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Chapter 34

Chapter 34. Environmental Emergencies. Overview. Temperature Regulation Cold Exposure Heat Exposure Water-Related Emergencies. Overview. Altitude Emergencies Lightning Strikes Bites and Stings. Temperature Regulation. Heat loss: Radiation

cynthia-warren
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Chapter 34

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  1. Chapter 34 Environmental Emergencies

  2. Overview • Temperature Regulation • Cold Exposure • Heat Exposure • Water-Related Emergencies

  3. Overview • Altitude Emergencies • Lightning Strikes • Bites and Stings

  4. Temperature Regulation • Heat loss: Radiation • Heat transfers from warm body to cool environment • 60% of body heat lost at room temperature

  5. Temperature Regulation • Heat loss: Convection • Heat transfers away from a warm surface via air currents

  6. Temperature Regulation • Heat loss: Conduction • Heat transfers from warm object to cool object when they’re in direct contact with each other

  7. Temperature Regulation • Heat loss: Evaporation • Heat transfers into body fluids, which then evaporate • Accounts for about 30% of body’s normal heat loss

  8. Temperature Regulation • Heat gain • Metabolism generates heat internally • Muscle contraction generates heat internally • External sources such as a warm environment can help body gain heat

  9. Temperature Regulation • Children and the elderly cannot protect themselves from temperature extremes • Certain medical conditions will alter the body’s ability to regulate temperature • Medications may also alter a person’s ability to maintain body temperature

  10. Stop and Review • Describe the ways the body loses heat. • Describe the ways the body gains heat.

  11. Cold Exposure • Local cold injuries • Chilblains: painful, inflamed skin lesions • Trenchfoot: cold, pale, swollen feet with diminished sensation

  12. Cold Exposure • Local cold injuries • Frostnip: blanched and numb skin that can be easily rewarmed Courtesy of Kevin Reilly, M.D., Albany Medical Center, Albany, NY

  13. Cold Exposure • Local cold injury • Frostbite: results in tissue damage Courtesy of Kevin Reilly, M.D., Albany Medical Center, Albany, NY

  14. Cold Exposure • Management • Remove patient from cold environment • Remove cold, wet clothing • Rewarm injured part

  15. Cold Exposure • Hypothermia • Net heat loss is greater than net heat gain resulting in a fall in body temperature • Core body temperature less than 95 degrees Fahrenheit • The colder the body the worse the symptoms

  16. Cold Exposure • Hypothermia: Early signs and symptoms • Poor coordination • Memory disturbances • Reduced sensation • Mood changes • Dizziness • Difficulty with speech

  17. Cold Exposure • Hypothermia: Mild signs and symptoms • Pale, cool skin • Vasoconstriction • Shivering • Increase in heart and respiratory rate • Stiff muscles and joints • Organ systems lack function

  18. Cold Exposure • Hypothermia: Management • Check body temperature • Remove from cold environment • Remove cold, wet clothing and cover in blankets • Administer oxygen • Attempt rewarming

  19. Stop and Review • What are the types of local cold injuries? • What are the signs and symptoms of hypothermia? • How is hypothermia managed?

  20. Heat Exposure • Heat cramps • Heat loss can result in dehydration of muscles, causing muscle cramping • Remove patient from hot environment and massage painful area • Encourage patient to drink water to rehydrate

  21. Heat Exposure • Heat exhaustion • Symptoms: dizziness, malaise, muscle aches, headache, fatigue, nausea, vomiting, light-headedness • May have elevated body temperature, heart rate, and respiratory rate • Cooling and rehydration are key to treatment

  22. Heat Exposure • Heatstroke • Life-threatening form of heat illness • Results in altered mental status from brain malfunction • Overall heat gain must greatly exceed heat loss • Body temperatures can exceed 106 degrees Fahrenheit

  23. Stop and Review • Differentiate between heat exhaustion and heatstroke. • Describe the management of the patient with heat exhaustion and heatstroke.

