Chapter 36: Environmental Emergencies

Environmental emergency- a medical condition caused or exacerbated by the weather, terrain, atmospheric pressure, or other local factors. Homeostasis- the natural tendency of the body to maintain a steady and normal internal environmental. Thermal gradient- the difference in temperature between the environment and the body. Thermogenesis- the production of heat, especially within the body. Heat Loss Conduction- moving electrons, ions, heat, or sound waves through a conductor or conducting medium. Convection- transfer of heat via currents in liquids or gases. Radiation- transfer of energy through space or matter. Evaporation- change from liquid to a gaseous state Respiration- the exchange of gases between a living organism and its environment. Thermoregulation- the maintenance or regulation of a particular temperature of the body. Core Temperature- the body temperature of the deep tissues, which usually does not vary more than a degree or so from its normal 37C (98.6F). Hypothalamus- portion of the diencephalons producing neurosecretions important in the control of certain metabolic activities, including body temperature regulation. Negative feedback- homeostatic mechanism in which a change in a variable ultimately inhibits the process that led to the shift. Basal metabolic rate- rate at which the body consumes energy just to maintain stability; the basic metabolic rate of an awake, relaxed person 12-14hours after eating and at a comfortable temperature. Exertional metabolic rate- rate at which the body consumes energy during activity. It is faster than basic metabolic rate. Temperture Emergencies Heat illness- increased core body temperature due to inadequate thermolysis. Dehydration often goes hand in hand w/heat disorders. Hyperthermia- unusually high core body temperature. Heat cramps-acute painful spasms of the voluntary muscles following strenuous activity in a hot environment without adequate fluid or salt intake. Heat exhaustion- a mild heat illness; an acute reaction to heat exposure. Heatstroke- acute, dangerous reaction to heat exposure, characterized by a body temperature usually above 105F and central nervous system disturbances. The body usually ceases to perspire. It is a environmental emergency! o Pyrexia (fever)- above normal body temp.

o Pyrogen- any substance causing a fever, such as viruses and bacteria or substances produced within the body in response to infection or inflammation. Cold Disorders Hypothermia- state of low body temperature, particularly low core body temperature. Frostbite- environmentally induced freezing of body tissues causing destruction of cells. Trench foot- a painful foot disorder resembling frostbite and resulting from exposure to cold and wet, which can eventually result in tissue sloughing or gangrene; also called immersion foot. Drowning- asphyxiation resulting from submersion in liquid w/death occurring within 24hrs. of submersion. Near-drowning- an incident of potentially fatal submersion in liquid which did not result in death or in which death occurred more than 24hrs after submersion. Mammalian diving reflex- complex cardiovascular reflex, resulting from submersion of the face and nose in water, that constricts blood flow everywhere except to the brain. The cold-water drowning victim is not dead until he is warm and dead! Rewarming shock- causing reflex peripheral vasodilation. Which can cause paradoxical afterdrop which causes the return of cool blood and acids from the extremities to further worsen hypothermia. Dive Emergencies Physical laws associated w/dive accidents o Boyles Law- the volume of a gas is inversely proportional to its pressure if the temperature is kept constant. o Daltons Law- the total pressure of a mixture of gases is equal to the sum of the partial pressures of the individual gases. o Henrys Law- the amount of gas dissolved in a given volume of fluid is proportional to the pressure of the gas above it. Injuries during Descent o Barotrauma- injuries caused by changes in pressure. Barotrauma that occurs from increasing pressure during a diving descent is commonly called the squeeze. Injuries on the Bottom o Nitrogen Narcosis- a state of stupor that develops during deep dives due to nitrogens effect on cerebral function; also called raptures of the deep. Injuries during Ascent o Decompression Illness- development of nitrogen bubbles within the tissues due to a rapid reduction of air pressure when a diver returns to the surface; also called the bends. o Pulmonary over pressure- expansion of air held in the lungs during ascent. If not exhaled, the expanded air may cause injury to the lungs and surrounding structures.

o Arterial Gas Embolism (AGE)- an air bubble, or air embolism, that enters the circulatory system from a damaged lung. o Pneumomediastinum- the presence of air in the Mediastinum. o Pneumothorax- a collection of air in the pleural space. Air may enter the pleural space from through an injury to the chest wall or through an injury to the lungs. In a tension pneumothorax, pressure builds because there is no way for the air to escape, causing lung collapse. High Altitude Illness- start to become manifest at altitudes >8,000ft o Physiologic Changes during Assent o Ventilatory Changes- as altitude increases, O2 decreases so the body responds by increasing ventilation o Cardiovascular Changes- increase in HR to carry more O2 to the tissues. Also peripheral veins constrict, increasing the central blood volume and the body responds by decreasing Anti-diuretic Hormone which causes concentration of the blood. o Blood Changes- within 2hrs. of ascent to high altitude the body begins making more red blood cells to carry O2. Over time this will compensate for the hypoxic environment and the person becomes acclimated. Medications o Acetazolamide (Diamox)- acts as a diuretic o Nifedipine (Procardia, Adalat)- used to treat high blood pressure. It causes blood vessels to dilate, preventing the increase in pulmonary pressure that often causes pulmonary edema. Acute Mountain Sickness- usually manifests in an unacclimatized person who ascends rapidly to an altitude of 2,000m (6,600ft) High Altitude Pulmonary Edema- develops as a result of increased pulmonary pressure and hypertension caused by changes in blood flow at high altitude. High Altitude Cerebral Edema- the increased fluid in the brain tissue causes a rise in ICP Radiation o The Atom Protons- positively charged particles that form the nucleus of atom. The atomic number of the element indicates the number of protons present. Neutrons- Subatomic particles that are approximately equal in mass to a proton, but lack an electrical charge. Electrons- Minute particles w/negative electrical charges that revolve around the nucleus of an atom. When emitted from radioactive substances, electrons are called beta particales. o Types of Radiation Alpha- very weak, stopped by paper Beta- more powerful than Alpha, stopped by clothing.

Gamma- most powerful ionizing radiation; great penetrating power, protection requires thick concrete or lead shielding. Ionization- the process of changing a substance into separate charged particles (ions). Isotopes- atoms in which the nuclear composition is unstable. That is, they give off Ionizing Radiation Ionizing Radiation- electromagnetic radiation (e.g. x-ray) or particulate radiation (e.g. alpha particles, beta particles, & neutrons) that, by direct or secondary processes, ionizes materials that absorb the radiation. It can penetrate the cells of living organisms, depositing an electrical charge within them. When sufficiently intense, this form of energy kills cells. Neutron- great penetrating power, but uncommon outside nuclear reactors and bombs. o Factors Affecting Exposure to Radiation Duration of Exposure Distance from source Shielding from the source