Environ flash cards.txt

Loss of sodium resulting in muscle cramps

Fluid loss and vasodilation resulting in shock

Failure of the bodies cooling mechanism resulting in increased core temperature

• Loss of essential electrolytes (Potassium) do to excessive water intake coupled with increases sweating and urination
• Very similar to heat exhaustion
• Key Hx is "in" and "out" (Fluid in VS fluid out)

LOC

• SXS: Hx, Muscle cramps
• Treatment: Stop activity, replace electrolytes, message

• BP normal no orthostatic changes
• HR < 100 (at rest ten minutes)
• Nausea and vomiting transit (less then 3 times)
• No Diarrhea
• No syncope
• No significant medication/medical history
• Treatment: Oral Rehydration

• SXS: BP decreases possible orthostatic changes, HR >120, Nausea and vomiting three or more times, diarrhea, syncope, Positive medications or medical Hx, able to tolerate oral fluids in two hrs
• Treatment: Oral rehydration/IV

• SXS: BP severe hypotension, HR > 140 or arrhythmias, nausea and vomiting persistent, positive orthostatic signs, Unable to tolerate oral fluids
• Treatment: IV, Transport and treat for shock

• Sever mental changes, reduced LOC, seizures, temperature hot (may or may not be sweating) Core temp >40C, VS pattern for volume shock, skin may be red or pale with shell/core
• Treatment: Modify activity, modify environment, rehydrate oral/IV, electrolyte replacement, immediate cooling, evacuation

Disrobing the patient, wetting them with tepid water and fanning

• Intake of water > 1 liter per hr
• Resting pulse <110
• Temperature normal or low
• BP normal or low
• Ataxia
• Urinary incontinence
• Seizures
• Polyuria

• CNS Alteration (No)
• Restrict fluids replace electrolytes
• Pee it out
• CNS Alteration (Yes)
• Evacuate
• Tx SXS
• High mortality

• The Hypothalamus
• The Hypothalamus takes measurements from the skin and blood and adjust the body's temperature through regulation both voluntary and involuntary

• Vasodilation
• Vasoconstriction
• Sweating
• Shivering
• Increased/ decreased activity
• Behavioral Responses

• Dilation: Increases surface blood flow, increases heat loss (Normal 300-500 cc/min can increase to 3000cc/min)
• Vasoconstriction: Decreases blood flow to the periphery, decrease heat loss (Decreases to 30cc/min)

• Sweating: Cools body through evaporation
• Shivering: Generates heat increase in chemical reaction of muscle activity (50% for a few hrs)

10% dehydration = a 40% decrease in metabolic efficiency

3 weeks

• Carl Bergmann 1847
• Within the same species of warm blooded animals populations having less massive individuals are found more in warm climates

• Joe Allen 1877
• The length of arm, legs and other appendages also has an effect in the amount of heat loss to the surroundings

• Increase fat storage
• Increase in Metabolic Rate
• Decrease response to the cold challenge

Sweating is not effective above 70% humidity

• Convection
• Radiation
• Evaporation
• Conduction

Convection os the transfer of heat by movements of air (or water) masses

Evaporation is the process of a liquid changing state into a gas

Radiation is the outward flow of energy (Long wave) from a source to the surrounding environment

Conduction is the process where energy is transferred between objects through direct contacts

The actual heat load on a person is roughly ten degrees higher than what a dry bulb thermometer reads

• Head
• Hands
• Feet
• genitalia

• Superficial - 1st degree - AKA: Frostnip
• Partial Thickness - 2nd degree
• Full Thickness - 3rd degree

• Soft, pale or red (Blushed) skin
• Intact sensation
• No actual freezing involved

• Soft, pale skin
• Dulled sensation in the area
• Involves dermis only
• Moves freely over subcutaneous tissue

• No sensation in the area
• Frozen into subcutaneous tissue
• Involved joints do not move

• Immediate field re-warming
• Reverse shell core effect
• Protect from refreezing

• Ideal - controlled re-warming in the hospital
• Pre-treat with ibuprofen 800mg P.0.
• Consider narcotics for additional pan control
• Immerse in 37 - 40.5 C water until warm
• Field treatment: Evacuation will exceed 24hrs
• Use of the extremity will not be necessary for survival and evacuation
• Re-freezing must be prevented

