0071643192.pdf

ENVIRONMENTAL EMERGENCIES

DIAGNOSIS

■ Typically obvious based on clinical presentation

■ ECG and cardiac monitor

■ Useful labs include: CBC, electrolytes, BUN, Cr, UA.

TREATMENT

■ ABCs

■ If on scene treat those in cardiac arrest (appear dead) FIRST. This is unlike

other mass-casualty incidents.

■ Trauma precautions and evaluation as indicated

■ Tetanus prophylaxis

■ Intravenous fluids

■ Admit all patients with cardiac findings (exam or ECG), neurologic abnor-

malities, or significant trauma/burns.

COMPLICATIONS

■ If pregnant: Fetal mortality (rate can be as high as 50%)

■ Neurologic sequelae are common but lower extremity paralysis is usually

only temporary.

■ Cataracts (delayed)

HIGH-ALTITUDE ILLNESS

High-altitude illness consists of three unique clinical presentations: Acute

mountain sickness (AMS), high-altitude pulmonary edema (HAPE), and

high-altitude cerebral edema (HACE). AMS occurs after several hoursof

exposure to altitude, while HAPE and HACE typically take days to develop.

Risk factors for developing high-altitude illness:

■ Children more than adults (age >50 years decreases risk).

■ Rapid ascent

■ Elevation attained

■ Heavy exertion

■ Cold exposure (exacerbates pulmonary HTN)

■ Obesity and COPD (hypoventilation)

■ Sickle cell disease

PATHOPHYSIOLOGY(SEETABLE13.10)

■ As altitude increases, partial pressure of O 2 decreases

■ Periodic breathing (exacerbates hypoxemia)

■ Pulmonary artery hypertension

■ Fluid retention

■ Cerebral hypoxia →cerebrovascular changes and damage.

High-altitude acclimatizationis the body’s ability to graduallyadjust to lower

O 2 concentrations by the following methods:

■ Carotid body hypoxemia →hypoxic ventilatory response that stimulates

ventilation to ↓PaCO 2 and↑PaO 2.

■ In response to the acute respiratory alkalosis the kidneys excrete bicarbonate

(to normalize pH).

Reverse triage applies in

lightning injuries →treat

those that appear dead first.

Duration of lightning is

extremely brief: Asystole is

common but internal burns

and rhabdomyolysis aren’t

typically seen.

Cataracts can occur acutely or

up to 3 years after lightning

injury.