Environmental Emergencies

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Environmental Emergencies
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• Exposure to cold
• How the body loses heat
• Conduction
• Transfer of heat through direct contact
• Heat will flow from warmer to cooler
• Water conducts heat away from body 25 faster
  than still air

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• Convection
• When current of air or water passes over water
  carrying away heat
• Effects of a cold environment are worsened when
  moving water or air surround the body wind chill

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• Radiation
• Bodys atoms and molecules sent out rays of heat
  as they move and change
• Most radiant heat loss occurs from head and neck

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• Evaporation
• When the body perspires or gets wet. As the
  moisture vaporized.generalized cooling effect
• Respiration
• Heat loss through exhaled warm air

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• Generalized Hypothermia
• When cooling affects the entire body
• Predisposing factors
• Shock
• Burns
• Head and spinal cord injury
• Generalized infection
• Diabetes with hypoglycemia

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• Under the influence of alcohol
• Unconscious, lying on cold surface
• Geriatric failing health, chronic illness, poor
  diet, certain medications, and/or lack of
  exercise
• Pediatric Larger skin surface area and little
  body fat. Because of small muscle mass, children
  to not shiver much at all

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• Obvious and subtle exposure
• Possibility of hypothermia when another condition
  or injury may be more obvious
• ETOH
• Underlying illness
• Overdose or poisoning
• Major trauma
• Outdoor resuscitation

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• Decreased ambient temperature
• (room temperature)
• I.e. entrapped or must remain in cool/cold
  environment
• Create a barrier with blankets or such
• Remove wet clothing when possible
• Cover the head

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• Patient Assessment
• Signs and symptoms
• Shivering (core temp is above 90 degrees)
• decreased or absent is severe cases
• Numbness or reduced-to-lost sense of touch
• Stiff or rigid posture
• prolonged cases

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• Drowsiness and/or unwillingness or inability to
  do even the simplest activities
• Tachapnea and Tachycardia (early)
• Bradyapnea and bradycardia (prolonged cases)
• Loss of motor sensation
• staggering, inability to hold things

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• Joint/muscle stiffness or muscle rigidity
• Decreased loc/unconscious, could have glassy
  stare
• Cool abdominal skin temperature
• Skin red in early stages
• pale to cyanotic in prolonged stages

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• Passive and Active Rewarming
• Passive Rewarming
• Warms self
• Cover and place warm barrier between pt. and
  surface
• Remove wet clothing

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• Active Rewarming
• Application of external heat source
• Follow local protocol

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• Patient Care
• A O x4/GCS 15
• Remove wet clothing
• Wrap and keep warm
• Keep still no activity or exertion
• Do not massage extremities
• In transport actively rewarmnot too quickly
• if delayed move to warm enviornment

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• Care for shock
• O2 warm and humidified if possible
• Give warm liquids but slowly
• Transport but if not dont allow to return to
  the cold environment
• When actively rewarming, must be done slowly and
  handle pt. with great care

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• When actively rewarming
• Use central rewarming
• lateral chest, neck, groin, armpits
• Rewarm the trunck leaving exremeties exposed
• If transport delayed, warm bath
• Do not allow to walk, avoid rough handling

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• Patient Care Unresponsive/decreased loc
• Do not actively rewarm
• Remove from environment and cover
• ABCs
• Do not allow to eat or drink
• Do not massage extremities
• Transport immediately

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• Extreme Hypothermia
• Unconscious
• No discernable VS
• Core body temperature lt80 degrees F

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• Care
• Assess carotid pulse 30 to 45 seconds
• CPR
• AED
• PATIENT IS NOT DEAD UNTIL WARM AND DEAD

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• Localized Cold Injuries
• Ears, nose, hands, feet and toes
• Tissues freeze
• Progression
• Exposed skin reddens
• dark skinned lightens to a blanched color
• As exposure continues, skin takes on gray or
  white blotchy appearance and becomes numb

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• If freezing continues, skin becomes dead white
  and all sensations are lost
• Local or superficial local injury sometimes
  called frostnip

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• Patient Assessment for frostnip
• Brought about by direct contact with cold object
  or exposure to cold air
• Most susceptible are tip of nose, tips of ears,
  upper cheeks, and fingers
• Pt. often unaware of onset

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• Signs and Symptoms
• Exposed skin reddens
• dark skinned lightens to a blanched color
• Affected area feels numb

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• Care
• Remove from cold environment
• Warm the effected area
• If to extremity, splint and cover
• Do not massage affected area
• Pt. may complain about tingling or burning
• If pt. does not respond to tx. ..

