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TRANSCRIPT
Environmental Emergencies:
Chapter 30
Heat and cold related injuries
Factors affecting exposure
• Physical Condition
• Age
• Nutrition/hydration
• Environmental conditions
Cold exposure
Terms to know:
• Hypothermia- lowering the temperature of the entire body (core temperature falls below 95 degrees)
• Conduction- direct transfer of heat from a part of the body to a colder object by direct touch
• Convection- heat transferred into circulating air • Evaporation- conversion of liquid into gas • Radiation- the transfer of heat through radiant energy
or invisible light • Respiration- Causes body heat to be lost when cold air
enters the lungs and warm air is exhaled into the atmosphere
Heat Loss
• The rate and amount of heat loss can be modified in three ways – Increase or decrease of
heat production: the body can increase heat production by increasing the metabolism of the cells (shivering)
– Move to an area where heat loss is increased or decreased:
– Wear insulated clothing to reduce heat loss:
Hypothermia Signs and symptoms
• 90-95: – Shivering/ foot stamping – Constricted blood
vessels/ rapid breathing – withdrawn
• 89-92: – Loss of coordination/
muscle stiffness – Slowing respirations/
slow pulse – Confused/ lethargic/
sleepy
• 80-88: • Coma
• Weak pulse/ arrhythmias/ slow respirations
• Unresponsive
• <80: • Apparent death
• Cardiac arrest
• unresponsive
Temperature assessment
• To assess patients general temperature- pull back your glove and with the back of your hand feel the patients abdomen
• Never assume that a cold pulse less patient is dead-patients can survive cold related arrests if proper emergency care is taken
• A patient is never dead until they are warm and dead
Focused Physical Exam
• You exam should focus on:
– Severity of hypothermia
– Areas directly affected by the cold
– And distinguish between frostbite and hypothermia
Interventions
• Move the patient out of the cold environment
• Do not allow the patient to walk • Remove wet clothing • Wrap the patient in dry blankets • Do not massage or allow the patient
to massage the extremities • Do not allow the patient any
stimulants • Give warm humidified oxygen • Begin passive re-warming (turn up
heart in ambulance and wrap the patient in blankets)
• If the patient is alert begin active re-warming with hot packs or water bottles
Local cold injuries
• Most injuries from cold are confined to exposed parts of the body – Frostnip- when
exposed parts of the body become cold but not frozen
– Frostbite- when exposed areas of the body become frozen
Emergency medical care for local cold injury
• Remove the patient from environment • Handle the injured area gently • Administer oxygen • Remove wet or restrictive clothing • Remove jewelry from injured part • Splint the injury and cover with dry sterile dressing • Evaluate the patient • Transport immediately • Contact medical control (if they instruct you to - warm the area) • Use a warm bath of water between 100 and 112 degrees • Stir the water continually • Keep the extremity away from the edge and bottom of the container • Keep immersed until it feels warm and sensation is regained • Dress with dry sterile dressing separating the fingers and toes
Heat exposure
Ambient temperature
• Ambient temperature- the temperature of the surrounding environment
• When it is hot outside and there is vigorous activity the body will attempt to cool itself by: – Sweating- During vigorous activity the body can lose
up to 1 liter of sweat per hour
– Dilating blood vessels close to the skin
– The person may remove clothing
• Hyperthermia- high core temperature (greater than 101 degrees)
Illness from heat exposure
• Heat cramps- painful muscle spasms that occur after increased activity
– Caused by loss of electrolytes (salt balance) during sweating
• Heat exhaustion- hypovolumia from loss of liquid during sweating
– Signs and symptoms include: • Dizziness/weakness
• Cold clammy skin
• Dry tongue and thirst
• Normal vital signs with rapid pulse and low diastolic BP
• Normal or elevated body temperature
Heat stroke
• Heat stroke-occurs when the body is subjected to more heat than it can handle – Signs and symptoms
include: • Hot dry flushed skin
• Possible decreased level of consciousness
• Rapid strong pulse
• As the patient goes unconscious the pulse rate falls and becomes weaker
Interventions for people with heat related injury
• Remove form environment • Remove any restrictive clothing • Cover patient with a sheet soaked
in water • If the patient is fully conscious give
them fluids • Turn on air conditioning in
ambulance • Place cold packs in the patient
groin and axially • Fan • Check patients turgor- ability of
the skin to withstand deformation (pinch the skin)
• If Nauseous place in in left lateral recumbent position
Bites and Envenomations:
Spider bites:
• only 2 spiders native to the US are able to deliver serious, life threatening bites
– Black Widow
– Brown recluse
Black Widow Bite
• Black widow: – Localized pain
– Agonizing muscle spasms
– Dizziness
– Sweating
– Vomiting
– Rashes
– Chest tightness
– Difficulty breathing
Brown Recluse Bites
• Brown recluse – Bite is not painful for a few
hours
– Localized swelling
– Tenderness
– A pale, molted, cyanotic center
– Possibly a small blister
– If left untreated an ulcer will form
Antivenin
• Antivenin- a serum containing antibodies that counteract the venom
– Must be administered by a physician
Snake Bites
