Transcript Mosby`s EMT-Basic Textbook

Chapter 22
Environmental Emergencies
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 1
Environmental Emergencies

Cold emergencies
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Hypothermia
Local cold injuries
Heat emergencies
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Heat cramps
Heat exhaustion
Heat stroke

Submersion incidents

Bites and stings


Insects
Snakebites
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Slide 2
Body Temperature Under
Different Conditions
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Slide 3
Skin Circulation and Heat
Regulation

Skin is “heat radiator system.”
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Blood flow to skin provides
means for heat transfer.

High blood flow to the skin
would promote heat loss.

Low blood flow would conserve
heat.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 4
Range of Temperature
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
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A – Under warm conditions
patient is comfortable.
B – Cold conditions lead to
shivering.
Note difference for deeper
structures compared to skin.

Difference can contribute to
frostbite.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 5
Heat Loss
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Radiation
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Conduction
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Convection
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Evaporation

Breathing
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Slide 6
Wind Chill Factor
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Slide 7
Heat Regulation –
Mechanisms of Control
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Normal body temperature: 37° C (98.6° F)
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Direct cardiovascular effects
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Maintained through heat production vs. loss
Changes directed by brain (hypothalamus).
Heat production affected by metabolic rate.
Vasodilation
Vasoconstriction
Skin

Primary site for heat loss
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Slide 8
Hypothermia
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Acute immersion hypothermia
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
Example – Man falls through ice on lake
Nonimmersion
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Subacute exposure – cold environment
• Example – Lost in snowy wilderness
Chronic exposure
• Elderly woman falls and lies on cool bedroom floor for 2 days
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Slide 9
Predisposing Factors – Age
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Very old
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Difficult to flee cold environment
Diminished muscular activity to generate heat
Body’s thermostat (hypothalamus) may be altered
Very young (infants and young children)
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Small body with large body surface area
Small muscle mass
• Children – poor ability to shiver
• Infants – no shivering capability at all
Less body fat
Cannot put on or take off clothes independently
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 10
Predisposing Factors –
Medical Conditions
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Shock (hypoperfusion)
Head injury
Burns
Generalized infection
Injuries to the spinal cord
Diabetes and hypoglycemia
Drugs/poisons
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Predisposing Factors –
Alcohol and Drugs
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Alcohol
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Vasodilator
Drugs
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Benzodiazepines
Antidepressants
Narcotics
Organophosphates
Narcotics
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 12
Mild Hypothermia –
Signs and Symptoms

Cool/cold skin temperature
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Check by placing the back of your hand between
the clothing and abdomen.
 Generalized hypothermia will present with cool
abdomen.
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

