Transcript Heat Emergencies - Presence Health

Presence Regional EMS System
July 2015
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Discuss thermoregulation in the body
Describe 5 ways the body can eliminate heat in
a hot environment
List 3 forms of illness caused by heat exposure
Using a variety of scenarios outline the
assessment findings and management of
patients suffering from heat exposure
Information for this presentation drawn from
Bledsoe, Porter and Cherry (2013) Paramedic Care: Principles and
Practice Prentice-Hall Inc. Upper Saddle River, NJ Volume 5
4th Edition
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The environment is defined as the surrounding
external factors that affect the development
and functioning of living beings.
Human beings depend on the environment for
life but must also be protected from its
extremes.
Homeostasis is the process the body uses to
maintain the correct peripheral temperatures
and the core body temperature.
The body gains and loses heat into the
environment via the thermal gradient.
 The thermal gradient is the difference in
temperature between the environment
(ambient temperature) and the body
 If the environment is warmer
than the body, heat flows from
the environment into the body
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How does the body generate heat???
Work induced thermogenesis from exercise
 Sugar breakdown in the cell – 60% of energy
generated lost as heat
 Epinephrine can increase the rate of sugar
breakdown and increase heat generation.
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The body loses heat into the environment from:
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Conduction – direct contact with a surface
 Sitting in a chair transfers heat to the chair
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Convection – air currents passing over the body
 Breezes or fanning the body
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Radiation
 A warm body radiates heat into a cooler environment
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Evaporation
 Water or sweat changes from a liquid to a vapor
removing energy/heat from the body
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Respiration
 Exhaling water vapor combines convection, radiation
and evaporation to remove heat
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The body’s core temperature deep in the
tissues does not vary much from 98.6° F. This is
the most efficient temperature for the chemical
reactions in the cell.
The body’s core temperature is controlled by
the hypothalamus in the brain stem.
When the hypothalamus senses a rise in core
temperature it directs the body systems to
decrease heat production and increase heat
loss.
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Decrease heat production
Feeling lethargic and lazy
 Rest
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Increase heat loss
Sweating
 Vasodilation – moving blood
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from the core of the body to
the periphery
Increase exhalation
 Fanning
 Loose clothing
 Craving cold drinks
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The outer shell of the body is more tolerant of
temperature extremes than the core.
The outer shell can manage temperatures of
from 0° F to 120° F for short periods of time
and still maintain a normal internal core
temperature.
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Not everyone is equal when it comes to
tolerating heat.
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Extremes of Age: geriatric and pediatric
populations
Health of the Patient: diabetes, heart disease
Medications: beta blockers, diuretics,
antihistamines, psychiatric medications
Level of Acclimatization: how adjusted is the
individual to this type of weather
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Length of exposure
Intensity of exposure
Environmental Factors: Wind and Humidity
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It’s not the heat, it’s the humidity.
The Heat Index factors in both heat and the
relative humidity to provide information for
problems related to the duration of exposure.
The higher the humidity, the less able
individuals are to tolerate heat.
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Preventing Heat Disorders is easier than
treating them:
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Maintain adequate fluid intake.
Thirst is a poor indicator of
hydration.
Allow time to get used to hot
environments before spending
long periods being active in
the heat.
Limit exposure to hot environments
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Situations which might result in heat illness
without extremes of ambient temperature
Industry
 Elderly
 Extreme exertion in
moderately warm weather
 Heat without an
environment of moving air.
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The main Heat Illnesses are:
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Heat Cramps
Heat Exhaustion
Heat Stroke
Complicating factors:
Dehydration
 Loss of sodium and other electrolytes
 Failure of thermoregulation systems
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Heat cramps are the least serious form of
heat illness
Muscular cramps or spasms.
Result from the loss of too much salt
through perspiration.
Adequate intake of water with
insufficient intake of salt
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Normal level of consciousness, mentally alert
May feel dizzy or faint
Vital signs normal
Core body temperature normal or near normal
Peripheral body temperature warm and moist
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Remove the patient from the hot environment
Administer water with salts added
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Sports drinks
Water with ¼ tsp of salt per quart
NO SALT TABLETS!!
