environmental emergencies. exposures to the cold how does the body lose heat conduction-body heat...
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Environmental Emergencies Exposures to the Cold How does the body lose heat
• Conduction-body heat lost to nearby objects through direct contact
• Convection- body heat lost to surrounding air• Radiation- body heat lost to nearby objects• Evaporation - perspiration lost from the body surface
when changed from a liquid to vapor• Respiration
Environmental Emergencies• Hypothermia
– Generalized cooling of the entire body
• Predisposition– Burns– Spinal injury– Infection– Diabetes– Drugs and alcohol
Environmental Emergencies• Often times the person most effected by
hypothermia are the very old and very young
Environmental Emergencies• Signs & Symptoms (general)
– Shivering (1st clinical indicator)– Cool, cold skin temperature– Indifference, apathy, Sleepiness– Lack of coordination– Poor judgement– Decreased mental status– Decreased vital signs– Muscular rigidity
Progressive Clinical Presentation of Hypothermia
oC oF Clinical Signs37.6 99.6 Normal rectal temp37 98.6 Normal oral temp35 95.0 Increased metabolic rate34 93.2 Maximum shivering33 91.4 Severe hypothermia below
this point32-31 89.6-87.8 Consciousness clouded, BP
difficult to obtain; pupilsdilated but reactive;shivering ceases
Progressive Clinical Presentation of Hypothermia
oC oF Clinical Signs30-29 86.0-84.2 Progressive loss of
consciousness; respiratory ratedecreases; pulse difficult toobtain; muscular rigidity
28 82.4 Ventricular fibrillation possible27 80.6 Voluntary motion ceases;
pupils non-reactive; deep tendon& superficial reflexes absent
25 77.0 Ventricular fibrillation mayoccur spontaneously
Progressive Clinical Presentation of HypothermiaoC oF Clinical Signs24 75.2 Pulmonary edema22-21 71.6-69.8 Maximum risk of ventricular
fibrillation20 68.0 Cardiac standstill18 64.4 Lowest accidental hypothermia
victim to recover9 48.2 Lowest artificially cooled
hypothermia patient to recover
Environmental EmergenciesPatient Care- Hypothermia• Scene size-up
• Activate EMS
• Perform initial assessment
• Remove patient from cold environment
• Protect from further heat loss
Environmental Emergencies
• Remove all wet clothing
• Handle patient gently
• Do not allow patient to exert themselves
• Do not give food or fluids
• O2
• Handle patient carefully
• Monitor vital signs
Environmental Emergencies
• Patient Care-
• O2 (warmed if possible)
• Wrap with blanket and handle gently can cause V-Fib with rough handling– Passive rewarming– Active rewarming
Environmental Emergencies
• Patient Care
• Extreme Hypothermia– Assess Carotid Pulse for 30-45 seconds – If no pulse begin CPR
Environmental Emergencies
• Immersion Hypothermia– Cold water?– Water conducts heat 25 X faster than air of
the same temperature– Most deaths in cold water are due to:
• rapid body heat loss• leading to unconsciousness• leading to drowning or cardiac failure
Environmental Emergencies
• Immersion hypothermia– Likely to become fatal when the core
temperature drops below 94oF
• Patient Care– Same as for other hypothermia patients– If long exposure time, keep patient
horizontal due to possible vascular collapse
Environmental Emergencies
• Increasing Survival Time– Drowning proofing– Treading water– Swimming– Holding still– HELP– Huddle
• (Note: survival times based on 50oF water temp)
Environmental Emergencies• Frostnip (early, superficial)
– Areas affected• tips of nose, ears, upper cheeks, fingers
• Signs and Symptoms– light skin reddens– dark skin lightens
• both blanch
– numbness of affected area– skin remains soft
Environmental Emergencies
• Frostnip - Emergency Care– Remove patient from cold environment– Slowly warm affected area
• Do Not rub or massage• Do Not re-expose to cold• Manually stabilize extremity, cover• Rewarm using own body heat
– Tingling & burning are common during rewarming
Environmental Emergencies
• Frostbite (late / deep)– Progressive from early (superficial) cold
injury– Areas affected
• skin, subcutaneous tissue, muscles, deep vessels, organ membranes, bones
Environmental Emergencies• Frostbite
– Signs and Symptoms• skin appears white & waxy• turning mottled or blotchy in appearance• color changes from white to grayish yellow to
grayish blue.• swelling• blistering
Environmental Emergencies
• Frostbite– Signs and Symptoms con’t.
