emt/emr environmental injuries powerpoint training preview
TRANSCRIPT
EMERGENCY MEDICAL TECHNICIAN
ENVIRONMENTAL EMERGENCIES
Brave Training SolutionsCopyright 2014
www.bravetraining.comEMT-50 V2
DESCRIPTION
This presentation reviews recognizing the signs and symptoms of heat and cold exposure, as well as the emergency medical care of these conditions. Information on aquatic emergencies and bites and stings will also be included in this lesson. Presentation is over 190 slides in length. Meets or exceeds USDOT NHTSA 2009 EMT training requirements. Recommended classroom time 4 hours.•
EMERGENCY MEDICAL TECHNICIAN
ENVIRONMENTAL EMERGENCIES
Brave Training SolutionsCopyright 2014
www.bravetraining.comEMT-50 V2
MODULE I
SUBMERSIONINCIDENTS
UNIQUE S & S
Airway Obstructed with water immediately after rescue
BreathingMay be coughing if early rescueAgonal breaths if prolonged submersionRespiratory arrest if very prolonged submersion
CirculationMay be in cardiac arrestSkin is cyanoticSkin may be cold
SPECIAL MANAGEMENT CONSIDERATIONS
If patient is in water be aware of EMT’s personal safety
Risk of vomiting is high & if patient vomitsRoll on sideSuction mouth
CONSIDER POSSIBILITY OF SPINE INJURY
If risk of spinal injury exists, manually stabilize the neck & spineIf no risk of spinal injury exists & patient is breathing
Place in recovery positionAdminister oxygen
If no risk of spinal injury exists & patient is not breathing, follow American Heart Association guidelines for CPR
IN WATER SPINAL STABILIZATION
Stabilize the spine with manual stabilizationRestore airway & begin ventilationSecure patient to backboardRemove patient from water
AIRWAY, VENTILATION, & OXYGENATION
Suction & maintain open airwayAnticipate vomitingPosition lateral recumbent if no risk of spinal injury
Ventilate with bag-mask if impaired ventilation or respiratory arrestUse CPAP if unconscious & breathingAdminister oxygen by non-rebreather mask if breathing is adequate
TRANSPORT CONSIDERATIONS
Transport to appropriate facilityAll patients who had submersion injury with
any report of signs & symptoms during or after submersion need transport to the
hospital
WARNINGPatients have been resuscitated after up to 2
hours of submersionResuscitation efforts need to be started immediately upon getting patient to a place where resuscitation efforts can be started
MODULE II
TEMPERATURE RELATED ILLINESS
13
COLD RELATED ILLINESSES
LOSS OF BODY HEAT
The amount & rate of heat loss or gain can be changed in 3 ways
Increased or decreased heat production
(Activity or inactivity)Going into a warmer or colder
environmentWearing insulated clothing
HYPOTHERMIA
Body temperature lowered below 95o F (35o F)Infants & elderly are at higher riskIllness & injury increases susceptibility for hypothermiaEnvironment does not have to be freezing for
risk of hypothermia
SIGNS & SYMPTOMS OF GENERALIZED HYPOTHERMIA
Obvious exposureSubtle exposure
Underlying illnessOverdose/poisoningAmbient temperature decreased (e.g., cool
home of elderly patient)
SIGNS & SYMPTOMS OF GENERALIZED HYPOTHERMIA
Cool/cold skin temperaturePlace the back of your hand between the
clothing & the patient's abdomen to assess the general temperature of the patient
The patient experiencing a generalized coldemergency will present with cool or cold
abdominal skin temperature iv. shivering
SIGNS & SYMPTOMS OF GENERALIZED HYPOTHERMIA
Decreasing mental status or motor functionDepends on the degree of hypothermiaPoor coordination Mood changesMemory disturbances/confusionReduced or loss of touch sensationLess communicative DizzinessSpeech difficultyStiff or rigid postureMuscular rigidity Slow pulsePoor judgment – patient may actually remove clothingComplaints of joint/muscle stiffness
SWISS SYSTEM OF HYPOTHERMIA CLASSIFICATION
Stage Symptoms By Degree
Temperature
1 Awake & shivering
Mild 89.6-95.0o F (32-35o C)
2 Drowsy & not shivering
Moderate 82.4-89.6o F (28-32o C)
3 Unconscious, not shivering
Severe 68.0-82.4o F (20-28o C)
4 No vital signs Profound <68.0o F (20o C)
DO NOT
Allow patient to walk, eat, use any stimulants, smoke (including e-cigarettes)or chew
tobaccoMassage extremities
LOCAL COLD EMERGENCIES
Freezing or near freezing of a body partUsually occurs in fingers, toes, face, ears, & nose
THREE TYPES
FrostnipFreezing of the outer skin but not the deeper surface
Immersion foot (Trench foot)Prolonged exposure to cold water
FrostbiteFreezing of a body part, normally an extremity
REWARMING BATH
Water temperature should be 100-102o FRegularly recheck temperature & Circulate water Keep affected body part in water until rewarmed & sensation returnsDress affected area with dry sterile dressings
MANAGEMENT CONSIDERATIONSFOR COLD RELATED LOCALIZED ILLINESS
Move patient out of cold environmentAdminister oxygenConsider active rewarming if no chance of re- injuryImmerse part in tepid (100 – 105 degrees Fahrenheit)