Moist cool towels to cramped areas
Advise patient to avoid exertion for 12 hours.
Transport may be warranted only if the patient
desires or has other associated symptoms or
conditions.
ALS: consider IV bolus of NS.
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Caused by blood pooling in dilated vessels
just below the skin.
Complicated by loss of salt and water
through sweating.
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Loss of 1-2 liters of water per hour
Loss of 20-50 mEq sodium per hour
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Signs and symptoms of dehydration and
hypovolemic shock
May have altered level of consciousness if poor
perfusion to brain
Rapid shallow respirations
Weak pulse
Low/normal blood pressure
Core temperature normal
Skin pale, cool, sweaty
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Remove the patient from the hot environment.
O2 and ventilation as needed.
Remove and/or loosen clothing.
Apply cold, wet compresses and/or fan the
patient lightly.
Shock position.
Do not give the patient fluids by mouth if he
has a decreased mental status or is nauseated
or vomiting.
ALS: consider IV boluses of NS at 20 ml/kg.
Transport to ED for further care
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Life-threatening emergency in which the ability
of the body to dissipate heat is completely lost.
Loss of normal thermoregulation
Extremely high core temperatures
The high body temperature damages and
destroys cells of the brain, heart, and kidneys,
leading to permanent disability and death of
the patient.
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Altered level of consciousness (confused,
unconscious)
Altered central nervous system
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Seizures, headache, psychosis
Cessation of sweating
Hot dry skin
Very high core temperature (102° F +++)
Shallow, slow respirations
Slow pulse
Low blood pressure
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Remove the patient from the hot environment.
Support oxygenation and ventilation as
needed.
Remove and/or loosen clothing.
Actively cool by pouring cool water over the
patient . Wrap the patient in a wet sheet.
Aggressively fan the patient.
Ice and cold packs are not recommended as
they can cause shivering and increase the
temperature.
Monitor body temperature to avoid accidental
hypothermia
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Watch for and manage seizures should they
arise.
ALS: establish IV and initiate fluid boluses of
NS as long as lungs remain clear.
Immediate transport indicated
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Answer the following questions as a group.
If doing this CE individually, please e-mail
your answers to:
[email protected]
Use “July 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
1. Which of these Risk factors predispose individuals
to environmental emergencies? (Pick all that apply)
A.
B.
C.
D.
E.
F.
G.
Pediatric patients
Geriatric patients
People in poor health
Eating hot spicy food such as tacos and Indian food
within 3 hours of exposure
Fatigue
Certain medications such as diuretics and beta blockers
Existing medical conditions
2.
The area of the brain responsible for
controlling thermoregulation in the body is:
A. the pons
B. the cerebellum
C. the hypothalamus
D. the limbic system
3. Bill, who is 20 years old, is working
construction this summer over school break.
At his first day of work, he is has neglected to
drink enough water or take in enough salt to
account for his losses due to sweating. What
uncomfortable condition is Bill likely to
experience:
A.
B.
C.
D.
heat exhaustion
hyperthermia
heat stroke
heat cramps
4. What treatment would be of help for Bill?
( Pick all that apply)
Remove him from the hot environment
B. Have him drink a sports drink over an hour
C. Have him gulp down large amounts of ice water
D. Keep him covered with warm blankets to prevent
heat loss
A.
Ed is 85 years old. He always helps carry the flag
for the American Legion Color Guard in the 4th of
July parade. It is 1200 hours and Ed is about
halfway through the parade. He is dressed in the
blue wool dress uniform of the American Legion.
The day is sunny with a temperature of 88° F with
85% humidity. A slight breeze is blowing.
Suddenly Ed gets weak and shaky. He staggers
to the side of the street and sits down on the curb.
You are called to help Ed.
5. Why is Ed at high risk for a Heat Related
Illness? (Pick all that apply)
A.
B.
C.
D.
Elderly
Possible existing medical conditions and
medications
Dressed too warm for the environment
Inadequate intake of fluids
6.
