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Paramedic Care: Principles & Practice Volume 3 Medical Emergencies Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 10 Environmental Emergencies Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Topics Homeostasis Pathophysiology of Heat and Cold Disorders Heat Disorders Cold Disorders Drowning Diving Emergencies High Altitude Illness Nuclear Radiation Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Introduction Environment – All of the surrounding external factors that affect the development and functioning of a living organism – Necessary to life – Extremes of environment cause emergencies Hypothermia, drowning, altitude sickness, nuclear radiation, and diving accidents or barotraumas Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Introduction Risk Factors – – – – – Age Poor General Health Fatigue Predisposing Medical Conditions Medications You need to be familiar with the specialized rescue resources these situations may require. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Homeostasis Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Homeostasis Process of maintaining constant suitable conditions within the body – Various body systems respond Maintain the correct core and peripheral temperature Oxygen level Energy supply Certain environmental conditions exceed the ability of the body to compensate Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology of Heat and Cold Disorders Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology of Heat and Cold Disorders Mechanisms of Heat Gain and Loss – Thermal Gradient Difference in temperature between the environment and the body If environment is warmer than the body, heat flows from the environment to the body If environment is cooler than the body, heat leaves body to the environment – Other Factors Wind Relative humidity Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology of Heat and Cold Disorders Thermogenesis – The amount of heat in the body continually fluctuates – The body gains heat from both external and internal sources – The creation of heat is called thermogenesis Work-induced Thermoregulatory Hormone induced Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology of Heat and Cold Disorders Thermolysis – – – – – Conduction Convection Radiation Evaporation Respiration Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology of Heat and Cold Disorders Thermoregulation – Body Temperature Core temperature Peripheral temperature – The Hypothalamus – Heat Dissipation Sweating, vasodilation – Heat Conservation Shivering, vasoconstriction Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology of Heat and Cold Disorders Thermoregulation (cont.) – Thermoreceptors Peripheral thermoreceptors Skin and certain mucous membranes Central thermoreceptors Deep tissues of the body Cold receptors outnumber warm receptors – Metabolic Rate Basal metabolic rate Exertional metabolic rate – Core temperature measurement Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Heat Disorders Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Heat Disorders Hyperthermia – Signs of thermolysis Diaphoresis, increased skin temperature – Signs of thermolytic inadequacy Altered mentation or altered level of consciousness – Manifestations Heat cramps Heat exhaustion Heat stroke Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Heat Disorders Predisposing Factors – Age of the Patient – Health of the Patient – Medications Diuretics, beta-blockers, psychotropics, and antihistamines – Level of Acclimatization – Length and Intensity of Exposure – Environmental Factors Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Heat Disorders Preventive Measures – Maintain adequate fluid intake – Allow time for gradual acclimatization – Limit exposure to hot environments Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Heat (Muscle Cramps) Caused by overexertion and dehydration in the presence of high atmospheric temperatures Signs and Symptoms – Cramps in the fingers, arms, legs, or abdominal muscles – Mentally alert with a feeling of weakness, dizziness, or syncope – Body temperature may be normal or slightly elevated – Skin is likely to be moist and warm Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Heat (Muscle Cramps) Management – Remove the patient from the environment – Administer an oral saline solution IV may be necessary © Scott Metcalfe Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Heat Exhaustion Considered to be a mild heat illness Dehydration and sodium loss due to sweating account for the presenting symptoms – History of high environmental heat Signs and Symptoms – Cool and clammy skin with heavy perspiration, breathing that is rapid and shallow, and a weak pulse – Headache, anxiety, paresthesia, and impaired judgment or even psychosis Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Heat Exhaustion Management – Remove the patient from the environment – Place the patient in a supine position – Administer an oral saline solution IV, if necessary – Remove some clothing and fan the patient – Treat for shock © Scott Metcalfe Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Heatstroke