Spring and Summer Emergencies Silver Cross EMS System May 2014 EMD CE

Heat Emergencies When a person is exposed to excess heat, the body’s mechanisms for regulating temp-erature can be overwhelmed, resulting in: Heat cramps Heat exhaustion Heatstroke

Heat Cramps Involuntary spasms of the muscles Often occur after exercise, especially in hot weather Most commonly occur in the leg or calf muscles When abdominal cramps occur, it may appear that the patient is having an acute abdominal problem.

Heat Cramps Treatment Move the patient to a cool place. Have the patient lie down in a comfortable position. Give the patient water to drink. If the cramps do not disappear, arrange to have the patient transported.

Heat Exhaustion Occurs when a person is exposed to temperatures greater than 80°F (27°C), usually in combination with high humidity Can also occur as the result of vigorous exercise at lower temperatures

Heat Exhaustion Signs and symptoms Profuse sweating Lightheadedness Dizziness Nausea Weak pulse Low blood pressure

Heat Exhaustion Predisposing factors may make some people more susceptible. Very young or old age Preexisting medical conditions Certain medications High ambient temperatures High humidity

Heat Exhaustion Treatment Move the patient to a cooler place and treat him or her for shock. Unless the patient is unconscious, nauseated, or vomiting, give fluids by mouth. Monitor the ABCs. Arrange transport to a medical facility.

Heatstroke Occurs when the body is subjected to more heat than it can handle and the normal mechanisms for getting rid of the excess heat are overwhelmed The patient’s body temperature rises until it reaches a level at which brain damage occurs. Signs and symptoms Flushed, dry skin that feels hot to the touch Semiconsciousness or unconsciousness Internal temperatures as high as 106°F (41.1°C)

Heatstroke Treatment Maintain the patient’s ABCs. Remove the patient from the hot environment. Remove the patient’s clothes, down to the underwear. Soak the patient with water. If the patient is conscious and not nauseated, administer small amounts of cool water. Ice packs to the core (torso). Arrange for rapid transport.

Heat Emergencies Comparison Normal Body Temp Cool, clammy skin Sweating Dizziness Nausea High Body Temp Sweating stops Flushed, hot skin Altered Mental Status or unconscious TRUE EMERGENCY! Heat Exhaustion Heat Stroke

EMD Protocol for Heat Emergencies How long was the patient exposed? Was the onset of symptoms sudden? Is the patient exhibiting any unusual behavior? Is the patient complaining of cramps, nausea or vomiting? Is the patient’s skin hot, dry and flushed? Yes? See HEAT STROKE pre-arrival HEAT EXHAUSTION Move patient to a cool, well ventilated area Remove the patient’s outermost clothing Sponge patient with cool water to lower body temp. or fan to cool them Keep them calm and don’t allow them to move around If patient is able to swallow and not nauseated, give them sips of water Call back if patient’s condition worsens prior to arrival of medical personnel HEAT STROKE Cool rapidly by placing ice packs behind neck, under armpits and in the groin area. If patient begins to shiver, remove ice. Key Questions Pre-Arrival Instructions

Lightning Injury Definition: Injuries from transmission of electricity between sky & ground Strikes injure 500-1000 per year and kill 100 Most common in spring and early summer, between 3:00PM and 6:00PM

Make yourself small and stay away from high profile targets

Lightning Injury Physical findings Minor injury Tympanic membrane rupture Confusion Amnesia – may deny event occurred Brief loss of consciousness Temporary deafness Blindness Numbness or tingling in extremities

Lightning Injury Physical findings Moderate injury Disorientation Combativeness (hypoxia) Coma Motor paralysis Absent pulses due to arterial spasm Sympathetic instability (cardiac irritability) Hypotension Vascular trauma Spinal shock Seizures Burns

Lightning Injury Physical findings Severe injury Cardiac arrhythmia Cardiac arrest Pulmonary edema Pulmonary contusion Ortho injuries

Lightning Injuries The electrical injury resulting from a lightning strike can cause cardiac irregularities or cardiac arrest. Treat patients by supporting their ABCs. CPR may be needed for some patients. Patients must be transported to a medical facility. Lightning injuries can cause electrical burns. This type of burn is mainly internal. The extent of burn damage will not be visible immediately after the injury occurs.

Electrical Shock/Electrocution EMD Protocol Is patient still in contact with the electricity? Yes? What’s the source? Can you safely disable it? If Yes, do so. If No, proceed to next step Once source is disabled, re- assess the patient. Is the patient now conscious and breathing? Yes – proceed to next step No – Go to CPR per age Are there any obvious injuries? Yes – go to proper protocol Do not touch or approach patient until it is safe to do so! Monitor the patient’s breathing and pulse. Call back if the patient’s condition worsens prior to arrival of medical personnel. Key Questions Pre-Arrival Instructions

Mosquitoes West Nile virus (WNV) is most commonly transmitted to humans by mosquitoes. You can reduce your risk of being infected with WNV by using insect repellent and wearing protective clothing to prevent mosquito bites. There are no medications to treat or vaccines to prevent WNV infection. Fortunately, most people infected with WNV will have no symptoms. About 1 in 5 people who are infected will develop a fever with other symptoms. Less than 1% of infected people develop a serious, sometimes fatal, neurologic illness.

