-
What does vasodilation do for heat loss?
Increases it
-
What does vasoconstriction do for heat loss?
Decreases it
-
How does sweating cool the body?
Through evaporation
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At what humidity does sweating become ineffective?
70%
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The actual heat load on a person is approximately _____ degrees higher than what a dry bulb thermometer reads.
10 degrees
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True or false. If bystanders start CPR on hypothermic patient you will have to continue working that code all the way through.
True
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What are two possibilities of obtaining an accurate core temperature in a hypothermic patient?
Rectal temp (if clean) or urine temp may give you a fairly accurate core temp
-
A patient can't stay hypothermic for any more than ____ hours to still have a chance of resuscitation.
24
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What are some methods available to us in the field to prevent further heat loss in a hypothermic patient?
- Hot packs
- Insulation
- Warm ambulance
- Warm IV
- Warm O2
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What does it mean if a patient's chest is frozen solid?
There is no chance of survival
-
What is the first and main goal of treatment in a hypothermic patient?
Treatment should address the environment - i.e. remove them from the wet clothing and get them out of the cold
-
What is the risk of using fluid resuscitation in a severely hypothermic patient?
Significant chance of flash pulmonary edema
-
What is the main body area to ensure is wrapped in a hypothermia wrap?
The head - take the time to wrap well and keep it tight
-
What causes tissue death in frostbite?
Tissue dies due to dehydration and freezing and expansion of water in tissue
-
Where do you take a patient who has frostbite?
A facility with a burn unit
-
What characteristics does "frostnip" have in regards to the skin?
Superficial redness with intact sensation
-
What color will the skin be in moderate frostbite?
Pale or translucent white color
-
When is it detrimental to rub frostbitten skin in an attempt to rewarm?
Past the superficial level of frostbite
-
What color will the skin be in severe or full thickness frostbite?
capillary beds, venules, and arteries have been ruptured and are leaking = creates uneven, mottled skin pale or bluish in color
-
What is the tip point in time for attempting rewarming of tissue in the field?
24 hours; after that, it has no viability
-
What are the guidelines for immersion rewarming of frostbitten areas?
- entire frozen area must be immersed at the same time
- bigger the container the better
- keep the water 37-40.5 degrees for 30 minutes max
-
What do blisters mean in frostbite?
- Blisters indicate how much tissue damage was actually done and how much could be lost; blisters mean circulation has returned (fluid flowing)
- Clear blisters are a good sign; blood filled blisters indicate deeper damage (ruptured vessels)
-
What does it mean if tissue turns black before blisters form?
Necrotic; no chance of keeping that tissue
-
Why do we apply sterile dressings to frostbitten skin after rewarming?
- To prevent topical spread of infection from damaged areas
- There is no co-mingling circulation or chance of infection through internal vessels
-
What is Raynaud's phenomenon?
- An abnormal vascular spasm in response to cold
- Involves white to blue discoloration often sharply demarcated from normal tissue
- Treatment is to keep warm
-
What's the pathophysiology chain of altitude sickness?
Less available O2 -> Hyperventilation -> More CO2 exhaled -> Respiratory Alkalosis -> Vessel changes -> Hypoxia & Edema of the brain and lungs
-
What are the SXS of Mild HACE/AMS?
- Mild headache
- Reduced appetite
- Nausea
-
What are the SXS of Moderate HACE?
- Severe headache
- Nausea
- Vomiting
-
What are the SXS of Severe HACE?
- AVPU changes
- Persistent vomiting
- Ataxia
-
How do we treat Mild HACE/AMS?
- Oxygen
- Hydration
- Food
- Pain meds
-
How do we treat Moderate HACE?
- Oxygen
- Hydration
- Food
- Pain meds
- Immediate descent of 500m
-
How do we treat Severe HACE?
- Gamow bag treatment
- Immediate descent of 500m
- PROP
- Dexamethazone
-
What are the SXS of Mild HAPE/AMS?
- Dry cough
- Mild SOB on exertion
-
What are the SXS of Moderate HAPE/AMS?
- Persistent cough
- Rales on auscultation
- SOB at rest
- Low grade fever
-
What are the SXS of Severe HAPE/AMS?
- AVPU changes
- Respiratory failure
- White or blood tinged sputum
- Marked rales
-
How do we treat Mild HAPE/AMS?
- Oxygen
- Rest day
- Hydration
- Food
- Medications
-
How do we treat Moderate HAPE?
