1. Environmental Emergencies

2. Exposures to the Cold How does the body lose heat Conduction-body heat lost to nearby objects through direct contact Convection- body heat lost to surrounding air Radiation- body heat lost to nearby objects Evaporation - perspiration lost from the body surface when changed from a liquid to vapor Respiration

3. Environmental Emergencies Hypothermia –Generalized cooling of the entire body Predisposition –Burns –Spinal injury –Infection –Diabetes –Drugs and alcohol

4. Environmental Emergencies Often times the person most effected by hypothermia are the very old and very young

5. Environmental Emergencies Signs & Symptoms (general) –Shivering (1st clinical indicator) –Cool, cold skin temperature –Indifference, apathy, Sleepiness –Lack of coordination –Poor judgement –Decreased mental status –Decreased vital signs –Muscular rigidity

6. Progressive Clinical Presentation of Hypothermia

9. Environmental Emergencies Patient Care- Hypothermia Scene size-up Activate EMS Perform initial assessment Remove patient from cold environment Protect from further heat loss

10. Environmental Emergencies Remove all wet clothing Handle patient gently Do not allow patient to exert themselves Do not give food or fluids O2 Handle patient carefully Monitor vital signs

11. Environmental Emergencies Patient Care- O 2 (warmed if possible) Wrap with blanket and handle gently can cause V-Fib with rough handling –Passive rewarming –Active rewarming

12. Environmental Emergencies Patient Care Extreme Hypothermia –Assess Carotid Pulse for 30-45 seconds –If no pulse begin CPR

13. Environmental Emergencies Immersion Hypothermia –Cold water? –Water conducts heat 25 X faster than air of the same temperature –Most deaths in cold water are due to: rapid body heat loss leading to unconsciousness leading to drowning or cardiac failure

14. Environmental Emergencies Immersion hypothermia –Likely to become fatal when the core temperature drops below 94 o F Patient Care –Same as for other hypothermia patients –If long exposure time, keep patient horizontal due to possible vascular collapse

15. Environmental Emergencies Increasing Survival Time –Drowning proofing –Treading water –Swimming –Holding still –HELP –Huddle (Note: survival times based on 50 o F water temp)

16. Environmental Emergencies Frostnip (early, superficial) –Areas affected tips of nose, ears, upper cheeks, fingers Signs and Symptoms –light skin reddens –dark skin lightens both blanch –numbness of affected area –skin remains soft

17. Environmental Emergencies Frostnip - Emergency Care –Remove patient from cold environment –Slowly warm affected area Do Not rub or massage Do Not re-expose to cold Manually stabilize extremity, cover Rewarm using own body heat –Tingling & burning are common during rewarming

18. Environmental Emergencies Frostbite (late / deep) –Progressive from early (superficial) cold injury –Areas affected skin, subcutaneous tissue, muscles, deep vessels, organ membranes, bones

19. Environmental Emergencies Frostbite –Signs and Symptoms skin appears white & waxy turning mottled or blotchy in appearance color changes from white to grayish yellow to grayish blue. swelling blistering

20. Environmental Emergencies Frostbite –Signs and Symptoms con’t. firm to frozen (affected area feels frozen on surface, soft beneath surface initially, normal resilience, progresses to firm frozen feeling) do not squeeze or poke tissue assess as it fractured if thawed skin may appear flushed with purple areas

21. Environmental Emergencies Frostbite Emergency Care –Provide same care as for frostnip –Protect frostbitten or frozen area handle as gently as possible –Arrange for transport (if transport is delayed) move patient indoors –Remove jewelry –Cover with dry sterile dressings

22. Environmental Emergencies Frostbite Emergency Care –Do Not: break blisters rub or massage area apply heat allow use of alcohol consumption allow patient to smoke allow patient to walk on affected extremity rewarm *

23. Environmental Emergencies Frostbite Emergency Care –Rewarming seldom recommended risk of causing permanent injury rewarm ONLY if to to do so by EMS or severely delayed transport complete submersion of the affected area in heated water (100 - 105 o F) dress & bandage as if burned (dry sterile dressings)

24. Environmental Emergencies Heat Emergencies –Hyperthermia Excessive body heat –Types of Emergencies Heat Cramps Heat Exhaustion Heat Stroke

