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Environmental Emergencies
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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
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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}
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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
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Evaporation When the body perspires or gets wet. As the moisture vaporized….generalized cooling effect Respiration Heat loss through exhaled warm air
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Generalized Hypothermia
When cooling affects the entire body Predisposing factors: Shock Burns Head and spinal cord injury Generalized infection Diabetes with hypoglycemia
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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
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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
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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
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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
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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
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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
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Passive and Active Rewarming
Passive Rewarming Warms self Cover and place warm barrier between pt. and surface Remove wet clothing
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Active Rewarming Application of external heat source Follow local protocol
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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
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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
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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
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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
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Extreme Hypothermia Unconscious No discernable VS Core body temperature <80 degrees F
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Care Assess carotid pulse 30 to 45 seconds CPR AED PATIENT IS NOT DEAD UNTIL WARM AND DEAD
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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
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If freezing continues, skin becomes dead white and all sensations are lost
Local or superficial local injury sometimes called frostnip
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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
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Signs and Symptoms Exposed skin reddens dark skinned; lightens to a blanched color Affected area feels numb
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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. ……..
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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
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Swelling and blistering may occur
Affected area feels frozen, but only on the surface do not squeeze or poke
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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
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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
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Active rewarming of frozen parts
Seldom recommended pp
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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
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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
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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
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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
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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
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Muscle cramps apply moist towels over cramped area Transport
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Patient with hot and dry or moist skin
{heat stroke} Cooling mechanisms fail Problem compounded with fluid and salt loss
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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
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Care Remove and place in cool environment Remove clothing Apply cold packs neck, groin, armpits Keep the skin wet Fan aggresively
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O2 Transport if delayed; immerse to neck in cold water
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WATER-RELATED EMERGENCIES
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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}
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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
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Drowning Definition by WHO Process of experiencing respiratory impairment from submersion/immersion in liquid
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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
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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
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If gastric distension interferes with ventilations:
*place on left side *suction immediately *apply firm pressure over the ABD
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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
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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
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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
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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
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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
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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
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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
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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)
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Numbness or paralysis Choking Labored breathing Behavior indicative of intoxication Chest pain Collapse leading to unconsciousness Skin rash in cases changes in appearance
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Care: decompression sickness
air embolism Airway O2 Rapid transport Medical direction for destination St E; Methodist; Wishard Keep warm
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Position on side or supine
position/reposition to airway mgt. Transport diving chart Diver Alert Network (DAN) p535
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Water Rescues *reach *throw and tow *row *go
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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
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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
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Black widow bite immediate reaction Scorpion stings Southwest can cause serious medical problems respiratory failure in children
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Patient Assessment AMS Noticeable stings or bites Puncture marks Blotchy skin Localized pain and itching Numbness in a limb or body part
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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
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Chills Fever Nausea and vomiting Muscle cramps, chest tightening, joint pain Excessive saliva formation Profuse sweating Anaphylaxis
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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
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Keep pt. still and extremity immobilized
Cold compresses protocol
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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
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Bites from diamond back rattler and coral snakes are very serious
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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
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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
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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
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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
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Poisonous stings and punctures
Jellyfish, sea nettle, Portuguese man-of-war, sea anemone and the hydra
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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
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