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 body Predisposing 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 exposure Possibility 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 Assessment Signs 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 Care A & 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 Assessment Signs 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 sickness air 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

IF POSSIBLE STAY ON SHORE 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 first IF POSSIBLE STAY ON SHORE Do not work alone Effects 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