1. What does vasodilation do for heat loss?
    Increases it
  2. What does vasoconstriction do for heat loss?
    Decreases it
  3. How does sweating cool the body?
    Through evaporation
  4. At what humidity does sweating become ineffective?
  5. The actual heat load on a person is approximately _____ degrees higher than what a dry bulb thermometer reads.
    10 degrees
  6. True or false. If bystanders start CPR on hypothermic patient you will have to continue working that code all the way through.
  7. 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
  8. A patient can't stay hypothermic for any more than ____ hours to still have a chance of resuscitation.
  9. 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
  10. What does it mean if a patient's chest is frozen solid?
    There is no chance of survival
  11. 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
  12. What is the risk of using fluid resuscitation in a severely hypothermic patient?
    Significant chance of flash pulmonary edema
  13. 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
  14. What causes tissue death in frostbite?
    Tissue dies due to dehydration and freezing and expansion of water in tissue
  15. Where do you take a patient who has frostbite?
    A facility with a burn unit
  16. What characteristics does "frostnip" have in regards to the skin?
    Superficial redness with intact sensation
  17. What color will the skin be in moderate frostbite?
    Pale or translucent white color
  18. When is it detrimental to rub frostbitten skin in an attempt to rewarm?
    Past the superficial level of frostbite
  19. 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
  20. What is the tip point in time for attempting rewarming of tissue in the field?
    24 hours; after that, it has no viability
  21. 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
  22. 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)