The body’s hypothalamic temperature regulation is lost, causing uncompensated hyperthermia – Causes cell death and damage to the brain, liver, and kidneys Classic Heatstroke Exertional Heatstroke Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Heatstroke Signs and Symptoms Cessation of sweating Hot skin that is dry or moist Very high core temperature Deep respirations that become shallow, rapid at first but may later slow Rapid, full pulse, may slow later Hypotension with low or absent diastolic reading Confusion or disorientation or unconsciousness Possible seizures Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Heatstroke Management – Remove the patient from the environment – Initiate rapid active cooling Target of 102°F (39°C) – – – – Administer oxygen Administer fluid therapy Monitor the ECG Avoid vasopressors and anticholinergic drugs – Monitor body temperature © Scott Metcalfe Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Heat Disorders Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Role of Dehydration in Heat Disorders Close Relationship to Heat Disorders – Dehydration prevents thermolysis Signs and Symptoms – Nausea, vomiting, and abdominal distress – Vision disturbances, decreased urine output – Poor skin turgor and signs of hypovolemic shock Treatment – Oral fluids if the patient is alert and oriented – IV fluids if the patient has an altered mental status or is nauseated Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Fever (Pyrexia) Pyrogens Differentiating fever from heatstroke – Usually a history of infection or illness with a fever Cooling the fever patient – Consider antipyretic medication Acetaminophen or ibuprofen – Avoid sponge baths May cause a rapid drop in the body core temperature Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Cold Disorders Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Cold Disorders Hypothermia – Core temperature of the body drops below 95°F (35°C) – Can be attributed to inadequate thermogenesis, excessive cold stress, or a combination Mechanisms of Heat Conservation and Loss – Piloerection, shivering and increased muscle tone, vasoconstriction, increase in cardiac output and respiratory rate – Conduction, convection, radiation, evaporation, and respiration Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Cold Disorders Predisposing Factors – – – – – Age of the Patient Health of the Patient Medications Prolonged or Intense Exposure Coexisting Weather Conditions Preventive Measures – Dress warmly and ensure plenty of rest – Eat appropriately or at regular intervals – Limit exposure to cold environments Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Cold Disorders Degrees of Hypothermia – Mild Core temperature greater than 90°F (32°C) – Severe Core temperature less than 90°F (32°C) – Compensated Hypothermia Signs and symptoms of hypothermia will be present but with a normal core body temperature Core temp will drop as compensation stops Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Hypothermia Signs and Symptoms Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Hypothermia ECG – Pathognomonic J waves (Osborn waves) – Eventual onset of bradycardia – Ventricular fibrillation probable below 86ºF Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Hypothermia Treatment – Remove wet garments – Protect against further heat loss and wind chill Use passive external warming methods such as application of blankets, insulating materials, and moisture barriers – Maintain the patient in a horizontal position – Avoid rough handling, which can trigger dysrhythmias – Monitor the core temperature – Monitor the cardiac rhythm Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Hypothermia Management Click here to view the Hypothermia Management diagram. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Hypothermia Resuscitation Considerations – BLS Perform pulse and respiration checks for longer periods Administer a single shock at 360 Joules (or the biphasic equivalent) Follow with CPR, rewarming, and rapid transport – ACLS Intubate and administer a single shock at 360 joules (or the biphasic equivalent Establish IV access, begin rewarming, and transport rapidly – Avoid further resuscitation until the core temperature is above 86ºF Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Frostbite Superficial Frostbite – Freezing of epidermal tissue – Redness followed by blanching and diminished sensation Deep Frostbite – Freezing of epidermal and subcutaneous layers – White, frozen appearance Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Frostbite Treatment – Do not thaw the affected area if there is the possibility of refreezing – Do not massage the affected area – Administer analgesia prior to thawing – Rewarm by immersion only if transport is lengthy or delayed Cover the thawed part with a loose, sterile dressing. Elevate and immobilize the thawed part – Do not puncture or drain blisters – Do not rewarm feet if walking will be required Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Trench Foot Trench Foot – Occurs above freezing Typically occurs from standing in cold water – Symptoms are similar to frostbite Pain may be present, and blisters may form with spontaneous rewarming – Treatment: Warm, dry, and aerate the feet Prevention is the best treatment Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Drowning Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Drowning A drowning is an incident in which someone is submersed or immersed in a liquid that results in a primary respiratory impairment. 