Transcript Paramedic Care: Principles & Practice Volume 3

Paramedic Care:
Principles & Practice
Volume 3
Medical Emergencies
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 10
Environmental Emergencies
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
Homeostasis
Pathophysiology of Heat and Cold Disorders
Heat Disorders
Cold Disorders
Drowning
Diving Emergencies
High Altitude Illness
Nuclear Radiation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Introduction
Environment
– All of the surrounding external factors that affect
the development and functioning of a living
organism
– Necessary to life
– Extremes of environment cause emergencies
Hypothermia, drowning, altitude sickness, nuclear
radiation, and diving accidents or barotraumas
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Introduction
Risk Factors
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Age
Poor General Health
Fatigue
Predisposing Medical Conditions
Medications
You need to be familiar with the specialized
rescue resources these situations may
require.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Homeostasis
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Homeostasis
Process of maintaining constant suitable
conditions within the body
– Various body systems respond
Maintain the correct core and peripheral temperature
Oxygen level
Energy supply
Certain environmental conditions exceed
the ability of the body to compensate
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of
Heat and Cold Disorders
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of
Heat and Cold Disorders
Mechanisms of Heat Gain and Loss
– Thermal Gradient
Difference in temperature between the environment and
the body
If environment is warmer than the body, heat flows from the
environment to the body
If environment is cooler than the body, heat leaves body to
the environment
– Other Factors
Wind
Relative humidity
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of
Heat and Cold Disorders
Thermogenesis
– The amount of heat in the body continually
fluctuates
– The body gains heat from both external and
internal sources
– The creation of heat is called thermogenesis
Work-induced
Thermoregulatory
Hormone induced
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of
Heat and Cold Disorders
Thermolysis
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Conduction
Convection
Radiation
Evaporation
Respiration
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of
Heat and Cold Disorders
Thermoregulation
– Body Temperature
Core temperature
Peripheral temperature
– The Hypothalamus
– Heat Dissipation
Sweating, vasodilation
– Heat Conservation
Shivering,
vasoconstriction
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of
Heat and Cold Disorders
Thermoregulation (cont.)
– Thermoreceptors
Peripheral thermoreceptors
Skin and certain mucous membranes
Central thermoreceptors
Deep tissues of the body
Cold receptors outnumber warm receptors
– Metabolic Rate
Basal metabolic rate
Exertional metabolic rate
– Core temperature measurement
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Heat Disorders
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Heat Disorders
Hyperthermia
– Signs of thermolysis
Diaphoresis, increased skin temperature
– Signs of thermolytic inadequacy
Altered mentation or altered level of consciousness
– Manifestations
Heat cramps
Heat exhaustion
Heat stroke
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Heat Disorders
Predisposing Factors
– Age of the Patient
– Health of the Patient
– Medications
Diuretics, beta-blockers, psychotropics, and
antihistamines
– Level of Acclimatization
– Length and Intensity of Exposure
– Environmental Factors
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Heat Disorders
Preventive Measures
– Maintain adequate fluid intake
– Allow time for gradual acclimatization
– Limit exposure to hot environments
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Heat (Muscle Cramps)
Caused by overexertion and dehydration in
the presence of high atmospheric
temperatures
Signs and Symptoms
– Cramps in the fingers, arms, legs, or abdominal
muscles
– Mentally alert with a feeling of weakness,
dizziness, or syncope
– Body temperature may be normal or slightly
elevated
– Skin is likely to be moist and warm
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Heat (Muscle Cramps)
Management
– Remove the
patient from the
environment
– Administer an
oral saline
solution
IV may be
necessary
© Scott Metcalfe
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Heat Exhaustion
Considered to be a mild heat illness
Dehydration and sodium loss due to
sweating account for the presenting
symptoms
– History of high environmental heat
Signs and Symptoms
– Cool and clammy skin with heavy perspiration,
breathing that is rapid and shallow, and a weak
pulse
– Headache, anxiety, paresthesia, and impaired
judgment or even psychosis
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Heat Exhaustion
Management
– Remove the patient
from the environment
– Place the patient in a
supine position
– Administer an oral
saline solution
IV, if necessary
– Remove some
clothing and fan the
patient
– Treat for shock
© Scott Metcalfe
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Heatstroke
The body’s hypothalamic temperature
regulation is lost, causing uncompensated
hyperthermia