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• Patient Assessment for late or deep local cold
  injury (frostbite)
• Affected skin appears white and waxy
• Skin
• mottled and blotchy white to grayish yellow
  grayish blue

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• Swelling and blistering may occur
• Affected area feels frozen, but only on the
  surface
• do not squeeze or poke

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• Care
• High concentration O2
• Transport immediately
• Cover affected area and handle gently
• Delayed transport take inside and keep warm, do
  not allow pt. to drink etoh or smoke

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• Warm the frozen part per protocol or by medical
  direction
• never rub a frostbitten or frozen part
• dont let pt. walk on affected exremity
• dont thaw a frozen limb if there is a chance
  of reexposure or refrozen

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• Active rewarming of frozen parts
• Seldom recommended
• pp525-526

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• Exposure to Heat
• Effects of heat on the body
• The body generates heat due to constant internal
  chemical processes
• Any heat not needed for temperature regulation
  must be lost by the body. If not
• Hyperthermia

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• Heat and humidity are often associated with
  hyperthermia
• Collapse from heat exposure may result in trauma
• Heat exposure may be hastened or intensified
• Age
• Alcohol and any other drug

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• Heat Exhaustion
• Exposure to excessive heat while working or
  exercising resulting from fluid and salt loss
• Moist, pale, cool to normal skin
• Heat cramps muscle cramps from heavy
  perspiration and salt loss

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• Signs and Symptoms
• Muscle cramps usually in legs and ABD
• Weakness and exhaustion sometimes dizziness or
  periods of faintness
• Rapid, shallow breathing
• Weak pulse
• Heavy perspiration

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• Care
• Remove from environment into cool place
• O2 NRB
• Loosen or remove clothing, fan without chilling.
  Watch for shivering
• Position supine with legs elevated
• If LOC permits, give small sips of water. If NV
  develop, discontinue.--Airway

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• Muscle cramps
• apply moist towels over cramped area
• Transport

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• Patient with hot and dry or moist skin
• heat stroke
• Cooling mechanisms fail
• Problem compounded with fluid and salt loss

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• Patient Assessment
• Signs and symptoms
• Rapid shallow breathing
• Full and rapid pulse
• Generalized weakness
• Little or no perspiration
• Loss of consciousness or AMS
• Dilated pupils
• Seizures may be seen no muscle cramps

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• Care
• Remove and place in cool environment
• Remove clothing
• Apply cold packs
• neck, groin, armpits
• Keep the skin wet
• Fan aggresively

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• O2
• Transport
• if delayed immerse to neck in cold water

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• WATER-RELATED EMERGENCIES

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• Consider that underlying medical conditions may
  be the cause of a water-related accident.
• Drowning can take place in a few inches of water
  bathtubs

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• Patient Assessment
• Airway obstruction spasms
• Cardiac arrest
• Signs of heart attack
• Injuries to the head and neck
• Internal injuries
• Generalized or hypothermia
• Substance abuse
• Drowning

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• Drowning
• Definition by WHO
• Process of experiencing respiratory impairment
  from submersion/immersion in liquid

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• Process of drowning
• Aprox. 10 who die from drowning die just from
  the lack of air
• Cold water drowning
• resuscitation can be successful after 30
  minutes or longer
• once water temp. falls below 70 degrees,
  biological death may be delayed

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• Transport should not be delayed
• Initiate care immediately even if pt. is still in
  the water
• Ventilations there may be some resistance,
  more force may be needed
• water in the lungs usually means water in the
  stomach as well which will add resistance

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• If gastric distension interferes with
  ventilations
• place on left side
• suction immediately
• apply firm pressure over the ABD

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• Care for possible spinal injuries
• Assume if unconscious there are neck or spinal
  injuries
• Start resuscitation before immobilization
• Do not delay bls
• Do not delay moving from water if there is clear
  and present danger
• Manual inline stabilization

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• Secure to long board before removing from water.
  