4,500 persons die annually Associated factors – Trauma – Hypothermia Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Drowning Pathophysiology – Following submersion, the victim will undergo a period of complete apnea for up to 3 minutes – Dry vs. Wet Drowning Gasping stimulates laryngospasm Prevents the influx of water into the lungs Dry drowning If no laryngospasm Wet drowning Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Drowning Pathophysiology (cont.) – Drowning is primarily due to asphyxia from airway obstruction. Coma ultimately ensues – Hypotension, bradycardia, and death result – Fresh vs. saltwater drowning Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Fresh vs Saltwater Drowning Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Drowning Factors Affecting Survival – – – – Cleanliness of Water Length of Time Submerged Victim’s Age and General Health Water Temperature Cold-water drowning Mammalian diving reflex The cold-water drowning patient is not dead until he is warm and dead Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Drowning Treatment – Remove the patient from the water Attempt rescue only if properly trained and equipped – Initiate ventilation while the patient is still in the water – Suspect head and neck injury if the patient experienced a fall or was diving – Protect the patient from heat loss – Evaluate ABCs Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Drowning Treatment (cont.) – Manage the airway using proper suctioning and airway adjuncts. – Administer oxygen at 100% concentration. – Use respiratory rewarming, if available. – Establish IV of lactated Ringer’s or normal saline at 75 mL/hr. – Follow ACLS protocols if the patient is normothermic. Treat hypothermic patients according to hypothermia guidelines. Adult Respiratory Distress Syndrome Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Diving Emergencies Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Diving Emergencies Scuba – Popular recreational sport The Effects of Air Pressure on Gases – Boyle’s Law The volume of a gas is inversely proportional to its pressure if the temperature is kept constant – Dalton’s Law The total pressure of a mixture of gases is equal to the sum of the partial pressures of the individual gases – Henry’s Law The amount of gas dissolved in a given volume of liquid is proportional to the pressure of the gas above it Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Diving Emergencies Pathophysiology of Diving Emergencies – Increased dissolution of gases during descent due to Henry’s law – Boyle’s law dictates that these gases have a smaller volume – In a controlled ascent, the process is reversed and the gases escape through respiration – A rapid ascent causes gases to come out of solution quickly Forming gas bubbles in the blood, brain, spinal cord, skin, inner ear, muscles, and joints Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Diving Emergencies Classification of Diving Emergencies – Injuries on the Surface – Injuries During Descent Barotrauma – Injuries on the Bottom Nitrogen narcosis – Injuries During Ascent Decompression illness Pulmonary overpressure and subsequent arterial gas embolism, pneumomediastinum, or pneumothorax Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Diving Emergencies General Assessment of Diving Emergencies – – – – Time at which signs and symptoms appeared Type of breathing apparatus used Type of hypothermia-protective garment worn Parameters of the dive Number of dives, depth, and duration – Aircraft travel following a dive Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Diving Emergencies Factors to Assess – Rate of ascent Associated with panic forcing a rapid ascent – – – – – – Inexperience of the diver Improper functioning of depth gauge Previous medical diseases Old injuries Previous episodes of decompression illness Use of alcohol or medications Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pressure Disorders Decompression Illness – May occur with dives of 33’ or more – Signs and Symptoms Occur within 36 hours Joint/abdominal pain Fatigue, paresthesias, and CNS disturbances – Treatment © Gregory G. Dimijian/Photo Researchers, Inc. Recompression Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Decompression Illness Treatment – Assess ABCs and begin CPR if required – Administer high-flow, high-concentration oxygen and intubate if indicated – Maintain supine position – Protect the patient from heat, cold, wetness, or noxious fumes – Transport and establish IV access Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Decompression Illness Consult with medical direction regarding administration of dexamethasone, heparin, or diazepam if CNS is involved If air evacuation is used, maintain cabin pressure at sea level or fly at the lowest possible