• Don't be lazy, act to correct cold response
• Stay hydrated/well fed
• Keep insulated dry and clean
• Don't underestimate the heat loss
• Dress for the conditions avoid vasoconstrictors and tight boots
• Early recognition = easy cure

• Prolonged cold exposure, >0 C
• Vasoconstriction and loss of local perfusion
• Ischemia to infarction in skin tissue
• Inflammation and secondary infection

• Dry and warm
• Preserve perfusion, reverse shell/core
• Clean, treat infection as necessary
• NSAID's

• Abnormal vascular spasm in response to cold
• White to blue discoloration
• Generally sharply demarcated

Keep warm

1hr

• Mild (98.6 - 93.2 F) (36-34 C)
• Moderate (86 F) (30 C)
• Severe (<86 F) (<30 C)
• 86 F is where the LOC id effected, normally loss of consciousness (don't rapidly rewarm normally)
• 86 F is also where the loss of deep tendon reflexes and dexterity are effected

• Increases metabolic rate
• Maximum shivering
• Thermogenesis
• Impaired judgement
• slurred speech

• Respiratory depression
• Myocardial irritability
• Bradycardia
• Arterial fibrillation
• Osborn waves

• BMR 50% of normal
• Loss of deep tendon reflexes
• Fixed and dilated pupils
• Spontaneous VF

• Rapid onset, minutes to hours
• Cold water, most common example
• Usually not dehydrated or calorie depleted
• Spontaneous re-warming is usually possible

• Slow onset, hours to days
• Dehydrate and calorie depleted
• Re-warming must include food and fluids

• SXS: Mild to moderate mental status changes, Cold, shivering, shell/core effect
• Treatment: Immediate field rewarming, exercise, trap heat generated by shivering
• Insulated from convection, conduction and radiation
• Dry skin and clothing to reduce evaporation
• No metabolic waste accumulation, safe to rewarm

• SXS: Mild to moderate mental status changes, cold, shivering, shell/core effect
• Treatment: Immediate field re-warming, food and fluid before exercise in Sub-Acute cases, trap heat generated by shivering, Insulate from convection, conduction and radiation, dry skin and clothing to reduce evaporation
• No metabolic waist built up, safe to re-warm

• V, P or U on AVPU
• Cold, shell/core effect
• No shivering
• Cardiac irritability
• Dehydration
• Metabolic derangement
• VS may be undetectable

• The urine
• The rectal

• Package to prevent heat loss
• Urgent but gentle transport
• Dry pt and or remove clothing
• PPV with heat and humidified oxygen
• IV warmed to 40 C

• Only one dose of meeds below 30 C
• Defibrillate once below 32 C
• Never defibrillate below 25 C
• Intubation is ok

Pt cant last more then 24hrs core hypothermia

• If the hypothermic patient does not respond to 1 shock, further defibrillation attempts should be deferred, and the rescuer should focus on continuing CPR and rewarming the patient to a range of 30 C to 32 C before repeating the defibrillation attempts. If core temperature is <30 C, successful conversion to normal sinus rhythm may not be possible until rewarming is accomplished.
• Remember to address the underlying problem

Pacemaker stimulation and defibrillation may cause the patient's heart to go into VF

There is concern that in the severely hypothermic patient cardioactive medications can accumulate to toxic levels in the peripheral circulation if given repeatedly. For thee reasons IV drugs are often withheld of the patients core temp is <30 C. Of the core temp is > 30 C, IV medications may be administered but with increases intervals between doses.

• Consider no performing CPR if:
• You can feel a pulse
• The monitor shows an organized activity
• There is any sign of life
• Performing CPR will endanger the rescuers
• Chest is frozen
• Chest compressions may cause a functioning but very slow cardiac rhythm to decay into ventricular fibrillation

8000ft

1 atmosphere is 14.7lbs at see level

• 8000 = 3/4 of 1 atmosphere
• 18000 = 1/2 atmosphere

In high altitude the air is much thinner, though the concentration of oxygen is the same the pressure gradient is different do to the pressure in hog altitudes being lower. When this is the case the body picks up the RR to compensate for the decrease in O2 due to the change in pressure. As the body increases it RR just to get the same amount of oxygen the same amount of oxygen, it is still blowing off the same amount of CO2 so the pt becomes alkalotic. As the bodies pH is altered it changes to permeability of the capillaries and causes them to begin to leak causing hypoxia and edema. This is the cause for HAPE and HACE

