Transcript Environmental Emergencies - For Medical Professionals

Environmental Emergencies
Cold Emergencies
AHC South Region EMS - Quarterly CE - 2009
Environmental Emergencies
Cold Emergencies
Hypothermia is a condition in which an organism's temperature drops below that
required for normal metabolismm and bodily functions. In warmblooded animals, core body temperature is maintained near a constant
level through biologic homeostasis. But, when the body is exposed to
cold, its internal mechanisms may be unable to replenish the heat that
is being lost to the organism's surroundings.
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Cold Emergencies
Mechanisms of Heat Loss
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Heat Loss Through Conduction
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Conduction –
is defined as the transfer of heat from a warmer object to a cooler
object when the two object are in direct contact with each other. A
common source of conductive heat loss is out of the feet via soles of
your footwear on cold ground. Conduction is also a major source of
heat loss in wet clothing, due water’s excellent conductive properties.
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Heat Loss Through Convection
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Cold Emergencies
Convection –
Convective heat loss occurs in response to movement of a fluid or gas.
In outdoor clothing systems, convective heat loss occurs when warm
air next to the body and in the clothing is displaced by cool air from
the outside environment. The biggest factor contributing to convective
heat loss, of course, is wind.
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Cold Emergencies
Heat Loss From Radiation
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Radiation –
Radiative heat loss from the human body occurs primarily due to
infrared emission. Radiative heat loss occurs primarily on cold, clear
nights, and is readily noticeable after sunset. Cloud cover dampens the
effects of radiative heat loss somewhat, by reflecting a significant
portion of radiant heat back to the earth’s surface.
- A person wearing proper cold weather clothing should not
expierience a significant amount of radiative heat loss unless he is
thinly clothed.
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Heat Loss from Evaporation
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Evaporation –
Evaporation occurs when a liquid (such as sweat) changes phase to a
vapor (sweat vapor). This phase change requires heat. Unfortunately,
your body heat drives this phase change. Evaporative heat loss may be
most noticeable in context of the “flash-off” effect, which occurs after
a period of intense physical activity and sweating in cold conditions,
followed by rapid evaporation and chill after stopping to rest.
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Heat Loss from Respiration
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Respiration –
Technically, respiration combines the processes of evaporation (of
moisture in the lungs) and convection (displacement of warm air in the
lungs by cold air from the outside environment).
Significant moisture (and thus, body heat) can be lost when that moist
air is exchanged with much drier outside air. In addition, some body
heat is lost to the process of warming the cold air entering your lungs
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Stages of Hypothermia
&
Treatment of Hypothermia
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Cold Emergencies
Mild Hypothermia 90 - 95 degrees F
- PT complains of feeling cold.
- More time than not the PT is wet.
- PT is shivering to some extent.
- Loss of interest in anything other than getting warm and PT is often
angry and agitated.
- Problems may begin to develop with PT’s muscular coordination,
beginning with fine motor tasks.
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Cold Emergencies
Mild Hypothermia
-
Protect from further cooling and re - warm by any convenient means.
Wet clothing MUST be removed.
Heat packs should be placed at points of least insulation.
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Moderate Hypothermia 86 – 89 degrees F
-
Severe Shivering in attempts to re – warm the body.
Slowing respirations.
Drowsiness.
PT’s heart rate may begin to slow.
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Moderate Hypothermia
-
Prevent further heat loss.
Remove wet clothing.
Cover with blankets.
IV with warm NS.
EKG.
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Severe Hypothermia 86 degrees F or lower
-
ALOC
A conscious PT will have no decision making skills.
No willingness to survive.
Will drift in and out of consciousness until lapsing into a coma.
Shivering stops.
Pulses are weak and extremely hard to find.
Breath may become fruity do to incomplete metabolism.
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Cold Emergencies
Severe Hypothermia
-
Prevent further heat loss.
Remove wet clothing and cover with blankets.
Secure Airway and assist with ventilations.
AVOID ROUGH HANDLING OF PT. – if victim is moved suddenly after long
periods of inactivity, the heart pumps cold blood from the body back into the heart
causing Ventricular Fibrillation ( V – Fib).
-
EKG and IV with warm NS
Do not give IV drugs to PT unless body temperature is > 86 degrees F or
ordered by Med Control.
If rhythm is V-Fib/pulseless VT Defib x 1.
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Cold Emergencies
Near Death
-
Profound Hypothermia can mimic death.
Some victims of sever hypothermia have been pronounced dead before
they really were.
An ECG may be required to determine if there is heart activity.
- “PT’s are not dead until they’re warm and dead.”
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Local Cold Injury
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Chilblains
-
Caused by chronic exposure to damp, nonfreezing ambient
temperatures.
Painful, inflammatory lesions on skin.
Hands, ears, lower legs, and feet are most common sites.
Treatment
- Re warm, bandage, and elevate.
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Trench Foot
-
Caused by prolonged skin exposure to cool, wet conditions.
Skin becomes pale, mottled, and anesthetic.
In late stages, sloughing and gangrene may occur.
Treatment
Clean, warm affected area, wrap in dry bandages, and elevate.
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Frostnip
-
Non freezing injury to the skin.
Extremity appears pale and PT may feel discomfort.
Tissue loss does not occur.
Treatment
- Local re warming.
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Frostbite
-
Destruction of body tissues due freezing.
Ice crystals form in the tissues and breaks apart cells.
Four degrees of frostbite.
1st Degree
-
Partial skin freezing. Redness, mild edema, and lack of blisters.
2nd Degree
- Full thickness freezing, substantial edema, and formation of clear blisters.
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3rd Degree
-
Full thickness skin and subcutaneous freezing, hemorrhagic blisters,
skin necrosis, and bluish-grey discoloration.
4th Degree
- Full thickness damage affecting muscles, tendons, and bones; little
edema, affected areas may initially be mottled or cyanotic, eventually
will turn dry, black, and mummified.
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Treatment
-
Move PT into warm environment.
Protect affected extremity and handle skin gently.
Do not rub.
Do not thaw area if if there is a chance of refreezing.
Cover affected extremities with warm blankets.
Anticipate severe pain when re warming partial thickness frostbite.
- Consider ALS transport for pain management if there is delayed or
extended transport times.
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Scenario 1
You are dispatched for a Snowmobile accident with two
patients. You are told be dispatch that the person who called
911 heard snowmobiles go past her house and then heard a
loud crash. It is 2130 Hrs, the Air Temp is 22 Degrees F, and it
is Snowing.
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This is what you find upon your arrival and you have two patients
both conscious lying on the ground. Both are wearing helmets. What
kind of injuries can you expect? How do you treat them? What other
considerations regarding the scene should you have?
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Scenario 2
You are dispatched on a Life Safety Box Alarm to Geneva Lakes Cold
Storage Warehouse in Darien. The Occupancy had a storage rack collapse
collapse on approximately 8 employees. You arrive on scene and find the
Fire Dept extricating your victim. The FD asks your unit to begin care on
your PT while they finish freeing your PT. The PT was working on a fork
lift when the collapse happened. The Temperature inside the warehouse is –
25 degrees F. The PT is wearing appropriate clothing. He has been trapped
for about and hour.
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What Type of Injuries?
Scene Considerations?
How do you treat injuries?
Appropriate PPE?
Mode of Transport?
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Questions??