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Chapters 25, 26 & 27: Environmental Emergencies: Cold, Heat, Lightning, Plants and Animals Tom Crocker Fall 2011 Hypothermia Body temperature progressively falls All body functions diminish or slow Hypothermia Primary Hypothermia: Due to environmental exposure Falling in a cold lake Secondary Hypothermia Associated with other trauma in a cold environment Afterdrop Continued drop in body temp even after treatment (Typical) Progression of Hypothermia Mild (93.2 - 95°F) Shivering, stumbling, mumbling, weakness, difficulty speaking, mild confusion Moderate (86° - 93.2°F) Shivering ceases, muscles become stiff, unable to stand or walk, impaired responsiveness, slow breathing and pulse Severe (< 86°F) Unresponsive, no pulse, very slow breathing, cardiac arrest (ventricular fibrillation) death Hypothermia Treatment “No one is dead until they are warm and dead” Mild Tx: Shivering, body-to-body contact, heating devices, hot tub, warm liquids (no caffeine) Moderate/Severe Tx: Gentle, prevent further cooling, rewarm slowly with active heat source, no CPR (VFib), transport Monitor – Temp Who to watch for… Skiers on stalled chairlifts Ski racers/gate keepers Event spectators All patients Other patrollers Cold Injuries Parts of the body become very cold or frozen Extremities (feet, ears, ears, nose, and face) are particularly susceptible Frostnip Very cold – Not frozen Most common S/S: Gray or yellowish skin, tingling, pain, numbness Tx: Direct body heat Frostbite Freezing of a body part Partial Thickness: only skin Full Thickness: skin, tissues, muscles, tendons, and bones freeze Normally hands or feet Treatment of Frostbite Consider hypothermia Rapidly rewarm Water 102°-108°F 20 – 30 minutes Painful Transport Do not let it refreeze Heat Exposure Heat Syncope Inadequate perfusion Temporary fainting Tx: Remove from heat, elevate legs, O2, cool water Heat Cramps Dehydration Muscular cramps Tx: salt water, massage, rest Heat Exposure Heat Exhaustion (<104°F) Dizziness, nausea, headache, cramping, dehydration due to hypovolemia (excessive sweating) Tx: Remove from heat, elevate legs, rehydrate with salt water, loosen clothing, O2 Heat Stroke (>104°F) High HR & RR, Decreased LOR Tx: Same, remove clothes, water and fan the skin, icepacks (armpits & groin), rapid transport Signs/Symptoms of Heat Emergencies Weakness/Exhaustion Hot Skin Muscle Cramps Headache Seizures Rapid Breathing Nausea Sweating Lightning Signs/Symptoms Respirator and cardiac arrest No breathing but irregular heart rhythm Severe tissue damage Entry and exit wounds Treatment Scene safety, safe to touch the patient, c-spine, CPR/AED, rescue breathing, O2 Toxin vs. Poison Toxin: from living creature Poison: from living creature or non-living substance Venom: toxin or poison specific to a certain animal Skin Toxic Plants Poison Ivy, Sumac, and Oak, Stinging Nettle Rashes, burns, blisters Ingestion Monkshood, Autumn Crocus, Foxglove, Rhododendron (azalea), Jimson weed Nausea, cardiovascular effects, shortness of breath, kidney failure, headache, dehydration, muscle spasms, diarrhea, delirium Tx: clean skin, transport for cases of ingestion Spiders Black widows Found under logs/stones in woods/fields Bull’s-eye or target appearance of bite Pain, swelling, nausea, abdominal pain, fever, sweating Brown Recluse Violin/fiddle shape on back, found under stones and backcountry toilets Prolonged stinging sensation (8 hours), tissue death Scorpions, Ticks, & Other Insects Scorpions Found in the Southwestern U.S. Severe pain lasting 24-72 hours Irregular cardiac rhythms, blurred vision, nausea, muscle spasms Ticks Live in wood piles, grass, on animals Painless bite, red rash around bite Lyme disease: flu-like symptoms and joint pain Tx: Scrape stinger with firm flat object, ice, epi-pen, transport Snake Bites Signs/Symptoms Burning pain, swelling, puncture wound, blood, tissue death, inability of blood clotting, paralysis, respiratory failure Treatment Rapid transport, wrap extremity proximal to distal to the fang mark with an elastic band, splint extremity, elevate to heart DON’T suck the poison out, no ice, limit physical exertion Marine Animals Sharks: eyes and gills!! Moray Eel: lives in coral reefs Stingray: think Crocodile Hunter Jellyfish: stinging chemicals Skin reactions, paralysis, respiratory, cardiac, and neurological distress Tx: wash skin with vinegar (30secs), immerse affected site in hot water, check with local healthcare personnel to standard procedures Mammals Bites, kicks, scratches, licks, hugs Treatment Clean wound, rapid transport, typical trauma treatment