Environmental Emergencies:

Chapter 30

Heat and cold related injuries

Factors affecting exposure

• Physical Condition

• Age

• Nutrition/hydration

• Environmental conditions

Cold exposure

Terms to know:

• Hypothermia- lowering the temperature of the entire body (core temperature falls below 95 degrees)

• Conduction- direct transfer of heat from a part of the body to a colder object by direct touch

• Convection- heat transferred into circulating air • Evaporation- conversion of liquid into gas • Radiation- the transfer of heat through radiant energy

or invisible light • Respiration- Causes body heat to be lost when cold air

enters the lungs and warm air is exhaled into the atmosphere

Heat Loss

• The rate and amount of heat loss can be modified in three ways – Increase or decrease of

heat production: the body can increase heat production by increasing the metabolism of the cells (shivering)

– Move to an area where heat loss is increased or decreased:

– Wear insulated clothing to reduce heat loss:

Hypothermia Signs and symptoms

• 90-95: – Shivering/ foot stamping – Constricted blood

vessels/ rapid breathing – withdrawn

• 89-92: – Loss of coordination/

muscle stiffness – Slowing respirations/

slow pulse – Confused/ lethargic/

sleepy

• 80-88: • Coma

• Weak pulse/ arrhythmias/ slow respirations

• Unresponsive

• <80: • Apparent death

• Cardiac arrest

• unresponsive

Temperature assessment

• To assess patients general temperature- pull back your glove and with the back of your hand feel the patients abdomen

• Never assume that a cold pulse less patient is dead-patients can survive cold related arrests if proper emergency care is taken

• A patient is never dead until they are warm and dead

Focused Physical Exam

• You exam should focus on:

– Severity of hypothermia

– Areas directly affected by the cold

– And distinguish between frostbite and hypothermia

Interventions

• Move the patient out of the cold environment

• Do not allow the patient to walk • Remove wet clothing • Wrap the patient in dry blankets • Do not massage or allow the patient

to massage the extremities • Do not allow the patient any

stimulants • Give warm humidified oxygen • Begin passive re-warming (turn up

heart in ambulance and wrap the patient in blankets)

• If the patient is alert begin active re-warming with hot packs or water bottles

Local cold injuries

• Most injuries from cold are confined to exposed parts of the body – Frostnip- when

exposed parts of the body become cold but not frozen

– Frostbite- when exposed areas of the body become frozen

Emergency medical care for local cold injury

• Remove the patient from environment • Handle the injured area gently • Administer oxygen • Remove wet or restrictive clothing • Remove jewelry from injured part • Splint the injury and cover with dry sterile dressing • Evaluate the patient • Transport immediately • Contact medical control (if they instruct you to - warm the area) • Use a warm bath of water between 100 and 112 degrees • Stir the water continually • Keep the extremity away from the edge and bottom of the container • Keep immersed until it feels warm and sensation is regained • Dress with dry sterile dressing separating the fingers and toes

Heat exposure

Ambient temperature

• Ambient temperature- the temperature of the surrounding environment

• When it is hot outside and there is vigorous activity the body will attempt to cool itself by: – Sweating- During vigorous activity the body can lose

up to 1 liter of sweat per hour

– Dilating blood vessels close to the skin

– The person may remove clothing

• Hyperthermia- high core temperature (greater than 101 degrees)

Illness from heat exposure

• Heat cramps- painful muscle spasms that occur after increased activity

– Caused by loss of electrolytes (salt balance) during sweating

• Heat exhaustion- hypovolumia from loss of liquid during sweating

– Signs and symptoms include: • Dizziness/weakness

• Cold clammy skin

• Dry tongue and thirst

• Normal vital signs with rapid pulse and low diastolic BP

• Normal or elevated body temperature

Heat stroke

• Heat stroke-occurs when the body is subjected to more heat than it can handle – Signs and symptoms

include: • Hot dry flushed skin

• Possible decreased level of consciousness

• Rapid strong pulse

• As the patient goes unconscious the pulse rate falls and becomes weaker

Interventions for people with heat related injury

• Remove form environment • Remove any restrictive clothing • Cover patient with a sheet soaked

in water • If the patient is fully conscious give

them fluids • Turn on air conditioning in

ambulance • Place cold packs in the patient

groin and axially • Fan • Check patients turgor- ability of

the skin to withstand deformation (pinch the skin)

• If Nauseous place in in left lateral recumbent position

Bites and Envenomations:

Spider bites:

• only 2 spiders native to the US are able to deliver serious, life threatening bites

– Black Widow

– Brown recluse

Black Widow Bite

• Black widow: – Localized pain

– Agonizing muscle spasms

– Dizziness

– Sweating

– Vomiting

– Rashes

– Chest tightness

– Difficulty breathing

Brown Recluse Bites

• Brown recluse – Bite is not painful for a few

hours

– Localized swelling

– Tenderness

– A pale, molted, cyanotic center

– Possibly a small blister

– If left untreated an ulcer will form

Antivenin

• Antivenin- a serum containing antibodies that counteract the venom

– Must be administered by a physician

Snake Bites

• Most poison snakes native to the US have 2 hollow fangs to inject poison – The injury will look like 2 holes, slightly raised and irritated – The patient will have localized tenderness