Ed is awake but slow to respond. His airway is open
and his respirations are unlabored at a rate of 16. His
pulse is fast at a rate of 104 and his skin is pale, cool and
sweaty. His BP is 90/60. His chest and abdomen are
warm but not hot to touch. What is wrong with Ed?
A.
B.
C.
D.
heat exhaustion
hyperthermia
heat stroke
heat cramps
7.
Which of these treatments will help you
manage ED in the field? (Pick all that apply)
Oxygen to an O2 sat of 94%
B. Remove from the heat
C. Remove heavy clothing
D. Rapid cooling with ice packs
E. IV of Normal Saline at 20 ml/kg
F. Adenosine 6 mg IV
G. Sips of 3.3% saline to drink if Ed is not nauseated
H. Sips of a sports drink if Ed is not nauseated
A.
Maude is 90 years old and lives alone. She does
not like to run the air conditioning in her house
and keeps the windows closed at night because
she is afraid. It is about 2000 hours on an August
evening. It is about 90º F out all day with 90%
humidity. It is currently about 83º F out.
Maude’s neighbor has called 911 because she has
not seen Maude for 24 hours.
Maude’s doors are locked. You can hear the
Television playing and hear a dog barking on the
other side of the door. The police are called to
break in the house.
Once the door is open you feel a hot blast of air
from the house and it smells of body fluids.
You find Maude seated in a recliner in front of the
television dressed in a pink sweat suit with an
afghan over her legs.
The thermostat in the house reads 90º F.
Maude is not responsive and does not respond to
shake and shout.
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Airway: No noises with breathing
Breathing:
Very slow and shallow. Poor rise
and fall of the chest.
Circulation: Skin color very red.
Very hot and dry to touch.
Radial pulses irregular, weak and very slow
Vital Signs:
 Pulse 60 and irregular
 Respirations: 6 and shallow
 BP: 70/50
 Pulse Oximetry: 85%
 Blood Sugar: 300
Head and Neck:
 Face is very red and hot.
 Pupils react sluggishly.
 No saliva noted.
 Mouth and lips are very dry.
 Lips purse out with exhalation.
 Jugular veins are flat.
Chest:
Breath sounds: slight rales in bases.
 Skin hot to touch.
Abdomen: Hot to touch.
No distention or gross abnormalities.
 GU:
Maude has been incontinent of urine.
 Extremities: Hot and dry. No pulses.
When you move her she moves only her left arm
and leg and not her right. She tries to pull away
from you, weakly.
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No one is able to give a history other than
Maude is old, but she does OK on her own.
8. What is wrong with Maude?
A. heat exhaustion
B. fever
C. heat stroke
D. heat cramps
9. What made Maude at high risk for this
problem? (Pick all that apply)
Age
B. Exposure to heat without cooling or air movement
C. Dehydration
D. Possible medical conditions
A.
10. What has happened to Maude? (Pick all that apply)
A.
Her body has become dehydrated.
B.
C.
D.
E.
She has overwhelmed the thermoregulation
system of her body.
Her body temperature is so high that cell
death in organs such as the brain has
occurred
She is suffering from results from exposure to
pathogens and infection.
She has had a stroke and was unable to move
or cool herself.
11. How do you want to manage Maude?
A.
B.
C.
D.
E.
F.
G.
H.
I.
Remove her from the house and out into the cooler
air outdoors
Remove her clothes and wrap her in a sheet
Soak the sheet with water
Apply cold packs to her armpits and groin.
Support oxygenation and ventilation to an O2 sat of
94%
IV of Normal Saline at 20 ml/kg
Atropine 0.5 mg IV to raise the pulse
Sips of a sports drink if Maude is not nauseated
Monitor her temperature and avoid hypothermia
12. How well will Maude do after this incident?
A.
B.
She will be fine in a few hours when she is cooler.
She will probably not survive this heat illness.
1.
2.
3.
4.
5.
6.
7.
8.
9.
A,B,C,E,F,G
C
D
A,B
A,B,C,D
A
A,B,C,E,H
C
A,B,C,D
11.
12.
A,B,C,E,F,I
B