Flying high, feeling low
The definitive treatment for high-altitude cerebral and pulmonary edema
What is immediate descent
The most important time frame, with a burn, when considering morbidity and mortality of a burn victim
What is the first 48 hours after a burn
Environmental emergency characterized by an elevated temp of less than 40 C, tachycardia, and moist skin.
What is Heat Exhaustion
The three classic acute radiation syndromes
What are bone marrow syndrome (hematopoietic syndrome), GI syndrome, and CV/CNS syndrome
The most common injury in divers
What is ear barotrauma
Primary treatment given in high- altitude associated neurological condition, HACE
What is dexamethasone
When the rule of nines is used
What are 2nd and 3rd degree burns
Disorder that is common amongst homeless population and has 3 stages: pre-hyperemic, hyperemic, and post-hyperemic.
What is trench foot
Initial treatment/monitoring for a patient with suspected radiation exposure.
What are secure ABCs, treat major burns and respiratory injuries, decontamination procedures, and CBC Q2-3H for 12 hours with special attention to the lymphocyte levels
When a diver rapidly ascends from depth inert gases can form these that impair tissue blood flow and perfusion.
What are bubbles
The leading cause of death from high-altitude illness
What is High-Altitude Pulmonary Edema (HAPE)
The characteristics of a 1st degree burn?
What are red or gray in color; and usually not blistered
Stage of hypothermia where shivering stops. Bradycardia, dilated pupils, slowed reflexes, confusion, and lethargy occur.
What is stage 2
The stages of cutaneous radiation injury (CRI)
Prodromal occurs within hours of exposure - Sx erythema, burning, itching
latent stage occurs 1-2 days post exposure. No injury is apparent and the higher dose received, the shorter this stage lasts
Manifest illness occurs days to weeks post exposure. starts with erythema, sensation of heat, and slight edema often accompanied by increased pigmentation. Varies from dry desquamation or ulceration to necrosis
Third wave erythema occurs 10-16 weeks postexposure (particularly after beta particle exposure). Characterized by injury to blood vessels, edema, and worsening pain along with a bluish coloration of the skin. New ulcerations are possible.
Late effects occur months to years postexposure in those exposed to 10Gy or 1000 rads. Varied symptoms from slight dermal atrophy, to constant ulcer recurrence, dermal necrosis, and deformity. Other possible effects are occlusion of small blood vessels and formation of telangiectasia, destruction of lymphatic flow, regional lymphostasis, and fibrosis, keratosis, vasculitis, and subcutaneous sclerosis of connective tissues. Pain and pigmentation are often present. Skin cancer is also a risk.
All data from slide 3 of the CRI content.
The key to prevent decompression sickness during a deep dive is to ascend in this. The key treatment is for the ailment is what?
What is slowly and what is hyperbaric therapy
Medication(s) used to prevent AMS and HACE
What is acetazolamide or dexamethasone
Something to watch for in a patient that presents with a burn that is associated with an electrical injury
What is cardiac arrhythmias
Temp greater than 40 C, hot dry skin, neurologic changes.
What are the signs of heat stroke
The treatment modalities for a patient in the manifestation stage of cutaneous radiation injury
What are anti-inflammatory medications (Ex corticosteroids and Lioxasol), antibiotic prophylaxis, repeated culture swabs, stimulate regeneration of DNA with Lioxasol then Actovegin and Solcoseril, stimulate blood supply in 3rd or 4th week with pentoxifylline, puncture blisters, pain control (usually quite difficult to control), and careful debridement of necrosis.
From slides 5 & 6 of CRI content
A diver returned to the surface and lost consciousness shortly after reaching the boat; prior to losing consciousness the diver reported some dizziness, weakness, and chest pain what is your top differential?
What is air embolism
High-Altitude illness occurs when
Hypoxic stress is greater than the individuals ability to accumulate
the first course of action for a patient with thermal burns
Primary survery - ABCDE's
Hypoxemia, laryngospasm, fluid aspiration, circulation collapse, brain injury, death.
What is the process that occurs with drowning.
Three drugs used in the treatment of internal radiation contamination
Potassium iodide
Prussian blue
DTPA (Diethylenetriamine pentaacetate) (a)
Potassium iodide is a non-radioactive form of iodine that is used to prevent the uptake of radioactive iodine by the thyroid. It does not remove radioactive particles from the body, but protects the thyroid from them. Radioacive iodine is most commonly released in nuclear power plant accidents and nuclear detonations (c).
Prussian blue is a pill that traps radioactive cesium and thallium in the intestine, preventing body absorbption of the radioactive particles. It reduces the half-life of cesium from 110 days to around 30 days and the half-life of thallium from 8 days to about 3 days. It is also safe to give in pregnancy (d).
DTPA (Diethylenetriamine pentaacetate) binds to some forms of radioactive plutonium, americium, and curium allowing them to be removed from the body in urine. Best if given shortly after exposure to plutonium, americium, and/or curium. Less effective if given >24 hours after these isotopes have entered the body, but still beneficial to some extent. Comes in two forms Ca-DTPA (calcium) and Zn-DTPA (zinc), the calcium variant is the most effective of the two. People of ALL AGES can recieve DTPA with pregnant women preferably being given Zn-DTPA (b).
References:
Centers for Disease Control and Prevention(a). (2022, June 3). Cdc radiation emergencies. Retrieved July 14, 2023, from https://www.cdc.gov/nceh/radiation/emergencies/countermeasures.htm
Centers for Disease Control and Prevention(b). (2023, March 10). Facts about dtpa(diethylenetriamine pentaacetate). Retrieved July 14, 2023, from https://www.cdc.gov/nceh/radiation/emergencies/dtpa.htm
Centers for Disease Control and Prevention(c). (2022, November 15). Facts about potassium iodide. Retrieved July 14, 2023, from https://www.cdc.gov/nceh/radiation/emergencies/ki.htm
Centers for Disease Control and Prevention(d). (2022, April 15). Facts about prussian blue. Retrieved July 14, 2023, from https://www.cdc.gov/nceh/radiation/emergencies/prussianblue.htm
A diver recently returned from a underwater welding assignment at an oil rig in off the coast of Scotland and presents to the ED with aching joints, fatigue, and new onset urinary incontinence. What is your first treatment?
100% o2 followed by isotonic glucose free fluids and a hyperbaric chamber if possible.