1. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter 26 Heat-Related Emergencies

2. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 26.1 Explain the way the body normally adjusts to a hot environment. 26.2 List the signs and symptoms of a patient with each of the four types of heat- related illness. 26.3 Describe and demonstrate the assessment and emergency care of a patient suffering from each of the four types of heat-related illness. continued

3. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 26.4 List the signs and symptoms of a patient who is a victim of a lightning strike. 26.5 Describe and demonstrate the assessment and emergency care for a patient who has been struck by lightning. 26.6 Explain what one can do to prevent heat-related illness.

4. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics Anatomy and Physiology Common Heat-Related Emergencies Heat-Related Illness Prevention Lightning Assessment Management Chapter Summary

5. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Presentation On a beautiful desert summer day, with the temperature at about 105°F, while your group is resting in the shade you encounter a female hiker from another group who is slower than the others, staggering, panting, flushed, and asking for rest and water.

6. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Thermoregulation ◦ Sweating ◦ Dilation of blood vessels in skin Heat Index Hydration Adaptation ◦ Prior exposure ◦ Physical training

7. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Mechanisms of Heat Loss

8. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Heat-Related Emergencies Heat Illnesses ◦ Causes ◦ Characteristics ◦ Progression ◦ Risk groups and factors continued

9. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Heat-Related Emergencies Four Levels ◦ Heat-induced syncope ◦ Heat cramps ◦ Heat exhaustion ◦ Heat stroke

10. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Heat-Related Emergencies

11. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Heat Syncope and Heat Cramps Syncope ◦ Cardiovascular ◦ Temporary ◦ Signs and symptoms Cramps ◦ Muscular ◦ Electrolyte/dehydration issues

12. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Heat Exhaustion and Heat Stroke

13. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Heat Exhaustion and Heat Stroke Exhaustion ◦ Exposure/dehydration ◦ Signs and symptoms Stroke ◦ Life threatening ◦ Signs and symptoms ◦ Effects

14. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Heat-Related Illness Prevention Heat acclimatization Hydration: ensure proper hydration; light yellow urine is a good indicator of being well hydrated. Behavior: prepare for the heat; wear light colored, layered clothing and a wide brimmed hat.

15. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Sunburn A superficial burn of the skin Repeated exposure may lead to degenerative skin changes and possible cancer High altitudes, snow, and water increase vulnerability Clouds may not filter the UV rays

16. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Sunburn Prevention Topical creams ◦ Physical sunscreens Mechanical blocking Opaque greases i.e., zinc or titanium dioxide ◦ Chemical sunscreens SPF factor Need frequent and sufficient application Clothing/Shade ◦ May need layers ◦ Thick brimmed hat

17. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Lightning Atmospheric discharge of electricity capable of generating 300,000 amps and 2 billion volts 1 in 5,000 chance of being struck Average of 62 deaths per year Cannot predict where it will strike

18. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Lightning

19. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Lightning Injuries Caused by direct electrical current – high voltage, short duration Respiratory arrest Cardiac arrest Severe tissue damage ◦ Internal may not be obvious, but muscle and internal organs may be affected continued

20. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Lightning Injuries Severe tissue damage ◦ Kidney injury may result from chemicals released into the blood ◦ Entrance and exit wounds will be present ◦ Skin injuries may occur in a fern leaf pattern continued

21. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Lightning Injuries Unpredictable neurologic deficits Muscular contractions can cause falls resulting in injury 30% fatality rate

22. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Reducing Risk of Lightning Strikes Seek shelter ◦ Outdoor safety ◦ Building safety 30/30 rule Clear ski lifts and exposed summit structures

23. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update You leave the shade of the rock overhang and walk out into the hot sun of a 105°F day to find a young woman who is sweating, asking for water, and complaining of fatigue, nausea, dizziness, and a headache. You offer to help and suggest that the young woman sit under the rock overhang, rest, and have some water and electrolyte drinks.

24. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment Standard assessment procedures to start – ABCDs and vitals Check skin temperature and appearance Check for muscle spasms / cramping May determine core body temp Behavior changes? Burns? Trauma?

25. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Move patient to cooler/shaded location Monitor condition and vitals Hydration and oxygen as needed ◦ Electrolyte or salt water Position for comfort, shock care Limit re-exposure to heat, sun Treat other injuries Transport as appropriate

26. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management of Heat Stroke All of the previous AND ◦ Lower the body temperature by any means possible. Ice packs for neck, armpits, groin Remove clothing, apply wet towels, fan Monitor temp, reduce to about 101º ◦ EMS transport ASAP ◦ If uncertain, treat for this!

27. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management of Heat Stroke

28. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Managing a Lightning-Strike Injury Treat as unresponsive ◦ Jaw thrust ◦ Protect c-spine CPR/AED ◦ Survivability is high ◦ Do first in triage situation ◦ Continue high flow oxygen Transport

29. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Disposition Her respiration is 20; her pulse is 100 BPM. She is responding to questions. She is able to drink a drink containing electrolytes, and once she lies down, she looks more comfortable. You fan her, she continues to rest and sip liquids over the next 30 minutes, her breathing slows, and she becomes more talkative. Her pulse is now 80 BPM. Your findings suggest that she was suffering from heat exhaustion.

30. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Allow the body to physiologically adapt to heat gradually, over several days (heat acclimatization). Exercise in the early-morning or late- evening hours during hot weather. Evaluate the risk of heat illness using the heat index. The higher the heat and humidity, the greater the risk for heat illness. continued

31. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Wear loose-fitting, light-colored clothing. The higher the heat and humidity, the greater the risk for heat illness. Wear loose-fitting, light-colored clothing. Drink plenty of water or electrolyte drinks. Heat exhaustion responds rapidly to treatment. continued

32. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Heat stroke is characterized by an elevated body temperature and an altered mental status. Heat stroke is life threatening and does not respond quickly to treatment. Patients struck by lightning are not electrically charged and (unlike victims of electrical injury) pose no threat to rescuers. continued

33. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary In a triage situation, care first for lightning- strike victims who appear dead.