• Most poison snakes native to the US have 2 hollow fangs to inject poison – The injury will look like 2 holes, slightly raised and irritated – The patient will have localized tenderness
• Pit viper snake bites: • Burning pain at the site • Swelling with bluish discoloration • Bleeding at various distant sites do to venom in the blood stream • Weakness • Sweating • Fainting • Shock
Treatment
• Calm and reassure the patient • Locate the bite area (DO NOT APPLY ICE) • Splint the extremity to decrease movement • Watch for vomiting and anxiety • (if bitten on the trunk) keep supine and transport immediately • Monitor the vitals • Mark the skin with a pen over where the injury has occurred • (if shock occurs) place the patient in the trendelenburg position • If the snake has been killed take it to the hospital with you • Notify the hospital (if possible describe the snake) • Transport immediately
Coral snake bite
• The wound will look like 1 or more puncture like wounds and scratches
• Treatment: – Calm the patient – Flush the area with 1-2 quarts of
warm soaps water (do not apply ice) – Splint the extremity – Keep the patient warm – Place in the trendelenburg position – Transport immediately
• (DO NOT give the patient anything by mouth)
Scorpion stings
• Can possibly cause: – Circulatory collapse – Severe muscle contractions – Excessive salivation – Hypertension – Convulsions
• Antivenin must be administered by a physician – Assess – Contact medical command – Give O2 – Transport
Tick Bites
• Ticks typically carry 2 diseases:
– Rocky Mountain spotted fever
– Lyme disease
Rocky Mountain spotted fever
• Rocky Mountain spotted fever – Occurs within 7-10 days after being bitten
– Symptoms include: • Nausea
• Vomiting
• Headache
• Weakness
• Rash
• Paralysis
• Cardio-respiratory collapse
Lyme disease:
• Occurs within 3 days of the bite
• Symptoms include:
– Bull’s eye rash
– Swelling of joints
– May cause permanent disability if left untreated
Drowning and near drowning:
Drowning and near drowning
• Drowning- death by suffocation after being submerged in water
• Near drowning- survival (for at least 24 hours) after suffocation from being submerged in water
• Steps of (many) drowning: – Panic
– Insufficient breathing
– Decreased buoyancy
– Exhaustion
– Cardiac or respiratory arrest
Larynospasm
• choking sensation felt when liquid is inhaled
– The larynx contracts to prevent more water from entering
– This can cause problems during resuscitation in submerged victims
EMT-B Safety
• To most effectively and safely rescue a drowning person complete the following steps:
– Reach
– Throw and tow
– Row
– Go
Spinal injuries
• You must assume that a primal injury exists in the following situations: – The submersion happened do to
diving, a mishap, or a fall
– The patient is unconscious and no information is available to rule out mechanism of injury
– The patient is conscious but complains of paralysis, numbness, or weakness
– You suspect a spinal cord injury despite testimony from witnesses
Treatment
• To treat a patient in the water with suspected spinal injury: – Turn the patient supine – Restore the airway/begin
ventilation – Float a backboard under the
patient – Secure the trunk and head to
the back board – Remove the patient from the
water – Cover the patient with a blanket
Recovery techniques
• Scuba- self contained breathing apparatus
• As a last resort (if standard recovery procedures are unsuccessful) you may use a grappling hook and rope or chain to attempt to remove the body
Resuscitation efforts
• Never give up on Resuscitation efforts if the patient has drowned or is cold (unless death is obvious)
• Diving reflex- slowing of the heart rate a respirations caused by cold water
• Bradycardia- slow heart/pulse rate
Diving emergencies
• Most serious water related injuries are associated with diving (with or without scuba gear)
– Descent
– Bottom
– Accent
Decent emergencies
• Descent emergencies- usually due to the sudden increase of pressure on the body as the person dives deeper – The usual areas affected by this are: (this is
referred to as squeeze problems) • Lungs
• Sinus cavity
• Middle ear
• Teeth
• Area of the face surrounded by the mask
Bottom
• Emergencies at the bottom: • Inadequate mixing of oxygen and carbon dioxide
• Increased carbon monoxide
• Injury
• Marine life
• entanglement
Ascent emergencies
• Most serious problems related to diving are during the ascent (the most common include) – Air embolism- bubbles of air in the blood vessels
• If air entered the pleural space it can compress the lungs • Pneumomedias- air in the thoracic cavity • Air can cause emboli- air in the blood stream
– Decompression sickness- (bends) bubbles of air (usually nitrogen) obstruct blood vessels • -these can block tiny blood vessels and cause tissue damage
from lack of circulation • -Typically show with abdominal and joint pain
• treatment requites a hyperbaric chamber
Diving interventions:
• To treat a patient who is suffering from a diving emergency:
– Remove the person from water and attempt to keep them calm
– Begin BLS and o2 administration
– Place patient in left lateral recumbent position
– Immediate transport to the nearest facility with a hyperbaric chamber
– Check for other injuries
Other water hazards
• Other hazards that can occur due to water include: – Breath holding syncope- loss of
consciousness caused by decrease stimulus for breathing
– Boat propellers/rocks/water ski’s
– Hypothermia
– Injuries caused by marine life
– Electrocution (mild, moderate, or severe)