Environmental Emergencies. Exposure to cold How the body loses heat Conduction Transfer of heat through direct contact Heat will flow from warmer to cooler.

Environmental Emergencies

Exposure to cold

How the body loses heat

• Conduction

Transfer of heat through direct contact

Heat will flow from warmer to cooler

Water conducts heat away from body 25% faster than still air

• Convection

When current of air or water passes over water carrying away heat

Effects of a cold environment are worsened when moving water or air surround the body {wind chill}

• Radiation

Body’s atoms and molecules sent out rays of heat as they move and change

Most radiant heat loss occurs from head and neck

• Evaporation

When the body perspires or gets wet. As the moisture vaporized….generalized cooling effect

• Respiration

Heat loss through exhaled warm air

Generalized Hypothermia• When cooling affects the entire bodyPredisposing factors:• Shock• Burns• Head and spinal cord injury• Generalized infection• Diabetes with hypoglycemia

• Under the influence of alcohol

• Unconscious, lying on cold surface

• Geriatric; failing health, chronic illness, poor diet, certain medications, and/or lack of exercise

• Pediatric; Larger skin surface area and little body fat. Because of small muscle mass, children to not shiver much at all

Obvious and subtle exposurePossibility of hypothermia when another

condition or injury may be more obvious• ETOH • Underlying illness• Overdose or poisoning• Major trauma• Outdoor resuscitation

• Decreased ambient temperature

(room temperature)

I.e. entrapped or must remain in cool/cold environment

Create a barrier with blankets or such

Remove wet clothing when possible

Cover the head

Patient AssessmentSigns and symptoms• Shivering (core temp is above 90 degrees)

decreased or absent is severe cases• Numbness or reduced-to-lost sense of

touch• Stiff or rigid posture

prolonged cases

• Drowsiness and/or unwillingness or inability to do even the simplest activities

• Tachapnea and Tachycardia (early)

Bradyapnea and bradycardia (prolonged cases)

• Loss of motor sensation

staggering, inability to hold things

• Joint/muscle stiffness or muscle rigidity

• Decreased loc/unconscious, could have glassy stare

• Cool abdominal skin temperature

• Skin; red in early stages

pale to cyanotic in prolonged stages

Passive and Active Rewarming

Passive Rewarming

• Warms self

• Cover and place warm barrier between pt. and surface

• Remove wet clothing

Active Rewarming

• Application of external heat source

• Follow local protocol

Patient CareA & O x4/GCS 15• Remove wet clothing• Wrap and keep warm• Keep still; no activity or exertion• Do not massage extremities• In transport actively rewarm;not too quickly

if delayed move to warm enviornment

Care for shock

O2 warm and humidified if possible

• Give warm liquids but slowly

• Transport but if not don’t allow to return to the cold environment

• When actively rewarming, must be done slowly and handle pt. with great care

When actively rewarming:

• Use central rewarming

lateral chest, neck, groin, armpits

• Rewarm the trunck leaving exremeties exposed

• If transport delayed, warm bath

• Do not allow to walk, avoid rough handling

Patient Care – Unresponsive/decreased loc

• Do not actively rewarm

• Remove from environment and cover

• ABCs

• Do not allow to eat or drink

• Do not massage extremities

• Transport immediately

Extreme Hypothermia

• Unconscious

• No discernable VS

• Core body temperature <80 degrees F

Care

• Assess carotid pulse 30 to 45 seconds

• CPR

• AED

PATIENT IS NOT DEAD UNTIL WARM AND DEAD

Localized Cold Injuries• Ears, nose, hands, feet and toes• Tissues freeze

Progression• Exposed skin reddens

dark skinned; lightens to a blanched color

• As exposure continues, skin takes on gray or white blotchy appearance and becomes numb

• If freezing continues, skin becomes dead white and all sensations are lost

Local or superficial local injury sometimes called frostnip

• Patient Assessment for frostnip:

• Brought about by direct contact with cold object or exposure to cold air

• Most susceptible are tip of nose, tips of ears, upper cheeks, and fingers

• Pt. often unaware of onset

Signs and Symptoms

• Exposed skin reddens

dark skinned; lightens to a blanched color

• Affected area feels numb

Care

• Remove from cold environment

• Warm the effected area

• If to extremity, splint and cover

• Do not massage affected area

• Pt. may complain about tingling or burning

• If pt. does not respond to tx. ……..

