Transcript Winter Emergencies

Winter Emergencies
Presence Regional EMS System
Continuing Education
January 2015
Objectives
1. List the National Weather Service criteria for
winter storm watches, advisories and warnings.
2. Outline ways to prepare your home and your
car for winter weather emergencies.
3. List four factors that affect how individuals
respond when exposed to a cold environment.
4. Describe five ways the body loses heat in a
cold environment.
5. Discuss hypothermia, risk factors, assessment
and management
6. Outline the different types of local cold
injuries including risk factors, assessment
and management.
7. Discuss the dangers of carbon monoxide
poisoning in the winter including the risk
factors, assessment and management.
Illinois Weather
► Since
1995 a total of 135 people
have died from exposure to cold
temperatures.
► This is more people than killed
by tornadoes, severe thunderstorms, floods and lightning
combined. (101 versus 135)
►
* National Weather Service in Lincoln IL.
normally experiences five severe
winter storms each year.
► There has not been a winter without a
winter storm in the last century.
► A winter storm may be snow, ice or a
combination.
► Illinois
* National Weather Service
in Lincoln IL.
►
Winter Weather Safety
► Keeping
posted on local weather conditions
via television, radio, internet or weather
service radios will keep you informed and
prepared for winter weather conditions.
► Web
page to monitor forecast winter storms
and to get winter road conditions:
►
www.weather.gov/Lincoln/?n=winter_monitor
Winter Weather Definitions
►Watches:
 Winter 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 Definitions
►Advisories:
 Wind Chill Advisory: Strong winds that
increase the danger of exposure to cold air
 Freezing Rain Advisory:
►Ice accumulation of < ¼ inch
 Winter Weather Advisory: Issued for 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 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
Winter Weather Safety
► The
leading cause of death during winter
storms is from automobile or other
transportation accidents/ incidents.
► Do
you know how to stay safe on the
roadway????
Winter Weather Safety
► Keep
the gas tank full
► Let someone know your destination, route and
ETA
► Be aware of approaching or existing winter
weather
► Allow yourself extra time to get to the destination
► Allow extra room for braking
► Monitor how close the vehicle behind you is to
avoid being rear-ended.
► Carry an emergency kit for each vehicle.
Winter Weather Safety
Emergency Roadway Kit Items:
► Blankets
or sleeping
bags
► Extra clothing to
include hats and
gloves
► Flashlight/batteries
► First aid kit
► Safety flares
► Jumper cables/Rope
► Candle and dry
matches
► Drinking
water
► Food (high calorie,
non-perishable)
► Shovel/ basic tool kit
► Sack of sand
► Plastic bags/covered
empty can for
sanitation
► Cellular phone and car
charger
Winter Weather Safety
► If
you get stranded…..
 Stay with the vehicle
►unless
help is visible within 100 yards.
 Occasionally run the motor for heat
►10
minutes every hour or 5 minutes every half hour
 Make yourself visible
►Turn
on the dome light while the engine is running
►Tie a red flag or piece of fabric to the antenna
►Raise the hood once it has stopped snowing
Winter Weather Safety
► If
you get stranded…..
 Do minor exercises to keep up circulation
 Keep a window that is away from blowing snow
slightly open for fresh air
 Drink fluids to avoid dehydration
 If more than one person:
►Huddle
together for warmth
►Take turns sleeping ( being awake will help with
circulation and body temperature)
Winter Weather Safety
► An
ordinary driver reacts to the road
situations…..
► A good driver anticipates crises and avoids
them.
► Be a good driver, be prepared.
Winter Weather Safety
► Have
an alternative heating source for your
home.
 Use it safely with proper ventilation to avoid
carbon monoxide poisoning
 Never bring an outdoor grill into your home for
cooking or heating purposes.
Winter Weather Safety
► Dress
