Environmental Emergencies Chapter 38 Environmental Emergencies

Part 1 You and your partner are called to the public library because of a man “acting strangely.” You notice that the spring day has turned cooler as you respond and begin to consider why someone would be acting strangely at the library.

Part 1 (cont’d) When you arrive, you run through the wind and rain to the entrance. You recognize one of the police officers. She tells you, “I think he’s just drunk,” and notes that she arrested the man a month ago after a bar disturbance. After you confirm that the police officer has checked the man for weapons, you ask the bystander, who has given up his coat to the patient, what is going on. He reports that the patient was standing outside trying to remove his shirt and pants. The patient told him that he was “too hot.”

Part 1 (cont’d) Primary Assessment Recording Time: 0 minutes Appearance Eyes open, no obvious distress Level of Consciousness V (Responsive to verbal stimuli); slurs words Airway Open; odor of alcohol on breath Breathing Adequate rate and tidal volume Circulation Radial pulse present; cold hands

Part 1 (cont’d) What are three things that could medically harm this man in the next hour? Do you believe the scene to be adequately secured? Where do you believe is the best place to properly assess the patient?

Part 2 You ask the patient what is going on as you assist him to the ambulance. His gait is unsteady. Your partner obtains an initial set of vital signs. The patient takes a moment and tells you that he had been drinking earlier and got caught in the rain. You notice the coat he is wearing is dry. When you ask him if it is his coat, the patient says “no.” Your EMT-B partner informs you the coat belongs to the bystander who initially helped him and the patient’s identification indicates he is 44 years old.

Part 2 (cont’d) As you begin to undress the patient as part of your primary assessment, you notice his clothes are wet and his appearance is unkempt. The patient states that his head hurts. He says “no” when asked about dizziness, visual disturbances, chest pain, and trouble breathing. He says that his stomach “always hurts,” and that he has trouble with his pancreas but can offer no more clarification on his pain or history. There is no nausea, vomiting, diarrhea, and he denies any unusually colored stools.

Part 2 (cont’d) The patient states he has been drinking most of the afternoon but does not know where he is or what day it is. He denies any psychiatric history.

Part 2 (cont’d) Vital Signs Recording Time: 5 minutes Skin Pink, cool, and dry Pulse 112 beats/min; irregular and weak Blood pressure 108/60 mm Hg Respirations 24 breaths/min SaO2 Not reading

Part 2 (cont’d) Does the additional information narrow the diagnostic possibilities? What interventions would benefit the patient? Why is the pulse oximetry not working?

Part 3 After getting the patient out of his wet clothes, you begin your exam. He is barely shivering. He has trouble following your commands but does not seem to have any focal weakness. His pupils are equal, round, and reactive to light. His voice is slurred, but his facial muscles are symmetric and intact. The spine is nontender, the lungs are clear, and there is moderate epigastric tenderness to palpation. You find no evidence of trauma.

Part 3 (cont’d) You insert an 18-gauge IV catheter, draw a blood sample, and check the patient’s glucose level. It is 162. Your partner has hung a bag of warm normal saline. The rectal temperature is 91.4°F (33°C). You begin to remove the patient’s clothes and place hot packs in the groin, axillae, and neck. You wrap the IV fluid warmer around the bag of the nonrebreathing mask and wrap the oxygen tubing in a hot pack.

Part 3 (cont’d) Reassessment Recording Time: 15 minutes Skin Getting pinker, cold, dry Pulse 108 beats/min; regular and strong Blood pressure 110/64 mm Hg Respirations 24 breaths/min SaO2 100% on nonrebreathing mask at 10 L/min supplemental oxygen; good waveform

Part 3 (cont’d) What information is important to convey to the emergency department staff when you call? What effect does alcohol have on hypothermia? Why did the patient remove his clothing if he was hypothermic?

Part 4 As you roll the patient into the emergency department, a member of the nursing staff comments that she saw him during her last shift. You politely convince her that despite his history, the patient is in moderate hypothermia and may have acute pancreatitis. She is appreciative of the blood draw and the care you have given. You assist the staff as they place the patient on a commercial hot-air warming blanket. When you follow up later, you learn that the patient was eventually rewarmed but was admitted for pancreatitis and observation overnight.