- Immediate descent of 500m
- Oxygen
- Rest day
- Hydration
- Food
- Medications
-
How do we treat Severe HAPE?
- Gamow bag treatment
- Immediate descent of 500m
- PROP
- Nifedipine
- Oxygen/Albuterol
-
What are some tick-borne diseases we should be aware of?
- Lyme Disease
- Colorado tick fever
- Rocky Mountain spotted fever
- Tularemia
- Tick-borne encephalitis
- West Nile virus
- Plague
-
What are the SXS of Lyme Disease?
- Rash
- Fever
- Headache
- Fatigue
- Joint pain
- "Bullseye" rash
-
What does cutaneous anthrax present with?
A small non-painful skin ulcer with a black center
-
What are the SXS of Tularemia?
- Skin ulcerations
- Enlarged lymph nodes
- Sore throat
- Headache
- Joint pain
- Muscle weakness
-
What are the SXS of plague?
- Swollen, enlarged lymph nodes
- Warm to touch
- Fever
- Headache
- General feeling of illness
-
What is the more severe form of plague and how is it spread?
- Pneumonic is more serious
- Spread through inhalation
- Highly contagious
-
What is the temperature range of mild hypothermia?
-
What is the temperature associated with moderate hypothermia?
-
What is the temperature range of severe hypothermia?
-
What are the physiological changes associated with mild hypothermia?
- Increased metabolic rate
- Maximum shivering
- Thermogenesis
- Impaired judgement
- Slurred speech
-
What are the physiological changes associated with moderate hypothermia?
- Respiratory depression
- Myocardial irritability
- Bradycardia
- A-Fib
- Osborn waves
-
What are the physiological changes associatead with severe hypothermia?
- BMR 50% of normal
- Loss of deep tendon reflexes
- Fixed and dilated pupils
- Spontaneous VFib
-
What is the difference between acute and sub-acute mild hypothermia?
- Acute is rapid onset, minutes to hours, most common example is cold water, usually no dehydration or calorie depletion
- Sub-acute is slow onset, hours to days, dehydrated and calorie depleted
-
How do we treat mild hypothermia?
- Immediate field re-warming
- Trap heat generated by shivering
- Insulation
- Dry skin and clothing to reduce evaporation
- Acute- exercise
- Sub-acute- food and fluid then exercise
-
How do we treat severe hypothermia?
- Package to prevent further heat loss
- Urgent but gentle transport
- Dry patient and/or remove clothing
- Heat and humidified oxygen
- Heat packs
- Warm IV to 40 C
-
How many psi is 1 atm?
14.7 psi
-
How many feet equal one atm when diving?
33 ft
-
What does Boyle's Law say?
Open air filled organs are reduced in volume inversely to the amount of pressure
-
What does Henry's Law say?
- Gas exchange over the alveolar membrane is pressure dependent
- As pressure increases, the amount of gas driven into solution in the blood increases
-
What are the SXS of middle ear barotrauma?
- External ear pain
- Facial paralysis
- Hearing loss
- Tinnitus
- Vertigo
-
How do we treat middle ear barotrauma?
- Ascend
- Equalize pressure
- Address eardrum if ruptured
-
How do we treat nitrogen narcosis?
- Ascend
- Limit depth of dive
- Use mixed gases
-
What is AGE?
- Arterial gas emboli
- Caused by rapid ascent from depth
- Rapid onset
- Hyper-expansion and rupture of lungs
- Air embolus from pulmonary tree
-
What are the SXS of AGE?
- Subcutaneous emphysema
- Neurologic deficit
- Bloody sputum
- Shock
-
What are some of the things AGE can present as/cause?
- Pneumothorax
- Mediastinum overpressurization
- SQ emphysema
- CVA
-
What are the SXS of decompression sickness?
- Onset somewhat delayed
- Skin itching
- Paresthesia
- Joint pain
- CNS symptoms; AVPU changes
- Respiratory distress and shock in severe cases
-
What is the first priority in a diving emergency?
Get the patient out of the water
-
How should a diver with an emergency be positioned for transport?
Left lateral recumbent
-
What are the SXS of mild heat exhaustion?
- BP normal with no orthostatic changes
- HR <100 at rest
- N/V transient less than 3 times
- No syncope
-
How do we treat mild heat exhaustion?
Oral rehydration
-
What are the SXS of moderate heat exhaustion?
