Environmental Emergenices
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Environmental Emergenices

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    Environmental Emergenices Environmental Emergenices Presentation Transcript

    • Chapter Environmental Emergencies Eighteen
    • Chapter
      • Effects of heat and cold on the body
      • Treatments for conditions caused by heat and cold
      • Personal safety concerns in water emergencies
      • Signs, symptoms, and treatment of near-drowning, bites, and stings
      Eighteen CORE CONCEPTS
    • The body tries to balance heat loss and heat gain to maintain normal temperature. T EMPERATURE REGULATION
    • Hypothermia (low temperature) Hyperthermia (high temperature)
    • The body loses heat in 5 ways:
      • Radiation
      • Convection
      • Conduction
      • Evaporation
      • Respiration
    • Heat Loss from Radiation Heat Loss from Convection
    • Heat Loss from Conduction Heat Loss from Evaporation
    • Heat Loss from Respiration
    • E XPOSURE TO COLD
    • Predisposing Factors Generalized Hypothermia
      • Cold water immersion
      • Cold air exposure
      • Cold environment
      (Continued)
      • Very old age
      Predisposing Factors
      • Failing body systems
      • Chronic illness
      • Lack of exercise
      • Certain medications
      Generalized Hypothermia (Continued)
      • Very young age
      Predisposing Factors
      • Large skin surface area/less fat
      • Little or no shivering
      • Inability to put on or take off clothing
      Generalized Hypothermia (Continued)
    • Predisposing Factors Generalized Hypothermia
      • Shock (hypoperfusion)
      • Head/spinal cord injury
      • Burns
      • Generalized infection
      • Diabetes and hypoglycemia
      • Drugs and poisons
      • Medical conditions
    • Patient ASSESSMENT Generalized Hypothermia Signs and Symptoms
      • Obvious or subtle exposure
      • Cool or cold skin temperature
      • Decreasing mental status/
      (Continued) motor function
    • Patient ASSESSMENT Generalized Hypothermia Signs and Symptoms
      • Stiff or rigid muscles/posture
      • Shivering in mild cases (lack of, in more
      severe cases)
      • Slow pupil reaction
      (Continued)
    • Patient ASSESSMENT Generalized Hypothermia Signs and Symptoms
      • Breathing variations
      • Rapid (early)
      • Shallow, slow, absent (late)
      • Blood pressure (low to absent)
      • Poor judgment
      (Continued)
    • Patient ASSESSMENT Generalized Hypothermia Signs and Symptoms
      • Pulse changes
      • Rapid (early)
      • Slow, weak, irregular, absent (late)
      • Muscle and joint stiffness
      (Continued)
    • Patient ASSESSMENT Generalized Hypothermia Signs and Symptoms
      • Skin
      • Red (early)
      • Pale
      • Cyanotic
      • Stiff/hard (late)
    • Patient CARE Generalized Hypothermia Emergency Care Steps
      • Remove patient from environment
      and prevent further heat loss.
      • Remove wet clothing and cover
      with blanket.
      • Handle patient gently.
      (Continued)
    • Patient CARE Generalized Hypothermia Emergency Care Steps
      • Do not allow patient to walk or
      exert self.
      • Give high-concentration oxygen
      (warmed and humidified).
      • If apneic, check pulse 30 – 45 seconds
      before starting CPR. (Continued)
    • Patient CARE Generalized Hypothermia Emergency Care Steps
      • Do not allow patient to eat or
      drink stimulants.
      • Do not massage extremities.
      (Continued)
    • Patient CARE Generalized Hypothermia Emergency Care Steps
      • If patient responds appropriately,
      rewarm actively:
      • Apply blankets.
      • Apply heat to groin, armpits, neck.
      • Increase heat in ambulance.
      (Continued)
    • Patient CARE Generalized Hypothermia Emergency Care Steps
      • If patient is unresponsive or responds
      inappropriately, rewarm passively:
      • Apply blankets.
      • Increase heat in ambulance.
      • Predisposing factors
      • Usually occur in extremities
      and exposed ears, nose, face Local Cold Injuries
    • Clear boundary separates injured/uninjured areas.
    • Patient ASSESSMENT Superficial (Early) Local Cold Injury Signs and Symptoms
      • Blanching of skin.
      • Loss of feeling in affected area.
      • Skin remains soft.
      • When rewarmed, area tingles.
    • Patient CARE Superficial (Early) Local Cold Injury Emergency Care Steps
      • Remove patient from environment.
      • Protect area from further injury.
      • Administer high-concentration
      • Remove wet or restrictive clothing.
      oxygen. (Continued)
    • Patient CARE Superficial (Early) Local Cold Injury Emergency Care Steps
      • Splint and cover extremity.
      • Do not rub or massage.
      • Do not reexpose to cold.
