winter emergencies presence regional ems system continuing education january 2015

Winter EmergenciesWinter Emergencies

Presence Regional EMS Presence Regional EMS System System

Continuing Education Continuing Education

January 2015January 2015

ObjectivesObjectives1.1. List the National Weather Service criteria for List the National Weather Service criteria for

winter storm watches, advisories and winter storm watches, advisories and warnings.warnings.

2.2. Outline ways to prepare your home and your Outline ways to prepare your home and your car for winter weather emergencies.car for winter weather emergencies.

3.3. List four factors that affect how individuals List four factors that affect how individuals respond when exposed to a cold respond when exposed to a cold environment.environment.

4.4. Describe five ways the body loses heat in a Describe five ways the body loses heat in a cold environment.cold environment.

5.5. Discuss hypothermia, risk factors, Discuss hypothermia, risk factors, assessment and managementassessment and management

6.6. Outline the different types of local Outline the different types of local cold injuries including risk factors, cold injuries including risk factors, assessment and management.assessment and management.

7.7. Discuss the dangers of carbon Discuss the dangers of carbon monoxide poisoning in the winter monoxide poisoning in the winter including the risk factors, assessment including the risk factors, assessment and management.and management.

Illinois WeatherIllinois Weather

►Since 1995 a total of 135 peopleSince 1995 a total of 135 people

have died from exposure to cold have died from exposure to cold temperatures. temperatures.

►This is more people than killed This is more people than killed

by tornadoes, severe thunder-by tornadoes, severe thunder-

storms, floods and lightningstorms, floods and lightning

combined. (101 versus 135)combined. (101 versus 135)► * National Weather Service in Lincoln IL.* National Weather Service in Lincoln IL.

► Illinois normally experiences Illinois normally experiences fivefive severe winter storms each year. severe winter storms each year.

►There has There has notnot been a winter without a been a winter without a winter storm in the last century. winter storm in the last century.

►A winter storm may be snow, ice or a A winter storm may be snow, ice or a combination.combination.

► * National Weather Service* National Weather Service

in Lincoln IL.in Lincoln IL.

Winter Weather SafetyWinter Weather Safety

►Keeping posted on local weather Keeping posted on local weather conditions via television, radio, internet conditions via television, radio, internet or weather service radios will keep you or weather service radios will keep you informed and prepared for winter informed and prepared for winter weather conditions.weather conditions.

►Web page to monitor forecast winter Web page to monitor forecast winter storms and to get winter road conditions:storms and to get winter road conditions:

► www.weather.gov/Lincoln/?n=winter_monitorwww.weather.gov/Lincoln/?n=winter_monitor

Winter Weather DefinitionsWinter Weather Definitions

►Watches:Watches: Winter Storm WatchWinter Storm Watch: : Conditions

favorable for a winter storm event which is a threat to life or property.

Blizzard Watch: Conditions favorable for a blizzard event (low visibility < ¼ mile with winds at least 35 mph)

Winter Weather DefinitionsWinter Weather Definitions►Advisories:Advisories:

Wind Chill Advisory:Wind Chill Advisory: Strong winds that Strong winds that increase the danger of exposure to cold airincrease the danger of exposure to cold air

Freezing Rain Advisory: Freezing Rain Advisory: ►Ice accumulation of < ¼ inchIce accumulation of < ¼ inch

Winter Weather AdvisoryWinter Weather Advisory: Issued for : Issued for one or more of the following:one or more of the following:►Snow of 3-5 inches in 12 hours►Sleet < ½ inch►Freezing rain with sleet/snow►Blowing snow

Winter Weather DefinitionsWinter Weather Definitions►Warnings:

Winter Storm Warning: Heavy snow of 6 inches in 12 hours or 8 inches in 24 hours or sleet of ½ inch or more.