25. Environmental Emergencies Heat cramps –Muscle cramps –Weakness –Respirations - normal to slightly increased –Pulse - normal to increased & weak –Skin color/temp - normal to pale/cool & moist –Heavy perspiration –Dizziness possible, seldom altered mental status

26. Environmental Emergencies Heat Exhaustion –Most commonly treated heat emergency –Weakness –Respirations - rapid & shallow –Pulse - Rapid & weak –Skin color/temp - pale to slightly flushed / cool & moist –Heavy perspiration –Possible altered mental status

27. Environmental Emergencies Care for Heat Cramps/Exhaustion –Move patient to a cool environment –Loosen or remove clothing to cool (do not chill patient) –Oxygen –Place patient in supine position –Small amounts of water IF patient is fully conscious

28. Environmental Emergencies Heat Stroke –Generalized weakness –Respirations - rapid & shallow –Pulse - rapid & full –Skin color/temp - red, hot, dry –Little or no perspiration –Altered mental status –Dilated pupils –Seizures

29. Environmental Emergencies Care for Heat Stroke –Activate EMS ASAP –Move patient to a cool environment –Remove clothing –Rapidly cool patient (without chilling) –Place patient in recovery position –Oxygen –Monitor vitals

30. Environmental Emergencies Water Related Emergencies Near Drowning, Drowning Diving accidents –AGE –DCS

31. Environmental Emergencies Near Drowning / Drowning –estimated 80,000 submersion incidents yearly –9,000 deaths annually in US (140,000 WW) –4th leading cause of accidental death for all age groups –2nd leading cause of accidental death in children –64% of all victims under 30 YOA

32. Environmental Emergencies Drowning –Risk Factors (Contributing Factors) Location Swimming ability Drugs /alcohol Underlying disease / injury Age Gender Race

33. Environmental Emergencies Near Drowning –At least temporary survival. Death more than 24 hours later Drowning –Death within 24 hours

34. Environmental Emergencies Sequence of Events (Conscious Patient) –Dry Drowning Immersion, breath holding, panic, hypoxia, loss of consciousness, spasm of epiglottis & larynx, asphyxia –Wet Drowning Immersion, breath holding, panic, hypoxia, loss of consciousness, relaxation of epiglottis & larynx, inhalation of water

35. Environmental Emergencies Sequence of Events (Unconscious patient) –Immersion, relaxation of epiglottis & larynx, inhalation of water

36. Environmental Emergencies Special Considerations –All cold water submersions should be worked –Documented cases of successful resuscitation after 1 hour of submersion in cold water –The lower the water temp the better the chances of survival Spinal injury should be considered All near drowning patients must be evaluated in ER

37. Environmental Emergencies Scuba Diving Emergencies –Decompression Illness Dysbaric injuries related to scuba diving Includes both –Arterial Gas Embolism (AGE) –Decompression Sickness (DCS)

38. Environmental Emergencies Air Embolism- AGE –Gas bubbles (usually air) entering the circulatory system through the alveoli Causes Breath holding on ascent Ascending to rapidly Air trapping in alveoli (from asthma, chest congestion, etc.) Time of onset - within 5 minutes

39. Environmental Emergencies Decompression Sickness Bubbles of inert gas (nitrogen) forming in the tissues & bloodstream Causes Rapid ascent from compressed gas diving Reduction in surrounding pressure such as flying in an aircraft after diving Time of onset - 1 to 48 hours

40. Environmental Emergencies Common Signs & Symptoms of DCI –Pain –Numbness –Dizziness –Unusual fatigue –Headache –Weakness –Nausea –Difficulty walking

41. Environmental Emergencies Other Signs & Symptoms of DCI –Difficulty breathing –Visual disturbances –Decreased skin sensation –Restlessness –Itching / Rash –Paralysis –Muscular twitching –Unconsciousness

42. Environmental Emergencies Other Signs & Symptoms of DCI –Speech disturbances –Personality changes –Altered mental status –Convulsions –Hearing loss / ringing ears –Bladder / bowel problems –Coughing blood

43. Environmental Emergencies Care for DCI –Maintain airway –Oxygen (Demand Valve) –Rapid transport nearest ER –Followed by care ASAP at hyperbaric chamber –Contact DAN (Diver Alert Network) Emergency 919-684-8111 or (919-684-4DAN) Medical information line 919-684-2948