Any illness at high altitude is considered caused by altitude illness until proven otherwise

• Hyperventilation and tachycardia
• Kidneys help maintain pH

• Boy produces more red blood cells and hemoglobin
• Capillary bed increase in density

Hyperventilation progresses to respiratory alkalosis, respiratory alkalosis leads to irregular respiratory control. Irregular respiratory control leads to sleep hypoxia and delayed adjustment

Swelling with increased ICP

• Mild AMS - Mild headache, reduced appetite and nausea
• Moderate HACE - Severe head ache, nausea and vomiting
• Severe HACE - AVPU changes, persistent vomiting and ataxia

• Mild AMS - Pain meeds, O2, hydration and food and Acetazolamide and rest a day
• Moderate HACE - Moderate HACE - Above plus immediate descent of 500 meters - Consider Dexamethazone
• Severe HACE - Gamow bag treatment, immediate descent of 500 meters, Dexamethazone and PROP

• Acetazolamide (Diamox)
• Dexamethazone (Decadron)

Capillary dilation and leakage of fluid into the alveoli of the lungs

• Mild AMS - Dry cough, mild SOB on exertion
• Moderate HAPE - Persistent cough, rales on auscultation, SOB at rest, low grade fever
• Severe HAPE - AVPU changes, respiratory failure, white or blood tinged sputum and marked rales

• Mild - O2, rest day and hydration and food, medications
• Moderate - Above plus immediate descent of 500 meters, consider Nifedipine
• Severe - Above plus Gamow bag treatment, immediate descent of 500 meters, Nifedipine and PROP

• Acetazolamide (Diamox)
• Nifedipine (Procardia, Alalat)
• Oxygen

• Contact lens
• Cough
• Dehydration
• Sunburn
• Slow blindness

• Regular lenses can obstruct oxygenation of the cornea resulting in ulceration
• Use high-permeability lenses (High DK valve)
• Remove lenses when sleeping

High probability due to dry air and reduced appetite

• Can be caused by dry air as well as HAPE
• Use dark UV protective lenses and shields

• Reduced oxygenation results in prolonged healing time
• No healing above 6000 meters

HACE = is swelling/hypoxia of the brain => to ICP the treatment for HACE is no different for ICP with the exception of the need to descend

HAPE = is progressive pulmonary edema/ The treatment for HAPE is no different than any other cause of pulmonary edema with the exception of the need to descend

• Past history of altitude illness
• Respiratory depression
• For AMS, age <50
• Rapid ascent
• Lives below 1000 meters
• Exertion and cols air for HAPE
• For HAPE, pre-existing respiratory illness
• Sudden drop in atmospheric pressure

• A Gamow bag is simply a pressurized sack that will allow you to simulate descending when travel is not possible
• Can't treat the patient when their in the Gamow bag

• O2
• Valium
• IV fluids
• Morphine Diuretics
• OTC for headache
• Acetazolamide (Diamox - Special approval)
• Dexamethazone (Decadron - Special approval)

Lightening is DC: High voltage and amperage, short duration. Lightening occurs to equalize the + and - charges created by large air masses moving across the ground

• DC - High Amperage, AC - Low Amperage
• DC - High Voltage, AC- Low Voltage
• DC - Short Duration, AC - Longer duration
• DC - No muscle tetany, AC - Muscle tatany
• DC - Internal burns uncommon, AC - Internal burns common
• DC - Rhabdomyolysis is rare, AC - Rhabdomyolysis more common
• DC - Entrance/exit wounds rare, AC - Entrance/exit wounds are common

• Cloud to ground
• Ground to cloud
• Within the cloud
• Cloud to space
• Cloud to cloud

• Every five seconds form flash to bang equals one mile distance
• Count 30 seconds means the strike is within 6mi, when the strike is within 6mi get to cover
• Times of less than 15 seconds from F to B should initiate your lightening drill

• Spread people out. People should be no more than 15 -20 feet
• Seek the lowest ground or hollow, away from trees, put on waterproofs and sit on mat with knees drawers up to body

• Lightening can travel through the ground, fence, water pipes etc
• The current can travel 100m

Typically the power is diminished enough at 15-20ft to survive the strike

May 2004 in Osborne country Kansas a cloud to ground bolt of lightening stretch 28 miles from the storm