Ice Storm Warning: Ice accumulation of ¼ inch or more

Blizzard Warning: Blizzard conditions for at least 3 hours


►The leading cause of death during The leading cause of death during winter storms is from automobile or winter storms is from automobile or other transportation accidents/ other transportation accidents/ incidents.incidents.

►Do you know how to stay safe on the Do you know how to stay safe on the roadway????roadway????


► Keep the gas tank fullKeep the gas tank full► Let someone know your destination, route and Let someone know your destination, route and

ETAETA► Be aware of approaching or existing winter Be aware of approaching or existing winter

weatherweather► Allow yourself extra time to get to the Allow yourself extra time to get to the

destinationdestination► Allow extra room for brakingAllow extra room for braking►Monitor how close the vehicle behind you is to Monitor how close the vehicle behind you is to

avoid being rear-ended.avoid being rear-ended.► Carry an emergency kit for each vehicle. Carry an emergency kit for each vehicle.

Winter Weather SafetyWinter Weather SafetyEmergency Roadway Kit Items:Emergency Roadway Kit Items:

► Blankets or Blankets or sleeping bagssleeping bags

► Extra clothing to Extra clothing to include hats and include hats and glovesgloves

► Flashlight/batteriesFlashlight/batteries► First aid kitFirst aid kit► Safety flaresSafety flares► Jumper Jumper

cables/Ropecables/Rope► Candle and dry Candle and dry

matchesmatches

► Drinking waterDrinking water► Food (high calorie, Food (high calorie,

non-perishable)non-perishable)► Shovel/ basic tool kitShovel/ basic tool kit► Sack of sandSack of sand► Plastic bags/covered Plastic bags/covered

empty can for empty can for sanitationsanitation

► Cellular phone and Cellular phone and car chargercar charger


► If you get stranded…..If you get stranded….. Stay with the vehicleStay with the vehicle

►unless help is visible within 100 yards. unless help is visible within 100 yards.

Occasionally run the motor for heatOccasionally run the motor for heat►10 minutes every hour or 5 minutes every half 10 minutes every hour or 5 minutes every half

hourhour

Make yourself visibleMake yourself visible►Turn on the dome light while the engine is runningTurn on the dome light while the engine is running►Tie a red flag or piece of fabric to the antenna Tie a red flag or piece of fabric to the antenna ►Raise the hood once it has stopped snowingRaise the hood once it has stopped snowing


► If you get stranded…..If you get stranded….. Do minor exercises to keep up circulationDo minor exercises to keep up circulation Keep a window that is away from blowing Keep a window that is away from blowing

snow slightly open for fresh airsnow slightly open for fresh air Drink fluids to avoid dehydrationDrink fluids to avoid dehydration If more than one person:If more than one person:

►Huddle together for warmthHuddle together for warmth►Take turns sleeping ( being awake will help Take turns sleeping ( being awake will help

with circulation and body temperature)with circulation and body temperature)


►An ordinary driver reacts to the road An ordinary driver reacts to the road situations…..situations…..

►A good driver anticipates crises and A good driver anticipates crises and avoids them.avoids them.

►Be a good driver, be prepared.Be a good driver, be prepared.


►Have an alternative heating source for Have an alternative heating source for your home. your home. Use it safely with proper ventilation to Use it safely with proper ventilation to

avoid carbon monoxide poisoningavoid carbon monoxide poisoning Never bring an outdoor grill into your Never bring an outdoor grill into your

home for cooking or heating purposes.home for cooking or heating purposes.


►Dress for the cold weatherDress for the cold weather Layer clothingLayer clothing Cover as much skin asCover as much skin as

possiblepossible Stay dry – if you Stay dry – if you

become wet, even from become wet, even from

perspiration, you will perspiration, you will

become colder quickerbecome colder quicker* National Weather Service* National Weather Service

Pathophysiology of Cold Pathophysiology of Cold ExposureExposure

►Body TemperatureBody Temperature Core temperature is normally 97.6Core temperature is normally 97.6°F to °F to

99.7°F (36.5°C to 37.5°C) for proper 99.7°F (36.5°C to 37.5°C) for proper functioning.functioning.

