Environmental Emergencies

In what ways does the body attempt to preserve normothermia when its cold

1. increase metabolic rate

2. peripheral vasoconstriction

3. shivering

At what point does hypothermia start to affect organs

As core temperature drops below 95°F (35C), progressive impairment occurs affecting all organ systems

T or F: before arriving to the hospital, EMS should gradually rewarm frostbite

FALSE!! Do not attempt rewarming until risk of refreezing eliminated

Classify this frostbite: Deeper, blisters are smaller and hemorrhagic, more proximal

third degree

Classify this frostbite: Superficial, central area of pallor, surrounded by edema

first degree

Classify this frostbite: Extends to muscle and bone, complete tissue necrosis

fourth degree

Classify this frostbite: Blisters with edema and erythema, may form eschar, but this later sloughs off to healthy granulation tissue, NO tissue loss

second degree

Patient appears unconscious but is still shivering. what severity hypothermia are they in.

moderate

inability to shiver indicates

severe hypothermia

at what point in hypothermia are corneal reflexes absent

core temp <23 C (73 F)

at what point in hypothermia are pupils fixed and dilated

when core temp < 29 C (84 F)

osborn J waves associated with

EKG finding in hypothermia when core temp <32 C

4 ways the body loses heat

1. conduction

2. convection

3. evaporation

4. radiation

what part of brain controls body temperature

hypothalamus

body temperature is regulated by the balance of what 3 things

1. heat production

2. heat accumulation

3. head dissipation

what does elevated temperature do to metabolic rate

increase in O2 consumption and metabolic rate -> hyperpnea and tachycardia

4 responses to heat stress

1. Dilatation of blood vessels

2. Increased sweat production

3. Decreased heat production

4. Behavioral heat control

define heat stroke

core temp > 104 F (whereas heat stress stays below 104)

Flashover

Lightning travels over the surface of the body

Elevated carboxyhemoglobin level suggests

carbon monoxide (CO) poisoning.

Majority allergic reactions from apids or vespids

Vespids (wasps/hornets)

What part of wasp venom is responsible for systemic reactions

protein enzymes (phospholipase and hyaluronidase)

fatalities within 1st hour of anaphylaxis due to

1. airway obstruction

2. hypotension

bee/wasp sting hospital admission recommended for

1. >100 stings

2. substantial comorbidities

3. extremes of age

unusual hymenoptera reactions

neuro, cardiovascular, urologic symptoms

“Red, white & blue sign” associated with

BROWN RECLUSE SPIDER - LOXOSCELES

sphingomyelinase D

component of brown recluse spider venom that causes local necrosis

α-latrotoxin

component of black widow venom that causes massive release of neurotransmitters acetylcholine and norepinephrine

after feeling a pinprick sensation, patient experienced muscle cramp-like, painful spasms that involve the trunk, back, and abdomen. what bit/stung them?

black widow (latrodectus) bite

linear bite pattern associated with

HEMIPTERA – BED BUGS

zigzag, whip-like pattern of raised red welts 2 to 3 mm wide

sea nettle jellyfish

Initially, the sting area appears as an irregular single line or multiple lines composed of red papules, beaded streaks, or erythematous welts

Wheals resolve in hours but may progress to vesicular, hemorrhagic, necrotic, or ulcerative stages before healing

Portuguese man of war jellyfish

Which jellyfish sting can cause ventricular arrhythmias and cardiac arrest, and respiratory failure

box jellyfish

linear welts that give the patient the appearance of having been whipped

box jellyfish

Irukandji syndrome associated with

box jellyfish sting

which venom alters blood vessel permeability -> loss of plasma and blood into surrounding tissue, causing hypovolemia

Snake bite venom

Cardinal manifestations of snake bite

1. 1+ fang marks

2. localized pain

3. progressive edema extending from bite

1st aid for snake bite

DONT use tourniquets, use constriction bands instead above bite to slow spread

Hospital discharge criteria for snake bite

1. swelling resolves

2. coagulopathy reversed

3. patient is ambulatory