Ambulatory Exam 2- Enviornmental

Paris Agreement of 2015

A goal to increase the global average temperature to well below 2 degrees celsius above pre industrial levels. All to limit the temperature increase

The 10 warmest years on record occurred when? 

In the last decade 

When was the warmest year?

2024

Greenhouse Gas Effect

Naturally occurring protection in our atmosphere that makes earth inhabitable. Natural release of C02 as part of the carbon cycle.

Cause of sea level temperatures rising

Acceleration of global glacier mass loss

How are half of human pathogenic diseases aggravated?

Climate change

Heat Exhaustion: Skin 

Pale, moist 

Heat stroke; skin

Warm, dry

Heat exhaustion: temp

> 100.4, 34c

Heat stroke: Temp

> 104, 40c

Heat exhaustion: GI

Nausea, vomiting, diarrhea

Heat stroke: GI

N/V, anorexia

Heat exhaustion: pain

Muscle cramps, HA

Heat stroke: Pain

HA

Heat exhaustion: HR 

WNL

Heat stroke: HR

Elevated

Heat exhaustion: energy

Fatigue, weak

Heat stroke: energy

Fatigue, lethargy, stupor

Heat exhaustion: Neuro 

Anxious 

Heat stroke: Neuro

Confusion, agitated, seizures

Which is more dangerous, heat exhaustion or heat stroke?

Heat stroke

What would your first step be?

“I just vomitted and my head is pounding.” Pt seems confused, standing, and staring at you

Have them sit down and then assess

What would you do first? 

Comes in clutching cramping leg, lays down on the stretcher and says “I feel so weak” 

Assess them, take vitals, remove excess clothing, fan, give sports drink with sugar and salt 

Frostbite: External Body

Skin feels cold, waxy, hard; Pt feels numb, pain, burning, or prickly, worsening= no pain

Hypothermia; external body

Shivering; if shivering stopped, severe, near death, wont feel pain

Frostbite; Temp

Core WNL, cold skin, air @ freezing

Hypothermia: temp

Core temp < 95F, 35c 

Frostbite; worsening

Waxy/shiny, blisters, could progress to gangrene, risk of infection

Hypothermia; worsening

Increased confusion, irregular HR, skin will turn blue, can become unresponsive

At freezing temps, how quick can frostbite occur?

30 minutes

Who is at greatest risk for frostbite in NYC?

Homeless 

Why would diabetes increase risk of frostbite?

Injures blood vessels

FDA approved IV med Iloprost for frostbite, what is the mechanism for this med?

Vasodilator

This substance is also a vasodilator and can increase your risk of frostbite…

Alcohol

What do we place on a patient who is experiencing hypothermia? 

Bair Hugger 

To prevent a drop in BP from suddenly moving from vasoconstriction to vasodilation, we need to…

Wrap up blankets, just keep room to breathe and some sort of plastic covering on top to prevent evaporation of heat

Both are potentially nuerotoxins

Lead and mercury

What is the most lead polluted place on earth?

Kabwe, Zambia

What number indicated lead poisoning? 

5 ug/dl 

How can lead poisoning affect individuals?

Developmental delays, behavioral issues and even lowering IQ among children

What is the minimum requirement for testing? 

at 12 Months (1yr old)  and 24 months old (2 years) 

What can help treat lead poisoning?

Foods high in vitamin C, Iron and calcium

What do you do if lead levels are higher then 45 micrograms per decilier?

Chelation therapy

What is chelation therapy?

A synthetic agent administered via IV, binds to lead and then compound is pulled out of body through urine.

When doing chelation therapy, what patients should we be careful of? 

Patients with kidney disease

For a patient with lead poisioning, you will encourage patients to eat more food with

iron and calcium 

Vitamin C role in tx of lead poisoning

Enhances bodys absorbtion of iron and calcium

What is a food rich in both iron and calcium?

Leafy greens (ex: spinach)

Catfish, cod, crab, lobster, oyster, salmon, sardine, scallop, shrimp, tilapia, tuna (canned light)

Best choices (low mercury level)

Tuna albacore

Good choices 

Shark, swordfish, marline, king macrel, tuna bigeye

Choices to avoid (high mercury level)

Pm2.5 

Small particulate matter in the air that can penetrate deep into the lungs and enter the bloodstream, posing health risks.

What is the second leading cause of Lung cancer that is found in homes that we should screen for?

Radon

1. avoiding non stick cookware and plastic tupperware as heat increases leaching

2. Use foil instead of plastic wrap

3. wear clothes made of natural fibers

4. Buy food products like panut butter in glass jars

5. Buy wooden or metal toys instead of plastic ones

6. look for plastic free cosmeticS

How to best decrease ingestion of microplastics

What equivalent of microplastics do we ingest per week?

One credit card 

Who has the highest healthcare waste (HCW)?

USA and Canada