Transcript a01648-22-ppt 2056KB Jan 14 2015 08:21:45 AM

Copyright © 2004, Mosby Inc. All rights reserved.
Chapter 22
Environmental Emergencies
Slide 1
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Environmental Emergencies
• Cold emergencies
 Hypothermia
 Local cold injuries
• Heat emergencies
 Heat cramps
 Heat exhaustion
 Heat stroke
• Submersion incidents
• Bites and stings
 Insects
 Snakebites
Slide 2
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Body Temperature Under
Different Conditions
Slide 3
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Skin Circulation and Heat
Regulation
• Skin is “heat radiator system.”
• 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.
Slide 4
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Range of Temperature
• 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.
Slide 5
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Heat Loss
• Radiation
• Conduction
• Convection
• Evaporation
• Breathing
Slide 6
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Wind Chill Factor
Slide 7
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Heat Regulation –
Mechanisms of Control
• Normal body temperature: 37° C (98.6° F)
 Maintained through heat production vs. loss
 Changes directed by brain (hypothalamus).
 Heat production affected by metabolic rate.
• Direct cardiovascular effects
 Vasodilation
 Vasoconstriction
• Skin
 Primary site for heat loss
Slide 8
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Hypothermia
• Acute immersion hypothermia
 Example – Man falls through ice on lake
• Nonimmersion
 Subacute exposure – cold environment
» Example – Lost in snowy wilderness
 Chronic exposure
» Elderly woman falls and lies on cool bedroom floor for 2 days
Slide 9
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Predisposing Factors – Age
• Very old
 Difficult to flee cold environment
 Diminished muscular activity to generate heat
 Body’s thermostat (hypothalamus) may be altered
• Very young (infants and young children)
 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
Slide 10
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Predisposing Factors –
Medical Conditions
•
•
•
•
•
•
•
Shock (hypoperfusion)
Head injury
Burns
Generalized infection
Injuries to the spinal cord
Diabetes and hypoglycemia
Drugs/poisons
Slide 11
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Predisposing Factors –
Alcohol and Drugs
• Alcohol
 Vasodilator
• Drugs





Benzodiazepines
Antidepressants
Narcotics
Organophosphates
Narcotics
Slide 12
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Mild Hypothermia –
Signs and Symptoms
• Cool/cold skin temperature
 Check by placing the back of your hand between
the clothing and abdomen.
 Generalized hypothermia will present with cool
abdomen.
• Shivering
• Difficulty in speech and movement
• Memory disturbances
Slide 13
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Moderate Hypothermia –
Signs and Symptoms
•
•
•
•
•
•
•
Skin – pale or cyanotic
Stupor
Shivering stops
Muscle rigidity develops
Decreased pulse (irregular) and respirations
Pupils dilate
VF possible
Slide 14
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Severe Hypothermia –
Signs and Symptoms
• Unresponsive to pain
• Hypotension
• VF cardiac arrest likely
Slide 15
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Summary of Levels
of Hypothermia
Slide 16
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General Care for Hypothermia
• Remove the patient from the environment.
• Protect the patient from further heat loss.
 Remove wet clothing and cover with blanket.
• Handle the patient extremely gently.
 Rough handling could precipitate VF.
• Do not allow the patient to walk or exert
himself or herself.
Slide 17
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Resuscitation of
Hypothermia Patient
• Assess pulses for 30-45 seconds before
starting CPR.
 If pulses not present, perform CPR
• Use AED up to 3 shocks.
 After 3 shocks, perform CPR until patient can be
rewarmed.
Slide 18
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Local Cold Injuries
• Freezing of superficial, then deep tissues
 Formation of ice crystals
• Most common sites
 Extremities
 Exposed areas
» Ears
» Nose
» Face
• Vasoconstriction
 Prevents hypothermia
 Contributes to localized cold injuries
Slide 19
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Frostnip –
Signs and Symptoms
• Local injury
• Loss of sensation
• Clear demarcation
• Blanching of the skin
• If rewarmed, tingling sensation
Slide 20
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Early or Superficial Frostbite –
Signs and Symptoms
• Feeling and sensation in affected body parts are lost.
• Outer skin is hard.
• Deep tissue remains soft.
• If rewarmed
 Appears flushed or mottled
 Possible blister formation
 Usually painful
Slide 21
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Surperficial Frostbite
Slide 22
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Deep Frostbite –
Signs and Symptoms
• White, waxy skin
• Firm to frozen feeling on palpation
• Resists depression
• If thawed or partially thawed
 Mottled, blue, gray
 Areas of demarcation separating injured and healthy tissues
Slide 23
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Deep Frostbite
Slide 24
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Emergency Medical Care –
Local Cold Injuries
•
•
•
•
•
Remove the patient from the environment.
Administer oxygen.
Remove wet or restrictive clothing.
Remove jewelry.
Protect injured extremity from further injury.