altitude Send diving equipment with the patient for analysis if possible Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pressure Disorders Pulmonary Overpressure Accidents – Can occur in depths as shallow as 6’ – Signs and Symptoms Substernal chest pain with associated respiratory distress and diminished breath sounds – Treatment Treat as a pneumothorax Provide rest and supplemental oxygen Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pressure Disorders Arterial Gas Embolism – Signs and Symptoms Onset is within 2–10 minutes of ascent There is dramatic onset of sharp, tearing pain Common presentation mimics a stroke; suspect AGE in any patient with neurological deficits immediately after ascent – Treatment Assess ABCs; provide high-flow, high-concentration oxygen Maintain a supine position; monitor vital signs frequently Establish IV access and consider administering corticosteroids Rapidly transport to a recompression chamber Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pressure Disorders Pneumomediastinum – Signs and Symptoms Substernal chest pain, irregular pulse, abnormal heart sounds, hypotension with a narrow pulse pressure, and a change in voice – Treatment Provide high-flow, high-concentration oxygen Establish IV access Transport for further evaluation Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pressure Disorders Nitrogen Narcosis – Occurs During a Dive Can contribute to accidents during the dive – Signs and Symptoms Altered levels of consciousness and impaired judgment – Treatment Return to shallow depth Use oxygen/helium mix during dive Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Diving Emergencies Other Diving-Related Emergencies – Oxygen Toxicity – Hypercapnia Diver’s Alert Network – Consultation and Referrals (919) 684-8111 Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ High-Altitude Illness Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ High-Altitude Illness Manifestation – Altitudes above 8,000 feet Prevention – – – – – Ascend gradually Limit exertion Descend for sleep Eat a high-carbohydrate diet Medications: Acetazolamide and nifedipine Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ High-Altitude Illness Types of High-Altitude Illness – Acute Mountain Sickness Mild cases include lightheadedness, breathlessness, weakness, headache, nausea, and vomiting Severe cases include weakness, severe vomiting, decreased urine output, shortness of breath, and an altered level of consciousness Treatment includes halting of ascent or descent, use of acetazolamide and antinausea drugs, and supplemental oxygen Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ High-Altitude Illness High-Altitude Pulmonary Edema (HAPE) – Mild symptoms include dry cough, shortness of breath, and slight crackles in the lungs – Severe cases develop cyanosis, dyspnea, frothy sputum, weakness, and possibly coma or death – Treatment Includes descent and supplemental oxygen, or portable hyperbaric bag Medications such as acetazolamide, nifedipine, and lasix may be useful also Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ High-Altitude Illness High-Altitude Cerebral Edema – Usually occurs as progression of AMS or HAPE – Symptoms include altered mental status, ataxia, decreased level of consciousness, and coma – Treatment includes descent and supplemental oxygen, or portable hyperbaric bag Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Nuclear Radiation Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Nuclear Radiation Personal Safety – Only appropriately trained and equipped personnel should handle radiation emergencies Basic Nuclear Physics – Atoms Protons, neutrons, and electrons – Isotopes and Half-Life Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Nuclear Radiation Ionizing Radiation – – – – Alpha particles Beta particles Gamma rays Neutrons Effects of Radiation on the Body – Detection of Radiation RAD and REM – Acute and Long-Term Effects Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Nuclear Radiation Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Nuclear Radiation Principles of Safety – – – – Time Distance Shielding Clean Accidents Patient is exposed but not contaminated – Dirty Accidents Patient is contaminated by radioactive particles, liquids, gases, or smoke Click here to view the Nuclear Radiation illustration. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Nuclear Radiation Management – Park upwind – Look for signs of radioactive exposure – Use portable instruments to detect radioactivity – Normal emergency care principles should be applied Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Nuclear Radiation Management (cont.) – Externally radiated and internally contaminated patients pose little danger Externally contaminated patients require decontamination – Internally contaminated patients pose little danger to rescue personnel Explosion at Chernobyl in 1986. ( Landov LLC) Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Summary Homeostasis Pathophysiology of Heat and Cold Disorders Heat Disorders Cold Disorders Drowning Diving Emergencies High-Altitude Illness Nuclear Radiation Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