Module 6 Emergency Procedures

1. Module 6 Emergency Procedures Dr. Laney Nelson

2. Snake Bites • Epidemiology • 8000 bits a year • Less than 12 deaths a year • Usually victim die because poor health • Victims usually have an allergic reaction • Symptoms occur immediately after bite • Most common is rattle snake • Younger snakes 3X more potent venenom

3. Snake Bites Mostly to hands of Children

4. Poisonous vs. Non Poisonous • Large fangs • Except for coral snake • Vertical splits for pupils • Like cat • Pits on side of face • 2 hole bite mark • Not important to bring the snake in • All antivenin is same in North America • Small fangs • Round pupils • No pits • Horseshoe bit mark • If no burning sensation within 1 hour • Probably non poisonous

5. Determining the Severity of Bite • Fatty vs. muscle Tissue • Fatty tissue is absorbed more slowly • Other Organisms in the venom • Mice or rat symbiotic infections • Size and weight of Victim • Children more pressed • General Health • Physical Activity after the bite

6. SS of Pit Viper Snake Bite • Immediate severe burning • Purplish discoloration and blood filled blisters • Numbness around site of injection bite • Nausea and vomiting • Weakness • Numbness of tongue and mouth • Excessive sweating • Fever and chills • Muscular Twitching • Dimmed Vision • A minty metallic or rubber taste in mouth

7. Entry vs. Injection Site

8. Pit Viper Strikes

9. What is a Pit Viper? • Pit on the side of head • Temperature sensor • Tongue is tasting you • Pit is sensing your heat

10. Coral Snake Bite • Black/Red/Yellow • Black on the head your dead • Horseshoe bite • Scratchy bite • Little or no pain • Slurred speech • Blurred vision dropping eyelids • Drowsiness , vomiting, nausea • Difficulty Breathing • Shock • Paralysis • Coma

11. First Aid for Snake Bites • Antivenin must be given within 4 hours • Short shelf life, be prepared for desert camping • Never cut the skin, use an extractor for 30 minutes • Never use a tourniquet • Never Apply ice • Wash the area, then splint • Keep them quiet, calm and non weight bearing. • Keep limb below heart • Wrap limb with conical overlapping elastic bandages • Slow venom

12. Extractor for Snake Bites

13. Black Widow Spider Bite • Shinny black bodies (5 species 3 are black) • Others brown and grey • Crimson red on belly • Dry dimly lit areas • Barns, corners, funnel shaped webs • Painful bites, • Children under 16 and over 60 with HBP

14. Black Widow • Cool moist places • Irrigation law boxes

15. SS of Spider Bites • Sharp pinprick at site • Small red fang marks • Severe muscle spasm and rigidly • Shoulders, back and chest 1-4 hours later • Fever and Chills • Profuse Sweating • Headache and dizziness • Restlessness, Anxiety • Nausea and Vomiting

16. Brown Recluse Spider Bite • Brown • Violin shape mark on its back • Southern and Midwestern states • Non in pacific northwest • Serious medical emergency • Do not heal • Requires surgical repair • Only bite when trapped against skin

17. Brown Recluse

18. SS of Brown Recluse Bite • Moderate itching and swelling • Blushing blood blister several hours after bite • White halo • 7-10 days blister becomes a ulcer • VOLCANO Lesion • Scab keep falling off until skin is grafted

19. Brown Recluse Requires Surgery

20. Common Tic, Deer Tic • Carry disease • Rock mountain spotted fever • Spotted rash that develops on wrists and ankles then spreads • Headache, muscle aches, joint aches • Fever and chills • Lyme disease • 40 states, deer tics small as a poppy seed • May and June most common • Begins as a rash looks like black & blue bruise • Flu like symptoms • Un treated: memory loss, vision disturbances, arthritis

21. Do not use Vaseline or burn their end

22. Removing Tic’s • Never squeeze the tic to get it out • Force infected blood back into victim • Use fine tweezers and grab it as close to skin as possible • Pull slowly and constant • Wash with soap and water • Use calamine or cortisone to relive itching

23. Scorpion Sting • Utah and Nevada Desert (3 species 1 bad) • 90% of stings are in hands • Occur at night when most active • SS: sharp pain, numbness, blister can progress to salivation, poor coordination, seizures • There is antivenin

24. When is medical help needed for a insect bite? • 2 million people allergic to bees, wasps, hornets • 15% of population have had previous allergic reaction • Always remove the stinger: limited venom injection use credit card or knife • Medical Care: • Tongue swells, eyelids swell • Wheezing and Labored breathing • Abdominal Cramps • Convulsions • Low Blood Pressure • Loss of Consciousness

25. Bee Stings

26. Signs of Anaphylactic Shock • 20-30 seconds and symptoms occur • They are in trouble • Greater chance of death • 100 people a year die • Usually air way obstruction • Remember 85% of people have not had a previous reaction

