Download Environmental Emergencies Fall 06

Environmental
Emergencies
Environmental Emergencies
 Cold
and heat exposures
 Drowning and near-drowning
 Diving emergencies
 Lightning strikes
 Bites and envenomations
Cold & Heat Emergencies
 Factors
that affect body temperature:
– Physical Condition
– Age
– Nutrition/hydration
– Environmental conditions
Body Heat Loss

Conduction
– Heat transfer form body to another object

Convection
– Heat transfer through circulating air

Evaporation
– Body cooling through sweating

Radiation
– Heat loss directly into the environment

Respirations
Body Heat Loss

Rate and amount of heat loss modified:
– Increasing heat production
– Move to a sheltered area where heat loss
is decreased
– Wearing insulated clothing
Exposure
Hypothermia

Body temperature below 95 degrees F
 Weather does not have to be below freezing
for hypothermia to occur
 Higher risks for geriatric and pediatric
patients
 People with other illnesses or injuries are at
increased risk
Mild Hypothermia
Core temperature between 90 – 95 F
 Signs and symptoms include:
– Shivering
– Rapid pulse and respirations
– Red, pale, cyanotic skin

Moderate to Severe
Hypothermia

Core temperature less than 90 F
 Signs and symptoms include:
–
–
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–
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Shivering stops
Muscular activity decreases
Mood changes, lethargy, impaired judgement
Stiff muscles, joints
Trouble speaking
Eventually, all muscle activity stops
Severe Hypothermia

Core temperatures below 80 F
 Signs and symptoms include:
– Decreased vital signs
– Shallow, absent respirations
– Cardiac arrhythmias
– Slow pupillary reaction
– Cessation of all cardiorespiratory activity
ALS Indicators

Decreased level of consciousness
 Temperatures less than 95 F
 Cessation of shivering
 Significant co-morbidities (age, illness)
 Cardiac arrest
 Hypotension
Patient Care

Remove patient from the cold environment
and protect from further heat loss
 O2 and/or ventilatory assist
 Remove wet clothing
 Position of comfort
 Warm the patient
 Monitor vital signs and temperature
Frostnip & Immersion Foot

Frostnip
– Freezing of the skin but not the deeper surface
– Usually not painful, but patient is aware

Immersion foot
– Also known as trench foot
– Caused by prolonged exposure of foot to cold
water
Frostbite

Serious local cold
injury
 Cellular damage
which can lead to
permanent
inflammation,
tenderness, cold
intolerance, or even
gangrene
Local Cold Injury Care

Remove patient from cold environment
 Protect cold-injured part from further injury
 Remove any constricting or wet clothing,
replace with dry bulky dressing
 Splint the injury, do not let patient walk or
use affected extremity
 Do not massage injury to re-warm!
Heat Exposure

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Normal body temperature is 98.6 F
Body attempts to maintain core temperature
despite ambient temperature
Cooling by seating and dilation of blood vessels
High temperatures and humidity decease the
effectiveness of cooling mechanism
Severity increase when core rises above 101 F
Risk Factors
 Newborns,
infants, children, and the
elderly
 Patients with heart disease, COPD,
diabetes, dehydration, obesity
 Patients with limited mobility
 Alcohol and drug use
Heat Cramps
 Painful
muscle spasms
 Remove patient from heat
 Rest the cramping muscle
 Re-hydrate
 Transport if cramps persist
Heat Exhaustion

Dizziness, weakness, fainting
 Dry tongue, mouth, increased thirst
 Cold, clammy skin
 Usually normal vital signs, but pulse can
increase
 Normal or slightly elevated body
temperature
Heat Stroke

Hot, flushed skin (not sweating)
 Change in behavior, decreased LOC leading
to unresponsiveness
 Rapid pulse then it slows
 Drop in blood pressure
 Death will occur if treatment not initiated
Heat Stroke vs. Exhaustion
ALS Indicators

Decreased or altered LOC
 Hot, dry skin in the presence of elevated
temperatures
 Sustained tachycardia
 Hypotension
 Positive postural changes
Patient Care

Medics?
 Remove patient from the hot environment,
place in cool place, position of comfort
 Cool patient with cold packs or wet
sheets/towels, fan aggressively
 O2, rehydrate
 Loosen or remove clothing
 Monitor vitals and temperature
Drowning and Near-drowning

Most are preventable
 Drowning
– Death as a result of suffocation after
submersion in water
 Near-drowning
– Survival, at least temporarily after
suffocation in water
Drowning Process

Panic, loss of control
 Decreased buoyancy
 Exhaustion
 Laryngospasms (diver’s reflex)
 Inefficient breathing
– CO2 retention, O2 deprivation

Cardiac or respiratory arrest
Drowning Types
Dry Lung
 15% of cases
 Small amount of
H20 aspirated
 Laryngospasm
occurs, closes
airway
 Patient asphyxiates
Wet Lung
 85% of cases
 Large amounts of
water enter lungs
 Fluid, electrolyte
imbalances occur
Wet Lung: Fresh Water

