Blast, Eyes, Near Drowning, and Environmental Emergencies

Blast Injury

injuries sustained from high explosive that can cause multisystem trauma

code white

this is activated when high alert or there are blasts that occurred in an institution or specific place

primary, secondary, tertiary, quarternary

four types of blast injuries

primary blast injury

injury from over-pressurization force (blast wave) impacting the body surface

• tympanic membrane rupture

• pulmonary damage

• air embolism

• hollow viscus injury

secondary blast injuries

injury from projectiles

• penetrating trauma

• blunt trauma

tertiary blast injury

injuries from displacement of victim by the blast wind

• fractures

• amputations

• blunt/penetrating trauma

quaternary blast injury

other injuries sustained from the blast

• crush

• burns

• asphyxia

• exacerbation of chronic illness

large burn, burn on face neck genitals skin over joints, difficulty breathing, a fire, possible carbon monoxide poisoning

five assessments to call EMS for burns

eye injuries

can result from direct blow, foreign bodies, or inadvertent scratching

flush, protect with bandage both eyes, never remove impaled object

three things to do when there is eye injury

enucleation of the eye

removal of the entire globe and its intraocular content to save eyeball and eyesight

acute angle closure glaucoma - pilocarpine

a class 1 emergency in eye and its medication

cup, cover both eyes

management for impaled eye

near drowning

refers to surviving temporarily from submersion in fluid

• difference from drowning - drowning is already dead due to cardiac arrest

hypoxemia

decreased oxygen in the blood

acidosis

a result from anerobic respiration where the by-product is lactic acid

hypoxemia and acidosis

two primary problems for near drowning

freshwater aspiration

changes in the character of lung surfactant result in exudation of protein rich plasma in alveoli

exudates

freshwater aspiration produces?

pulmonary edema and hypoxemia

freshwater aspiration leads to?

saltwater aspiration

the hypertonicity of sea water exerts an osmotic force which pulls fluid from pulmonary capillaries into the alveoli

pneumonia

aspiration of sand, mud, or polluted rivers may cause?

hypothermia, inability to swim, diving accident, alcohol and drug ingestion, exhaustion

five risk factors for near drowning

dry, wet, secondary

three classification of near drowning

dry near drowning

(classification of near drowning) the victim doesn’t aspirate fluid but suffers respiratory obstruction

• vasovagal stimulation

wet near drowning

(classification of near drowning) victims aspirates fluid and suffers asphyxia

secondary near drowning

(classification of near drowning) victim suffers recurrence of respiratory distress

• usually aspiration pneumonia

beyond 8 hours

amount of time when the patient is rescued with pulmonary edema

cough with pink frothy sputum

unique symptom of near drowning

arterial blood gas and electrocardiogram

two diagnostic test for near drowning

• first, reveals hypercarbia, hypoxemia, and metabolic acidosis

sodium bicarbonate

given to a patient of near drowning if they have acidosis

heat exhaustion

the inadequacy or collapse of peripheral circulation due to volume and electrolyte depletion

heat stroke

untreated heat exhaustion may lead to?

pale, ashen, moist

skin of a patient with heat exhaustion

• the patient is still sweating

heat stroke

medical emergency defined as the combination of hyperpyrexia and neurological symptom

• shutdown of heat regulating mechanism of the body

40.6 degree celsius

temperature of hyperpyrexia

hyperpyrexia and neurological symptom

heat stroke is the combination of these two symptoms

hypothalamus

regulator of body temperature

assess ABCDE, no sweating, hot to touch, hypotension, orthostatic changes, increased PR and RR

six assessment for heat stroke

move to cool environment, position supine feet slightly elevated, increase fluid intake, ice packs in neck armpits groin scalp

four management for heat exhaustion or heat stroke

plain lactated ringer

fluid of choice for heat stroke

iced saline lavage, cool fluid peritoneal dialysis, or cool fluid bladder irrigation

three procedure to cool core temperature

102 F or 38.9 C

(heat stroke) quickly reduce the internal core temperature to?

acute tubular necrosis

complication of heat stroke

• decrease blood flow in the renal tubules

potassium chloride

given to patient if they have hypokalemia

frostbite

trauma due to exposure to freezing temperatures - actual freezing of the tissue

frostnip, superficial, deep

three classifications or stages of frostbite

frostnip

(stage 1 of frostbite) skin appears red and has numbness of pain sensation

superficial frostbite

(stage 2 of frostbite) damaged in skin and subcutaneous, white and waxy, absent sensation, stiff on touch but soft inside

deep frostbite

(stage 3 of frostbite) frozen and hard in palpation, mottled blue-white

place warm hand over chilled area

treatment for frostnip

• any rewarming treatment shouldn’t be stopped as refreezing will cause more damage

37C to 40C

rewarming of water temperature for frostbite

• no dry heat (ex. blower)

whirlpool bath

(frostbite procedure) aid circulation, debride dead tissue, and help prevent infection

escharotomy

(frostbite procedure) incision through eschar to prevent tissue damage and allow normal circulation (joint motion)

fasciotomy

(frostbite procedure) treatment for compartment syndrome, release pressure on muscles, nerves, and blood vessels

hypothermia less than 35C

a condition which the core temperature is dangerously low due to exposure to cold

shiver, peripheral vasoconstrict, raise baseline metabolic rate

three things the body does to compensate for hypothermia

• first, muscular activity to produce heat

• second, to decrease heat loss

malignant hyperthermia

common in operating room which occurs due to anesthesia

cold diuresis

increase urinary output due to peripheral vasoconstriction

plain normal saline solution

fluid of choice for hypothermia

passive external, active external, active core

three rewarming techniques for hypothermia

• external if above 28C

• core if below 28C

passive external rewarming

(rewarming technique) provide insulation by wrapping the patient and giving warm drinks

active external rewarming

(rewarming technique) provide external heat like warm water bottles in armpits neck groin

• warm water immersion

active core rewarming

(rewarming technique) inhaled of warm oxygen, warm IV and lavage

• open thoracotomy

• cardiopulmonary bypass