1. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 16 Environmental Emergencies

2. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Topics Heat and Cold Emergencies Bites and Stings

3. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Heat and Cold Emergencies

4. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Heat and Cold Emergencies Body temperature –Regulated mainly through metabolism –Heat loss from the body Convection Conduction Radiation Evaporation Respiration

5. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Heat and Cold Emergencies

6. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Heat and Cold Emergencies Generalized hypothermia Local cold injury

7. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Heat and Cold Emergencies Generalized hypothermia –Hypothermia Risk factors Medical history Drug or alcohol use Extremes in age

8. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Heat and Cold Emergencies Generalized hypothermia –Assessment findings Progressive condition Shivering Mental status declines

9. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Heat and Cold Emergencies

10. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Mild hypothermia –Still alert and oriented –Shivering –Elevated vital signs –Slow speech –Lack of muscle control Heat and Cold Emergencies

11. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Heat and Cold Emergencies

12. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Mild hypothermia –Treatment Warm fluid intake Warm with blankets Heat packs to the neck, armpits, and groin Heat and Cold Emergencies

13. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Heat and Cold Emergencies Severe hypothermia –Altered mental status –Heart rate and breathing slow –Rigid extremities –No shivering

14. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Heat and Cold Emergencies Severe hypothermia –Treatment Remove from environment Remove wet clothing Maintain airway and breathing Assess carotid pulse for 1 minute prior to CPR Handle gently Passively rewarm

15. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Heat and Cold Emergencies Local cold injuries –Decreased blood flow to exposed tissues –Tissue freezes –Can result in gangrene

16. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Heat and Cold Emergencies Local cold injury –Do not allow patient to walk while moving patient from environment –Administer oxygen –Remove wet clothing –Protect area from further injury –Monitor for hypothermia

17. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Heat and Cold Emergencies Heat emergencies –Heat cramps – individual muscle cramps –Heat exhaustion – mild state of shock –Heat stroke – overheating without rehydration

18. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Heat and Cold Emergencies Heat emergencies –Contributing factors Heat and humidity Activity level Medical history and medication usage Extremes in age Drug and alcohol abuse

19. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Heat and Cold Emergencies Heat emergencies –Patient assessment Hot skin Exhaustion Rapid heart rate Seizures Altered mental status

20. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Heat and Cold Emergencies

21. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Heat and Cold Emergencies Heat emergencies –Treatment Remove patient from environment Administer oxygen Cool patient Do not make patient shiver Position patient supine with legs elevated

22. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bites and Stings

23. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bites and Stings Patient assessment –Scene safety –Monitor for signs of allergic reaction –Inspect for location of bite or sting –Skin changes –Respiratory distress –Circulatory compromise

24. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bites and Stings

25. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bites and Stings First Responder care –Treat life-threats –Maintain airway and adequate breathing –Position extremity below the heart and remove constricting objects –Remove stinger –Wash with soap and water

26. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bites and Stings Specific bites and stings –Snakebite –Insect bites –Marine-life poisoning

27. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bites and Stings Snakebite –Attempt to identify the snake Hollow fangs Elliptical pupils Presence of a pit Special markings Triangular head –Watch for signs of central nervous system damage

28. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bites and Stings

29. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bites and Stings Black widow spider Brown recluse spider Tarantula Scorpion Fire ants Mites Ticks Bee, wasp, or hornet stings

30. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bites and Stings Black widow spider –Extremely toxic –Pain and spasms –Rigid abdomen with cramping –Fever, rash –High blood pressure

31. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Brown recluse spider –Not often serious –Bite forms a bulls-eye pattern –May develop an ulcer with fever Bites and Stings

32. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Tarantula –Complications other than pain are rare Bites and Stings

33. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Scorpion –Bite results in Drooling Poor coordination Incontinence Seizures Bites and Stings

34. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Fire ants –Bite causes intense burning pain –Create vesicles, which develop into pustules Bites and Stings

35. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Mites –Embed in the skin until engorged with blood –Create a red lesion that can enlarge into a node Lasts 2–3 weeks Bites and Stings

36. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Ticks –Can be carriers of bacterial diseases –May lead to progressive paralysis –May need to be removed –Require observation for infection Bites and Stings

37. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bee, wasp, or hornet sting –Observe for signs of allergic reaction –Remove the stinger –Treat patient as needed Bites and Stings

38. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bites and Stings

39. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bites and Stings

40. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Bites and Stings Marine-life bites and stings –Clean the wound site –Remove stingers, treat spines as impaled objects –Apply heat –Prevent movement of extremity

41. Limmer, First Responder: A Skills Approach, 7th ed. © 2007 by Pearson Education, Inc. Upper Saddle River, NJ Summary Cold emergencies can occur at any time of year A hypothermic patient in cardiac arrest is not dead until he or she is warm and dead Treat heat emergencies rapidly to prevent progression Stay safe while attempting to identify the source of a bite or sting Above all else, treat for deficits to airway, breathing, and circulation