Environmental Emergencies: Chapter 18 Part 1 Heat and cold related injuries Chapter 18 Part 1 Heat and cold related injuries.

Environmental Emergencies:

Chapter 18 Part 1Heat and cold related injuries

Factors affecting exposure

• Physical Condition• Age• Nutrition/hydration• Environmental

conditions

Cold exposure

(page 545)

Terms to know:

• Hypothermia- lowering the temperature of the entire body (core temperature falls below 95 degrees)

• Conduction- direct transfer of heat from a part of the body to a colder object by direct touch

• Convection- heat transferred into circulating air• Evaporation- conversion of liquid into gas• Radiation- the transfer of heat through radiant energy or

invisible light• Respiration- Causes body heat to be lost when cold air

enters the lungs and warm air is exhaled into the atmosphere

Heat Loss

• The rate and amount of heat loss can be modified in three ways– Increase or decrease of heat

production: the body can increase heat production by increasing the metabolism of the cells (shivering)

– Move to an area where heat loss is increased or decreased:

– Wear insulated clothing to reduce heat loss:

Hypothermia Signs and symptoms

• 90-95:– Shivering/ foot stamping– Constricted blood vessels/

rapid breathing– withdrawn

• 89-92:– Loss of coordination/

muscle stiffness– Slowing respirations/ slow

pulse– Confused/ lethargic/ sleepy

• 80-88:• Coma• Weak pulse/

arrhythmias/ slow respirations

• Unresponsive

• <80:• Apparent death• Cardiac arrest• unresponsive

Temperature assessment

• To assess patients general temperature- pull back your glove and with the back of your hand feel the patients abdomen

• Never assume that a cold pulse less patient is dead-patients can survive cold related arrests if proper emergency care is taken• A patient is never dead until they are warm and dead

Focused Physical Exam

• You exam should focus on:– Severity of

hypothermia– Areas directly

affected by the cold– And distinguish

between frostbite and hypothermia

Interventions• Move the patient out of the cold

environment• Do not allow the patient to walk• Remove wet clothing• Wrap the patient in dry blankets• Do not massage or allow the patient to

massage the extremities• Do not allow the patient any stimulants• Give warm humidified oxygen• Begin passive re-warming (turn up

heart in ambulance and wrap the patient in blankets)

• If the patient is alert begin active re-warming with hot packs or water bottles

Local cold injuries

• Most injuries from cold are confined to exposed parts of the body– Frostnip- when exposed

parts of the body become cold but not frozen

– Frostbite- when exposed areas of the body become frozen

Emergency medical care for local cold injury

• Remove the patient from environment• Handle the injured area gently• Administer oxygen• Remove wet or restrictive clothing• Remove jewelry from injured part• Splint the injury and cover with dry sterile dressing• Evaluate the patient• Transport immediately• Contact medical control (if they instruct you to - warm the area)• Use a warm bath of water between 100 and 112 degrees• Stir the water continually• Keep the extremity away from the edge and bottom of the container• Keep immersed until it feels warm and sensation is regained• Dress with dry sterile dressing separating the fingers and toes

Heat exposure

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Ambient temperature

• Ambient temperature- the temperature of the surrounding environment

• When it is hot outside and there is vigorous activity the body will attempt to cool itself by:– Sweating- During vigorous activity the body can lose up

to 1 liter of sweat per hour– Dilating blood vessels close to the skin– The person may remove clothing

• Hyperthermia- high core temperature (greater than 101 degrees)

Illness from heat exposure

• Heat cramps- painful muscle spasms that occur after increased activity– Caused by loss of electrolytes (salt balance) during

sweating

• Heat exhaustion- hypovolumia from loss of liquid during sweating– Signs and symptoms include:

• Dizziness/weakness• Cold clammy skin• Dry tongue and thirst• Normal vital signs with rapid pulse and low diastolic BP• Normal or elevated body temperature

Heat stroke

• Heat stroke-occurs when the body is subjected to more heat than it can handle– Signs and symptoms

include:• Hot dry flushed skin• Possible decreased level of

consciousness• Rapid strong pulse• As the patient goes

unconscious the pulse rate falls and becomes weaker

Interventions for people with heat related injury

• Remove form environment• Remove any restrictive clothing• Cover patient with a sheet soaked in

water• If the patient is fully conscious give

them fluids• Turn on air conditioning in ambulance• Place cold packs in the patient groin

and axially• Fan• Check patients turgor- ability of the

skin to withstand deformation (pinch the skin)

• If Nauseous place in in left lateral recumbent position

Bites and Envenomations:

Spider bites:

• only 2 spiders native to the US are able to deliver serious, life threatening bites– Black Widow– Brown recluse

Black Widow Bite

• Black widow:– Localized pain– Agonizing muscle spasms– Dizziness– Sweating– Vomiting– Rashes– Chest tightness– Difficulty breathing

Brown Recluse Bites

• Brown recluse– Bite is not painful for a few

hours– Localized swelling– Tenderness– A pale, molted, cyanotic

center– Possibly a small blister– If left untreated an ulcer will

form

Antivenin

• Antivenin- a serum containing antibodies that counteract the venom– Must be administered by a physician

