Transcript Environmental Emergencies

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 90degrees)
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 waterrelated 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)
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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
Care:
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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
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
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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-ofwar, 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