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Transcript
CHAPTER 22
Environmental
Emergencies
Thermoregulatory
Emergencies
Thermoregulatory emergency:
An increase or decrease in the
temperature of the body or body
part that results in an injury.
Temperature Regulation
in the Body
The body performs a delicate
balancing act between the heat
generated in the body
and the heat lost from it.
Types of
Heat Loss
Convection
Respiration
Conduction
Radiation
Evaporation
Heat loss occurs during
respiration - when the
body warms and
humidifies the air.
Maintenance of Body Temp

Falling body temperature



Peripheral blood vessels constrict
Muscles produce heat through shivering
Rising body temperature


Blood vessels dilate
Sweat glands produce moisture
The body also
produces heat
by shivering.
Ambient temperature affects
how the body maintains its
temperature.
This results from the combined
effects of wind and humidity.
Exposure to
the Cold
Extreme weather conditions can
produce a variety of cold emergencies.
Hypothermia:
A condition in which the core body
o
o
temperature falls below 35 C (95 F)
and the body’s normal functions are
impaired.
Caused by prolonged
exposure to cold.
The most common cause of
generalized hypothermia is
exposure to a cold
environment.
Factors that Contribute
to Hypothermia

Cold environments

Immersion or submersion in water

Age (the very young and the elderly)

Alcohol

Shock (hypoperfusion)

Some medications and poisons
Factors that Contribute
to Hypothermia continued


Medical conditions

Diabetes and hypoglycemia

Metabolic and infectious processes
Trauma

Hypovolemia or shock

Head injuries

Spinal cord injuries

Burns
Alcohol use is a complicating factor in
many hypothermic patients.
Mental & Motor Function
Changes caused by Hypothermia

Dizziness and poor coordination

Altered mental status


Memory disturbances

Poor judgement

Mood changes
Communication and speech
difficulties
Mental & Motor Function Changes
caused by Hypothermia continued

Stiffness/rigid posture

Reduced or absent sense of
touch

Changes in vital signs

Joint or muscle pain
Vital Signs in Hypothermia
SIGN
EARLY
LATE
Pulse
Rapid
Slow & barely
palpable
Blood
Pressure
Normal
Low or absent
Breathing
Rapid
Shallow, slow
or absent
Skin
Red
Pale, cyanotic
Stiff & hard
Pupils
Reactive
Sluggish
Focused Assessment

What was the source of the cold?

If water, what was the temperature?

What were the general environmental
conditions like?

Did the patient experience a loss of
consciousness?

Are the effects general or local?
Hypothermia Treatment

Remove the patient from the cold
environment and protect from heat loss

Remove any cold or wet clothing, and
cover the patient with blankets

Handle the patient with care, and avoid
rough handling

Warm the patient compartment of the
ambulance as much as possible
Hypothermia Treatment
continued

Apply high-flow oxygen; warmed and
humidified if possible

Use no stimulants such as caffeine or
alcohol

Do not massage the extremities

Check for a pulse for 30 - 45 seconds
before starting CPR
Do not attempt to actively warm
hypothermic patients who have a
decreased level of consciousness...
...simply prevent further
heat loss.
Care for Hypothermia with
No Signs of Life

Ensure a patent airway

Ventilate the patient with 100%
oxygen

Begin CPR if no pulse for 30 - 45
seconds

Use the AED according to local
established protocols, or call medical
direction
Local cold injuries result from
decreased blood flow to, or
freezing of, a body part.
These injuries are often called
frostbite or frostnip.
Local cold injury after thawing.
Frostbite
Early or Superficial Cold Injury

Pale skin with delayed capillary refill

Loss of feeling/sensation in
injured area

Skin still soft

Tingling sensation when rewarmed
Late or Deep Cold Injury

White or waxy skin appearance

Firm or frozen skin presentation

Swelling and blister formation

Loss of sensation in injured area

If thawed, skin may be purple and
pale
Care for Local Cold Injuries

Remove patient from cold environment

Protect the cold extremity from injury

Administer oxygen

Remove wet or restrictive clothing and
all jewelry

Splint if extremity involved, and cover
with dry, sterile dressing
Place dressings
between those
fingers affected
by local cold
injury.
Never
re-expose the area to cold,
break blisters, rub or
massage the area, apply
heat, or allow the patient to
use the affected area.
In a cold emergency,
if transport time will be long:

Immerse the affected part in warm water
(102o - 104o F)

Continuosly stir and add warm water to
maintain temperature

Continue immersion until the area is soft and
color and sensation return

Pat gently and dress with dry, sterile
dressings

Protect the injured area from refreezing

Refer to local protocols for other treatment
Exposure to Heat
Hyperthermia:
A condition in which the core body
temperature exceeds normal limits
and starts to malfunction.
Caused by exposure to heat.
Predisposing Factors for
Heat Emergencies

Hot, humid weather

Vigorous physical activity

Age (the very young and the elderly)

Medical conditions



Diabetes
Heart disease
Fever
Predisposing Factors for
Heat Emergencies continued

Dehydration

Obesity

Fatigue

Drugs and medications

Previous history of hyperthermia
Working in a hot environment
can result in a heat emergency.
Signs and Symptoms of
Hyperthermia

Muscle cramps

Weakness or exhaustion

Dizziness or fainting

Rapid, bounding pulse

Altered mental status

Moist, pale, cool, hot or normal skin

Nause, vomiting and abdominal cramps
Care for Hyperthermia with Moist,
Pale, Cool or Normal Skin (Heat Exhaustion)

Remove patient from hot environment

Administer oxygen

Loosen or remove clothing

Cool the patient by fanning

Place responsive patient supine with legs
elevated; if vomiting, place on side

If no nausea, provide cool water to drink
Remove patients
from the hot
environment and
allow them to
cool off.
Care for Hyperthermia with Hot,
Dry Skin (Heat Stroke)

Remove patient from hot environment

Remove clothing and administer
oxygen

Apply cold to neck, groin and armpits

Moisten patient’s skin with wet towels

Fan the patient aggressively

Transport patient immediately
Severe hyperthermia can lead
to cardiac arrest.
Drowning and Near
Drowning
Water-related Emergencies:
Drowning is death following
submersion in water.
Near-Drowning is survival (either
short or long term) following
submersion in water.
Water rescue requires specialized
training - NEVER ENDANGER
yourself or others by attempting
something you are not trained to
do.
Water Rescue with Spinal
Immobilization
Care of the Near Drowning Patient

Immobilize spine if trauma is suspected

Ensure adequate airway, provide oxygen
and ventilate if necessary

Provide CPR if pulseless
(use AED if allowed by local protocols)

Suction as needed

If no trauma, place patient on left side

Transport immediately
DO NOT attempt to relieve
gastric distention unless it
interferes with ventilation.
There is significant risk of
aspiration.
Bites and Stings
Creatures that Bite and Sting
Signs & Symptoms
of Bites and Stings
Rash,
redness
Headache,
dizziness
Local pain,
swelling
Nausea,
vomiting
Fever and chills may
also follow the bite
or sting.
Bite
marks
Care of Bites and Stings

Ensure adequate ABC’s

Inspect the site for stinger or bite marks

Wash the area gently

Remove jewelry from injured area

If extremity, position just below level of
heart

If snakebite, consult medical direction

Watch for development of allergic
reaction
SUMMARY

Thermoregulatory Emergencies

Drowning and Near-Drowning

Bites and Stings