for the cold weather
 Layer clothing
 Cover as much skin as
possible
 Stay dry – if you
become wet, even from
perspiration, you will
become colder quicker
* National Weather Service
Pathophysiology of Cold Exposure
► Body
Temperature
 Core temperature is normally 97.6°F to 99.7°F
(36.5°C to 37.5°C) for proper functioning.
 Hypothalamus in the brain contains a
thermoregulatory center that constantly
monitors the body temperature
 Homeostasis: Body mechanisms to maintain a
normal body temperature
Pathophysiology of Cold
► Thermoregulation
 Body Temperature
►Core
temperature
►Peripheral
temperature
 Heat Dissipation
►Sweating,
vasodilation
 Heat Conservation
►Shivering,
vasoconstriction
Pathophysiology Cold Disorders
► Mechanisms
of Heat Gain and Loss
 Thermal Gradient greatly affected by
►Wind
►Relative
Humidity
► Thermogenesis
(creating heat)
 Exercise-Induced
 Diet-Induced
► The
body must maintain an optimum body
temperature so that the cells can continue
to function normally.
► In order to do so, the amount of heat lost
by the body must equal the amount of heat
gained by the body.
► If the amount of heat lost exceeds the
amount of heat gained, the patient’s body
core temperature will begin to decrease.
Ways the Body Loses Heat
► Thermolysis
 Conduction
 Convection
 Radiation
 Evaporation
 Respiration
* Radiation is the most
significant mechanism
of heat loss
Convection
► Anything
that speeds movement of the air,
such as the wind, also speeds the cooling
process. That is where the concept of wind
chill comes into understanding and
predicting hypothermia.
Wind Chill
► Affect
of wind on temperature
Evaporation
► Water
conducts heat 240 times faster than
air, and conduction is the method of heat
loss in water chill.
► This means that water and wet clothing will
conduct heat away from the body at a much
higher rate than air and dry clothing and
much more rapidly than the body can
produce it.
► Conduction and convection combined
produce about 15 percent of the heat loss.
► Affect
of water temperature on core
temperature
Factors Affecting Cold Exposure
► Patient’s
physical condition
 Patients in poor physical condition or who have
chronic illness involving the cardiovascular,
metabolic or neurologic systems are at greater
risk for cold exposure
Factors Affecting Cold Exposure
 Age
► Extreme
ages (young or old) are more prone to exposure
injuries.
► Children
 Infants do not have the ability to shiver to generate heat
until 12-18 months of age.
 Children have a larger surface area to mass ratio causing
increased heat loss.
 Small children do not know or understand how to dress
appropriately for the weather conditions.
► Elderly
 Loss of subcutaneous tissue used for insulation.
 Poor circulation contributes to increased heat loss.
 Certain medications taken by elderly can affect their body’s
thermostat
Factors Affecting Cold Exposure
 Nutrition and Hydration
►Body
heat
needs calories to fuel metabolism to create
 Environmental Conditions
►Air
temperature (does not have to be below freezing)
►Wind speed to create wind chill
►Presence of water
 Poisoning or Substance Abuse
Cold Exposure
► Cold
exposure can cause two types of cold
emergencies:
 Generalized hypothermia
 Local cold injuries
Generalized Hypothermia
Cold Exposures
► Generalized
Hypothermia
 When more heat is lost from the body than is produced,
the body temperature falls resulting in hypothermia.
 Hypothalamus looses the ability to regulate body
temperature when the core body temperature falls
below 95°F (35°C).
 Patient may appear dead or be in a coma when core
temperature reaches 79°F (never assume a cold
pulseless patient is dead unless there is sustained
asystole on a monitor screen)
 Death can occur within 2 hours of the first signs and
symptoms.
Cold Exposures
Cold Exposures
►
Generalized hypothermia can be broken into five stages:
Cold Exposures
► Generalized
Hypothermia Scene Size-Up
 Scene safety
►Note
weather conditions (dress appropriately for
weather)
►Note road hazards (snow, ice or wet)