Cardiac arrest caused by lightening is triaged as immediate in a triage situation. CPR is not stopped in lightening strike patients

• Punctate lightening burn
• Ferning lightening burn

• Small deep entry/exit (Maybe absent)
• Contact metal burns
• Superficial (Flash over)
• Lichtenberg figure
• Clothing and shoes exploded off, torn, singed shredded

• Tympanic rupture
• Deafness, tinnitus, vertigo
• Transient blindness - Photophobia, conjunctivitis, corneal damage
• Retinal abnormalities - macular hole, optic neuritis, cataracts

A condition marked by intermittent muscular spasms, caused by malfunction of the parathyroid glands and a consequent deficiency of calcium

Every 33ft a diver descends equals another 14.7 psi

3 = 1 from sea level + 1 at sea level + 1 at 33ft + 1 at 66 ft

• Boyles law - P = I/V
• For every additional atmosphere the driver picks up an additional 14.7 psi of pressure is added to their body.
• Closed air filled pagans are crushed
• Water filled organs experience an increase in pressure but no change in size
• Open air filled organs are reduced in volume in exactly the reverse relationship to the amount of pressure - Twice the pressure = 1/2 the volume

• Gas exchange over the Alveoli membrane is pressure dependent. As the Pressure increases the amount of gas driven into solution (in the blood) increases
• The amount of dissolved gas is pressure dependent
• Increase in pressure = Increase Gas in Solution

Breathing - Excess gas just takes more time

AGE (Arterial Gas Embolus)

Mask Squeeze - Results from not equalizing pressure in diving mask on descent

Ruptured capillaries of the eyes, nose and soft tissue

Intoxication

• Ascend
• Limit depth of dive
• Use mixed gases

• Rapid ascent from depth, rapid onset
• Hyper-expansion and rupture of the lungs
• Air embolus from pulmonary tree

• Subcutaneous emphysema
• Neurologic deficit
• Bloody sputum
• Shock
• Pneumotórax
• Mediasteinum
• CVA

• Caissons disease
• Bends

• Prolonged exposure, delayed onset
• Insufficient time to decompress
• Bubbles in blood from slow dissolution of gas
• Micro vascular damage

• Skin itching
• Paresthesia, joint pain
• CNS symptoms, focal signs, AVPU changes
• Respiratory distress and shock in severe cases

• Treat each SxS, ie. pneumo, CVA
• Left sided recumbent
• Hyperbaric chamber
• DAN 1-919-684-8111
• If flying stay below 1000' (300m)
• Don't disturb diving equipment

To recompose a diver you must go much deeper than their last dive

Usually only 3 atmospheres

• AGE:
• Onset fast
• SQ Emphysema
• Neuro Deficit (AVPU)
• Cardiovascular collapse
• Respiratory distress
• Bends:
• Onset somewhat delayed
• Skin rash and itching
• Neuro complaints
• Cardiovascular collapse
• Respiratory distress
• Biggest clues:
• Onset
• Length of dive
• Depth of dive

• Stinging problems
• Spine problems
• Bite problems

A specialized cell in the tentacles of a jellyfish or other coelenterate, containing a barbed or venomous coiled thread that can be projected in self-defense or to capture prey

• Corals
• Jellyfish
• Anemones

Stinging

• Tx Do:
• Salt water rinse
• Vinegar
• Scrape off remains
• Topical corticosteroids
• Tx Don't:
• Fresh water rinse
• Rub

• Sting rays
• Catfish
• Stone fish
• Sea Urchins

• H2O soak (105 F, 40 C) 90 min or until pain subsides
• Remoce barb/stinger
• Pain medication

• Spine:
• Typically tissue toxin, sometimes combined with neurotoxin
• Immediate evacuation for progressive neurologic symptoms
• Stinging injuries:
• Typically neurotoxin with some skin inflammation
• Immediate evacuation for progressive neurologic symptoms

• Any of the large predator fish
• Sharks
• Barracuda
• Eels

• Hit and run
• Bump and bite
• Sneak attack

• Remove pt. from water
• Hemorrhage control
• Temperature control
• Tx for shock
• Wound high risk for infection

The shark had identifies its prey and has decided to feed

This is typically a castoff mistaken identity. The shark assumes it is feeding on its normal prey and discovers the mistake on the first bite - Typically does not return

The shark is uncertain what it is dealing with. In some cases it will bump into the pry and scrap off a small amount of fresh to try and identify the prey - typically returns to bite

• Fresh water
• Salt water
• Cold water

• Occurs when the larynx closes involuntarily do to irritation. This occurs in most drowning. As a result most drowning results in dry lungs initially
• 15% of Laryngospasm don't relax when the patient surfaces. Consider what your airway pitons are.