- BP decreases with possible orthostatic changes
- HR >120
- N/V three or more times
- Syncope
-
How do we treat moderate heat exhaustion?
- Oral rehydration if possible
- IV rehydration
-
What are the SXS of severe heat exhaustion?
- BP severely hypotensive with positive orthostatic changes
- HR >140 or severe arrythmias
- N/V persistent
-
How do we treat severe heat exhaustion?
- IV
- Transport
- Treat for shock
-
What are the SXS of heat stroke?
- Severe mental status changes
- Reduced LOC
- Seizures
- Temperature hot (may or may not be sweating)
- Core temperature >40 C
- Vital sign pattern for hypovolemic shock
- Skin may be red or pale with shell/core shunting
-
What happens in slow onset heat stroke?
Patient's ability to compensate for environment is slowly overcome, resulting in increase in core temp
-
What happens in sudden onset heat stroke?
- Damage to the hypothalamus via trauma, tumor, drugs or medications results in sudden failure in body's ability to regulate temp
- Potentially dangerous temperatures can be reached in 15 minutes or less
-
How do we treat heat stroke?
- Rehydrate
- Electrolyte replacement
- Immediate cooling
- Evacuation
- Disrobe the patient
- Wet with tepid water
- Fanning
-
What are the SXS of hyponatremia?
- Intake of water > liter per hour
- History is critical
- Resting pulse <110
- BP normal or low
- Temperature normal or low
- Ataxia
- Urinary incontinence
- Seizures
- Polyuria
-
What is hyponatremia caused by?
Excessive fluid intake with low electrolyte intake
-
How do we treat hyponatremia with no CNS alterations?
- Restrict fluids
- Replace electrolytes
- Pee it out
-
How do we treat hyponatremia with CNS alterations?
- Evacuate
- Treat SXS
- High mortality
-
Every ___ seconds from flash to bang equals 1 mile distance.
5 seconds
-
How far apart should people be to avoid lightning conduction from person to person?
15 to 20 feet
-
In a triage situation, how is cardiac arrest classified when caused by lightning strike?
Immediate
-
In a lightning injury, what happens to the respiratory and cardiac rates?
- Respiratory rate stops and stays stopped
- Cardiac rate stops but will restart
-
How do we treat lightning strikes in the field?
- Treatment specific to SXS
- Consider respiratory arrest, cardiac arrest, fx, penetrating wounds, deafness, paralysis, concussion
-
What are the SXS of a nematocyst or "stinging" injury?
- Local pain, tenderness
- Itching, rash
- Minimal systemic effects
-
How do we treat a stinging injury?
- Salt water rinse
- Vinegar
- Scrape off remains
- Topical corticosteroids
-
What are the SXS of a spine marine injury?
- Puncture/laceration
- Pain, tenderness
- Systemic SXS
-
How do we treat a spine marine injury?
- Freshwater soak 105 F, 40 C for 90 minutes
- Remove barb/stinger
- High risk wound
- Pain medication
- Immediate evacuation for progressive neurologic symptoms
-
What is a "sneak attack" bite?
Shark has identified the prey and has decided to feed
-
What is a "hit and run" bite?
- Mistaken identity
- Typically does not return
-
What is a "bump and bite" attack?
- Shark will bump and scrape a small amount of flesh to identify prey
- Typically returns to bite
-
How do we treat any type of shark bite?
- Remove patient from water
- Hemorrhage control
- Temperature control
- Tx for shock
-
What is the first priority for any marine injury?
Deal with the environment
-
What is a laryngospasm in relation to drowning?
- Larynx closes due to irritation
- Occurs in most drownings
- Most drownings result in dry lungs initially
- 15% don't resolve even after patient reaches the surface
-
What is the first priority in any drowning event?
Get the patient out of the water
-
What can salt water near-drowning result in?
Pulmonary edema and lysing of RBCs
-
What can freshwater near-drowning result in?
- Dry lungs
- Diluted blood and destroyed RBCs
-
What is the water temperature in a cold water drowning?
70 F or colder
-
What is the Mammalian Diving Reflex?
Cold water reduces oxygen consumption needs by slowing down the metabolic rate
-
How long do we consider a patient viable for in a cold water drowning?
less than or equal to 60 minutes
-
How do we treat near-drownings?
- Positive pressure ventilations
- Treat hypothermia as needed
- Anticipate pulmonary edema and increased ICP
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