Hypothalamus in the brain contains a Hypothalamus in the brain contains a thermoregulatory center that constantly thermoregulatory center that constantly monitors the body temperaturemonitors the body temperature

Homeostasis: Body mechanisms to Homeostasis: Body mechanisms to maintain a normal body temperaturemaintain a normal body temperature

►ThermoregulationThermoregulation Body TemperatureBody Temperature

►Core temperatureCore temperature►Peripheral Peripheral

temperaturetemperature

Heat DissipationHeat Dissipation►Sweating, Sweating,

vasodilationvasodilation

Heat ConservationHeat Conservation►Shivering, Shivering,

vasoconstrictionvasoconstriction

Pathophysiology of ColdPathophysiology of Cold

►Mechanisms of Heat Gain and LossMechanisms of Heat Gain and Loss Thermal Gradient greatly affected byThermal Gradient greatly affected by

►WindWind►Relative HumidityRelative Humidity

►Thermogenesis (creating heat) Thermogenesis (creating heat) Exercise-Induced Exercise-Induced Diet-InducedDiet-Induced

Pathophysiology Cold Pathophysiology Cold DisordersDisorders

►The body must maintain an optimum The body must maintain an optimum body temperature so that the cells can body temperature so that the cells can continue to function normally. continue to function normally.

► In order to do so, the amount of heat In order to do so, the amount of heat lost by the body must equal the lost by the body must equal the amount of heat gained by the body. amount of heat gained by the body.

► If the amount of heat lost exceeds the If the amount of heat lost exceeds the amount of heat gained, the patient’s amount of heat gained, the patient’s body core temperature will begin to body core temperature will begin to decrease.decrease.

►ThermolysisThermolysis ConductionConduction ConvectionConvection RadiationRadiation EvaporationEvaporation RespirationRespiration* * Radiation is the Radiation is the

most significant most significant mechanism of mechanism of heat lossheat loss

Ways the Body Loses HeatWays the Body Loses Heat

ConvectionConvection

►Anything that speeds movement of the Anything that speeds movement of the air, such as the wind, also speeds the air, such as the wind, also speeds the cooling process. That is where the cooling process. That is where the concept of wind chill comes into concept of wind chill comes into understanding and predicting understanding and predicting hypothermia.hypothermia.

Wind ChillWind Chill

►Affect of wind on temperatureAffect of wind on temperature

Evaporation Evaporation

►Water conducts heat 240 times faster Water conducts heat 240 times faster than air, and conduction is the method of than air, and conduction is the method of heat loss in water chill. heat loss in water chill.

►This means that water and wet clothing This means that water and wet clothing will conduct heat away from the body at will conduct heat away from the body at a much higher rate than air and dry a much higher rate than air and dry clothing and much more rapidly than the clothing and much more rapidly than the body can produce it. body can produce it.

►Conduction and convection combined Conduction and convection combined produce about 15 percent of the heat produce about 15 percent of the heat loss.loss.

►Affect of water temperature on core Affect of water temperature on core temperaturetemperature

Factors Affecting Cold Factors Affecting Cold ExposureExposure

►Patient’s physical conditionPatient’s physical condition Patients in poor physical condition or who Patients in poor physical condition or who

have chronic illness involving the have chronic illness involving the cardiovascular, metabolic or neurologic cardiovascular, metabolic or neurologic systems are at greater risk for cold systems are at greater risk for cold exposureexposure

Factors Affecting Cold Factors Affecting Cold ExposureExposure AgeAge

►Extreme ages (young or old) are more prone to Extreme ages (young or old) are more prone to exposure injuries. exposure injuries.