– Causes cell death and damage to the brain,
liver, and kidneys
Classic Heatstroke
Exertional Heatstroke
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Heatstroke
Signs and Symptoms
Cessation of
sweating
Hot skin that is dry or
moist
Very high core
temperature
Deep respirations
that become shallow,
rapid at first but may
later slow
Rapid, full pulse,
may slow later
Hypotension with
low or absent
diastolic reading
Confusion or
disorientation or
unconsciousness
Possible seizures
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Heatstroke
Management
– Remove the patient
from the environment
– Initiate rapid active
cooling
Target of 102°F (39°C)
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Administer oxygen
Administer fluid therapy
Monitor the ECG
Avoid vasopressors
and anticholinergic
drugs
– Monitor body
temperature
© Scott Metcalfe
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Heat Disorders
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Role of Dehydration
in Heat Disorders
Close Relationship to Heat Disorders
– Dehydration prevents thermolysis
Signs and Symptoms
– Nausea, vomiting, and abdominal distress
– Vision disturbances, decreased urine output
– Poor skin turgor and signs of hypovolemic shock
Treatment
– Oral fluids if the patient is alert and oriented
– IV fluids if the patient has an altered mental
status or is nauseated
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Fever (Pyrexia)
Pyrogens
Differentiating fever from heatstroke
– Usually a history of infection or illness with a
fever
Cooling the fever patient
– Consider antipyretic medication
Acetaminophen or ibuprofen
– Avoid sponge baths
May cause a rapid drop in the body core temperature
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Cold Disorders
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Cold Disorders
Hypothermia
– Core temperature of the body drops below 95°F
(35°C)
– Can be attributed to inadequate thermogenesis,
excessive cold stress, or a combination
Mechanisms of Heat Conservation and Loss
– Piloerection, shivering and increased muscle
tone, vasoconstriction, increase in cardiac
output and respiratory rate
– Conduction, convection, radiation, evaporation,
and respiration
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Cold Disorders
Predisposing Factors
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Age of the Patient
Health of the Patient
Medications
Prolonged or Intense Exposure
Coexisting Weather Conditions
Preventive Measures
– Dress warmly and ensure plenty of rest
– Eat appropriately or at regular intervals
– Limit exposure to cold environments
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Cold Disorders
Degrees of Hypothermia
– Mild
Core temperature greater than 90°F (32°C)
– Severe
Core temperature less than 90°F (32°C)
– Compensated Hypothermia
Signs and symptoms of hypothermia will be present
but with a normal core body temperature
Core temp will drop as compensation stops
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Hypothermia
Signs and Symptoms
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Hypothermia
ECG
– Pathognomonic J waves (Osborn waves)
– Eventual onset of bradycardia
– Ventricular fibrillation probable below 86ºF
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Hypothermia
Treatment
– Remove wet garments
– Protect against further heat loss and wind chill
Use passive external warming methods such as
application of blankets, insulating materials, and
moisture barriers
– Maintain the patient in a horizontal position
– Avoid rough handling, which can trigger
dysrhythmias
– Monitor the core temperature
– Monitor the cardiac rhythm
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Hypothermia Management
Click here to view the Hypothermia Management diagram.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Hypothermia
Resuscitation Considerations
– BLS
Perform pulse and respiration checks for longer
periods
Administer a single shock at 360 Joules (or the
biphasic equivalent)
Follow with CPR, rewarming, and rapid transport
– ACLS
Intubate and administer a single shock at 360 joules
(or the biphasic equivalent
Establish IV access, begin rewarming, and transport
rapidly
– Avoid further resuscitation until the core
temperature is above 86ºF
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Frostbite
Superficial Frostbite
– Freezing of
epidermal tissue
– Redness followed
by blanching and
diminished
sensation
Deep Frostbite
– Freezing of
epidermal and
subcutaneous layers
– White, frozen
appearance
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Frostbite
Treatment
– Do not thaw the affected area if there is the
possibility of refreezing
– Do not massage the affected area
– Administer analgesia prior to thawing
– Rewarm by immersion only if transport is
lengthy or delayed
Cover the thawed part with a loose, sterile dressing.
Elevate and immobilize the thawed part
– Do not puncture or drain blisters
– Do not rewarm feet if walking will be required
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
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
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Drowning
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Drowning
A drowning is an incident in which someone
is submersed or immersed in a liquid that
results in a primary respiratory impairment.