Shivering
Difficulty in speech and movement
Memory disturbances
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 13
Moderate Hypothermia –
Signs and Symptoms
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Skin – pale or cyanotic
Stupor
Shivering stops
Muscle rigidity develops
Decreased pulse (irregular) and respirations
Pupils dilate
VF possible
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 14
Severe Hypothermia –
Signs and Symptoms
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Unresponsive to pain
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Hypotension
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VF cardiac arrest likely
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Summary of Levels
of Hypothermia
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General Care for Hypothermia
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Remove the patient from the environment.
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Protect the patient from further heat loss.
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Handle the patient extremely gently.
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Remove wet clothing and cover with blanket.
Rough handling could precipitate VF.
Do not allow the patient to walk or exert
himself or herself.
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Resuscitation of
Hypothermia Patient
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Assess pulses for 30-45 seconds before
starting CPR.
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
If pulses not present, perform CPR
Use AED up to 3 shocks.
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After 3 shocks, perform CPR until patient can be
rewarmed.
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Local Cold Injuries
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Freezing of superficial, then deep tissues
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Most common sites
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Formation of ice crystals
Extremities
Exposed areas
• Ears
• Nose
• Face
Vasoconstriction
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Prevents hypothermia
Contributes to localized cold injuries
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Frostnip –
Signs and Symptoms
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Local injury
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Loss of sensation
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Clear demarcation
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Blanching of the skin
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If rewarmed, tingling sensation
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 20
Early or Superficial Frostbite –
Signs and Symptoms
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Feeling and sensation in affected body parts are lost.
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Outer skin is hard.
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Deep tissue remains soft.
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If rewarmed
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Appears flushed or mottled
Possible blister formation
Usually painful
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Surperficial Frostbite
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Deep Frostbite –
Signs and Symptoms
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White, waxy skin
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Firm to frozen feeling on palpation
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Resists depression
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If thawed or partially thawed
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Mottled, blue, gray
Areas of demarcation separating injured and healthy tissues
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Deep Frostbite
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Emergency Medical Care –
Local Cold Injuries
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Remove the patient from the environment.
Administer oxygen.
Remove wet or restrictive clothing.
Remove jewelry.
Protect injured extremity from further injury.
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Splint extremity.
Cover the extremity.
Do not rub or massage.
Do not reexpose to the cold.
Do not apply heat.
Do not allow patient to walk on frostbitten extremity.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 25
Emergency Medical Care –
Late or Deep Cold Injury
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Not usually done in prehospital setting
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For extremely long or delayed transport
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Active rapid rewarming
• Immerse affected part in warm water bath (105° F)
• Monitor the water to ensure that it does not cool the
frozen part (104 ° to 108 ° F)
• Continuously stir water.
• Continue until the part is soft and color and sensation
return.
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Heat-Related Illnesses
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Heat cramps
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Heat exhaustion
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Heat stroke
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Predisposing Factors
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Climate
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Temperature, humidity, wind velocity
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Exercise and activity
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Age
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Elderly
• Poor thermoregulation
• Medications
• Lack mobility
 Newborn/infants
• Poor thermoregulation
• Cannot remove own clothing
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Predisposing Factors –
Illness and Conditions
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Heart disease
Dehydration
Obesity
Fever
Fatigue
Diabetes
Drugs/medications
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 29
Heat Cramps
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Signs and symptoms
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Muscular cramps of heavily exercised muscles
Excessive loss of sodium
Heavy sweating
Treatment
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Move to cool environment
Have patient drink fluids
• Water, dilute salt solution, electrolyte-balanced drinks
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Case History
You respond to a marathon race on a very hot (98 ° F)
and humid day and find a 23-year-old male who
collapsed in the 21st mile of the race. Physical exam
reveals the patient is lethargic and has pale, cool,
and sweaty skin. His vital signs are pulse 90 and
regular, respirations 20 and shallow, and blood
pressure 120/80. However, the blood pressure drops
to 90/70 when the patient sits up.
What is the problem?
What is the treatment?
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 31
Heat Exhaustion
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Signs and symptoms
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Skin
• Moist, pale (or pink), normal to cool temperature
Weakness or exhaustion
Vital signs normal (pulse may be rapid)
Dizziness when sitting up
Treatment
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Move patient to cool environment.
Lay patient supine with legs elevated.
Fan patient.
Have patient drink fluids.
• Water, dilute salt solution, electrolyte-balanced drinks
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Case History
You respond to the home of a 83-year-old female who
has been bedridden for 3 days with a fever. Her daughter states that
she was unable to awaken her this morning. The temperature in the
room is in the high 90s and it is very humid. The patient is covered
with blankets. Physical exam reveals the patient is unresponsive to
pain and has hot and dry skin. Her vital signs are pulse 120 and
regular, respirations 26 and shallow, and blood pressure 80/60. She
takes several medications, including Valium and antidepressants.
What is the problem?
What is the treatment?
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 33
Case History
You respond to a 5K race on a very hot (95 ° F) and
humid day and find a 48-year-old male who collapsed in
the third mile of the race. His friend states that he has
never raced before and rarely exercised. Physical exam
reveals the patient is unresponsive to pain and has
pale, hot, and sweaty skin. His vital signs are pulse 130
and regular, respirations 28 and shallow, and blood
pressure 74/60. A nurse on the scene took the patient’s
temperature, which was 105 ° F.
What is the problem?
What is the treatment?
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 34
Heat Stroke – Assessment
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Loss of heat-regulatory ability
Very high body temperatures (>104° F)
Brain death likely without immediate cooling
Signs and symptoms
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Altered mental status
Hot and dry (or moist) skin
Very high body temperature
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Heat Stroke – Treatment
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Apply cool packs to neck, groin, and armpits.
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Keep the skin wet by applying water with
sponge or wet towels.
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Fan aggressively.