Patient Assessment for late or deep local cold injury (frostbite)

• Affected skin appears white and waxy

• Skin

mottled and blotchy – white to grayish yellow – grayish blue

• Swelling and blistering may occur

• Affected area feels frozen, but only on the surface

do not squeeze or poke

Care

• High concentration O2

• Transport immediately

• Cover affected area and handle gently

• Delayed transport; take inside and keep warm, do not allow pt. to drink etoh or smoke

• Warm the frozen part per protocol or by medical direction

*never rub a frostbitten or frozen part

*don’t let pt. walk on affected exremity

*don’t thaw a frozen limb if there is a chance of reexposure or refrozen

Active rewarming of frozen parts

Seldom recommended

pp525-526

Exposure to Heat

Effects of heat on the body

• The body generates heat due to constant internal chemical processes

• Any heat not needed for temperature regulation must be lost by the body. If not

Hyperthermia

• Heat and humidity are often associated with hyperthermia

• Collapse from heat exposure may result in trauma

• Heat exposure may be hastened or intensified:

Age

Alcohol and any other drug

Heat Exhaustion

Exposure to excessive heat while working or exercising resulting from fluid and salt loss

• Moist, pale, cool to normal skin

• Heat cramps {muscle cramps} from heavy perspiration and salt loss

Signs and Symptoms

• Muscle cramps; usually in legs and ABD

• Weakness and exhaustion; sometimes dizziness or periods of faintness

• Rapid, shallow breathing

• Weak pulse

• Heavy perspiration

Care

• Remove from environment into cool place

• O2; NRB

• Loosen or remove clothing, fan; without chilling. Watch for shivering

• Position; supine with legs elevated

• If LOC permits, give small sips of water. If N&V develop, discontinue.--Airway

• Muscle cramps

apply moist towels over cramped area

• Transport

• Patient with hot and dry or moist skin

{heat stroke}

• Cooling mechanisms fail

• Problem compounded with fluid and salt loss

Patient AssessmentSigns and symptoms• Rapid shallow breathing• Full and rapid pulse• Generalized weakness• Little or no perspiration• Loss of consciousness or AMS• Dilated pupils• Seizures may be seen; no muscle cramps

Care

• Remove and place in cool environment

• Remove clothing

• Apply cold packs

neck, groin, armpits

• Keep the skin wet

• Fan aggresively

• O2

• Transport

if delayed; immerse to neck in cold water

WATER-RELATED EMERGENCIES

• Consider that underlying medical conditions may be the cause of a water-related accident.

• Drowning can take place in a few inches of water {bathtubs}

Patient Assessment• Airway obstruction; spasms• Cardiac arrest• Signs of heart attack• Injuries to the head and neck• Internal injuries• Generalized or hypothermia• Substance abuse• Drowning

Drowning

Definition by WHO

Process of experiencing respiratory impairment from submersion/immersion in liquid

Process of drowning• Aprox. 10% who die from drowning die just

from the lack of air• Cold water drowning

*resuscitation can be successful after 30 minutes or longer*once water temp. falls below 70 degrees, biological death may be

delayed

• Transport should not be delayed

• Initiate care immediately even if pt. is still in the water

*Ventilations; there may be some resistance, more force may be needed

*water in the lungs usually means water in the stomach as well which will add resistance

If gastric distension interferes with ventilations:

*place on left side

*suction immediately

*apply firm pressure over the ABD

Care for possible spinal injuries

• Assume if unconscious there are neck or spinal injuries

• Start resuscitation before immobilization

• Do not delay bls

• Do not delay moving from water if there is clear and present danger

• Manual inline stabilization

• Secure to long board before removing from water.