►ChildrenChildren Infants do not have the ability to shiver to generate Infants do not have the ability to shiver to generate

heat until 12-18 months of age.heat until 12-18 months of age. Children have a larger surface area to mass ratio Children have a larger surface area to mass ratio

causing increased heat loss.causing increased heat loss. Small children do not know or understand how to Small children do not know or understand how to

dress appropriately for the weather conditions. dress appropriately for the weather conditions. ►Elderly Elderly

Loss of subcutaneous tissue used for insulation.Loss of subcutaneous tissue used for insulation. Poor circulation contributes to increased heat loss.Poor circulation contributes to increased heat loss. Certain medications taken by elderly can affect their Certain medications taken by elderly can affect their

body’s thermostatbody’s thermostat

Factors Affecting Cold Factors Affecting Cold ExposureExposure

Nutrition and HydrationNutrition and Hydration►Body needs calories to fuel metabolism to Body needs calories to fuel metabolism to

create heatcreate heat Environmental ConditionsEnvironmental Conditions

►Air temperature (does not have to be below Air temperature (does not have to be below freezing)freezing)

►Wind speed to create wind chillWind speed to create wind chill►Presence of waterPresence of water

Poisoning or Substance AbusePoisoning or Substance Abuse

Cold ExposureCold Exposure

►Cold exposure can cause two types of Cold exposure can cause two types of cold emergencies:cold emergencies:

Generalized hypothermiaGeneralized hypothermia

Local cold injuriesLocal cold injuries

Generalized HypothermiaGeneralized Hypothermia

Cold ExposuresCold Exposures►Generalized HypothermiaGeneralized Hypothermia

When more heat is lost from the body than is When more heat is lost from the body than is produced, the body temperature falls resulting in produced, the body temperature falls resulting in hypothermia.hypothermia.

Hypothalamus looses the ability to regulate body Hypothalamus looses the ability to regulate body temperature when the core body temperature temperature when the core body temperature falls below 95falls below 95°F (35°C).°F (35°C).

Patient may appear dead or be in a coma when Patient may appear dead or be in a coma when core temperature reaches 79°F (never assume a core temperature reaches 79°F (never assume a cold pulseless patient is dead unless there is cold pulseless patient is dead unless there is sustained asystole on a monitor screen)sustained asystole on a monitor screen)

Death can occur within 2 hours of the first signs Death can occur within 2 hours of the first signs and symptoms.and symptoms.

Cold ExposuresCold Exposures

Cold ExposuresCold Exposures► Generalized hypothermia can be broken into five Generalized hypothermia can be broken into five

stages:stages:


►Generalized Hypothermia Generalized Hypothermia Scene Size-UpScene Size-Up Scene safetyScene safety

►Note weather conditions (dress appropriately for Note weather conditions (dress appropriately for weather)weather)

►Note road hazards (snow, ice or wet)Note road hazards (snow, ice or wet) BSIBSI Assess NOI/ MOIAssess NOI/ MOI # of patients# of patients Do I need extra help?Do I need extra help? Is C-Spine an issue?Is C-Spine an issue?


► Generalized Hypothermia Generalized Hypothermia Initial AssessmentInitial Assessment General impression (sick/ not sick)General impression (sick/ not sick) Mental status (AVPU)Mental status (AVPU) Airway Airway BreathingBreathing

► Apply oxygen with NRB or BVM at 15lpm, do not use Apply oxygen with NRB or BVM at 15lpm, do not use mechanical airway adjuncts mechanical airway adjuncts

► If using BVM, do not hyperventilate, assist at 12 breaths per If using BVM, do not hyperventilate, assist at 12 breaths per minute if patient’s rate is <5.minute if patient’s rate is <5.

