Environmental emergencies.

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Which of the following heat illnesses is the most dangerous to get?

In heat stroke there is an alteration in mentation associated with elevated body temperature. They also often get vomiting, headaches, seizures. It is a medical emergency to get the core temperature down and treat the complications.

Heat cramps.

Heat exhaustion.

Heat stroke.

H.E.A.T. (Hot Exhausted And Trembles).

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Why is Decompression sickness, seen in scuba divers called the bends?

Apart from painful and stiff joints Decompression sickness (Type 1)--the bends, can also cause headaches, dizziness, clouded thoughts and a myriad of other symptoms.
The photo is of a Peruvian diver who got massive amounts of nitrogen into his tissues. Google (Peruvian diver bends) for more info on his fate.

Because the nitrogen bubbles often go to the joints and you cant straighten them.

Because ascending too quickly in a bent position worsens decompression sickness.

Named after Dr John Bend an early deep water researcher on decompression sickness.

Because when the nitrogen bubbles come out of solution the pain makes you bend over.

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These ECG Chest leads were taken on a severely hypothermic patient. What does it show?

J or Osborn waves --seen on the downward slope of the QRS can be sometimes seen in patients with temps < 30 degrees. This example is very obvious. Don't confuse it with the j point---which is where the QRS meets the ST segment---and that is on every ECG.

Sinus bradycardia and RBBB.

Junctional bradycardia and J waves.

Wolf Parkinson White syndrome.

Sinus bradycardia and LBBB.

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What is the lowest body temperature that an adult has survived?

Anna Bagenholm--(pictured) a Norwegian doctor fell into an icy river in 1999 with only her legs and skiis protruding for 80min. She found an air pocket under the ice. When she got to hospital she was "clinically dead". Eventually after a long ICU stay she is cognitively fine, has a few numb areas but is back skiing.

2.8 degrees centigrade.

18.2 degrees centigrade.

8.6 Degrees centigrade.

13.7 Degrees centigrade.

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This is a Gamow bag used in high altitude trekkers. What does it do?

The Gamow bag (pronounced Gam off) is used in patients with altitude sickness. It is pressurised delivering the equivilant increased pressure of dropping 2000 metres in height. It can also deliver 02. Mind you its pretty tight.

Gives warmth and humidification to cold trekkers.

Artificially increases the air pressure and can deliver 02 to trekkers with altitude sickness.

Is used to prepare climbers for working in confined spaces.

Is a transport vehicle for tired trekkers who cannot continue.

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This is the tennis star Martina Navaratilova. She developed high altitude pulmonary oedema attempting to climb which mountain?

She reached 14,800 feet (Mt Kilimanjaro is 19,340ft) and was stretchered down with high altitude pulmonary oedema. It shows that even if you are very fit you can still get altitude sickness.

Mt Everest.

Mt Kosciusko.

Mt Kilimanjaro

Mt K2.

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What is not true about Malignant Hyperthermia?

In those prone to Malignant Hyperthermia there is excessive Ca release causing sustained muscle contraction and heat production. It is rare and precipitated most often by inhalational anaesthetics.
Treatment mnemonic ---Some Hot Dude Better Give Iced Fluids Fast
S--Stop trigger H---Hyperventilate/Hundred % 02 D---Dantrolene
B---Bicarbonate G---Glucose I---IV fluids F---Frusemide F---Fast heart rate.

You cannot use Nitrous Oxide is patients with a history of Malignant Hyperthermia.

The use of IV Dantrolene decreases the death rate from 70% to 5%.

It is an autosomal dominant condition.

Many inhalational anaesthetics can trigger it in those prone to the syndrome.

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4 Anaesthetists took ABGs and pulse oximetry just below the summit of Everest. What was their average 02 saturation?

The lowest 02 saturation of the 4 people was 34%. They did femoral stabs for the ABGs. Average PaC02 was 13.3 and a Ph of 7.53 because of hyperventilation.

90%

82%

54%

31%

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Which of the following is untrue about nitrogen narcosis---also known as the rapture of the deep?

Divers need to be aware of the potential of nitrogen narcosis as it can impair your judgement at depth. The phrase "Rapture of the deep" was apparently coined by Jacques Cousteau.

It is caused by inert gases like nitrogen at depths usually > 30m.

It can impair your judgement and put you in serious situations when diving.

Also known as the "Martini effect"

It can cause irreversible damage on surfacing.

/10

This man has a tree like fractal pattern on his arm after being struck by lightning. Which about this effect is untrue?

This comes up after about 20min after the strike and fades in 24 to 48hrs. Unusual effect of lightning but very cool. PS it is painful.

It is called the Lichtenberg effect.

It is thought to occur because of injury to the underlying blood vessels.

It is a permanent tatoo.

You can sometimes see similar fractal shapes when lightning strikes sand.

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