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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: – – – – – – 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 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 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 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: – – – – 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