Seattle/King County EMT-B Class

1. Seattle/King County EMT-B Class

2. 1 2 3 Topics Environmental Emergencies: Chapter 18 Behavioral Emergencies: Chapter 19 Ob/Gyn Emergencies: Chapter 20

3. 1 Environmental Emergencies

4. 1 Factors Affecting Exposure • Physical condition • Age • Nutrition and hydration • Environmental conditions

5. Conduction Transfer of heat from body to colder object Convection Transfer of heat through circulating air Evaporation Cooling of body through sweating Radiation Loss of body heat directly into a colder environment Respirations Loss of body heat during breathing 1 Loss of Body Heat

6. 1 Loss of Body Heat, continued • Rate and amount of heat gain or loss can be modified in three ways: • Increase or decrease heat production. • Move to sheltered area where heat loss is increased or decreased. • Wear insulated clothing.

7. 1 Hypothermia • Lowering of the body temperature below 95°F (35°C) • Weather does not have to be below freezing for hypothermia to occur. • Older persons and infants are at higher risk. • People with other illnesses and injuries are susceptible to hypothermia.

8. Signs and symptoms include: Shivering Rapid pulse and respirations Red, pale, cyanotic skin 1 Mild Hypothermia

9. 1 Severe Hypothermia • Signs and symptoms include: • Shivering stops. • Muscular activity decreases. • Fine muscle activity ceases. • Eventually, all muscle activity stops.

10. Patient may appear dead (or in a coma). Never assume that a cold, pulseless patient is dead. 1 Core Temperature Less Than 80F

11. 1 Scene Size-up • Note weather conditions. • Identify safety hazards such as icy roads, mud, or wet grass. 1. Scene Size-up

12. 1 Initial Assessment • Decide SICK/NOT SICK • Check temperature on patient’s abdomen. • Ensure adequate airway. • Palpate for carotid pulse; wait 30–45 seconds. • ANY kind of pulse=NO CPR. • Transport immediately or move to warmer location. 1. Scene Size-up • Initial Assessment

13. 1 Focused History/Physical Exam • If unconscious, do a rapid physical exam. • If conscious, obtain SAMPLE history. • Determine how long the patient was exposed. • Medications can affect the patient’s metabolism. • Concentrate on areas of body directly affected by exposure. 1. Scene Size-up • Initial Assessment • Focused History/ Physical Exam

14. 1 Detailed Physical Exam • Aimed at determining degree and extent of cold injury • Evaluate skin temperature, texture, and turgor. 1. Scene Size-up • Initial Assessment • Focused History/ Physical Exam • Detailed Physical Exam

15. 1 Ongoing Assessment • Rewarming can be harmful; monitor carefully. • Communicate conditions at scene, clothing, changes in mental status. 1. Scene Size-up • Initial Assessment • Focused History/ Physical Exam • Detailed Physical Exam • Ongoing Assessment

16. 1 Baseline Vital Signs • Can be altered by hypothermia • Monitor for changes in mental status. • Check body temperature: (oral, tympanic or axillary)

17. 1 Interventions • Move from cold environment. • Do not allow patient to walk, eat, use any stimulants, or smoke or chew tobacco. • Remove wet clothing. • Place dry blankets under and over patient. • Handle gently. • Do not massage extremities.

18. 1 Local Cold Injuries • Frostnip • Freezing of the skin but not the deeper surface • Immersion (trench) foot • Prolonged exposure to cold water • Frostbite • Freezing of a body part, usually an extremity

19. 1 Emergency Care for Local Cold Injury • Remove the patient from further exposure to the cold. • Handle the injured part gently. • Administer oxygen. • Remove any wet or restrictive clothing. • Never rub the area. • Do not break blisters. • Transport.

20. 1 Warm-Water Bath • Water temperature should be between 100-112oF. • Recheck water temperature and stir to circulate. • Keep body part in water until warm and sensation returns. • Dress with dry, sterile dressings.

21. 1 Cold Exposure and You • EMT-Bs are at risk for hypothermia when working in a cold environment. • Stay aware of local weather conditions. • Dress appropriately and be prepared. • Vehicle must be properly equipped and maintained. • Never allow yourself to become a casualty!

22. 1 Heat Exposure • Normal body temperature is 98.6°F. • Body attempts to maintain normal temperature despite ambient temperature. • Body cools itself by sweating (evaporation) and dilation of blood vessels. • High temperature and humidity decrease effectiveness of cooling mechanisms.

23. 1 Heat Cramps • Painful muscle spasms • Remove the patient from hot environment. • Rest the cramping muscle. • Replace fluids by mouth. • If cramps persist, transport the patient to hospital.

24. 1 Heat Exhaustion • Signs and symptoms include: • Dizziness, weakness, or fainting • Onset while working hard or exercising in hot environment • In older people and young, onset may occur while at rest in hot, humid, and poorly ventilated areas. • Cold, clammy skin

25. 1 Heat Exhaustion, continued • Dry tongue and thirst • Patients usually have normal vital signs, but pulse can increase and blood pressure can decrease. • Normal or slightly elevated body temperature

26. 1 Emergency Medical Care • Remove extra clothing and remove from hot environment. • Give patient oxygen. • Have patient lie down and elevate legs. • If patient is alert, give water slowly. • Be prepared to transport.

27. 1 Heatstroke • Signs and symptoms include: • Hot, dry, flushed skin • Change in behavior leading to unresponsiveness • Pulse rate is rapid, then slows. • Blood pressure drops. • Death can occur if the patient is not treated.