• Pit viper snake bites: • Burning pain at the site • Swelling with bluish discoloration • Bleeding at various distant sites do to venom in the blood stream • Weakness • Sweating • Fainting • Shock

Treatment

• Calm and reassure the patient • Locate the bite area (DO NOT APPLY ICE) • Splint the extremity to decrease movement • Watch for vomiting and anxiety • (if bitten on the trunk) keep supine and transport immediately • Monitor the vitals • Mark the skin with a pen over where the injury has occurred • (if shock occurs) place the patient in the trendelenburg position • If the snake has been killed take it to the hospital with you • Notify the hospital (if possible describe the snake) • Transport immediately

Coral snake bite

• The wound will look like 1 or more puncture like wounds and scratches

• Treatment: – Calm the patient – Flush the area with 1-2 quarts of

warm soaps water (do not apply ice) – Splint the extremity – Keep the patient warm – Place in the trendelenburg position – Transport immediately

• (DO NOT give the patient anything by mouth)

Scorpion stings

• Can possibly cause: – Circulatory collapse – Severe muscle contractions – Excessive salivation – Hypertension – Convulsions

• Antivenin must be administered by a physician – Assess – Contact medical command – Give O2 – Transport

Tick Bites

• Ticks typically carry 2 diseases:

– Rocky Mountain spotted fever

– Lyme disease

Rocky Mountain spotted fever

• Rocky Mountain spotted fever – Occurs within 7-10 days after being bitten

– Symptoms include: • Nausea

• Vomiting

• Headache

• Weakness

• Rash

• Paralysis

• Cardio-respiratory collapse

Lyme disease:

• Occurs within 3 days of the bite

• Symptoms include:

– Bull’s eye rash

– Swelling of joints

– May cause permanent disability if left untreated

Drowning and near drowning:

Drowning and near drowning

• Drowning- death by suffocation after being submerged in water

• Near drowning- survival (for at least 24 hours) after suffocation from being submerged in water

• Steps of (many) drowning: – Panic

– Insufficient breathing

– Decreased buoyancy

– Exhaustion

– Cardiac or respiratory arrest

Larynospasm

• choking sensation felt when liquid is inhaled

– The larynx contracts to prevent more water from entering

– This can cause problems during resuscitation in submerged victims

EMT-B Safety

• To most effectively and safely rescue a drowning person complete the following steps:

– Reach

– Throw and tow

– Row

– Go

Spinal injuries

• You must assume that a primal injury exists in the following situations: – The submersion happened do to

diving, a mishap, or a fall

– The patient is unconscious and no information is available to rule out mechanism of injury

– The patient is conscious but complains of paralysis, numbness, or weakness

– You suspect a spinal cord injury despite testimony from witnesses

Treatment

• To treat a patient in the water with suspected spinal injury: – Turn the patient supine – Restore the airway/begin

ventilation – Float a backboard under the

patient – Secure the trunk and head to

the back board – Remove the patient from the

water – Cover the patient with a blanket

Recovery techniques

• Scuba- self contained breathing apparatus

• As a last resort (if standard recovery procedures are unsuccessful) you may use a grappling hook and rope or chain to attempt to remove the body

Resuscitation efforts

• Never give up on Resuscitation efforts if the patient has drowned or is cold (unless death is obvious)

• Diving reflex- slowing of the heart rate a respirations caused by cold water

• Bradycardia- slow heart/pulse rate

Diving emergencies

• Most serious water related injuries are associated with diving (with or without scuba gear)

– Descent

– Bottom

– Accent

Decent emergencies

• Descent emergencies- usually due to the sudden increase of pressure on the body as the person dives deeper – The usual areas affected by this are: (this is

referred to as squeeze problems) • Lungs

• Sinus cavity

• Middle ear

• Teeth

• Area of the face surrounded by the mask

Bottom

• Emergencies at the bottom: • Inadequate mixing of oxygen and carbon dioxide

• Increased carbon monoxide

• Injury

• Marine life

• entanglement

Ascent emergencies

• Most serious problems related to diving are during the ascent (the most common include) – Air embolism- bubbles of air in the blood vessels

• If air entered the pleural space it can compress the lungs • Pneumomedias- air in the thoracic cavity • Air can cause emboli- air in the blood stream

– Decompression sickness- (bends) bubbles of air (usually nitrogen) obstruct blood vessels • -these can block tiny blood vessels and cause tissue damage

from lack of circulation • -Typically show with abdominal and joint pain

• treatment requites a hyperbaric chamber

Diving interventions:

• To treat a patient who is suffering from a diving emergency:

– Remove the person from water and attempt to keep them calm

– Begin BLS and o2 administration

– Place patient in left lateral recumbent position

– Immediate transport to the nearest facility with a hyperbaric chamber

– Check for other injuries

Other water hazards

• Other hazards that can occur due to water include: – Breath holding syncope- loss of

consciousness caused by decrease stimulus for breathing

– Boat propellers/rocks/water ski’s

– Hypothermia

– Injuries caused by marine life

– Electrocution (mild, moderate, or severe)