  24. Water-Related Emergencies • Near-drowning • Victim holds breath, causing carbon-dioxide levels in the blood to rise • Then victim takes a breath, allowing water to enter the airway • Water in the airway causes laryngospasm and bronchospasm • Heart rate slows, blood pressure falls, cardiopulmonary arrest may develop

  25. Water-Related Emergencies • Management • Reach • Throw • Row • Go

  26. Water-Related Emergencies • Diving emergencies • Boyle’s law: the volume of a gas varies inversely with the surrounding pressure

  27. Water-Related Emergencies • Descent • Called squeeze-related problems • Results in compression of air in body spaces such as the ears and sinuses • Will cause pain during descent • Usually managed with pain medication

  28. Water-Related Emergencies • Ascent • Decompression sickness • Occurs during rapid ascent • Gases cannot decompress appropriately • Symptoms occur 1 to 6 hours after the dive • Called the bends

  29. Water-Related Emergencies • Ascent • Pulmonary overpressurization syndrome • As pressure decreases, air expands in the lungs • Volume of air in the lungs increases, causing alveoli to rupture

  30. Water-Related Emergencies • Ascent • Air embolism • Air bubble within the bloodstream that may cause a blood clot • Patients with ascent injuries should be treated in hyperbaric chambers

  31. Water-Related Emergencies • Nitrogen narcosis • Also diving related • Known as rupture of the deep • Patient appears as though intoxicated during the dive • Resolves upon ascent

  32. Stop and Review • What are the signs and symptoms of the diving-related emergencies discussed in this chapter? • What are the principles of management of diving-related emergencies discussed within this chapter?

  33. Altitude Emergencies • Acute mountain sickness • Occurs during rapid ascent 2,000 to 6,600 feet above sea level • Initial symptoms include light-headedness and mild breathlessness • Symptoms progress to headache, nausea, weakness, and fatigue

  34. Altitude Emergencies • High-altitude cerebral edema (HACE) • Results from further progression of untreated acute mountain sickness • Symptoms: altered mental status, trouble walking, decrease in level of consciousness, focal neurologic weakness

  35. Altitude Emergencies • High-altitude pulmonary edema (HAPE) • Progression to this state may be fatal • Symptoms: dry cough, dyspnea upon exertion • Further progression • Dyspnea while at rest • Fluid buildup in the alveoli

  36. Stop and Review • List the signs and symptoms of altitude emergencies. • Describe the management of the patient suffering from an altitude emergency.

  37. Minor injuries Confusion Amnesia Short-term memory difficulties Headache Muscle pain Numbness Temporary visual and auditory problems Ruptured eardrum Superficial burns Blunt trauma Lightning Strikes

  38. Lightning Strikes • Severe injury • Halts cardiac electrical activity • Results in cardiac arrest • Stuns the lungs, impairing breathing • Loss of consciousness • Permanent neurologic injury

  39. Lightning Strikes • Management • Scene safety • Determine treatment priority if multiple victims • Manage the ABCs • Assume blunt trauma injuries and properly immobilize patient

  40. Stop and Review • What are the effects of a lightning strike, and what are the priorities in treating victims?

  41. Bites and Stings • Snakes • Pit vipers • Two fang marks • Local pain and swelling • Severe envenomation results in edema, nausea, tachycardia, altered mental status, respiratory distress

  42. Bites and Stings • Snakes • Coral snake • Neurologic decompensation, tremor, salivation, seizures, respiratory paralysis

  43. A pit viper can be recognized by the sunken pit in front of each eye. The bite produces local pain and swelling. Courtesy of Dr. Sean Bush, Loma Linda University Medical Center, Loma Linda, CA • Despite its beautiful coloring, the coral snake is quite venomous. Courtesy of PhotoDisc

  44. Bites and Stings • Spiders • Brown recluse • Mildly red lesion that can develop severe pain, blister, and bluish discoloration • Severe bites can result in necrosis of tissue

  45. Bites and Stings • Spiders • Black widow • Redness, swelling, muscle cramping • More serious complications include hypertension, respiratory failure, shock, coma

  46. The venomous brown recluse spider is found most commonly in the southern and western United States. Courtesy of Dr. Sean Bush, Loma Linda University Medical Center, Loma Linda, CA • The black widow spider has been found throughout the United States in crevices, woodpiles, stables, and garbage piles. Courtesy of Dr. Sean Bush, Loma Linda University Medical Center, Loma Linda, CA

  47. Bites and Stings • Scorpions • Rarely fatal • Reddened area, burning or stinging sensation, local tissue damage • Severe reactions may occur in children

  48. Bites and Stings • Marine animals • A variety of marine animals can produce harmful injuries • If marine-animal bites and stings are prevalent in the area, acquire further training

  49. Stop and Review • What are the various types of animals that can cause harmful emergent injuries? • Describe the care of a patient suffering from a bite or a sting.

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