Caring for Environmental Emergencies

1. 16 Caring for Environmental Emergencies

2. Objectives • Define the following terms: • Anaphylaxis • Conduction • Convection • Core temperature • Drowning • Evaporation (continued)

3. Objectives • Define the following terms: • Frostbite • Heat cramps • Heat exhaustion • Heat stroke • Hyperthermia • Hypothermia • Radiation (continued)

4. Objectives • Explain the four ways the body loses excess heat. • Describe the signs and symptoms of a patient experiencing a heat-related emergency. • Explain the appropriate assessment and care for a patient experiencing a heat-related emergency. • Differentiate the signs and symptoms of heat stroke and heat exhaustion. • Describe the signs and symptoms of a cold-related emergency. (continued)

5. Objectives • Explain the appropriate assessment and care for a patient experiencing a cold-related emergency. • Describe the signs and symptoms of emergencies related to bites and stings. • Explain the appropriate assessment and care for a patient experiencing an emergency related to a bite or sting. • Describe common factors leading to submersion injuries. (continued)

6. Objectives • Describe common methods used for water-related rescue. • Explain the hazards related to a water rescue. • Describe the signs and symptoms of a submersion injury. • Explain the appropriate care for a victim of a submersion injury. • Demonstrate the ability to appropriately assess and care for a patient experiencing a heat-related emergency. (continued)

7. Objectives • Demonstrate the ability to appropriately assess and care for a patient experiencing a cold-related emergency. • Demonstrate the ability to appropriately assess and care for a patient experiencing a bite or sting emergency. • Value the importance of proper training when attempting to conduct a water rescue.

8. Topics • Temperature and the Body • Heat Emergencies • Cold Emergencies • Bites and Stings • Water-Related Incidents • Ice-Related Incidents

9. TEMPERATURE AND THE BODY

10. Temperature and the Body • Temperature regulation • Process of maintaining proper body temperature. • Hypothermia • When body loses heat faster than it can produce heat. • Hyperthermia • When heat gain occurs faster than body can shed heat.

11. Temperature and the Body • Radiation • Body heat is emitted into environment. • Conduction • Loss of body heat through direct contact with object or ground. • Convection • Loss of body heat when air close to skin moves away, taking body heat with it.

12. Temperature and the Body • Evaporation • Loss of body heat through evaporation of moisture in form of sweat on skin. • Respiration • Heat leaves body with each breath.

13. Mechanisms of heat loss for the body.

14. Think About It It is late fall and you respond to a call for a teen who has fallen into the river after standing in his canoe. A rescue team has been dispatched. While waiting for help, how might he be losing heat?

15. HEAT EMERGENCIES

16. Heat Emergencies • Core temperature: temperature in core of body 98.6°F (37°C). • Heat generated through digestion, metabolism, movement. • Heat lost through breathing and sweating. • Hypothalamus: body's thermostat.

17. Algorithm for the assessment of patients with a heat emergency.

18. Heat Emergencies • Effects of heat loss through evaporation greatly reduced when humidity is high. • Perform history and physical exam. • Very young, very old, those with chronic illnesses susceptible to effects of heat and cold.

19. Heat Cramps/Exhaustion

20. Heat Stroke

21. Heat Emergencies • Heat Cramps • Painful muscle spasms following strenuous activity in hot environment. • Usually caused by electrolyte imbalance. • Patient fully alert and sweaty with normal to warm skin temperature. • Move to cool environment; replenish fluids.

22. Heat Emergencies • Heat Exhaustion • Exposure to excessive heat for prolonged period of time. • Body barely able to shed as much heat as it is generating. (continued)

23. Heat Emergencies • Heat Exhaustion • Signs and Symptoms • Mild to moderate perspiration • Warm or cool skin temperature • Skin color may be normal to pale • Weakness, exhaustion, dizziness • Nausea and vomiting (continued)

24. Heat Emergencies • Heat Exhaustion • Signs and Symptoms • Muscle cramps (usually in legs) • Rapid, weak pulse • Rapid, shallow breathing • Altered mental status (extreme cases)

25. Heat Emergencies • Emergency Care for Heat Exhaustion • Take appropriate BSI precautions. • Primary assessment; ensure breathing is adequate. • Move patient to cool area. • Loosen or remove excess clothing. (continued)

26. Heat Emergencies • Emergency Care for Heat Exhaustion • Cool patient by fanning. • Be careful not to overcool patient. • Place patient in recovery position. • Provide oxygen per local protocol.

