Environmental Emergencies

Environmental Emergencies

Exposure to cold How the body loses heat • Conduction Transfer of heat through direct contact Heat will flow from warmer to cooler Water conducts heat away from body 25% faster than still air

Convection When current of air or water passes over water carrying away heat Effects of a cold environment are worsened when moving water or air surround the body {wind chill}

Radiation Body’s atoms and molecules sent out rays of heat as they move and change Most radiant heat loss occurs from head and neck

Evaporation When the body perspires or gets wet. As the moisture vaporized….generalized cooling effect • Respiration Heat loss through exhaled warm air

Generalized Hypothermia • When cooling affects the entire body Predisposing factors: • Shock • Burns • Head and spinal cord injury • Generalized infection • Diabetes with hypoglycemia

Under the influence of alcohol • Unconscious, lying on cold surface • Geriatric; failing health, chronic illness, poor diet, certain medications, and/or lack of exercise • Pediatric; Larger skin surface area and little body fat. Because of small muscle mass, children to not shiver much at all

Obvious and subtle exposure Possibility of hypothermia when another condition or injury may be more obvious • ETOH • Underlying illness • Overdose or poisoning • Major trauma • Outdoor resuscitation

Decreased ambient temperature (room temperature) I.e. entrapped or must remain in cool/cold environment Create a barrier with blankets or such Remove wet clothing when possible Cover the head

Patient Assessment Signs and symptoms • Shivering (core temp is above 90degrees) decreased or absent is severe cases • Numbness or reduced-to-lost sense of touch • Stiff or rigid posture prolonged cases

Drowsiness and/or unwillingness or inability to do even the simplest activities • Tachapnea and Tachycardia (early) Bradyapnea and bradycardia (prolonged cases) • Loss of motor sensation staggering, inability to hold things

Joint/muscle stiffness or muscle rigidity • Decreased loc/unconscious, could have glassy stare • Cool abdominal skin temperature • Skin; red in early stages pale to cyanotic in prolonged stages

Passive and Active Rewarming Passive Rewarming • Warms self • Cover and place warm barrier between pt. and surface • Remove wet clothing

Active Rewarming • Application of external heat source • Follow local protocol

Patient Care A & O x4/GCS 15 • Remove wet clothing • Wrap and keep warm • Keep still; no activity or exertion • Do not massage extremities • In transport actively rewarm;not too quickly if delayed move to warm enviornment

Care for shock O2 warm and humidified if possible • Give warm liquids but slowly • Transport but if not don’t allow to return to the cold environment • When actively rewarming, must be done slowly and handle pt. with great care

When actively rewarming: • Use central rewarming lateral chest, neck, groin, armpits • Rewarm the trunck leaving exremeties exposed • If transport delayed, warm bath • Do not allow to walk, avoid rough handling

Patient Care – Unresponsive/decreased loc • Do not actively rewarm • Remove from environment and cover • ABCs • Do not allow to eat or drink • Do not massage extremities • Transport immediately

Extreme Hypothermia • Unconscious • No discernable VS • Core body temperature <80 degrees F

Care • Assess carotid pulse 30 to 45 seconds • CPR • AED PATIENT IS NOT DEAD UNTIL WARM AND DEAD

Localized Cold Injuries • Ears, nose, hands, feet and toes • Tissues freeze Progression • Exposed skin reddens dark skinned; lightens to a blanched color • As exposure continues, skin takes on gray or white blotchy appearance and becomes numb

If freezing continues, skin becomes dead white and all sensations are lost Local or superficial local injury sometimes called frostnip

Patient Assessment for frostnip: • Brought about by direct contact with cold object or exposure to cold air • Most susceptible are tip of nose, tips of ears, upper cheeks, and fingers • Pt. often unaware of onset

Signs and Symptoms • Exposed skin reddens dark skinned; lightens to a blanched color • Affected area feels numb

Care • Remove from cold environment • Warm the effected area • If to extremity, splint and cover • Do not massage affected area • Pt. may complain about tingling or burning • If pt. does not respond to tx. ……..

Patient Assessment for late or deep local cold injury (frostbite) • Affected skin appears white and waxy • Skin mottled and blotchy – white to grayish yellow – grayish blue

Swelling and blistering may occur • Affected area feels frozen, but only on the surface do not squeeze or poke

Care • High concentration O2 • Transport immediately • Cover affected area and handle gently • Delayed transport; take inside and keep warm, do not allow pt. to drink etoh or smoke

Warm the frozen part per protocol or by medical direction *never rub a frostbitten or frozen part *don’t let pt. walk on affected exremity *don’t thaw a frozen limb if there is a chance of reexposure or refrozen

Active rewarming of frozen parts Seldom recommended pp525-526

Exposure to Heat Effects of heat on the body • The body generates heat due to constant internal chemical processes • Any heat not needed for temperature regulation must be lost by the body. If not Hyperthermia

Heat and humidity are often associated with hyperthermia • Collapse from heat exposure may result in trauma • Heat exposure may be hastened or intensified: Age Alcohol and any other drug

Heat Exhaustion Exposure to excessive heat while working or exercising resulting from fluid and salt loss • Moist, pale, cool to normal skin • Heat cramps {muscle cramps} from heavy perspiration and salt loss

Signs and Symptoms • Muscle cramps; usually in legs and ABD • Weakness and exhaustion; sometimes dizziness or periods of faintness • Rapid, shallow breathing • Weak pulse • Heavy perspiration

Care • Remove from environment into cool place • O2; NRB • Loosen or remove clothing, fan; without chilling. Watch for shivering • Position; supine with legs elevated • If LOC permits, give small sips of water. If N&V develop, discontinue.--Airway

Muscle cramps apply moist towels over cramped area • Transport

Patient with hot and dry or moist skin {heat stroke} • Cooling mechanisms fail • Problem compounded with fluid and salt loss

Patient Assessment Signs and symptoms • Rapid shallow breathing • Full and rapid pulse • Generalized weakness • Little or no perspiration • Loss of consciousness or AMS • Dilated pupils • Seizures may be seen; no muscle cramps

Care • Remove and place in cool environment • Remove clothing • Apply cold packs neck, groin, armpits • Keep the skin wet • Fan aggresively

O2 • Transport if delayed; immerse to neck in cold water

WATER-RELATED EMERGENCIES

Consider that underlying medical conditions may be the cause of a water-related accident. • Drowning can take place in a few inches of water {bathtubs}

Patient Assessment • Airway obstruction; spasms • Cardiac arrest • Signs of heart attack • Injuries to the head and neck • Internal injuries • Generalized or hypothermia • Substance abuse • Drowning

Drowning Definition by WHO Process of experiencing respiratory impairment from submersion/immersion in liquid

Process of drowning • Aprox. 10% who die from drowning die just from the lack of air • Cold water drowning *resuscitation can be successful after 30 minutes or longer *once water temp. falls below 70 degrees, biological death may be delayed

Transport should not be delayed • Initiate care immediately even if pt. is still in the water *Ventilations; there may be some resistance, more force may be needed *water in the lungs usually means water in the stomach as well which will add resistance

If gastric distension interferes with ventilations: *place on left side *suction immediately *apply firm pressure over the ABD

Environmental Emergencies