Download Emergency Care for Frostbite

LESSON 15
ENVIRONMENTAL EMERGENCIES
© 2011 National Safety Council
15-1
Introduction
• Body temperature problems
occur when body becomes too
cold or too hot
• Cold- and heat-related injuries
can begin gradually but become
an emergency
• Cold or heat emergencies can
lead to serious injury or death
• Submersion in water can cause
a third type of environmental
emergency
© 2011 National Safety Council
15-2
Body Temperature
• Constant core body temperature necessary
• Body has several mechanisms to create or lose heat
• Mechanisms cannot maintain constant temperature when
exposed to temperature extremes for extended period
• Infants and elderly are more susceptible
© 2011 National Safety Council
15-3
Mechanisms For Staying Warm
• Metabolic processes – most body heat produced
this way
• Contraction of muscle tissue – including shivering
• Vasoconstriction – less radiation of heat away
from skin
© 2011 National Safety Council
15-4
Mechanisms For Staying Cool
• Vasodilation
- More warm blood to surface of skin to be radiated away
- Primary heat loss method
• Sweating – evaporation from skin surface cools body
© 2011 National Safety Council
15-5
Prolonged Exposure to Cold
• Especially when wet:
- The body cannot conserve heat
- Shivering cannot produce enough heat
• Hypothermia develops
• Organ systems gradually begin to fail, leading
eventually to death
© 2011 National Safety Council
15-6
Prolonged Exposure to Heat
• Body cannot maintain normal temperature
• Profuse sweating leads to dehydration
- Blood volume and blood pressure decrease
- Without fluid, body cannot cool itself
• With activity or exercise, body loses fluid quickly
• Heatstroke occurs when body temperature rises
• Without treatment, organ damage or death occurs
© 2011 National Safety Council
15-7
Heat and Cold
Injuries Risk Factors
• Young children
• Too much body fat
• Elderly
• Activity in extreme
environments
• Injuries
• Chronic health problems
• Mental impairment
• Environmental variables
(water immersion, wind
chill, humidity)
• Dehydration
• Too little body fat
© 2011 National Safety Council
• Medications and drugs
(including alcohol)
15-8
Hypothermia
• Occurs when body cannot make heat as fast as it
loses it
• Body temperature <95°F
• Can occur whenever and wherever person feels cold
• Progressive
• May occur gradually or quickly
• About 600 people die each year in United States
© 2011 National Safety Council
15-9
Hypothermia with Obvious or
Subtle Exposure to Cold
• Obvious cases involve exposure in cold environment
• Duration of exposure and exposed skin or thin clothing
increases risk
• More subtle cases may occur with underlying illness,
overdose, poisoning or an elderly patient in a cool home
© 2011 National Safety Council
15-10
Signs and Symptoms
of Hypothermia
• Pale, cool skin  even under clothing
• Slow breathing
• Uncontrollable shivering (may stop in severe hypothermia)
• Decreasing mental status or motor function
• Patient seems apathetic, confused or irrational
• Lethargy, clumsy movements, drowsiness, dizziness
© 2011 National Safety Council
15-11
Signs and Symptoms
of Hypothermia (continued)
• Memory disturbances or confusion
• Reduced or loss of touch or sensation
• Speech difficulty
• Poor judgment
• Stiff or rigid posture, muscular rigidity, joint or
muscle stiffness
© 2011 National Safety Council
15-12
Early Signs and Symptoms
of Hypothermia
• Shivering
• Numbness
• Lethargy
• Poor coordination
• Slurred speech
• Infants may have bright red skin and little energy
Take early action to prevent progression!
