ENVIRONMENTAL INJURIES. 2 Environmental Injuries The Patroller is most likely to be called and treat environmental injuries, both on and off the ski.

ENVIRONMENTAL INJURIES

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Environmental Injuries The Patroller is most likely to be called and treat

environmental injuries, both on and off the ski hill: Altitude Sickness Cold Exposure Injuries Heat Exposure Injuries Electrical Shock Lightning Strikes

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Altitude Sickness Altitude sickness can be categorised into three

groups: Mild acute mountain sickness High altitude pulmonary edema (HAPE) High altitude cerebral edema (HACE)

Mild Acute Mountain Sickness Can show up at elevations as low as 2,100 to 2.400 m Signs and symptoms:

Mild headache Mild insomnia Loss of appetite Shortness of breath when exercising

Treatment: Symptoms should disappear within 24 hours If not, take patient to lower altitude If persist, consider oxygen and further medical care

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High Altitude Pulmonary Edema Continued shortage of oxygen increases pressure in

arteries which results in damage to the lungs with fluid accumulation

Can become life threatening quickly Signs and symptoms:

Marked breathlessness on exertion and at rest Headache and cough

Treatment: Take to lower altitude ASAP Oxygen Keep the patient at rest

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High Altitude Cerebral Edema Swelling in the brain due to cell wall damage can lead to cerebral

edema Generally develops slowly over a few days

Signs and symptoms: Severe headache Insomnia Nausea and vomiting Ataxia (loss of co-ordination) Lassitude or irrational behaviour

Treatment: Get to low altitude ASAP Give oxygen and keep at rest Treat as Load and Go and seek medical care

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Heat & Cold Injuries The systems of the body function less effectively

as the internal body temperature falls below its normal temperature.

The body may also be severely damaged if the internal temperature rises above normal.

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Body Temperature The temperature-regulating mechanisms of the body

continuously attempt to maintain a balance between internal heat production (metabolism) and external heat gains or losses

Heat injuries systemic - heat stroke localized – burns

Cold injuries systemic – hypothermia localized - frostbite

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Heat Transfer Mechanisms Basic heat transfer mechanisms are identical

whether applied to cold or heat injuries Heat transfer occurs as a result of:

Radiation Conduction Convection Evaporation Respiration

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Other Factors Affecting BodyHeat Balance Additional factors can affect the basic heat

transfer mechanisms: Wind and wind chill factor Water Clothing Nutrition

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Cold Exposure - Hypothermia Hypothermia is a serious cold injury which occurs when

the body loses more heat than it can produce or retain.

The nervous, cardiovascular, respiratory and digestive systems function less efficiently as the body core temperature falls below the normal 37°C.

Should the core temperature continue to fall, these functions may cease and death will follow.

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Types of HypothermiaAcute Hypothermia May develop over a short period of time as a

result of immersion in cold water, or over a period of up to 12 ~ 24 hours exposure to cool or cold weather conditions

Chronic Hypothermia Develops over a period of time. This is seen most

commonly in the elderly as a result of aging processes, some diseases, some medications, and inadequate heating in their homes.

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Prevention of Hypothermia Place insulating material between the patient

and the snow Replace clothing if necessary Put a layer of warm clothing on top of the patient Provide some shelter and warmth by huddling Remove the patient from the hill or trail as soon

as possible

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General Treatment of Hypothermia Ensure that the patient’s airway, breathing and

circulation are adequate. Prevent further heat loss. For patients in mild to severe condition, add heat

to re-warm the patient’s body. If the patient is fully conscious, give fuel in the

form of hot sweet drinks and sweetened foods . Handle the patient gently. If the patient in unresponsive, place the patient

in a semi-prone position, monitor and treat as Load and Go

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Localized Cold Injuries Non-freezing Cold Injury:

Also known as frostnip, immersion foot or trench foot Skin is cold to the touch and pale, but not frozen

Superficial Frostbite: Skin surface is hard, but tissue underneath is soft Frequently occur on tip of nose, earlobes, cheeks,

toes and fingers

Deep Frostbite: Tissue freezes down into and beyond the

subcutaneous layers

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Signs and Symptoms of Localized Hypothermia Non-freezing cold injury:

Feeling is usually still present to some extent Usually there will be tingling, pain and redness during the

re-warming Superficial Frostbite:

Skin initially reddens, then blanches and becomes white Tingling sensation or sharp pain

Deep frostbite: Injured person cannot feel the frozen area Skin surface is white, hard and tissue underneath is hard

Deep Frostbite

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Picture A: shows lack of blood flow to frozen areas Picture B: blood flow returning to foot extremityPicture C: external picture of same stage of healing

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Treatment of LocalizedHypothermia Remove the patient from the exposure Remove wet clothing Re-warm the part - this can be done by contact

with a warm body part such as a hand or armpit, or immersion in warm water

Additionally with superficial frostbite: protect the injured area with dressings and elevate

Deep frostbite: leave frozen until can send patient to a medical aid facility

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Heat Exposure Injuries Body heat cannot be dissipated from the body or

external heat is added Rise in body temperature results in severe damage to

the central nervous system and the kidneys The body dissipates heat by:

Conduction Convection Radiation Evaporation

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Prevention Heat exposure injuries are relatively easy to

prevent: Gradually acclimatize to working in warm or hot

environments Wear light-coloured garments made of materials that

allow the easy passage of moisture to facilitate evaporation (fabrics that ‘breathe’)

Increase fluid intake, while avoiding those which contain caffeine

Schedule peak physical work periods to cooler periods of the day

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Heat Injuries Heat exposure injuries, in order of increasing

severity are: Heat Cramps Heat Syncope Heat Exhaustion Heat Stroke

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Heat Cramps Heat cramps are painful muscular cramps that

occur as a result of the depletion of the chemical stores within the muscles as a result of profound sweating.

