Chapter 18 Environmental medicine
Disease and the environment
Nutrition, poverty and affluence
Purity of water sources, sanitation and atmospheric pollution
Environmental disasters and accidents
Background ionizing radiation and man-made radiation exposure, deliberate or accidental
Political forces determining levels of healthcare, preventative strategies and effects of war on civilian populations.
Heat
Cold
Frostbite: the local cold injury that follows freezing of tissue
Non-freezing cold injury: the damage – usually to feet – following prolonged exposure to TEnv between 0 and 5°C, usually in damp conditions.
Hypothermia
Hypothermia occurs in many settings.
Severe hypothermia
In severe hypothermia, people look dead. Always exclude hypothermia before diagnosing brainstem death (see p. 897). Warm gradually, aiming at a 1°C/hour increase in TCore. Direct mild surface heat from an electric blanket can be helpful. Treat any underlying condition promptly, e.g. sepsis. Monitor all vital functions. Correct dysrhythmias. Check for sedative drugs.