© 2011 National Safety Council
15-13
Late Signs and Symptoms
of Hypothermia
• Shivering typically stops
• Patient may not feel cold
• Breathing becomes shallow, pulse slows
• Mental status deteriorates
• Patient may become unresponsive and stop breathing
© 2011 National Safety Council
15-14
Emergency Care for
Hypothermia
• Perform standard patient care
• Remove patient from cold environment immediately
• Protect from further heat loss
• Remove wet clothing, cover with warm blankets
• Have patient lie down, handle gently
• Follow local protocol for oxygen
• Don’t allow patient to walk or exert self
• Don’t give patient any food or drink
© 2011 National Safety Council
15-15
Emergency Care for
Hypothermia (continued)
• Don’t allow patient to use stimulants such as caffeine
or nicotine
• Don’t massage skin or extremities
• Don’t immerse patient in hot water
• Don’t use direct heat
• Assess unresponsive patient for pulse for 30-45 seconds
before CPR
• Follow local protocol to use AED as usual
© 2011 National Safety Council
15-16
Remote Location
Emergency Care
• Only if patient is far from medical care, use active
rewarming
• Put patient near heat source or put warm water in
containers against skin
© 2011 National Safety Council
15-17
Frostbite
• Freezing of skin or deeper
tissues
• Usually clear demarcation of
area of injury
• More common in exposed
skin areas (head, hands, feet)
• Wind chill increases risk
• Severe frostbite kills tissue
and can result in gangrene
and need for amputation
© 2011 National Safety Council
15-18
Signs and Symptoms
of Frostbite
Early or superficial frostbite:
• Skin color doesn’t return after palpation
• Skin remains soft
• Area is numb, tingles or aches when rewarmed
© 2011 National Safety Council
15-19
Severe Frostbite
• Skin looks waxy, white,
gray, yellow or bluish
• Area feels firm or frozen
hard on palpation
• Swelling or blisters
© 2011 National Safety Council
15-20
Severe Frostbite
• Affected area may
become painless
• After warming, area
becomes:
- Swollen
- Blistered and flushed
- Mottled and cyanotic
© 2011 National Safety Council
15-21
(continued)
Emergency Care for Frostbite
• Perform standard patient care
• Remove patient from environment
• Remove wet or constrictive clothing
• Protect patient from further heat loss
• Handle patient very gently
• Have patient rest and avoid movement or exertion
• Check for hypothermia
• Protect cold-injured area from further injury
© 2011 National Safety Council
15-22
Emergency Care for Frostbite
(continued)
• For early or superficial injury:
- Manually stabilize and cover extremity
- Do not rub or massage area
- Prevent another exposure to cold
• For late or deep cold injury:
- Remove jewelry and tight-fitting clothing
- Put dry gauze between frostbitten fingers or toes
- Protect and elevate area
© 2011 National Safety Council
15-23
Emergency Care for Frostbite
(continued)
• Do not:
- Break blisters
- Rub or massage area
- Apply heat
- Rewarm area
- Allow patient to walk on affected extremity
- Give food or drink
- Allow tobacco use
© 2011 National Safety Council
15-24
Rewarming Frostbite
• If help is delayed, rewarm
severe frostbite by immersing
area in lukewarm (not hot)
water for 20-30 minutes
 Do this only if there is no
risk of refreezing
 Never apply a direct heat
source
© 2011 National Safety Council
15-25
Heat Emergencies
• Heat exhaustion
- Develops when body becomes dehydrated
- Can progress to heatstroke
• Heatstroke
- Medical emergency
- If untreated, can cause death
© 2011 National Safety Council
15-26
Heat Emergencies
(continued)
• Most occur during hot weather but can also occur in hot
settings (furnace room, factory, vehicle)
• Average 400 deaths/year in United States
• Heatstroke is progressive  starts with milder symptoms
• Recognize signs and symptoms early and treat
© 2011 National Safety Council
15-27
Signs and Symptoms of
Heat Exhaustion
• Early signs and symptoms:
- Sweating, pale/ashen moist skin
- Thirst
- Fatigue, weakness, exhaustion
- Muscle cramps
• Later signs and symptoms
- Headache, dizziness, fainting
- Nausea, vomiting
- Fast, shallow breathing
- Rapid heart rate
© 2011 National Safety Council
15-28
Emergency Care for
Heat Exhaustion
1. Move patient from heat to
rest in cool place
2. Loosen or remove clothing
3. Give sports drink or water