BSI
Assess NOI/ MOI
# of patients
Do I need extra help?
Is C-Spine an issue?
Cold Exposures
►
Generalized Hypothermia Initial Assessment




General impression (sick/ not sick)
Mental status (AVPU)
Airway
Breathing
► Apply
oxygen with NRB or BVM at 15lpm, do not use mechanical
airway adjuncts
► If using BVM, do not hyperventilate, assist at 12 breaths per minute if
patient’s rate is <5.
 Circulation
► Check
for carotid pulse for a full minute before deciding patient is
pulseless
► Check skin temperature on the core of patient
 Determine priority
Cold Exposures
► Generalized
hypothermia Focused History and
Physical Exam
 Responsive
► SAMPLE
History
 Include length of exposure, if wind or water were a factor
► Focused
exam
► Vitals
 Unresponsive
► Rapid
medical exam
► Vitals
► SAMPLE
History
Cold Exposures
► Generalized
Hypothermia Interventions
 Move from cold environment
 Do not allow patient to walk, eat, use any
stimulants or tobacco products
 Remove wet clothing
 Place warm blankets under and on top of
patient
 Handle gently (rough handling may cause
patient to go into ventricular tachycardia/
fibrillation)
 DO NOT massage extremities
Cold Exposures
► Generalized
Hypothermia Interventions (cont.)
 Unresponsive
► Transport
in supine position or 10 degrees Trendelenburg if
available
► Passive rewarming measures
 Cover with warm dry blankets
 Warm humidified oxygen
 Increase temperature in ambulance
 Responsive
► Active
rewarming measures
 Passive rewarming techniques and:
 Hot packs to the groin, arm pits, and abdominal area
Cold Exposures
► Generalized
Hypothermia Interventions (cont.)
 Advanced providers
►IV
of Normal Saline- bolus 500mL (warmed if
possible to 102◦F to 106◦F)
►Reassess and repeat IV boluses if lungs remain clear
►Monitor
Hypothermia
 ECG changes with hypothermia
►Pathognomonic
J waves (Osborn waves).
►Eventual onset of bradycardia.
►Ventricular fibrillation probable below 86º F.
Cold Exposure
► Generalized
Hypothermia Ongoing Exam
 Reassess vitals every 5 minutes
 Monitor Level of Consciousness
 Monitor generalized hypothermic patients for
cardiac arrest
►Rewarming
or rough handling of patient can irritate
the heart causing Ventricular Fibrillation or
Ventricular Tachycardia.
Cold Exposures
► Hypothermic
Cardiac Arrest
**consider that pulses may be very weak or
not palpable in a severely hypothermic
patient. Take one full minute to assure
pulselessness; unnecessary CPR could cause
Ventricular Fibrillation.**
Cold Exposures
► Hypothermic
Cardiac Arrest Interventions
 BLS
► Load
and Go, consider intercept if available
► Airway/ Breathing control: BVM only, with oxygen at 15 lpm
(warmed and humidified if available)
► Circulation
 AED- shock only ONE time if indicated
 CPR
► Passive
rewarming
 Warm blankets
 Warm humidified oxygen
 Increase temperature in vehicle
► Transport
supine or 10 degrees Trendelenburg if available
Cold Exposures
► Hypothermic
Cardiac Arrest Interventions
 ALS
►All
BLS interventions plus:
 Cardiac monitor
► Defibrillation and cardioversion attempts should be
limited to three total.
 IV solution of NS wide open, warm solution as available to
102◦F to 106◦F
 IV medications according to appropriate dysrhythmia
protocol
► Only one round of medications should be administered
until body temperature is above 95◦ F.
Local Cold Injuries
Local Cold Injuries
► Local
Cold Injuries
 Occurs when a portion of the skin is exposed to
cold temperatures and freezes.
 Exposed areas of the body are most prone to
local cold injuries
►Fingers
►Toes
►Ears
►Nose
►Chin
Local Cold Injuries
► Local








Cold Injuries Risk Factors
Any trauma in cold weather
Extremes of age
Tight footwear
Use of alcohol during exposure to cold
Wet clothing
High altitudes
Loss of blood
Arteriosclerosis
Local Cold Injuries
► Local
Cold Injuries Classification
 Early or superficial (frost nip)
►Freezing
of the skin, but not the tissue underneath
►Loss of feeling or sensation in the affected areas
►Skin may be pale to gray in color
►Cold to touch, but soft
►Normal skin color does not return after palpation of
the area
Local Cold Injuries
► Local
Cold Injuries
Classification
 Late or deep (frost bite)
►Freezing of the body
part to include skin
and underlying tissue
►Skin appears white
and waxy
►Area will be firm to
hard (frozen feeling)
►Loss of sensation
► Late
or deep frostbite
►Swelling
and fluid filled blisters may be present 24
hours after rewarming
►Skin may become blotchy or mottled as warming
occurs
►Deep
frostbite may result in black
gangrene several days after warming
Cold Exposures
► Local
Cold Injuries Treatment
 Remove patient from further exposure
► Do
not re-expose to cold
 Handle injured part gently
► Do
not allow to stand or walk if extremities are involved
 Protect from further injury
► Splint




