0071643192.pdf

ENVIRONMENTAL EMERGENCIES

SYMPTOMS/EXAM

■ Symptoms depend on tissues involved. Typically symptoms begin >10 min-

utes after surfacing.

■ Type I decompression sickness = “the bends” (skin, joint, and extremities).

■ Pruritis, erythema, and skin marbling

■ Limb and joint pain

■ Lymphedema

■ Type II decompression sickness= other organ involvement (CNS, inner

ear, lungs).

■ More serious manifestations

■ Mental status changes, headache, visual changes

■ Upper lumbar spine particularly susceptible →weakness, paralysis

■ “The Staggers”—inner ear involvement with vertigo, nystagmus, and N/V

■ “The Chokes”—dyspnea, cough, chest pain

TREATMENT

■ 100% O 2 by mask

■ Recumbent/supine position

■ Intravenous fluids

■ Rapid recompression in hyperbaric chamber

SUBMERSION INJURY

The submersion victim is defined as any person who requires medical evalua-

tion after a submersion event. Drowning = death from a submersion event.

To contradict earlier beliefs, there appears to be no difference between fresh-

water and saltwater submersion unless VERY large volume of freshwater is

aspirated, where hemodilution and hemolysis is possible.

Precipitating injuries include spinal cord injury, hypothermia, seizure, syncope.

PATHOPHYSIOLOGY

■ In the majority of submersion events:

■ Aspiration of water into the lungs →loss of surfactant and alveolar col-

lapse→hypoxia→brain cell death after 3 minutes.

■ In 10–15% submersions are “dry”→hypothesized due to laryngospasm

and bronchospasm (controversial).

■ Diving reflex: (in young infants) →transiently protective bradycardia, apnea,

and peripheral vasoconstriction.

■ Immersion syndrome: immersion in very cold water →vagally mediated

asystolic cardiac arrest.

SYMPTOMS/EXAM

■ Respiratory distress with wheezes, rales, or rhonchi on exam

■ May be delayed up to 6 hours (“secondary drowning”)

■ AMS ranging from confusion to coma

■ Hypothermia if cold water submersion

■ Cardiac dysrhythmias

The effect on electrolyte status

is the same regardless of

seawater (oceans and some

lakes) or freshwater (lakes,

rivers, pools) drowning.

Respiratory deterioration can

be delayed for up to 6 hours.

Arterial gas embolism and

decompression sickness

require hyperbaric therapy.