• firm to frozen (affected area feels frozen on surface, soft beneath surface initially, normal resilience, progresses to firm frozen feeling)
• do not squeeze or poke tissue• assess as it fractured• if thawed skin may appear flushed with purple
areas
Environmental Emergencies• Frostbite Emergency Care
– Provide same care as for frostnip– Protect frostbitten or frozen area
• handle as gently as possible
– Arrange for transport (if transport is delayed)
• move patient indoors
– Remove jewelry– Cover with dry sterile dressings
Environmental Emergencies
• Frostbite Emergency Care– Do Not:
• break blisters• rub or massage area• apply heat• allow use of alcohol consumption• allow patient to smoke• allow patient to walk on affected extremity• rewarm *
Environmental Emergencies
• Frostbite Emergency Care– Rewarming
• seldom recommended• risk of causing permanent injury• rewarm ONLY if to to do so by EMS or severely
delayed transport• complete submersion of the affected area in
heated water (100 - 105oF)• dress & bandage as if burned (dry sterile
dressings)
Environmental Emergencies
• Heat Emergencies– Hyperthermia
• Excessive body heat
– Types of Emergencies• Heat Cramps• Heat Exhaustion• Heat Stroke
Environmental Emergencies• Heat cramps
– Muscle cramps– Weakness– Respirations - normal to slightly increased– Pulse - normal to increased & weak– Skin color/temp - normal to pale/cool &
moist– Heavy perspiration– Dizziness possible, seldom altered mental
status
Environmental Emergencies
• Heat Exhaustion– Most commonly treated heat emergency– Weakness– Respirations - rapid & shallow– Pulse - Rapid & weak– Skin color/temp - pale to slightly flushed /
cool & moist– Heavy perspiration– Possible altered mental status
Environmental Emergencies
• Care for Heat Cramps/Exhaustion– Move patient to a cool environment– Loosen or remove clothing to cool (do not
chill patient)– Oxygen– Place patient in supine position– Small amounts of water IF patient is fully
conscious
Environmental Emergencies• Heat Stroke
– Generalized weakness– Respirations - rapid & shallow– Pulse - rapid & full– Skin color/temp - red, hot, dry– Little or no perspiration– Altered mental status– Dilated pupils– Seizures
Environmental Emergencies
• Care for Heat Stroke– Activate EMS ASAP– Move patient to a cool environment– Remove clothing– Rapidly cool patient (without chilling)– Place patient in recovery position– Oxygen– Monitor vitals
Environmental Emergencies
Water Related Emergencies
• Near Drowning, Drowning
• Diving accidents– AGE– DCS
Environmental Emergencies• Near Drowning / Drowning
– estimated 80,000 submersion incidents yearly
– 9,000 deaths annually in US (140,000 WW)– 4th leading cause of accidental death for
all age groups– 2nd leading cause of accidental death in
children– 64% of all victims under 30 YOA
Environmental Emergencies
• Drowning – Risk Factors (Contributing Factors)
• Location• Swimming ability• Drugs /alcohol• Underlying disease / injury• Age• Gender• Race
Environmental Emergencies
• Near Drowning– At least temporary survival. Death more
than 24 hours later
• Drowning – Death within 24 hours
Environmental Emergencies
• Sequence of Events (Conscious Patient) – Dry Drowning
• Immersion, breath holding, panic, hypoxia, loss of consciousness, spasm of epiglottis & larynx, asphyxia
– Wet Drowning• Immersion, breath holding, panic, hypoxia, loss of
consciousness, relaxation of epiglottis & larynx, inhalation of water
Environmental Emergencies
• Sequence of Events (Unconscious patient)– Immersion, relaxation of epiglottis & larynx,
inhalation of water
Environmental Emergencies• Special Considerations
– All cold water submersions should be worked– Documented cases of successful resuscitation
after 1 hour of submersion in cold water – The lower the water temp the better the
chances of survival
• Spinal injury should be considered
• All near drowning patients must be evaluated in ER
Environmental Emergencies
• Scuba Diving Emergencies– Decompression Illness
• Dysbaric injuries related to scuba diving• Includes both
– Arterial Gas Embolism (AGE)– Decompression Sickness (DCS)
Environmental Emergencies
• Air Embolism- AGE– Gas bubbles (usually air) entering the
circulatory system through the alveoli
• Causes• Breath holding on ascent• Ascending to rapidly• Air trapping in alveoli (from asthma, chest
congestion, etc.)
• Time of onset - within 5 minutes
Environmental Emergencies• Decompression Sickness
• Bubbles of inert gas (nitrogen) forming in the tissues & bloodstream
• Causes• Rapid ascent from compressed gas
diving• Reduction in surrounding pressure such
as flying in an aircraft after diving
• Time of onset - 1 to 48 hours
Environmental Emergencies• Common Signs & Symptoms of DCI
– Pain– Numbness– Dizziness– Unusual fatigue– Headache– Weakness– Nausea– Difficulty walking
Environmental Emergencies
• Other Signs & Symptoms of DCI– Difficulty breathing– Visual disturbances– Decreased skin sensation– Restlessness– Itching / Rash– Paralysis– Muscular twitching– Unconsciousness
Environmental Emergencies
• Other Signs & Symptoms of DCI– Speech disturbances– Personality changes– Altered mental status– Convulsions– Hearing loss / ringing ears– Bladder / bowel problems– Coughing blood
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