or bandage as needed
Remove any wet or restrictive clothing
Never rub the area
Do not break any blisters
Transport
Cold Exposures
► Local
Cold Injuries Treatment
 If ETA is greater than 60 minutes, begin active
rewarming:
►Immerse
extremity in water keep at a temperature of
100◦F-105◦F.
►Rewarming should take 30-60 minutes.
►Rewarming is complete when frozen area is warm to
touch and deep red or bluish in color.
►After rewarming, dry gently and cover part with dry
sterile dressing and elevate on pillow.
Caution
► If
active rewarming with warm water is
begun
 Do not let the water temperature drop below
100◦F until rewarming is complete.
 Stay at the scene until rewarming is complete.
 This is almost impossible to do in a
moving ambulance.
Trench Foot
► Trench
Foot
 Occurs above freezing.
►Typically
occurs from standing
in cold water.
 Symptoms are similar
to frostbite.
►Pain
may be present,
and blisters may form
with spontaneous
rewarming.
 Treatment:
►Warm,
dry, and aerate the feet.
►Prevention is the best treatment.
Carbon Monoxide Poisoning
Carbon Monoxide Poisoning
► Carbon
Monoxide (CO) poisoning is the
leading cause of accidental poisoning deaths
in America.
► CDC estimates annually:
 500 deaths from CO
 15,000 Emergency Room visits
Carbon Monoxide Poisoning
► Carbon




Monoxide is:
Formed when organic compounds burn
Colorless
Odorless
Tasteless
Carbon Monoxide Poisoning
Sources
► Motor
vehicle exhaust
► Smoke from fires
► Gas hot water heaters
► Kerosene space
heaters
► Charcoal grills
► Propane heaters and
stoves
► Cigarette smoke
► Gas
or diesel
generators
► Gas powered tools
(chain saw, weed
eater, etc.)
► Indoor tractor pulls
► Boat engine exhaust
► Spray paint, solvents,
degreasers, and paint
removers
Carbon Monoxide Poisoning
Risks
► Industrial
workers
► Personnel at fire
scenes
► Using heating sources
or generators during a
power outage
► Working indoors with
engines
► Swimming
near or
under the stern or
swim step of a boat
with a running engine
► Improper or impaired
gas appliance
ventilations (water
heater, stove, or
furnace)
► Grilling indoors
Carbon Monoxide Poisoning
Signs and Symptoms
► Headache
► Dizziness
► Nausea/
vomiting
► Flu like symptoms
► Fatigue
► Dyspnea
► Chest pain
► Abdominal pain
► Altered
mental status
► Agitation
► Hallucinations
► Visual changes
► Syncope
► Seizures
► Memory problems
► Cherry red skin
► Pale to cyanotic skin
Carbon Monoxide Poisoning
Caution
Signs and symptoms of Carbon
Monoxide Poisoning can mimic the flu.
Carbon Monoxide Poisoning
► Treatment
Scene safety
Remove patient from the environment
Monitor level of consciousness
Maintain airway (be prepared to suction if
patient begins to vomit)
 High flow oxygen




Carbon Monoxide Poisoning
► Removal
from environment = half life of
Carbon Monoxide = 180 minutes
► High flow oxygen (15 liters non rebreather
mask) = half life of Carbon Monoxide = 90
minutes
Questions
► Answer
the following questions as a group.
► If doing this CE individually, please e-mail
your answers to:
► [email protected]
Use “January 2015 CE” in subject box.
► You will receive an e-mail confirmation.
Print this confirmation for your records, and
document the CE in your PREMSS CE record
book.
► IDPH site code: 067100E1215
Questions
1. What is a winter weather advisory?
2. Name three ways to stay safe on the road
during winter weather.
3. Identify at least 5 items that should be in
an emergency road kit.
Questions
4. Identify 3 factors affecting cold
emergencies.
5. Name two ways the body loses heat.
6. Define two types of cold emergencies.
Questions
7. List at least four signs and symptoms of
generalized hypothermia.
8. Outline the treatment for generalized
hypothermia (including hypothermic
arrest).
9. Describe the difference between superficial
local cold injuries and deep local cold
injuries.
Questions
10.Outline the treatment for local cold
injuries.
11.What do you need to keep in mind if you
choose to actively rewarm and extremity
with local cold injuries?
12.What is the difference between frostbite
and trench foot?
Questions
13.Identify 5 signs and symptoms of carbon
monoxide poisoning.
14.Identify 4 sources of carbon monoxide
poisoning
15.What is the treatment for carbon
monoxide poisoning?