• Care
• Initial assessment protect the spine
• Rescue breathing if in arrest, CPR and AED
• Look for and control profuse bleeding

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• Take 60 seconds to assess pulse in cold water
  rescues before determination of cardiac arrest
• Care for shock
• O2
• Conserve body heat
• Focused and detailed exam in transport
• If no spinal injury left lateral recumbent
• Suction
• Consider transport to specialty center

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• Diving accidents
• Most diving accidents involve the head and neck
• A medical emergency may have led to the diving
  accident
• If unresponsive, assume possible neck and spine
  injury

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• Scuba Diving Accidents
• Air embolism
• arterial gas embolism (AGE)
• Gas leaves an injure lung and enters the blood
  stream
• Most often when a diver holds his breath

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• Decompression Sickness
• Usually caused when a diver comes up too quickly
  from a deep, prolonged drive
• 90 of symptoms occur within 3 hrs. of the dive

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• Signs and symptoms of air embolism
• Blurred vision
• Chest pain
• Numbness and tingling in sensation in the
  extremities
• Generalized or specific weakness
• Possible paralysis
• Frothy blood in mouth or nose

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• Rapid lapse into unconsciousness
• Respiratory and/or cardiac arrest
• Signs and symptoms of decompression sickness
• Personality changes
• Fatigue
• Deep pain in the muscle and joints (bends)

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• Numbness or paralysis
• Choking
• Labored breathing
• Behavior indicative of intoxication
• Chest pain
• Collapse leading to unconsciousness
• Skin rash in cases changes in appearance

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• Care decompression sickness
• air embolism
• Airway
• O2
• Rapid transport
• Medical direction for destination
• St E Methodist Wishard
• Keep warm

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• Position on side or supine
• position/reposition to airway mgt.
• Transport diving chart
• Diver Alert Network (DAN) p535

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• Water Rescues
• reach
• throw and tow
• row
• go

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• Ice Rescue
• Wear a flotation device
• Rope with a loop can be tossed
• Ladder with rope attached
• Small aluminum, flat-bottomed boat with rope
  attached pushed stern first
• IF POSSIBLE STAY ON SHORE
• Do not work alone
• Effects of hypothermia (weak, loc) may hamper
  rescue efforts

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Bites and stings

• Insects bites and stings
• Toxins/venom
• substances produced animals or plants that are
  poisonous to humans
• Black widow and brown recluse spider bite
• Can produce medical emergencies
• Brown recluse
• painless lesion in 10 of cases

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• Black widow bite
• immediate reaction
• Scorpion stings
• Southwest
• can cause serious medical problems
• respiratory failure in children

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• Patient Assessment
• AMS
• Noticeable stings or bites
• Puncture marks
• Blotchy skin
• Localized pain and itching
• Numbness in a limb or body part

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• Burning sensations at the site followed by pain
  spreading throughout the limb
• Redness
• Swelling or blistering at the site
• Weakness or collapse
• Respiratory distress/abnormal pulse
• Headache and dizziness

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• Chills
• Fever
• Nausea and vomiting
• Muscle cramps, chest tightening, joint pain
• Excessive saliva formation
• Profuse sweating
• Anaphylaxis

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• Patient care
• Treat for shock
• Contact medical direction if unknown
• Remove stinger or venom sac
• scrape
• Remove jewelry from affected limb
• If extremity involved and per protocol
• restricting band

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• Keep pt. still and extremity immobilized
• Cold compresses
• protocol

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Snake Bites

• Two type of poisonous snakes
• Pit vipers
• rattlesnakes, copperheads, water moccasins
• Coral snakes
• 25 of pit vipers, 50 of coral snakes are dry
  bites

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• Bites from diamond back rattler and coral snakes
  are very serious

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• Patient Assessment
• Noticeable bite on the skin
• Pain and swelling in are of bite
• may take 30 min. to several hours
• Rapid pulse and labored breathing
• Progressive general weakness
• Vision problems dim or blurred
• N V
• Seizures
• Drowsiness and unconsciousness

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• Transport the snake
• dead or alive
• if alive not loose in the ambulance but
• in a sealed container
• do not get close or endanger self to identify
• do not attempt to capture

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• Care
• Stay calm
• Contact medical direction
• Keep warm
• Clean fang marks with soap and water
• Remove jewelry etc
• Immobilize and elevate extremities
• Constricting band
• Transport

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Poisoning from marine life

• Occurs in two ways
• Eating improperly prepared seafood
• may resemble anaphylactic shock
• May resemble food poisoning
• be on alert for vomiting, convulsions,
  respiratory arrest

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• Poisonous stings and punctures
• Jellyfish, sea nettle, Portuguese man-of-war, sea
  anemone and the hydra

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• Sting produces few complications
• Some pts may develop anaphylactic shock
• Stings to face require physicians attention
• Puncture wounds
• steps on or grabs a stingray, sea urchin,
  spiny catfish etc
• do not delay transport
• pt. may need tetanus
• pt. could develop anaphylactic shock

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