27. Marine Animals vs. Land Animals • 2,000 poisonous marine animals • Shark bites: resemble a chain saw • Marine more extensive tissue damage • Venom of marine animals are destroyed by heat • Apply hot packs to stings and bites

28. First Aid Care for Marine Life Poisoning • Get them to dry ground • Flush with water • Can use sea water • Soak in hot water 30 minutes • Clean and cover • Jelly fish, man of war • Apply vinegar, rubbing alcohol, baking soda paste • No Fresh Water increase fire • No meat tenderizer • Octopus, Sea Snake • Use extractor to suck venom

29. Bites and Stabs

30. The Prettier the Deadlier

31. Early March in Maui

32. Burn Emergencies • 2,000,000 burn victims a year • 12,000 die • 1,000,000 long term hospitalization • Complex injury • 3 classifications • First= superficial • Second= partial thickness • Third= full thickness

33. How burns affect the body • Fluids accumulate in upper airway • Proteins clot, enzymes break down • Heart rate increases, then plunges • Liver Swells • Hormones disrupted • Fluid accumulates in body from plasma release • Red cells die causing anemia • Muscle Degenerates • Body cells die • Arteries dilate, fluid leaks from capillaries • Kidney function disrupted, urinary output decreased

34. First Degree • Epidermal layer only • Skin is dry and red no blisters • Painful 2-5 days no scarring • Sun burn

35. Second Degree • Hot liquids, solids, flash of electricity, flame, chemicals, sun • Skin is moist & mottled • White to cheery red • Blistered • Extremely painful • 5-21 days • scarring

36. 3rd Degree • Hot liquids, solids, flame, electricity, chemicals • Gets to the bone • Skin is dry and leathery • Charred blood vessels visible • Skin is white dark and charred • No pain - no nerve endings • Recovery weeks to years • Requires surgery and skin grafting

37. Rule of Nine Adult • Head and neck 9% • Posterior Trunk 18% • Anterior trunk 18% • Each Upper Extremity 9% • External Genitalia 1% • Each lower Extremity 18%

38. Fingers and Toes

39. Rule of Nine Children • Head and neck 18% • Upper Extremities 9% • Font Torso 18% • Back Torso 18% • Lowe Extremities 14%

40. Critical Thinking in Burn Victims • First Degree • Greater than 75% of body • Greater than 20% of child • Second Degree • Greater than 30% of body surface adults • 20% in child • Third Degree • Greater than 10% adult • 2-3 % in child

41. Electrical burns • Medical emergency • Deep unseen damage • Apparent minor superficial changes, welded together vital organs • Always hospitalized for 2 days for observation

42. Assessing the Severity of Burns • Depth of burn • Percentage of Body burned • Severity of the burn • Location of the burn • Head & face • Circumferential burns of arms and legs- tourniquet • Chest, back and neck= strangulate expansion • Accompanying complications • Physical or mental conditions • Age of victim • Under 5 over 60

43. Management of Thermal Burns • Caused by flame, or radiant heat • Death by airway closure • Infection and fluid loss will follow • Immediately: Stop the Burning, • Manage the airway:ABpCDE • Cool down the burn • Cool water • Infection is a major killer of burn victims • Wet sterile dressings is best • Never apply butter or grease • Never apply ice or ice pack

44. Management of Inhalation Injuries • Smoke inhalation • Heat scorches mucous membranes • Edema blocks airway • Facial burns, singed nasal hairs • Burned speck in saliva • Sooty burn smell on breath • Respiratory distress – restriction of chest wall • Horseness, noisy breathing • Coughing, Cyanosis

45. Carbon Monoxide • CO is released during combustion of most things • Colorless, odorless, tasteless • Tents at elevation • Key: burns do not usually render someone unconscious, if unconscious then think CO poisoning

46. Chemical Burns • Sulfuric acid • Battery explodes • Cell phones, Laptops • Phenols (carbolic acid) • Use low pressure fresh water • High pressure drives it in deeper • Irrigate 20 minites

47. Electrical Burns • 3 types • Thermal • Electricity causes flame • Electricity does not pass through body • Contact • Where current is most intense • Arcing • Current jumps form one surface to another • Does not pass through the body

48. Amperage and Seriousness • .9-1 mA no effect • 1-10 mA sensation /pain • 10-30 mA paralysis of arm • 30-75 mA respiratory arrest • 75 mA -4 A ventricular fibrillation, cardiac arrest • 4A and up heart paralysis, death

49. Management of Electrical Shock • Protect yourself • ABpCDE • Check for spinal injuries • Victims can be thrown • Check for burn wounds • Treat for Shock

50. Signs of Electrocution • Dazed and confused • Obvious and severe skin surface • Unconsciousness • Weak irregular pulse • Shallow or absent respiration • Possibly multiple fracture form AC current causing contractoins