  23. What does it mean if tissue turns black before blisters form?
    Necrotic; no chance of keeping that tissue
  24. 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
  25. 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
  26. 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
  27. What are the SXS of Mild HACE/AMS?
    • Mild headache
    • Reduced appetite
    • Nausea
  28. What are the SXS of Moderate HACE?
    • Severe headache
    • Nausea
    • Vomiting
  29. What are the SXS of Severe HACE?
    • AVPU changes
    • Persistent vomiting
    • Ataxia
  30. How do we treat Mild HACE/AMS?
    • Oxygen
    • Hydration
    • Food
    • Pain meds
  31. How do we treat Moderate HACE?
    • Oxygen
    • Hydration
    • Food
    • Pain meds
    • Immediate descent of 500m
  32. How do we treat Severe HACE?
    • Gamow bag treatment
    • Immediate descent of 500m
    • PROP
    • Dexamethazone
  33. What are the SXS of Mild HAPE/AMS?
    • Dry cough
    • Mild SOB on exertion
  34. What are the SXS of Moderate HAPE/AMS?
    • Persistent cough
    • Rales on auscultation
    • SOB at rest
    • Low grade fever
  35. What are the SXS of Severe HAPE/AMS?
    • AVPU changes
    • Respiratory failure
    • White or blood tinged sputum
    • Marked rales
  36. How do we treat Mild HAPE/AMS?
    • Oxygen
    • Rest day
    • Hydration
    • Food
    • Medications
  37. How do we treat Moderate HAPE?
    • Immediate descent of 500m
    • Oxygen
    • Rest day
    • Hydration
    • Food
    • Medications
  38. How do we treat Severe HAPE?
    • Gamow bag treatment
    • Immediate descent of 500m
    • PROP
    • Nifedipine
    • Oxygen/Albuterol
  39. 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
  40. What are the SXS of Lyme Disease?
    • Rash
    • Fever
    • Headache
    • Fatigue
    • Joint pain
    • "Bullseye" rash
  41. What does cutaneous anthrax present with?
    A small non-painful skin ulcer with a black center
  42. What are the SXS of Tularemia?
    • Skin ulcerations
    • Enlarged lymph nodes
    • Sore throat
    • Headache
    • Joint pain
    • Muscle weakness
  43. What are the SXS of plague?
    • Swollen, enlarged lymph nodes
    • Warm to touch
    • Fever
    • Headache
    • General feeling of illness
  44. What is the more severe form of plague and how is it spread?
    • Pneumonic is more serious
    • Spread through inhalation
    • Highly contagious
  45. What is the temperature range of mild hypothermia?
    • 98.6 - 93.2 F
    • 36 - 34 C
  46. What is the temperature associated with moderate hypothermia?
    • 86 F
    • 30 C
  47. What is the temperature range of severe hypothermia?
    • <86 F
    • <30 C
  48. What are the physiological changes associated with mild hypothermia?
    • Increased metabolic rate
    • Maximum shivering
    • Thermogenesis
    • Impaired judgement
    • Slurred speech
  49. What are the physiological changes associated with moderate hypothermia?
    • Respiratory depression
    • Myocardial irritability
    • Bradycardia
    • A-Fib
    • Osborn waves
  50. What are the physiological changes associatead with severe hypothermia?
    • BMR 50% of normal
    • Loss of deep tendon reflexes
    • Fixed and dilated pupils
    • Spontaneous VFib
  51. 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
  52. 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
  53. 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
  54. How many psi is 1 atm?
    14.7 psi
  55. How many feet equal one atm when diving?
    33 ft
  56. What does Boyle's Law say?
    Open air filled organs are reduced in volume inversely to the amount of pressure
  57. 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
  58. What are the SXS of middle ear barotrauma?
    • External ear pain
    • Facial paralysis
    • Hearing loss
    • Tinnitus
    • Vertigo
  59. How do we treat middle ear barotrauma?
    • Ascend
    • Equalize pressure
    • Address eardrum if ruptured
  60. How do we treat nitrogen narcosis?
    • Ascend
    • Limit depth of dive
    • Use mixed gases
  61. 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
  62. What are the SXS of AGE?
    • Subcutaneous emphysema
    • Neurologic deficit
    • Bloody sputum
    • Shock
  63. What are some of the things AGE can present as/cause?
    • Pneumothorax
    • Mediastinum overpressurization
    • SQ emphysema
    • CVA
  64. 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
  65. What is the first priority in a diving emergency?
    Get the patient out of the water
  66. How should a diver with an emergency be positioned for transport?
    Left lateral recumbent
  67. 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
  68. How do we treat mild heat exhaustion?
    Oral rehydration
  69. What are the SXS of moderate heat exhaustion?
    • BP decreases with possible orthostatic changes
    • HR >120
    • N/V three or more times
    • Syncope
  70. How do we treat moderate heat exhaustion?
    • Oral rehydration if possible
    • IV rehydration
  71. What are the SXS of severe heat exhaustion?
    • BP severely hypotensive with positive orthostatic changes
    • HR >140 or severe arrythmias
    • N/V persistent
  72. How do we treat severe heat exhaustion?
    • IV
    • Transport
    • Treat for shock
  73. 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
  74. What happens in slow onset heat stroke?
    Patient's ability to compensate for environment is slowly overcome, resulting in increase in core temp
  75. 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
  76. How do we treat heat stroke?
    • Rehydrate
    • Electrolyte replacement
    • Immediate cooling
    • Evacuation
    • Disrobe the patient
    • Wet with tepid water
    • Fanning
  77. 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
  78. What is hyponatremia caused by?
    Excessive fluid intake with low electrolyte intake
  79. How do we treat hyponatremia with no CNS alterations?
    • Restrict fluids
    • Replace electrolytes
    • Pee it out
  80. How do we treat hyponatremia with CNS alterations?
    • Evacuate
    • Treat SXS
    • High mortality
  81. Every ___ seconds from flash to bang equals 1 mile distance.
    5 seconds
  82. How far apart should people be to avoid lightning conduction from person to person?
    15 to 20 feet
  83. In a triage situation, how is cardiac arrest classified when caused by lightning strike?
  84. In a lightning injury, what happens to the respiratory and cardiac rates?
    • Respiratory rate stops and stays stopped
    • Cardiac rate stops but will restart
  85. How do we treat lightning strikes in the field?
    • Treatment specific to SXS
    • Consider respiratory arrest, cardiac arrest, fx, penetrating wounds, deafness, paralysis, concussion
  86. What are the SXS of a nematocyst or "stinging" injury?
    • Local pain, tenderness
    • Itching, rash
    • Minimal systemic effects
  87. How do we treat a stinging injury?
    • Salt water rinse
    • Vinegar
    • Scrape off remains
    • Topical corticosteroids
  88. What are the SXS of a spine marine injury?
    • Puncture/laceration
    • Pain, tenderness
    • Systemic SXS
  89. 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
  90. What is a "sneak attack" bite?
    Shark has identified the prey and has decided to feed
  91. What is a "hit and run" bite?
    • Mistaken identity
    • Typically does not return
  92. What is a "bump and bite" attack?
    • Shark will bump and scrape a small amount of flesh to identify prey
    • Typically returns to bite
  93. How do we treat any type of shark bite?
    • Remove patient from water
    • Hemorrhage control
    • Temperature control
    • Tx for shock
  94. What is the first priority for any marine injury?
    Deal with the environment
  95. 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
  96. What is the first priority in any drowning event?
    Get the patient out of the water
  97. What can salt water near-drowning result in?
    Pulmonary edema and lysing of RBCs
  98. What can freshwater near-drowning result in?
    • Dry lungs
    • Diluted blood and destroyed RBCs
  99. What is the water temperature in a cold water drowning?
    70 F or colder
  100. What is the Mammalian Diving Reflex?
    Cold water reduces oxygen consumption needs by slowing down the metabolic rate
  101. How long do we consider a patient viable for in a cold water drowning?
    less than or equal to 60 minutes
  102. How do we treat near-drownings?
    • Positive pressure ventilations
    • Treat hypothermia as needed
    • Anticipate pulmonary edema and increased ICP
Card Set
EMS Environmental