4. Raise legs 6-12 inches
5. Cool patient
© 2011 National Safety Council
15-29
Emergency Care for
Heat Exhaustion (continued)
• Cool patient with one of these methods:
- Put wet cloths on forehead and body
- Sponge skin with cool water
- Spray skin with water from spray bottle and then fan area
(ineffective in high humidity)
• Do not give salt tablets
• If patient is lethargic, nauseous or vomiting, do not give liquids
• Seek medical care if condition worsens or does not improve in
30 minutes
• Seek urgent medical attention if patient has heart condition or
high blood pressure
© 2011 National Safety Council
15-30
Heatstroke vs. Heat Exhaustion
Heatstroke
Heat Exhaustion
• Patient’s skin is flushed
and feels hot to touch
• Skin may be pale, or
ashen, and clammy
• Patient becomes confused
and irrational and may
become unresponsive or
have convulsions
• Patient dizzy or tired or
may be irritable and
have a headache
© 2011 National Safety Council
15-31
Signs and Symptoms
of Heatstroke
• Skin is flushed, dry, hot
• Sweating usually has stopped
• Fast breathing
• Headache, dizziness, extreme confusion, other signs of
altered mental status
• Irrational or belligerent behavior
• Possible convulsions or unresponsiveness
© 2011 National Safety Council
15-32
Emergency Care for Heatstroke
• Perform standard patient care
• Move to cool place
• Remove outer clothing
• Cool quickly with any means at hand
• Follow local protocol for oxygen
• Cool until temperature drops to 101°F (38.3°C)
• Do not apply rubbing alcohol to skin
© 2011 National Safety Council
15-33
Emergency Care for Heatstroke
(continued)
Cool quickly using one or more of these techniques:
• Immerse patient up to neck in cold water
• Spray skin with water and then fan (ineffective in
high humidity)
• Wrap patient in wet sheet and keep it wet
• Sponge patient with cold water
• Put ice bags or cold packs beside neck, armpits and
femoral pressure point area near groin
© 2011 National Safety Council
15-34
Emergency Care for Heatstroke
(continued)
• No pain relievers or salt tablets
• No caffeine or alcohol
• No liquids if nauseous, vomiting, diminished mental
status
• Monitor patient and provide needed care
• Put unresponsive patient in recovery position if
breathing normally
• Assist patient with ventilation if breathing is inadequate
© 2011 National Safety Council
15-35
Submersion Injury
• Drowning occurs when airway is surrounded by water
or another liquid that prevents breathing
• About 3,700 people die each year from drowning in
United States
• For every child who dies from drowning, 4 more
receive emergency care for submersion injury
• Often results in permanent disabilities and brain
damage
© 2011 National Safety Council
15-36
Drowning Patients
• Begin rescue breaths as soon as possible
• If possible, begin rescue breaths still in shallow water
• Must remove patient from water to give CPR
• If cause of incident is unknown, assume patient may
have spinal injury
• Keep head in line with body when moving or
positioning patient
• Use jaw thrust to open airway
© 2011 National Safety Council
15-37
Assessing Submersion Injury
• Perform standard assessment
• Severity of patient’s condition depends on duration of
submersion and other factors
© 2011 National Safety Council
15-38
Signs and Symptoms of
Submersion Injury
• Patient may still be responsive or may have
become unresponsive
• Coughing
• Vomiting
• Difficulty breathing
• Respiratory arrest
• Cardiac arrest
© 2011 National Safety Council
15-39
Emergency Care for
Submersion Injury
• Perform standard patient care
• If patient is still in water, maintain your personal safety
• If spinal injury suspected, manually stabilize patient’s neck
and spine
• If patient is breathing normally, place in recovery position
• Follow local protocol for oxygen
• If patient is not breathing normally, first open airway and
give 2 rescue breaths, then quickly check for pulse
© 2011 National Safety Council
15-40
Emergency Care for
Submersion Injury (continued)
• If patient has pulse but is still not breathing normally,
continue rescue breathing
• If patient does not have pulse, give CPR immediately –
begin with chest compressions
• Because of high risk for vomiting, be prepared to roll
patient on side and to suction mouth
© 2011 National Safety Council
15-41