waterAfter rewarming, apply sterile dressingsKeep patient warmTransport as soon as possible
HEAT RELATED EMERGENCIES
HEAT EXPOSURE
Normal body temperature is 98.6o FBody cools by dilation of blood vessels & sweatingBody will attempt to maintain it’s temperature
despite ambient temperatureHumidity & temperatures may defeat body’s
temperature control mechanisms
PATHPHYSIOLOGY OFHEAT RELATED ILLINESS
Patient with moist, pale, cool skin – excessive fluid & salt loss
Patient with hot, dry skinTrue emergencySeen on hot, humid days in patients with fluid &
salt lossBody unable to regulate temperature
SIGNS & SYMPTOMS OF HEAT RELATED ILLINESS
Moist, Pale SkinMuscle crampsChange in level of consciousness, dizzinessWeaknessWeak, rapid pulseNausea & vomitingApply pulse oximetry
MODULE III
BITES & STINGS
PATHYPHYSIOLOGY OF BITES & ENVENMATIONS
Spider bites (black widow) -- inject neurotoxins
PATHYPHYSIOLOGY OF BITES & ENVENMATIONS
Snake bites -- rattlesnake is most common in United States
Toxins affect blood & nervous system both at the bite site & systemically
Patient age & size cause different effectsAmount of toxin injected is related to
toxicity (often none at all)Initial 6-8 hours of care is essential
BLACK WIDOW SPIDER
Found in all states except AlaskaHas a distinctive red-orange hour glass marking
on abdomenDamages nerve tissueNo recent reported deaths
in the USAnti-venom primarily used for pain relief
4 TYPES OF VENOMOUS SNAKES IN THE USRattle Snake
Cottonmouth
CopperheadCoral Snake
CORAL SNAKE
Small snake with red, yellow, & black bands
“Red on black, friend of Jack. Red on yellow kills a fellow” or “yellow, red, stop” for North America
Primarily found in southern statesInjects venom with teeth, using a chewing motion which leaves puncture wounds
SCORPION STINGS
Venom gland & stinger in tailPrimarily found in SE StatesMost species stings are only
painful except the “Centruroides sculpturatus”
TICK BITES
Ticks bite the skin & attach to skinBite is not painful, but potential
for infectionTick bites can carry Rocky Mountain Spotted
Fever, Lyme Disease, Typhus, Tularemia, Colorado Tick Fever, & others
TICK BITES
EMS careWash & disinfectareaRemove tick with tick tweezersTransport if indicated
MODULE IV
DIVING INJURIES
DIVING INJURIES(DYSBARISM)
Mechanism of InjurySCUBA diving at greater depths for long
periods of timeRepeated dives at depth on the same day
DECOMPRESSION SICKNESS
AKA Caisson disease, bendsA condition arising from the dissolved gases coming out of solution forming bubbles as the diver ascends from depthWith current technology divers can stay under
pressure for months at a time with long decompression times
S & S OF DECOMPRESSION SICKNESS
Joint pain Primarily large joints 60-70% of time
SkinItching, sensation of insect bites, mottled
or marbled, swelling of the skinS & S may not show up for hours after surfacing
FLYING
Most aircraft fly with lower cabin pressures than at sea level
This could cause a diver to have the gases in the blood stream to surface causing the bends
Divers who may have needed decompression are told to refrain from flying for 48 hours after their dive
AIR EMBOLISM
Signs & symptomsBlotching of skin Froth at mouth &
noseSevere muscle, joint, & abdominal painDyspnea &/or chest pain
DysphasiaDizziness Nausea VomitingVision difficulties Paralysis &/or
comaIrregular pulse or cardiac arrest
EAR SQUEEZE
Caused by blockage of Eustachian tubes orfailure to clear ears during descent
S & SPain in ear on assentRinging in earsBleeding from the ear
MODULE V
MARINE ANIMAL INJURIES
MARINE ANIMAL INJURIES
Numerous aquatic animals have toxic bites or stingsThey include
Sea urchinJelly fishPortuguese man of warFire coralCone SnailStingrayTorpedo Ray
SEA URCHIN INJURY
Hard spines are brittle & can easily break off upon entering the skin
JELLYFISH
Has nematocysts that can be triggered by touch & inject venom into the skinBeached or dead jellyfish may stingSome species may be deadly
PORTUGUESE MAN O WAR
Float on surface with tentacles that may reach 30 feet which have stinging nematocysts
FIRE CORAL
Not a true coral but related to the jellyfish
Stings in similar manor as jellyfish with similar S & S, & EMS careDivers often mistake fire coral
for regular coral
CONE SNAIL
They have a harpoon which can penetrate a
wetsuitThe harpoon injects a an
analgesic which with some species can kill
a human in 5 minutesby paralyzing the victim
STINGRAY
Most injuries are caused by stepping on their venomous stinger
Estimated 2,000 injuries annually in US
Stinger in cm
MODULE VI
LIGHTNINGEFFECT OF THE SUN
ELECTRICAL INJURIES
Skin wounds may not indicate seriousness of burn
Entrance & exit woundsMay cause cardiac arrest or other cardiac arrhythmiasLighting strikes may cause cardiac arrest
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