CirculationCirculation► Check for carotid pulse for a full minute before deciding Check for carotid pulse for a full minute before deciding

patient is pulselesspatient is pulseless► Check skin temperature on the core of patientCheck skin temperature on the core of patient

Determine priorityDetermine priority


►Generalized hypothermia Generalized hypothermia Focused History Focused History and Physical Examand Physical Exam ResponsiveResponsive

►SAMPLE HistorySAMPLE History Include length of exposure, if wind or water were a factorInclude length of exposure, if wind or water were a factor

►Focused examFocused exam►VitalsVitals

UnresponsiveUnresponsive►Rapid medical examRapid medical exam►VitalsVitals►SAMPLE HistorySAMPLE History

Cold ExposuresCold Exposures►Generalized Hypothermia Generalized Hypothermia InterventionsInterventions

Move from cold environmentMove from cold environment Do not allow patient to walk, eat, use any Do not allow patient to walk, eat, use any

stimulants or tobacco productsstimulants or tobacco products Remove wet clothingRemove wet clothing Place warm blankets under and on top of Place warm blankets under and on top of

patientpatient Handle gently (rough handling may cause Handle gently (rough handling may cause

patient to go into ventricular tachycardia/ patient to go into ventricular tachycardia/ fibrillation)fibrillation)

DO NOT massage extremitiesDO NOT massage extremities


► Generalized Hypothermia Generalized Hypothermia Interventions (cont.)Interventions (cont.) UnresponsiveUnresponsive

►Transport in supine position or 10 degrees Trendelenburg Transport in supine position or 10 degrees Trendelenburg if availableif available

►Passive rewarming measuresPassive rewarming measures Cover with warm dry blanketsCover with warm dry blankets Warm humidified oxygenWarm humidified oxygen Increase temperature in ambulanceIncrease temperature in ambulance

ResponsiveResponsive►Active rewarming measuresActive rewarming measures

Passive rewarming techniques and:Passive rewarming techniques and: Hot packs to the groin, arm pits, and abdominal areaHot packs to the groin, arm pits, and abdominal area


►Generalized Hypothermia Generalized Hypothermia Interventions Interventions (cont.)(cont.) Advanced providersAdvanced providers

►IV of Normal Saline- bolus 500mL (warmed if IV of Normal Saline- bolus 500mL (warmed if possible to 102◦F to 106◦F)possible to 102◦F to 106◦F)

►Reassess and repeat IV boluses if lungs Reassess and repeat IV boluses if lungs remain clearremain clear

►MonitorMonitor

HypothermiaHypothermia ECG changes with hypothermiaECG changes with hypothermia

►Pathognomonic J waves (Osborn waves).Pathognomonic J waves (Osborn waves).►Eventual onset of bradycardia.Eventual onset of bradycardia.►Ventricular fibrillation probable below 86Ventricular fibrillation probable below 86º º

F.F.

Cold ExposureCold Exposure

►Generalized Hypothermia Generalized Hypothermia Ongoing Ongoing ExamExam Reassess vitals every 5 minutesReassess vitals every 5 minutes Monitor Level of ConsciousnessMonitor Level of Consciousness Monitor generalized hypothermic patients Monitor generalized hypothermic patients

for cardiac arrestfor cardiac arrest►Rewarming or rough handling of patient can Rewarming or rough handling of patient can

irritate the heart causing irritate the heart causing Ventricular Ventricular Fibrillation or Ventricular TachycardiaFibrillation or Ventricular Tachycardia..


►Hypothermic Cardiac ArrestHypothermic Cardiac Arrest

**consider that pulses may be very **consider that pulses may be very weak or not palpable in a severely weak or not palpable in a severely hypothermic patient. Take hypothermic patient. Take one full one full minuteminute to assure pulselessness; to assure pulselessness; unnecessary CPR could cause unnecessary CPR could cause Ventricular Fibrillation.**Ventricular Fibrillation.**


►Hypothermic Cardiac Arrest Hypothermic Cardiac Arrest InterventionsInterventions BLSBLS

►Load and Go, consider intercept if availableLoad and Go, consider intercept if available►Airway/ Breathing control: BVM only, with oxygen at 15 Airway/ Breathing control: BVM only, with oxygen at 15

lpm (warmed and humidified if available)lpm (warmed and humidified if available)►CirculationCirculation