4,500 persons die annually
Associated factors
– Trauma
– Hypothermia
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Drowning
Pathophysiology
– Following submersion, the victim will undergo a
period of complete apnea for up to 3 minutes
– Dry vs. Wet Drowning
Gasping stimulates laryngospasm
Prevents the influx of water into the lungs
Dry drowning
If no laryngospasm
Wet drowning
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Drowning
Pathophysiology (cont.)
– Drowning is primarily due to asphyxia from
airway obstruction.
Coma ultimately ensues
– Hypotension, bradycardia, and death result
– Fresh vs. saltwater drowning
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Fresh vs Saltwater Drowning
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Drowning
Factors Affecting Survival
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Cleanliness of Water
Length of Time Submerged
Victim’s Age and General Health
Water Temperature
Cold-water drowning
Mammalian diving reflex
The cold-water drowning patient is not dead until he is
warm and dead
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Drowning
Treatment
– Remove the patient from the water
Attempt rescue only if properly trained and equipped
– Initiate ventilation while the patient is still in the
water
– Suspect head and neck injury if the patient
experienced a fall or was diving
– Protect the patient from heat loss
– Evaluate ABCs
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Drowning
Treatment (cont.)
– Manage the airway using proper suctioning and
airway adjuncts.
– Administer oxygen at 100% concentration.
– Use respiratory rewarming, if available.
– Establish IV of lactated Ringer’s or normal saline
at 75 mL/hr.
– Follow ACLS protocols if the patient is
normothermic.
Treat hypothermic patients according to hypothermia
guidelines.
Adult Respiratory Distress Syndrome
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Diving Emergencies
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Diving Emergencies
Scuba
– Popular recreational sport
The Effects of Air Pressure on Gases
– Boyle’s Law
The volume of a gas is inversely proportional to its
pressure if the temperature is kept constant
– Dalton’s Law
The total pressure of a mixture of gases is equal to the
sum of the partial pressures of the individual gases
– Henry’s Law
The amount of gas dissolved in a given volume of
liquid is proportional to the pressure of the gas above it
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Diving Emergencies
Pathophysiology of Diving Emergencies
– Increased dissolution of gases during descent
due to Henry’s law
– Boyle’s law dictates that these gases have a
smaller volume
– In a controlled ascent, the process is reversed
and the gases escape through respiration
– A rapid ascent causes gases to come out of
solution quickly
Forming gas bubbles in the blood, brain, spinal cord,
skin, inner ear, muscles, and joints
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Diving Emergencies
Classification of Diving Emergencies
– Injuries on the Surface
– Injuries During Descent
Barotrauma
– Injuries on the Bottom
Nitrogen narcosis
– Injuries During Ascent
Decompression illness
Pulmonary overpressure and subsequent arterial gas
embolism, pneumomediastinum, or pneumothorax
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Diving Emergencies
General Assessment of Diving Emergencies
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Time at which signs and symptoms appeared
Type of breathing apparatus used
Type of hypothermia-protective garment worn
Parameters of the dive
Number of dives, depth, and duration
– Aircraft travel following a dive
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Diving Emergencies
Factors to Assess
– Rate of ascent
Associated with panic forcing a rapid ascent
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Inexperience of the diver
Improper functioning of depth gauge
Previous medical diseases
Old injuries
Previous episodes of decompression illness
Use of alcohol or medications
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pressure Disorders
Decompression Illness
– May occur with dives of
33’ or more
– Signs and Symptoms
Occur within
36 hours
Joint/abdominal
pain
Fatigue,
paresthesias,
and CNS
disturbances
– Treatment
© Gregory G. Dimijian/Photo Researchers, Inc.