Spiders Black widow spider signs/symptoms High Blood Pressure Severe pain at bite site Swelling at bite site Sweating Tachycardia High Blood Pressure Fever, hyperthermia Muscle spasms Abdominal pain

Spiders Brown recluse spider signs/symptoms Local: itchiness at site bite redness, edema Papule formation Necrotic lesion Bull’s-eye rash Systemic: fever, chills Malaise, weakness Nausea, vomiting Rash Seizures Hypotension

Ticks Tick diseases Rocky Mountain spotted fever Lyme disease Fever, headache, abdominal pain, vomiting, muscle pain, rash. Lyme disease Fever, headache, fatigue, characteristic skin rash. Can spread to joints, heart, nervous system.

Ticks Treatment Remove tick with tweezers (get close to skin and be patient) Clean wound with soap & water, dress Treat symptoms Watch for rash

Bites and Stings Signs and symptoms Obvious injury site (bite or sting marks) Tenderness Swelling Red streaks radiating from the injection site Weakness Dizziness Localized pain Itching

Treatment for Insect Stings and Bites Keep the patient quiet and still. Apply ice packs to reduce swelling and pain. Some people may experience an extreme allergic reaction and go into anaphylactic shock. Signs and symptoms of anaphylactic shock Itching Hives Swelling Wheezing and severe respiratory distress Generalized weakness Loss of consciousness

Treatment for Insect Stings and Bites Signs and symptoms of anaphylactic shock (cont’d) Rapid, weak pulse Rapid, shallow breathing Treatment for anaphylactic shock Maintain the patient’s ABCs. Administer oxygen if available. Elevating the patient’s legs may help.

Treatment for Insect Stings and Bites Treatment for anaphylactic shock (cont’d) Remove the allergen if possible. Stingers should be scraped off skin and area cleaned with soap and water. Monitor the patient’s vital signs. If the patient’s condition progresses to the point of respiratory or cardiac arrest, begin mouth-to-mask breathing or CPR. Immediately arrange for rapid transport.

Treatment for Insect Stings and Bites Treatment for anaphylactic shock (cont’d) If the patient has a prescribed auto-injector, tell them to follow their doctor’s orders for use. Place the tip of the auto- injector against the outer thigh. Push the auto-injector firmly against the thigh and hold it for at least 10 seconds.

Allergic Reactions/Stings/Hives EMD Protocol Is the patient responding normally? Is the patient having DIB or problems swallowing? Does the patient have a history of allergic reactions? Does the patient have or take allergy meds? Yes – Oral, when was it last taken? Does the patient have an Epi-pen? Yes – follow their doctor’s instructions for use and notify responders if used Has patient had any allergic reactions in the past? Recently eaten? Any bites or stings? Recent medications? Any swelling noted to face, throat or airway? Do not give anything by mouth Call back if patient’s condition worsens prior to the arrival of medical personnel On insect stings, if stinger is still present, gently scrape off of skin and clean area with soap and water. Do not use tweezers. Key Questions Pre-Arrival Instructions

Snake Bites

Snake Bites Four kinds of poisonous snakes in the United States: Rattlesnake Cottonmouth (water moccasin) Copperhead Coral snake (Red on yellow bands) A snake injects its poison into a person’s skin and muscles with its fangs. Coral snakes chew with a row of teeth.

Snake Bites Signs and symptoms Immediate pain at the bite site Swelling and tenderness around the bite site Fainting (from the emotional shock) Sweating Nausea and vomiting Shock

Snake Bites The bite of the coral snake delivers a slightly different poison that may cause these additional problems: Respiratory difficulties Slurred speech Paralysis Coma Seizures

Treatment for Snake Bites Keep the patient calm and quiet. Have the patient lie down and try to relax. Wash the bite area with soap and water. If the bite occurred on the arm or leg, splint the affected extremity. Treat the patient carefully. Arrange for prompt transport to a hospital for possible antivenin.

Animal Bites EMD Protocol Where is the animal now? Any serious bleeding? Yes, go to bleeding protocol What body part was bitten? What type of animal was involved? Isolate patient from the animal, if safe to do so Call back if the condition worsens prior to the arrival of medical personnel Advise responders if risk from animals still exist Key Questions Pre-Arrival Instructions

Resources Silver Cross EMS March 2012 CME AAOS Emergency Medical Responder, Your First Response in Emergency Care, 5th Edition Google Images CDC.GOV Mosby Wilderness Medicine, 5th Edition Will County 9-1-1 EMD Protocols