AED- shock only ONE time if indicatedAED- shock only ONE time if indicated CPRCPR

►Passive rewarming Passive rewarming Warm blanketsWarm blankets Warm humidified oxygenWarm humidified oxygen Increase temperature in vehicleIncrease temperature in vehicle

►Transport supine or 10 degrees Trendelenburg if Transport supine or 10 degrees Trendelenburg if availableavailable


►Hypothermic Cardiac Arrest Hypothermic Cardiac Arrest InterventionsInterventions ALSALS

►All BLS interventions plus:All BLS interventions plus: Cardiac monitorCardiac monitor

►Defibrillation and cardioversion attempts should be Defibrillation and cardioversion attempts should be limited to three total.limited to three total.

IV solution of NS wide open, warm solution as available IV solution of NS wide open, warm solution as available to 102◦F to 106◦Fto 102◦F to 106◦F

IV medications according to appropriate dysrhythmia IV medications according to appropriate dysrhythmia protocolprotocol►Only one round of medications should be Only one round of medications should be

administered until body temperature is above 95◦ F.administered until body temperature is above 95◦ F.

Local Cold InjuriesLocal Cold Injuries


►Local Cold InjuriesLocal Cold Injuries Occurs when a portion of the skin is Occurs when a portion of the skin is

exposed to cold temperatures and exposed to cold temperatures and freezes.freezes.

Exposed areas of the body are most prone Exposed areas of the body are most prone to local cold injuriesto local cold injuries►FingersFingers►ToesToes►EarsEars►NoseNose►Chin Chin


►Local Cold Injuries Local Cold Injuries Risk FactorsRisk Factors Any trauma in cold weatherAny trauma in cold weather Extremes of ageExtremes of age Tight footwearTight footwear Use of alcohol during exposure to coldUse of alcohol during exposure to cold Wet clothingWet clothing High altitudesHigh altitudes Loss of bloodLoss of blood ArteriosclerosisArteriosclerosis


►Local Cold Injuries Local Cold Injuries ClassificationClassification Early or superficial (frost nip)Early or superficial (frost nip)

►Freezing of the skin, but not the tissue Freezing of the skin, but not the tissue underneath underneath

►Loss of feeling or sensation in the affected Loss of feeling or sensation in the affected areasareas

►Skin may be pale to gray in colorSkin may be pale to gray in color►Cold to touch, but softCold to touch, but soft►Normal skin color does not return after Normal skin color does not return after

palpation of the areapalpation of the area

Local Cold InjuriesLocal Cold Injuries► Local Cold Injuries Local Cold Injuries

ClassificationClassification Late or deep (frost Late or deep (frost

bite)bite)►Freezing of the Freezing of the

body part to include body part to include skin and underlying skin and underlying tissuetissue

►Skin appears white Skin appears white and waxyand waxy

►Area will be firm to Area will be firm to hard (frozen hard (frozen feeling)feeling)

►Loss of sensationLoss of sensation

►Late or deep frostbiteLate or deep frostbite►Swelling and fluid filled blisters may be Swelling and fluid filled blisters may be

present 24 hours after rewarmingpresent 24 hours after rewarming►Skin may become blotchy or mottled as Skin may become blotchy or mottled as

warming occurswarming occurs

►Deep frostbite may result in black Deep frostbite may result in black gangrene several days after gangrene several days after warmingwarming


► Local Cold Injuries Local Cold Injuries TreatmentTreatment Remove patient from further exposureRemove patient from further exposure

►Do not re-expose to coldDo not re-expose to cold Handle injured part gentlyHandle injured part gently

►Do not allow to stand or walk if extremities are involvedDo not allow to stand or walk if extremities are involved Protect from further injury Protect from further injury