27. Algorithm for the emergency care of patients with a heat emergency.

28. Heat Emergencies • Heat Stroke • Temperature-regulating mechanism fails; unable to rid excess heat. • Core temperature allowed to rise uncontrolled, causing body to overheat. • It is life-threatening emergency. • Temperature may increase to 105°F (40.5°C) or higher. (continued)

29. Heat Emergencies • Heat Stroke • Signs and Symptoms • Altered mental status • Skin hot to touch • Skin slightly moist to dry • Rapid, shallow breathing • Rapid pulse (continued)

30. Heat Emergencies • Heat Stroke • Signs and Symptoms • Weakness, exhaustion, dizziness • Nausea and vomiting • Convulsions

31. Heat Emergencies • Emergency Care for Heat Stroke • Take appropriate Standard Precautions. • Primary assessment; ensure breathing is adequate. • Move patient to cool area; remove excess clothing. • Cool patient by dowsing or immersing in cool water. (continued)

32. Heat Emergencies • Emergency Care for Heat Stroke • Do not overcool patient to the point of him/her shivering. • Wrap cold packs or ice bags; place under armpits, on groin, and each side of neck. (continued)

33. Heat Emergencies • Emergency Care for Heat Stroke • Place patient in recovery position. • Provide oxygen per local protocol. • Monitor vital signs.

34. Think About It It is a hot summer day and you are dispatched for a “man down.” You arrive to find a 36-year-old male jogger who is seated on the ground. His shirt and shorts are wet from perspiration. He seems confused and has just vomited. What do you suspect? What else should you assess? How will you proceed?

35. COLD EMERGENCIES

36. Cold Emergencies • Hypothermia • Body loses heat faster than it can be generated (generalized cold emergency). • Young children and elderly more susceptible. (continued)

37. Cold Emergencies • Hypothermia • Signs and Symptoms • Cool or cold skin temperature • Shivering (may stop later) • Altered mental status • Abnormal pulse (rapid, then slow) • Lack of coordination (continued)

38. Cold Emergencies • Hypothermia • Signs and Symptoms • Muscle rigidity • Impaired judgment • Complaints of joint/muscle stiffness

39. Signs and symptoms of hypothermia.

40. Cold Emergencies • Emergency Care for Hypothermia • Take appropriate BSI precautions. • Primary assessment; ensure adequate breathing. • Remove patient from cold environment. • Do not allow patient to walk or exert himself/herself in any way. (continued)

41. Cold Emergencies • Emergency Care for Hypothermia • Protect patient from further heat loss. • Remove wet clothing and place blanket over and under patient. • Handle patient gently. • Administer oxygen per local protocols. (continued)

42. Cold Emergencies • Emergency Care for Hypothermia • Monitor vital signs. • Do not give patient anything to eat or drink, including hot coffee, tea, alcohol.

43. Cold Emergencies • Severe Hypothermia • Patient unresponsive with skin cold to the touch; no vital signs. • Do not assume patient is dead. • Assess pulse for 30-45 seconds. If no pulse, begin CPR. • Not be pronounced dead until core temperature to within normal range.

44. Cold Emergencies • Localized Cold Injury • Cold injury or frostbite: freezing or near freezing of body part. • Caused by significant exposure to cold temperature (below 0°F or 17°C). • Occurs in extremities (fingers, toes, ears, face, nose). (continued)

45. Cold Emergencies • Localized Cold Injury • Signs and Symptoms (Early Signs) • Numbness, tingling exposed area • Slow or absent capillary refill • Skin remains soft • If thawed, tingling and pain present (continued)

46. Cold Emergencies • Localized Cold Injury • Signs and Symptoms (Late Signs) • White, waxy skin • Firm to frozen feeling upon palpation • Swelling • Blisters • If thawed, flushed with areas of purple and blanching

47. Severe frostbite.

48. Cold Emergencies • Emergency Care for Cold Injury • Take appropriate BSI precautions. • Primary assessment; ensure adequate breathing. • Remove patient from cold environment; protect from cold exposure. • Remove wet or constrictive clothing. (continued)

49. Cold Emergencies • Emergency Care for Cold Injury • Early injury: • Manually stabilize extremity, affected part. • Cover affected part. • Do not rub or massage it. • Do not re-expose part to cold. (continued)

50. Cold Emergencies • Emergency Care for Cold Injury • Late injury: • Remove jewelry from injured part. • Cover injured part with dry, sterile dressings. Place dressing between fingers and toes prior to covering. • Do not break blisters. (continued)