Transport immediately.
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Drowning and Submersion
Episodes
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Drowning
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Near drowning
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Submersion incident victim who dies within 24 hours
Submersion incident victim who survived longer than 24
hours
Submersion incident

Incident where submersion victim required prehospital care
and hospital transport
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Submersion Incident – Safety

Ensure the safety of the rescue personnel.
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When possible, throw flotation device or
rescue equipment in boat.

Heroic rescuers who swim toward the victim
may become victims.
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Submersion Incident

Suspect possible spine injury if diving
accident is involved or unknown.
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Consider length of time in cold water
incidents.

Cardiac arrest patients submerged in cold water –
attempt resuscitation
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Submersion Victim –
Unresponsive and Breathing
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Spine injury suspected
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In-line immobilization
Removal from water with backboard
Spine injury not suspected
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Place patient in recovery position.
Allow water, vomitus, and secretions to drain.
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Suction as needed.

Administer oxygen.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 40
Submersion Victim –
Cardiac Arrest Management
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Emphasis on ABCs
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Spinal immobilization as needed
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CPR

Suction as needed
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Submersion Victim –
Cardiac Arrest Management
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Heimlich maneuver
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Not routinely used to clear water from lungs
Used when airway obstruction detected
Use AED after moving patient to dry surface
and drying chest.

If patient is hypothermic, provide up to 3 shocks,
then begin CPR.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 42
Submersion Victim –
Cardiac Arrest Management
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If gastric distention interferes with artificial
ventilation
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Place patient on left side.
 Suction immediately.
 Provide firm pressure to epigastrium.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 43
General Care –
Bites and Stings
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Be alert for anaphylaxis.
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If stinger present
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
Remove or scrape stinger out.
Wash area gently.

Remove jewelry from injured area.

Place ice pack over area.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 44
Brown Recluse Spider

Black “violin-shaped” band on
back
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Red spot with central blister after
bite

Few serious systemic reactions

Treatment is hospital based.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 45
Black Widow Spider

Black, shiny body with red
hourglass shape on abdomen
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Stinger contains neurotoxins.
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Serious symptoms are rare.


Abdominal pain and rigidity
Fever, chills, and spasms of
large muscles
 Respiratory depression
 Weakness

Treatment



Immobilize affected part.
Avoid unnecessary movement.
Transport
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 46
Snakebites – Pit Vipers

Pit vipers
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

Rattlesnake
Copperhead
Triangular head
Elliptical eyes
Fangs

Fang marks at bite site
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Eastern Diamondback
Rattlesnake
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Cottonmouth Water Moccasin
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Copperhead
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Swelling and Necrosis from
Pit Viper
Swelling and early necrosis
Necrosis 7 weeks later
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Snakebites – Coral Snakes

Color


“Red on black, venom lack”
(top)
“Red on yellow, kill a
fellow” (bottom)

Holds on and chews
victim

Minimal pain and swelling
at bite site
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 52
Australian Compression
Technique for Coral Snake Bites
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Snakebites –
Emergency Medical Care

Remove jewelry.

Have victim rest.

Immobilize affected part.

Do not apply cold to
snakebites.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 54
Snakebites –
Emergency Medical Care

Consult medical direction regarding
constricting band for snakebite.

For coral snakes, apply elastic bandage (per local
protocol)

Observe for development of signs and
symptoms of an allergic reaction.

Do not cut the wound.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 55
Summary

History is a key aspect of medical patients.

Responsive patients require a focused exam.

Unresponsive patients require a rapid
assessment.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 56