►Splint or bandage as neededSplint or bandage as needed Remove any wet or restrictive clothingRemove any wet or restrictive clothing Never rub the areaNever rub the area Do not break any blistersDo not break any blisters Transport Transport


►Local Cold Injuries Local Cold Injuries TreatmentTreatment If ETA is greater than 60 minutes, begin If ETA is greater than 60 minutes, begin

active rewarming:active rewarming:►Immerse extremity in water keep at a Immerse extremity in water keep at a

temperature of 100◦F-105◦F. temperature of 100◦F-105◦F. ►Rewarming should take 30-60 minutes.Rewarming should take 30-60 minutes.►Rewarming is complete when frozen area is Rewarming is complete when frozen area is

warm to touch and deep red or bluish in color.warm to touch and deep red or bluish in color.►After rewarming, dry gently and cover part After rewarming, dry gently and cover part

with dry sterile dressing and elevate on pillow.with dry sterile dressing and elevate on pillow.

CautionCaution

► If active rewarming with warm water is If active rewarming with warm water is begunbegun Do not let the water temperature drop Do not let the water temperature drop

below 100◦F until rewarming is complete.below 100◦F until rewarming is complete. Stay at the scene until rewarming is Stay at the scene until rewarming is

complete.complete. This is almost impossible to do in a This is almost impossible to do in a

moving ambulance.moving ambulance.

Trench FootTrench Foot►Trench FootTrench Foot

Occurs above freezing.Occurs above freezing.►Typically occurs from standingTypically occurs from standing in cold water.in cold water.

Symptoms are similar Symptoms are similar to frostbite.to frostbite.

►Pain may be present, Pain may be present, and blisters may formand blisters may formwith spontaneous with spontaneous rewarming.rewarming.

Treatment:Treatment:►Warm, dry, and aerate the feet.Warm, dry, and aerate the feet.►Prevention is the best treatment.Prevention is the best treatment.

Carbon Monoxide PoisoningCarbon Monoxide Poisoning


►Carbon Monoxide (CO) poisoning is the Carbon Monoxide (CO) poisoning is the leading cause of accidental poisoning leading cause of accidental poisoning deaths in America.deaths in America.

►CDC estimates annually:CDC estimates annually: 500 deaths from CO500 deaths from CO 15,000 Emergency Room visits15,000 Emergency Room visits


►Carbon Monoxide is:Carbon Monoxide is: Formed when organic compounds burnFormed when organic compounds burn ColorlessColorless OdorlessOdorless TastelessTasteless

Carbon Monoxide PoisoningCarbon Monoxide PoisoningSourcesSources

►Motor vehicle exhaustMotor vehicle exhaust► Smoke from firesSmoke from fires►Gas hot water heatersGas hot water heaters► Kerosene space Kerosene space

heatersheaters► Charcoal grillsCharcoal grills► Propane heaters and Propane heaters and

stovesstoves► Cigarette smokeCigarette smoke

► Gas or diesel Gas or diesel generatorsgenerators

► Gas powered tools Gas powered tools (chain saw, weed (chain saw, weed eater, etc.)eater, etc.)

► Indoor tractor pullsIndoor tractor pulls► Boat engine exhaustBoat engine exhaust► Spray paint, Spray paint,

solvents, solvents, degreasers, and degreasers, and paint removerspaint removers

Carbon Monoxide PoisoningCarbon Monoxide PoisoningRisksRisks

► Industrial workersIndustrial workers► Personnel at fire Personnel at fire

scenesscenes► Using heating Using heating

sources or sources or generators during a generators during a power outagepower outage

►Working indoors Working indoors with engineswith engines

► Swimming near or Swimming near or under the stern or under the stern or swim step of a boat swim step of a boat with a running with a running engineengine

► Improper or impaired Improper or impaired gas appliance gas appliance ventilations (water ventilations (water heater, stove, or heater, stove, or furnace)furnace)

► Grilling indoorsGrilling indoors

Carbon Monoxide PoisoningCarbon Monoxide PoisoningSigns and SymptomsSigns and Symptoms