Water moves from alveoli to bloodstream to
red blood cells
 Hemodilution occurs causing cell rupture
– Potassium release causes arrhythmias
– Hemoglobin release causes renal failure

Loss of surfactant causes alveolar collapse
greatly diminishes O2 carrying ability
Wet Lung: Salt Water

Water moves from bloodstream to alveoli
 Hemoconcentration occurs resulting in
shock
 Pulmonary edema occurs
ALS Indicators

Any underwater rescue
 Altered or decreased LOC
 Respiratory distress, labored breathing
 Hypotension
 Hypothermia
 Significant co-morbidity
 Cardiac or respiratory arrest
Patient Care

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Medics?
C-spine precautions (suspect spinal injury)
Remove patient form water
Left, lateral recumbent position
O2, BVM, suctioning
Monitor vital signs, temperature
Follow resuscitation protocols if in arrest
All immersion incidents get transport to ED!
Diving Emergencies

Descent problems
– Usually due to the sudden increase in pressure
on the diving body, perforated eardrum

Bottom problems
– Not commonly seen (equipment problems)

Ascent problems
– Air embolism and decompression sickness
Air Embolism

Most common diving emergency and the
most dangerous
 Breath holding during rapid ascent
 Air pressure in lungs remains high while
external pressure decreases causing alveaoli
to rupture
 Pneumothorax, pneumomediastinum, air
emboli
Air Embolism

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Blotching
Froth at mouth and nose, dysphasia
Severe muscle, joint, abdominal pain
Dyspnea, chest pain
Dizziness, nausea, vomiting
Vision problems
Paralysis, coma
Irregular pulse or cardiac arrest
Decompression Sickness

Occurs when gas bubbles obstruct blood
vessels
 Rapid ascent, “the bends”
 Most commonly presents as abdominal or
joint pain
 Symptoms may develop hours later
 Treatment is hyperbaric chamber
Patient Care

Consider c-spine precautions
 Request medics!
 Maintain airway, O2 by NRM or BVM
 Position of comfort either supine or on side
to avoid cerebral edema
 Monitor vital signs and temperature
 Transport to hyperbariatric facility
Lightning Strikes

Estimated 25 million cloud-to-ground
strikes in the U.S. each year
 Third most common cause of death from
isolated environmental phenomena
 Most common strikes hit boaters, golfers,
swimmers, anyone in large, open areas
 Cardiac arrest and tissue damage
Lightning Strikes

Mild:
– Loss of consciousness, amnesia, tingling,
superficial burns

Moderate:
– Seizures, respiratory arrest, asystole
(spontaneously resolves), superficial burns

Severe:
– Cardiopulmonary arrest
Patient Care

Protect yourself
 Medics?
 Move patient to sheltered area or stay close
to ground
 Use reverse triage
 Treat for electrical injuries
 Transport
Bites and Envenomations

Spider bites
 Snakebites
 Scorpion stings
 Tick bites
 Injuries from marine animals
Snakebites

In the U.S. approximately 40,000 to 50,000
snakebites are reported
 7,000 bites from poisonous species
 Fatalities are very rare, about 15 per year
 19 species of venomous snakes in North
America, none found in Western WA
Venomous Snakes
Snakebite Risk Factors

Tequila
 Testosterone
 Tattoo
 Teeth (more missing = greater chance)
 Trailer park
 T-shirt (heavy metal band)
Signs and Symptoms

Severe burning at the bite site
 Swelling and bluish discoloration
 Bleeding at various distant sites
 Watch for:
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Weakness
Fainting
Sweating
Shock
Pit Viper Bites

Pain, swelling
 Progressive edema
 Bruising
 Blood-filled vesicles
Patient Care

Calm and reassure the patient
 Cleanse the bite area
 Do not apply ice or constricting bands
 Splint to minimize movement
 Nothing by mouth
 Monitor vital signs
 Snake to hospital for ID if it has been killed
Spiders, Scorpions, and Ticks
Spiders, Scorpions, and Ticks

10 year period only 63 deaths reported from
spider bites, only 2 from the brown recluse.
 Scorpion sting deaths even rarer as there is
only one deadly scorpion species.
 Tick bites can transmit Rocky Mountain
Spotted Fever or Lyme disease
Brown Recluse

Local signs/symptoms
– No pain or only mild
stinging
– Within 2 hours: Local
pain, blue-gray halo
– 12 to 18 hours: Bleb
formation, growing
ischemic zone
– 5 to 7 days: Aseptic
necrosis, necrotic ulcer
Patient Care
Transport!
Marine Animals
Marine Animals

Coelenterates are responsible for most
marine animal envenomations
 Nemocysts (stinging cells) contact can
result in painful, reddish lesions
 Symptoms include headache, dizziness,
muscle cramps, and fainting
Patient Care

Limit further discharge by minimizing
patient movement
 Inactivate nemocysts with alcohol
 Remove the remaining tentacles by
scrapping them off
 Transport