Recompression
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Decompression Illness
Treatment
– Assess ABCs and begin CPR if required
– Administer high-flow, high-concentration oxygen
and intubate if indicated
– Maintain supine position
– Protect the patient from heat, cold, wetness, or
noxious fumes
– Transport and establish IV access
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Decompression Illness
Consult with medical direction regarding
administration of dexamethasone, heparin,
or diazepam if CNS is involved
If air evacuation is used, maintain cabin
pressure at sea level or fly at the lowest
possible altitude
Send diving equipment with the patient for
analysis if possible
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pressure Disorders
Pulmonary Overpressure Accidents
– Can occur in depths as shallow as 6’
– Signs and Symptoms
Substernal chest pain with associated respiratory
distress and diminished breath sounds
– Treatment
Treat as a pneumothorax
Provide rest and supplemental oxygen
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pressure Disorders
Arterial Gas Embolism
– Signs and Symptoms
Onset is within 2–10 minutes of ascent
There is dramatic onset of sharp, tearing pain
Common presentation mimics a stroke; suspect AGE
in any patient with neurological deficits immediately
after ascent
– Treatment
Assess ABCs; provide high-flow, high-concentration
oxygen
Maintain a supine position; monitor vital signs
frequently
Establish IV access and consider administering
corticosteroids
Rapidly transport to a recompression chamber
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pressure Disorders
Pneumomediastinum
– Signs and Symptoms
Substernal chest pain, irregular pulse, abnormal heart
sounds, hypotension with a narrow pulse pressure,
and a change in voice
– Treatment
Provide high-flow, high-concentration oxygen
Establish IV access
Transport for further evaluation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pressure Disorders
Nitrogen Narcosis
– Occurs During a Dive
Can contribute to accidents during the dive
– Signs and Symptoms
Altered levels of consciousness and impaired
judgment
– Treatment
Return to shallow depth
Use oxygen/helium mix during dive
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Diving Emergencies
Other Diving-Related Emergencies
– Oxygen Toxicity
– Hypercapnia
Diver’s Alert Network
– Consultation and Referrals
(919) 684-8111
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
High-Altitude Illness
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
High-Altitude Illness
Manifestation
– Altitudes above 8,000 feet
Prevention
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Ascend gradually
Limit exertion
Descend for sleep
Eat a high-carbohydrate diet
Medications:
Acetazolamide and nifedipine
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
High-Altitude Illness
Types of High-Altitude Illness
– Acute Mountain Sickness
Mild cases include lightheadedness, breathlessness,
weakness, headache, nausea, and vomiting
Severe cases include weakness, severe vomiting,
decreased urine output, shortness of breath, and an
altered level of consciousness
Treatment includes halting of ascent or descent, use of
acetazolamide and antinausea drugs, and
supplemental oxygen
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
High-Altitude Illness
High-Altitude Pulmonary Edema (HAPE)
– Mild symptoms include dry cough, shortness of
breath, and slight crackles in the lungs
– Severe cases develop cyanosis, dyspnea, frothy
sputum, weakness, and possibly coma or death
– Treatment
Includes descent and supplemental oxygen, or
portable hyperbaric bag
Medications such as acetazolamide, nifedipine, and
lasix may be useful also
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
High-Altitude Illness
High-Altitude Cerebral Edema
– Usually occurs as progression of AMS or HAPE
– Symptoms include altered mental status, ataxia,
decreased level of consciousness, and coma
– Treatment includes descent and supplemental
oxygen, or portable hyperbaric bag
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Nuclear Radiation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Nuclear Radiation
Personal Safety
– Only appropriately trained and equipped
personnel should handle radiation emergencies
Basic Nuclear Physics
– Atoms
Protons, neutrons, and electrons
– Isotopes and Half-Life
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Nuclear Radiation
Ionizing Radiation
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Alpha particles
Beta particles
Gamma rays
Neutrons
Effects of Radiation on the Body
– Detection of Radiation
RAD and REM
– Acute and Long-Term Effects
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Nuclear Radiation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Nuclear Radiation
Principles of Safety
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–
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Time
Distance
Shielding
Clean Accidents
Patient is exposed
but not contaminated
– Dirty Accidents
Patient is
contaminated by
radioactive particles,
liquids, gases, or
smoke
Click here to view the Nuclear
Radiation illustration.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Nuclear Radiation
Management
– Park upwind
– Look for signs of
radioactive exposure
– Use portable
instruments to detect
radioactivity
– Normal emergency
care principles should
be applied
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Nuclear Radiation
Management (cont.)
– Externally radiated and
internally contaminated
patients pose little
danger
Externally contaminated
patients require
decontamination
– Internally contaminated
patients pose little
danger to rescue
personnel
Explosion at Chernobyl in 1986. ( Landov LLC)
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
Homeostasis
Pathophysiology of Heat and Cold Disorders
Heat Disorders
Cold Disorders
Drowning
Diving Emergencies
High-Altitude Illness
Nuclear Radiation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