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.
Slide 25
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Emergency Medical Care –
Late or Deep Cold Injury
• Not usually done in prehospital setting
• For extremely long or delayed transport
 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.
Slide 26
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Heat-Related Illnesses
• Heat cramps
• Heat exhaustion
• Heat stroke
Slide 27
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Predisposing Factors
• Climate
 Temperature, humidity, wind velocity
• Exercise and activity
• Age
 Elderly
» Poor thermoregulation
» Medications
» Lack mobility
 Newborn/infants
» Poor thermoregulation
» Cannot remove own clothing
Slide 28
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Predisposing Factors –
Illness and Conditions
•
•
•
•
•
•
•
Heart disease
Dehydration
Obesity
Fever
Fatigue
Diabetes
Drugs/medications
Slide 29
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Heat Cramps
• Signs and symptoms
 Muscular cramps of heavily exercised muscles
 Excessive loss of sodium
 Heavy sweating
• Treatment
 Move to cool environment
 Have patient drink fluids
» Water, dilute salt solution, electrolyte-balanced drinks
Slide 30
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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?
Slide 31
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Heat Exhaustion
• Signs and symptoms
 Skin
» Moist, pale (or pink), normal to cool temperature
 Weakness or exhaustion
 Vital signs normal (pulse may be rapid)
 Dizziness when sitting up
• Treatment




Move patient to cool environment.
Lay patient supine with legs elevated.
Fan patient.
Have patient drink fluids.
» Water, dilute salt solution, electrolyte-balanced drinks
Slide 32
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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?
Slide 33
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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?
Slide 34
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Heat Stroke – Assessment
•
•
•
•
Loss of heat-regulatory ability
Very high body temperatures (>104° F)
Brain death likely without immediate cooling
Signs and symptoms
 Altered mental status
 Hot and dry (or moist) skin
 Very high body temperature
Slide 35
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Heat Stroke – Treatment
• Apply cool packs to neck, groin, and armpits.
• Keep the skin wet by applying water with
sponge or wet towels.
• Fan aggressively.
• Transport immediately.
Slide 36
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Drowning and Submersion
Episodes
• Drowning
 Submersion incident victim who dies within 24 hours
• Near drowning
 Submersion incident victim who survived longer than 24
hours
• Submersion incident
 Incident where submersion victim required prehospital care
and hospital transport
Slide 37
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Submersion Incident – Safety
• Ensure the safety of the rescue personnel.
• When possible, throw flotation device or
rescue equipment in boat.
• Heroic rescuers who swim to victim may
become victim.
Slide 38
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Submersion Incident
• Suspect possible spine injury if diving
accident is involved or unknown.
• Consider length of time in cold water
incidents.
 Cardiac arrest patients submerged in cold water –
attempt resuscitation
Slide 39
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Submersion Victim –
Unresponsive and Breathing
• Spine injury suspected
 In-line immobilization
 Removal from water with backboard
• Spine injury not suspected
 Place patient in recovery position.
 Allow water, vomitus, and secretions to drain.
• Suction as needed.
• Administer oxygen.
Slide 40
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Submersion Victim –
Cardiac Arrest Management
• Emphasis on ABCs
• Spinal immobilization as needed
• CPR
• Suction as needed
Slide 41
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Submersion Victim –
Cardiac Arrest Management
• Heimlich maneuver
 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.
Slide 42
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Submersion Victim –
Cardiac Arrest Management
• If gastric distention interferes with artificial
ventilation
 Place patient on left side.
 Suction immediately.
 Provide firm pressure to epigastrium.
Slide 43
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General Care –
Bites and Stings
• Be alert for anaphylaxis.
• If stinger present
 Remove or scrape stinger out.
 Wash area gently.
• Remove jewelry from injured area.
• Place ice pack over area.
Slide 44
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Brown Recluse Spider
• Black “violin-shaped” band on
back
• Red spot with central blister after
bite
• Few serious systemic reactions
• Treatment is hospital based.
Slide 45
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Black Widow Spider
• Black, shiny body with red
hourglass shape on abdomen
• Stinger contains neurotoxins.
• 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
Slide 46
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Snakebites – Pit Vipers
• Pit vipers
 Rattlesnake
 Copperhead
• Triangular head
• Elliptical eyes
• Fangs
 Fang marks at bite site
Slide 47
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Eastern Diamondback
Rattlesnake
Slide 48
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Cottonmouth Water Moccasin
Slide 49
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Copperhead
Slide 50
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Swelling and Necrosis from
Pit Viper
Swelling and early necrosis
Necrosis 7 weeks later
Slide 51
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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
Slide 52
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Australian Compression
Technique for Coral Snake Bites
Slide 53
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Snakebites –
Emergency Medical Care
• Remove jewelry.
• Have victim rest.
• Immobilize affected part.
• Do not apply cold to
snakebites.
Slide 54
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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.
Slide 55
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Summary
• History is a key aspect of medical patients.
• Responsive patients require a focused exam.
• Unresponsive patients require a rapid
assessment.
Slide 56
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