Usually the cramps occur in the muscles which perform the most work - those in the legs or arms.

The onset of cramps may be delayed into a resting period.

Generally, no lasting damage is found

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Heat Syncope (Fainting) Caused by a decrease in blood volume reaching

the brain Hot environment:

increased movement of blood to the skin and muscles results a temporary insufficiency of blood flow to the

brain

A temporary loss of consciousness Fainting is usually followed by a fall Horizontal position improves the blood flow to

the brain and allows spontaneous recovery

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Heat Exhaustion Same mechanism as for heat syncope The patient, however, may not experience a loss of

consciousness Because heat exhaustion is usually accompanied by fluid

loss, there may be signs and symptoms of mild hypovolemic shock

NOTE: The greatest danger of heat exhaustion is that it may rapidly progress to heat stroke, which can be life-threatening

Heat ExhaustionSigns and Symptoms: Pale, cool clammy skin Body temp normal, but

may be low Weak rapid pulse Rapid, shallow respiration Headache Nausea Profuse sweating

Treatment: Remove to a cooler

environment Remove any extra

clothing If conscious, give cool

water Give oxygen Consider transport to

medical aid

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Heat Stroke Result of the collapse of the body's cooling

system Body's temperature rises Structures of the central nervous system are

usually affected Death may rapidly ensue if conditions are not

corrected Heat stroke is fatal if not treated and has a fairly

high mortality rate even when treated

Heat StrokeSigns and symptoms: Rapid onset of condition Hot, dry, flushed skin Full, rapid pulse initially Deep respiration then shallow Muscle twitching or

convulsions Dilated pupils Very high body temperature Progressive decrease in LOC

Treatment: Remove as much clothing as

possible Cool the patient down rapidly

(cold shower or immersion in cold water)

Wrap the patient in a sheet and sprinkle with water

Place cold packs under the arms, on the neck, groin and behind each knee

Oxygen and monitor vital signs Transport to medical aid

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Burns A burn is an injury to the skin, or deeper tissues of the

body, caused by contact with heat, radiation or chemicals.

The contact causing the burn may be in the form of: Hot solids Liquids Steam, air or other gases Sunlight or ultraviolet light Electricity X-rays, radium Chemicals such as strong acids or alkalis

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Classifications of Burns Burns are classified according to the depth of

tissue damage: First Degree Burns Second Degree Burns Third Degree Burns

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First Degree Burns Superficial skin burn,

merely reddens the skin Minor pain Could be compared to a

mild sunburn Heals in two to five days Leaves no scarring

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Second Degree Burns Partial thickness skin burns

that involve both the epidermis and the dermis, and may blister the skin

Compared to sunburn with blistering

Most painful type of burn as nerve endings are damaged

Take 5 to 21 days to heal, unless infection occurs

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Third Degree Burns Full thickness burns destroy the

skin completely and may extend into the deeper tissues

Sometimes even charring the muscle and bone

May not be very painful because the nerve endings may also have been destroyed

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Estimating the Size of the Burn Any second degree burn involving more than 10% of the

body area, around the mouth or the 1% perineal area is serious

Any third degree burn regardless of size is serious. These must be referred to medical aid.

For small areas, it is possible to estimate the size of the burn by comparing it with the size of the patient's outstretched palm and fingers, which represents an area of about 1%.

For larger burn areas, the rule of nines is useful

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Rule of Nine Head and neck - 9%

Upper limbs - 9% each

Trunk 18% front 18% back

Lower limbs - 18% each

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Shock in Burn Injuries Is due to a fall in effective circulating blood

volume due to drainage of fluids from the burn Drainage of fluid similar to plasma into the area

of a burn causes swelling and blistering The greater the area of the burn, the greater the

loss of fluid As volume of fluid loss increases, hypovolemic

shock occurs

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Treatment Remove the cause Initiate basic life support if necessary Cool the burn, using sterile water if available, or cool

clean water Apply dry, sterile dressings to the burned area Treat for shock Transport to medical aid For burns over 20% of the body, do not use water, due

to the danger of hypothermia. Wrap the patient in clean sheets and transport to medical aid.

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Electrical Shock Electrical shock can be caused by contact with

or proximity to: High voltage power lines Lower voltage used in industrial and house wiring

Current usually travels through the nervous system and through the heart

May result in mild shock to respiratory or cardiac arrest, or cardiac fibrillation

Monitor and apply AR/CPR as needed

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Lightning Strike Average voltage may be of the order of 10 to 20

million volts Duration is short (0.1 to 1 milliseconds) Often little energy is delivered to the body, and

therefore tissue damage and burns tend to be minor.

The major effect are cardiac and respiratory arrest.

The fatality rate is about 30%.

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Sunburn or UltravioletLight Exposure Cool the burned area and protect it from further

injury by applying a damp dressing. If no other injury exists, encourage a sunburn

patient to take fluids orally to replace lost fluid. Transport to medical aid if:

the burn covers a considerable area there are blisters the patient develops a fever

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Conclusion Many cold exposure injuries are the result of a

failure to take proper precautions. Most can be prevented by common sense. In the case of heat injuries, stress the

importance of adequate fluid replacement. Proper first aid treatment of burns will prevent

infection, relieve pain, and maintain blood volume.

Consider burns as an emergency potentially leading to the onset of shock.