Care

• Initial assessment; protect the spine

• Rescue breathing; if in arrest, CPR and AED

• Look for and control profuse bleeding

• Take 60 seconds to assess pulse in cold water rescues before determination of cardiac arrest

• Care for shock• O2• Conserve body heat• Focused and detailed exam in transport• If no spinal injury; left lateral recumbent• Suction• Consider transport to specialty center

Diving accidents

• Most diving accidents involve the head and neck

• A medical emergency may have led to the diving accident

• If unresponsive, assume possible neck and spine injury

Scuba Diving Accidents

Air embolism

{arterial gas embolism (AGE)}

• Gas leaves an injure lung and enters the blood stream

• Most often when a diver holds his breath

Decompression Sickness

• Usually caused when a diver comes up too quickly from a deep, prolonged drive

• 90% of symptoms occur within 3 hrs. of the dive

Signs and symptoms of air embolism• Blurred vision• Chest pain• Numbness and tingling in sensation in the

extremities• Generalized or specific weakness• Possible paralysis• Frothy blood in mouth or nose

• Rapid lapse into unconsciousness

• Respiratory and/or cardiac arrest

Signs and symptoms of decompression sickness

• Personality changes

• Fatigue

• Deep pain in the muscle and joints (bends)

• Numbness or paralysis

• Choking

• Labored breathing

• Behavior indicative of intoxication

• Chest pain

• Collapse leading to unconsciousness

• Skin rash in cases changes in appearance

Care: decompression sicknessair embolism

• Airway• O2• Rapid transport• Medical direction for destination

St E; Methodist; Wishard• Keep warm

• Position on side or supine

position/reposition to airway mgt.

• Transport diving chart

• Diver Alert Network (DAN) p535

Water Rescues

*reach

*throw and tow

*row

*go

Ice Rescue• Wear a flotation device• Rope with a loop can be tossed• Ladder with rope attached• Small aluminum, flat-bottomed boat with rope

attached pushed stern firstIF POSSIBLE STAY ON SHORE

Do not work aloneEffects of hypothermia (weak, loc) may hamper

rescue efforts

Bites and stings

Insects bites and stings• Toxins/venom

substances produced animals or plants that are poisonous to humans

Black widow and brown recluse spider bite• Can produce medical emergencies• Brown recluse

painless; lesion in 10% of cases

• Black widow bite

immediate reaction

• Scorpion stings

Southwest

can cause serious medical problems

respiratory failure in children

Patient Assessment

• AMS

• Noticeable stings or bites

• Puncture marks

• Blotchy skin

• Localized pain and itching

• Numbness in a limb or body part

• Burning sensations at the site followed by pain spreading throughout the limb

• Redness

• Swelling or blistering at the site

• Weakness or collapse

• Respiratory distress/abnormal pulse

• Headache and dizziness

• Chills

• Fever

• Nausea and vomiting

• Muscle cramps, chest tightening, joint pain

• Excessive saliva formation

• Profuse sweating

• Anaphylaxis

Patient care• Treat for shock• Contact medical direction if unknown• Remove stinger or venom sac

scrape• Remove jewelry from affected limb• If extremity involved and per protocol

restricting band

• Keep pt. still and extremity immobilized

• Cold compresses

protocol

Snake Bites

Two type of poisonous snakes

• Pit vipers

rattlesnakes, copperheads, water moccasins

• Coral snakes

• 25% of pit vipers, 50% of coral snakes are dry bites

• Bites from diamond back rattler and coral snakes are very serious

Patient Assessment• Noticeable bite on the skin• Pain and swelling in are of bite

may take 30 min. to several hours• Rapid pulse and labored breathing• Progressive general weakness• Vision problems; dim or blurred• N & V• Seizures• Drowsiness and unconsciousness

• Transport the snake

*dead or alive

*if alive not loose in the ambulance but

in a sealed container

*do not get close or endanger self to identify

*do not attempt to capture

Care• Stay calm• Contact medical direction• Keep warm• Clean fang marks with soap and water• Remove jewelry etc• Immobilize and elevate extremities• Constricting band• Transport

Poisoning from marine life

Occurs in two ways

• Eating improperly prepared seafood

*may resemble anaphylactic shock

*May resemble food poisoning

*be on alert for vomiting, convulsions, respiratory arrest

Poisonous stings and punctures

• Jellyfish, sea nettle, Portuguese man-of-war, sea anemone and the hydra

• Sting produces few complications• Some pts may develop anaphylactic shock• Stings to face require physician’s attention• Puncture wounds

*steps on or grabs a stingray, sea urchin, spiny catfish etc*do not delay transport*pt. may need tetanus*pt. could develop anaphylactic shock