►HeadacheHeadache►DizzinessDizziness►Nausea/ vomitingNausea/ vomiting► Flu like symptomsFlu like symptoms► FatigueFatigue►DyspneaDyspnea► Chest painChest pain► Abdominal painAbdominal pain

► Altered mental Altered mental statusstatus

► AgitationAgitation►HallucinationsHallucinations► Visual changesVisual changes► SyncopeSyncope► SeizuresSeizures►Memory problemsMemory problems► Cherry red skinCherry red skin► Pale to cyanotic skinPale to cyanotic skin


CautionCautionSigns and symptoms of Carbon Signs and symptoms of Carbon Monoxide Poisoning can mimic the Monoxide Poisoning can mimic the flu.flu.


►TreatmentTreatment Scene safetyScene safety Remove patient from the environmentRemove patient from the environment Monitor level of consciousnessMonitor level of consciousness Maintain airway (be prepared to suction if Maintain airway (be prepared to suction if

patient begins to vomit)patient begins to vomit) High flow oxygenHigh flow oxygen


►Removal from environment = half life Removal from environment = half life of Carbon Monoxide = 180 minutesof Carbon Monoxide = 180 minutes

►High flow oxygen (15 liters non High flow oxygen (15 liters non rebreather mask) = half life of Carbon rebreather mask) = half life of Carbon Monoxide = 90 minutesMonoxide = 90 minutes

QuestionsQuestions►Answer the following questions as a Answer the following questions as a

group.group.► If doing this CE individually, please e-If doing this CE individually, please e-

mail your answers to:mail your answers to:►[email protected]@presencehealth.org

Use “January 2015 CE” in subject box.Use “January 2015 CE” in subject box.►You will receive an e-mail confirmation. You will receive an e-mail confirmation.

Print this confirmation for your records, Print this confirmation for your records, and document the CE in your PREMSS and document the CE in your PREMSS CE record book.CE record book.

► IDPH site code: 067100E1215IDPH site code: 067100E1215

QuestionsQuestions

1.1. What is a winter weather advisory?What is a winter weather advisory?

2.2. Name three ways to stay safe on the road Name three ways to stay safe on the road during winter weather.during winter weather.

3.3. Identify at least 5 items that should be in an Identify at least 5 items that should be in an emergency road kit.emergency road kit.

QuestionsQuestions

4.4. Identify 3 factors affecting cold Identify 3 factors affecting cold emergencies.emergencies.

5.5. Name two ways the body loses heat.Name two ways the body loses heat.

6.6. Define two types of cold emergencies.Define two types of cold emergencies.

QuestionsQuestions

7.7. List at least four signs and symptoms of List at least four signs and symptoms of generalized hypothermia.generalized hypothermia.

8.8. Outline the treatment for generalized Outline the treatment for generalized hypothermia (including hypothermic hypothermia (including hypothermic arrest).arrest).

9.9. Describe the difference between Describe the difference between superficial local cold injuries and deep superficial local cold injuries and deep local cold injuries.local cold injuries.

QuestionsQuestions10.10.Outline the treatment for local cold Outline the treatment for local cold

injuries.injuries.

11.11.What do you need to keep in mind if What do you need to keep in mind if you choose to actively rewarm and you choose to actively rewarm and extremity with local cold injuries?extremity with local cold injuries?

12.12.What is the difference between What is the difference between frostbite and trench foot?frostbite and trench foot?

Questions Questions

13.13.Identify 5 signs and symptoms of Identify 5 signs and symptoms of carbon monoxide poisoning.carbon monoxide poisoning.

14.14.Identify 4 sources of carbon Identify 4 sources of carbon monoxide poisoningmonoxide poisoning

15.15.What is the treatment for carbon What is the treatment for carbon monoxide poisoning? monoxide poisoning?

winter emergencies presence regional ems system continuing education january 2015

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