sick • Exertional- athletes
- 19. Heat Stroke- mimics • Neuroleptic malignant syndrome (antipsychotic meds) • Anticholinergic medication • Malignant hyperthermia
- 20. Heat Stroke- Treatment • Ice bath • Ice packs alone not good enough, but nice try. • Stop after 102 (38.9) • Normal saline • TACO procedure
- 22. Cold Emergencies
- 23. Topics • Frostbite • Hypothermia • Really bad hypothermia
- 24. Frostbite • Frostnip • Superficial frostbite • Deep frostbite • Trench foot • Chilblains
- 26. Mild Hypothermia Moderate Hypothermia Severe Hypothermia Wilderness Medical Society 90°-95° 32°-35° 82°-90° 28°-32° < 82° < 28° American Heart Association > 93° > 34° 86°-93° 30°-34° < 86° < 30° Per Diane Shivering Too cold to shiver or nearly dead Looks dead
- 27. “umbles” • stumbles • mumbles • fumbles • grumbles
- 28. Primary hypothermia is caused by cold exposures. Secondary hypothermia is due to problems such as sepsis.
- 29. Cold diuresis Hypothermia initially causes vasoconstriction which shunts blood to the body core. Receptors are tricked into thinking there is increased blood volume. Lack of sodium reabsorption leads to increased urine output. Fluid also shifts to the interstitial spaces.
- 30. J- Wave (Osborn Wave)
- 31. Progression • Shivering (burns glucose – check Bgl) • Rapid heart rate • Cold diuresis • Fluid shifting (pulmonary edema ?) • Hypoventilation
- 34. Severe Hypothermia < 82 • Warm IV fluids • Warm, humidified oxygen • Body cavity lavage • Extra corporeal rewarming • Esophageal rewarming tubes • Rewarm until CBT > 95
- 35. No Pulse, No Breathing He’s not dead until he’s warm (and dead)… • Per AHA: • One attempt of defibrillation if in vf/pvt • Don’t defibrillate again or give meds until temp > 86. • Organized rhythm without pulse… follow protocols. • AHA says CPR, WMS says no.
- 36. Drowning
- 37. A drowning is a drowning… near-drowning, wet drowning, dry drowning, freshwater drowning, saltwater drowning…. Who cares !
- 38. Newest Terminology • Drowning with death • Drowning with morbidity • Drowning with no morbidity
- 39. Process • DRY • Laryngospasm • Asphyxia • Hypoxemia • Hypercapnea • Lung injury • Poor lung compliance • Death • WET • Aspiration • Surfactant washout • Lung injury • Poor lung compliance • Death
- 40. Surfactant mixed with water will make foam. Do not waste time trying to suction the foam. Suction if you need to see vocal cords. The foam can be pushed back into the lungs with ventilation.
- 41. With drowning, don’t waste a lot of time trying to immobilize the patient if not necessary. When to immobilize: • Significant MOI • AMS or intoxication • Focal neuro deficit • Significant distracting injury
- 42. After a Submersion Incident Adult respiratory distress syndrome (ARDS), hypoxic brain injury, multiorgan failure, and sepsis can occur hours to days after a submersion. Symptoms are initially subtle (slight cough, mild tachypnea). Advise transport !
- 44. Boyle’s Law • Volume of gas inversely proportional to its pressure if temperature is kept constant. • P1V1=P2V2
- 49. Dalton’s Law • Partial Pressures
- 50. Henry’s Law • P= concentration of dissolved gases / solubility coefficient In other words: The amount of a gas dissolved in a given volume of fluid is proportional to the pressure of the gas above it.
- 51. The concentration of gas dissolved in a liquid is directly proportional to the partial pressure of the gas above the liquid.
- 52. Barotrauma Injuries caused by changes in pressure.
- 56. The ‘Squeeze’ • Barotrauma during descent o Middle ear pain o Dizziness o Ringing in ears o Hearing loss o Rupture of eardrum o Sinus infection while diving = bad
- 57. Injuries at the bottom
- 59. Injuries at the Bottom • Nitrogen Narcosis (state of stupor) • “Raptures of the Deep”
- 62. Injuries During Ascent • Decompression Sickness- The Bends • Pulmonary Overpressure Syndrome (POPS) • Do NOT give PEEP on pt with POPS. • Arterial Gas Embolism • Pneumomediastinum • Pneumothorax
- 65. Resources
- 69. Acetazolamide (Diamox) is only medication approved by FDA for altitude sickness.
- 72. Bites and Stings
- 74. Brown Recluse
- 75. Spider Bite
- 76. Black Widow
- 77. Treatment
- 78. Scorpion Stings • Bark scorpion • Opens sodium channels • Causes neuron excitation • Nystagmus, hypersalivation, dysphagia, mydriasis, and restlessness • Use constricting band ? • Beta blockers? • Do not give analgesics
- 79. Venomous Snakes • Crotalins (Pit Vipers) • Elapids (coral snake)
- 80. Common Pit Vipers • Cottonmouths • Rattlesnakes • Copperheads
- 81. Step 1: Get real close to snake so you can easily identify it. • http://www.flmnh.ufl.edu/herpetology/fl- guide/snakekey.htm
- 82. Friend or Foe
- 83. “Red on black… friend of Jack.”
- 84. Friend or Foe
- 85. “Red on yellow, kill the fellow.”
- 86. Name the Florida Snake
- 88. Florida Racer
- 94. Copperhead
- 100. Florida Corn Snake (Red rat snake)
- 102. Gray Rat Snake (Oak Snake)
- 104. Black Rat Snake
- 106. Ring Neck Snake
- 107. Snakebite Treatment • 25 % of bites are dry bites. • IV • Keep calm, supine, and motionless • Immobilize in neutral position below the heart.
- 108. Snakebite Treatment (what NOT to do) • Ice • Incision and suck • Electric shock • Tourniquets
- 109. CroFab
- 110. Marine Animal Injection • Heat will relieve pain and inactivate venom • Secondary infection possible
- 112. Galerina
- 113. Amanita
- 114. Signs and Symptoms • Excessive salivation • lacrimation • diaphoresis • abdominal cramps • nausea / vomitting / diarrhea • Sound familiar?