Snake Bites

• Most poison snakes native to the US have 2 hollow fangs to inject poison– The injury will look like 2 holes, slightly raised and irritated– The patient will have localized tenderness

• Pit viper snake bites:• Burning pain at the site• Swelling with bluish discoloration• Bleeding at various distant sites do

to venom in the blood stream• Weakness• Sweating• Fainting• Shock

Treatment• Calm and reassure the patient• Locate the bite area (DO NOT APPLY ICE)• Splint the extremity to decrease movement• Watch for vomiting and anxiety• (if bitten on the trunk) keep supine and transport immediately• Monitor the vitals• Mark the skin with a pen over where the injury has occurred• (if shock occurs) place the patient in the trendelenburg position• If the snake has been killed take it to the hospital with you• Notify the hospital (if possible describe the snake)• Transport immediately

Coral snake bite

• The wound will look like 1 or more puncture like wounds and scratches

• Treatment:– Calm the patient– Flush the area with 1-2 quarts of

warm soaps water (do not apply ice)– Splint the extremity– Keep the patient warm– Place in the trendelenburg position– Transport immediately

• (DO NOT give the patient anything by mouth)

Scorpion stings

• Can possibly cause:– Circulatory collapse– Severe muscle contractions– Excessive salivation– Hypertension– Convulsions

• Antivenin must be administered by a physician– Assess– Contact medical command– Give O2– Transport

Tick Bites

• Ticks typically carry 2 diseases:– Rocky Mountain spotted fever– Lyme disease

Rocky Mountain spotted fever

• Rocky Mountain spotted fever– Occurs within 7-10 days after being bitten– Symptoms include:• Nausea• Vomiting• Headache• Weakness• Rash• Paralysis• Cardio-respiratory collapse

Lyme disease:

• Occurs within 3 days of the bite

• Symptoms include:– Bull’s eye rash– Swelling of joints– May cause permanent

disability if left untreated

Drowning and near drowning:

Chapter 18 part 2

Drowning and near drowning

• Drowning- death by suffocation after being submerged in water

• Near drowning- survival (for at least 24 hours) after suffocation from being submerged in water

• Steps of (many) drowning:– Panic– Insufficient breathing– Decreased buoyancy– Exhaustion– Cardiac or respiratory arrest

Larynospasm

• choking sensation felt when liquid is inhaled– The larynx contracts to prevent

more water from entering– This can cause problems during

resuscitation in submerged victims

EMT-B Safety

• To most effectively and safely rescue a drowning person complete the following steps:– Reach– Throw and tow– Row– Go

Spinal injuries

• You must assume that a primal injury exists in the following situations:– The submersion happened do to diving,

a mishap, or a fall– The patient is unconscious and no

information is available to rule out mechanism of injury

– The patient is conscious but complains of paralysis, numbness, or weakness

– You suspect a spinal cord injury despite testimony from witnesses

Treatment

• To treat a patient in the water with suspected spinal injury:– Turn the patient supine– Restore the airway/begin

ventilation– Float a backboard under the

patient– Secure the trunk and head to the

back board– Remove the patient from the

water– Cover the patient with a blanket

Recovery techniques

• Scuba- self contained breathing apparatus

• As a last resort (if standard recovery procedures are unsuccessful) you may use a grappling hook and rope or chain to attempt to remove the body

Resuscitation efforts

• Never give up on Resuscitation efforts if the patient has drowned or is cold (unless death is obvious)

• Diving reflex- slowing of the heart rate a respirations caused by cold water

• Bradycardia- slow heart/pulse rate

Diving emergencies

• Most serious water related injuries are associated with diving (with or without scuba gear)– Descent– Bottom– Accent

Decent emergencies

• Descent emergencies- usually due to the sudden increase of pressure on the body as the person dives deeper– The usual areas affected by this are: (this is

referred to as squeeze problems)• Lungs• Sinus cavity• Middle ear• Teeth• Area of the face surrounded by the mask

Bottom

• Emergencies at the bottom:• Inadequate mixing of oxygen and carbon dioxide• Increased carbon monoxide• Injury• Marine life• entanglement

Ascent emergencies

• Most serious problems related to diving are during the ascent (the most common include)– Air embolism- bubbles of air in the blood vessels

• If air entered the pleural space it can compress the lungs• Pneumomedias- air in the thoracic cavity• Air can cause emboli- air in the blood stream

– Decompression sickness- (bends) bubbles of air (usually nitrogen) obstruct blood vessels• -these can block tiny blood vessels and cause tissue damage from

lack of circulation• -Typically show with abdominal and joint pain

• treatment requites a hyperbaric chamber

Diving interventions:

• To treat a patient who is suffering from a diving emergency:– Remove the person from water and attempt to

keep them calm– Begin BLS and o2 administration– Place patient in left lateral recumbent position– Immediate transport to the nearest facility with a

hyperbaric chamber– Check for other injuries

Other water hazards

• Other hazards that can occur due to water include:– Breath holding syncope- loss of

consciousness caused by decrease stimulus for breathing

– Boat propellers/rocks/water ski’s– Hypothermia– Injuries caused by marine life– Electrocution (mild, moderate, or

severe)