28. 1 Care for Heat Stroke • Move patient out of the hot environment. • Provide air conditioning at a high setting. • Remove the patient’s clothing. • Give the patient oxygen. • Apply cold packs to the patient’s neck, armpits, and groin.

29. 1 Care for Heat Stroke, continued • Cover the patient with wet towels or sheets. • Aggressively fan the patient. • Immediately transport patient. • Notify the hospital of patient’s condition.

30. 1 Scene Size-up • Do environmental assessment. • Protect yourself from heat and biological hazards. • ALS may need to give IV fluids. 1. Scene Size-up

31. 1 Initial Assessment • Decide SICK/NOT SICK • The more altered the mental status, the more severe the exposure. • Keep airway patent. • Oxygen may decrease nausea. • Treat for shock aggressively. 1. Scene Size-up • Initial Assessment

32. 1 Focused History/Physical Exam • Note activities/medications that may make patient susceptible to heat-related problems. • Determine exposure and activities prior to symptoms. • Assess for muscle cramps, confusion. • Examine for mental status, skin temperature, wetness. 1. Scene Size-up • Initial Assessment • Focused History/ Physical Exam

33. 1 Detailed Physical Exam • Pay attention to skin temperature, turgor, wetness. • Turgor = skin’s ability to resist deformity • In dehydration, skin will tent when pinched on back of hand. • Perform careful neurologic exam. 1. Scene Size-up • Initial Assessment • Focused History/ Physical Exam • Detailed Physical Exam

34. 1 Ongoing Assessment • Watch for deterioration. • Reassess vital signs every 5 minutes. • Do not cause shivering. • Document weather conditions and activities prior to emergency. 1. Scene Size-up • Initial Assessment • Focused History/ Physical Exam • Detailed Physical Exam • Ongoing Assessment

35. 1 Baseline Vital Signs • May be tachycardic or tachypneic • In heat exhaustion, patient may have normal skin temp; may also be cool and clammy. • In heat stroke, patient will have hot skin.

36. 1 Interventions • Remove from hot environment. • Give cool fluids by mouth. • Cover with sheet and soak with cool water. • Set A/C on high. • Place ice packs on groin and axillae. • Fan aggressively.

37. 1 Drowning and Near Drowning • Drowning • Death as a result of suffocation after submersion in water • Near drowning • Survival, at least temporarily, after suffocation in water

38. 1 Drowning Process

39. 1 Spinal Injuries • Suspect spinal injury if: • Submersion has resulted from a diving mishap or long fall. • Patient is unconscious. • Patient complains of weakness, paralysis, or numbness.

40. 1 Spinal Stabilization in Water • Turn the patient supine. • Restore the airway and begin ventilation. • Secure a backboard under the patient. • Remove the patient from the water. • Cover the patient with a blanket.

41. 1 Resuscitation Efforts • Hypothermia can protect vital organs from hypoxia. • Documented case of a survivor of a 66-minute cold water submersion • Diving reflex may cause heart rate to slow.

42. 1 Diving Problems • Descent problems • Usually due to the sudden increase in pressure on the body as the person dives • Bottom problems • Not commonly seen • Ascent problems • Air embolism and decompression sickness

43. 1 Air Embolism • Signs and symptoms include: • Blotching • Froth at the mouth and nose • Severe pain in muscle, joints, or abdomen • Dyspnea and/or chest pain

44. 1 Air Embolism, continued • Signs and symptoms include: • Dizziness, nausea, and vomiting • Dysphasia • Difficulty with vision • Paralysis and/or coma • Irregular pulse or cardiac arrest

45. 1 Decompression Sickness (Bends) • Can result from rapid ascent • Most common symptom is abdominal and/or joint pain. • Symptoms may develop after hours. • Treatment is BLS and hyperbaric chamber.

46. 1 Scene Size-up • Never drive through moving water; be cautious driving through still water. • Never attempt water rescue without proper training and equipment. • Consider trauma and spinal stabilization. • Check for additional patients. 1. Scene Size-up

47. 1 Initial Assessment • Decide SICK/NOT SICK. • Pay attention to chest pain, dyspnea, complaints of sensory changes. • Be suspicious of alcohol use. • Maintain airway; suction. • If pulse cannot be obtained, begin CPR. • Evaluate for shock and adequate perfusion. 1. Scene Size-up • Initial Assessment

48. 1 Focused History/Physical Exam • If responsive, listen to breath sounds. • If unresponsive, look for signs of trauma. • Check divers for indications of air embolism or bends. • Focus on pain in joints and abdomen. • Check for signs of hypothermia. 1. Scene Size-up • Initial Assessment • Focused History/ Physical Exam

49. 1 Detailed Physical Exam • Examine respiratory, circulatory, neurologic systems. • Distal circulatory, sensory, and motor function tests determine extent of injury. • Examine for peripheral pulses, skin color, and discoloration, itching, pain, numbness/tingling. 1. Scene Size-up • Initial Assessment • Focused History/ Physical Exam • Detailed Physical Exam

50. 1 Ongoing Assessment • Assess mental status frequently. • Document: • Circumstances of drowning and extrication • Time submerged • Temperature of water • Clarity of water • Possible spinal injury • Bring dive log, dive computer, and dive equipment to hospital. 1. Scene Size-up • Initial Assessment • Focused History/ Physical Exam • Detailed Physical Exam • Ongoing Assessment