• Get the patient out of the water
• It is possible to provide PPV while in shallow water
• If there is the possibility of a C-spine injury immobilize the patient

• Gasp the patient head, neck and shoulder
• Moving backward roll them onto their back
• Submerge the backboard underneath the patient
• Consider partial immobilization and rapid extrication if the water is cold

• Salt water drownings result in pulmonary edema over time
• Water flows to the area of lower concentration to higher concentration
• If the water in the lungs is higher concentration of salt then the blood it will take the fluid from the blood to the lungs

• RBC will accept the water until it laces/blows-up/ruptures
• Water goes into the area of higher concentration, in this case the blood
• Fresh water drowning typically result in dry lungs. However, as water migrates into the circulation volume it can dilute the blood and destroy RBC

Cold water drowning can result in the MDR (Mammalian Diving reflex). The cold water reduce oxygen consumption by slowing down the metabolic rate

• The Mammalian diving reflex is where a patient drowns in cold water lower then 70F and the patient is completely submerged
• The MDR reduced the O2 consumption by slowing down the metabolic rate

• Length of submersion
• Age of patient
• Temperature of the water

Consider the patient viable if they have been submerged in water 70F or colder for less then 60 min. Do not stop BLS or ALS treatment until you have reached the hospital or are in voice contact with medical control

Easily transmuted from patient to rescuer so where gloves and change and wash uniform at work

• Treatments like permethrin should be applied to dry hair
• Can also be smothered with Vaseline, Mayonnaise or Dippity-Do
• Malathione (Ovide) is fastes-killing

• Lyme disease
• Colorado tick fever
• Rocky Mt spotted fever
• Ehirlichiosis
• Q-fever
• Tularemia
• Tick-borne encephalitis
• West Nile virus
• Plague

Grab the head of the tic when removing them. Because the head is cemented into the host it mat become detached when trying to remove the tick. If it happens it may be necessary to dig the head out with a scalpel blade. Tick cement themselves to their host. This requires less energy than hanging on to the hosts hair follicles during the blood meal. This is why they are so hard to pull off. The tick dissolves the cement by disgorging part of it blood meal at the end of the feed cycle - this is the point that the infection occurs.

• Rash (Bull's-eye Rash) - Typically occurs 3-30 days after bite. Rash occurs in 70-80% of infected people
• Fever
• Head ache
• Fatigue
• Joint pain
• Circulatory system
• Nervous system

• Cutaneous
• Gastrointestinal
• Inhalation

• Small sore >
• Blister
• Skin ulcer (Black center)
• Not painful

Nausea, loss of appetite, bloody diarrhea fever and stomach pain

• Flu like symptoms, severe head ache
• Mild fever, tiredness, muscle ache
• SOB and cough

• Bacterium
• Soil
• Infected animals
• Infected animal products
• Inhaling spores
• Eating uncooked meat which is infected

• Skin ulcerations
• Swollen and painful Enlarged lymph nodes
• Sore throat
• Head ache
• Muscle weakness/joint pain

• Bacterium
• Tick
• Deer flies
• Food
• Water
• Inhalation
• NOT: person to person

• Swollen, enlarged lymph node (called Bubo)
• Warm to touch
• Fever
• Headache
• General feeling of illness

• Blood poisoning, esp. that caused by bacteria or their toxins
• This happens when the Plague hits the blood stream

• Bubonic:
• Spread by a tick or flea bite
• Pneumonic:
• Inhaled

• Pneumonic is the more serious form of plague
• Bite flea
• Inhalation of spores
• Break in skin
• Contact with infected body fluid

• An intermittent and remittent fever caused by a protozoan parasite that invades the red blood cells. The parasite is transmitted by mosquitoes in many tropical and subtropical regions.
• Blood disease
• Passed by anopheles mosquito
• Infected with plasmodium falciparum
• Digest red blood cells
• Changes adhesion properties of cell