    • Patient ASSESSMENT Deep (Late) Local Cold Injury Signs and Symptoms
      • White, waxy skin
      • Firm or frozen when palpated
      • Swelling and blisters (especially when
      • thawed)
      • Flushed, red, mottled, or cyanotic skin
      (when thawed)
    • Local Cold Injury
    • Patient CARE Deep (Late) Local Cold Injury Emergency Care Steps
      • Remove patient from environment.
      • Protect area from further injury.
      • Administer high-concentration
      • Remove wet or restrictive clothing.
      oxygen. (Continued)
    • Patient CARE Deep (Late) Local Cold Injury Emergency Care Steps
      • Remove jewelry.
      • Cover with dry dressings or clothing.
      (Continued)
    • Patient CARE Deep (Late) Local Cold Injury Emergency Care Steps
      • Do not :
      • Break blisters
      • Rub or massage area
      • Apply heat or rewarm
      • Allow patient to walk on
      affected extremity (Continued)
    • Patient CARE Deep (Late) Local Cold Injury Emergency Care Steps
      • If transport is delayed or extremely
      long, rewarm actively and rapidly (e.g., wilderness situation) .
    • Immerse affected part in warm-water bath.
    • Patient CARE Deep (Late) Local Cold Injury Emergency Care Steps
      • Continuously stir water/monitor
      • Add warm water to maintain
      temperature. temperature.
      • Continue until area is soft, and color
      and sensation return. (Continued)
    • Patient CARE Deep (Late) Local Cold Injury Emergency Care Steps
      • Dress area with dry, sterile dressings.
      • Protect against refreezing.
      • Expect complaint of severe pain.
    • If there is any chance that a warmed body part that has sustained frostbite may refreeze in the time it takes to get the patient out of the backwoods, the experts say we should delay on the initial warming. When the tissue refreezes, the cells can be severely damaged. P RECEPTOR P EARL
    • E XPOSURE TO HEAT
    • Predisposing Factors
      • Climate
      • High temperature
      • High humidity
      • Exercise and activity
      Heat Exposure (Continued)
      • Age: Elderly
      Predisposing Factors
      • Poor thermoregulation
      • Medications
      • Limited ability to escape heat
      Heat Exposure (Continued)
    • Predisposing Factors
      • Poor thermoregulation
      • Can’t remove own clothing
      Heat Exposure (Continued)
      • Age: Newborns/Infants
      • Preexisting illness
      • Heart disease
      • Dehydration
      • Obesity
      • Infections/fever
      • Fatigue
      • Diabetes
      • Drugs/medications
      Predisposing Factors Heat Exposure
    • Patient ASSESSMENT Heat Exposure Signs and Symptoms
      • Muscle cramps
      • Weakness
      • Exhaustion
      • Dizziness, faintness
      • Rapid heart rate
      (Continued)
    • Patient ASSESSMENT Heat Exposure Signs and Symptoms
      • Altered mental status (may be unresponsive)
      • Skin
      EMERGENCY
      • Moist and pale, temperature normal to cool
      • Dry or moist, temperature hot
    • Patient CARE Heat Exposure Patient with Normal to Cool Skin Emergency Care Steps
      • Remove from hot environment.
      • Administer high-concentration oxygen.
      • Loosen or remove clothing.
      (Continued)
    • Patient CARE Heat Exposure Patient with Normal to Cool Skin Emergency Care Steps
      • Cool by fanning.
      • Put in supine position; elevate legs.
      • Patient is responsive/not nauseated
      • Give water.
      • Patient is unresponsive/vomiting
      • Transport/no water.
    • Patient CARE Heat Exposure Patient with Hot Skin Emergency Care Steps
      • Remove from hot environment.
      • Remove clothing.
      • Administer high-concentration
      (Continued) oxygen.
    • Patient CARE Heat Exposure Patient with Hot Skin Emergency Care Steps
      • Apply cool packs to neck, groin,
      • Keep skin wet.
      • Fan aggressively.
      • Transport immediately.
      armpits.
    • W ATER EMERGENCIES
    • Drowning Death associated with immersion in water K EY TERM
      • Reach
      • Throw and tow
      • Row
      • Go
      Order of Water Rescue Procedures
    • Near-Drowning
      • Primary concern is everyone’s safety.
      • Treat for spine injury:
      • If diving injury cannot be ruled out.
      • Attempt resuscitation of
      submerged cardiac arrest patient unless medical direction rules out. (Patient Submerged But Survives)
    • Patient CARE Near-Drowning (submersion) Emergency Care Steps
      • If patient is responsive and spine
      • Immobilize head manually.
      • Use backboard to remove
      injury is not ruled out: from water.
    • Patient is found face down in shallow water. Extend patient’s arms straight up.
    • Rotate torso toward you as you lower yourself into the water.
    • Maintain stabilization by holding the patient’s head between his arms.
    • Patient CARE Near-Drowning (submersion) Emergency Care Steps
      • If no suspected spine injury:
      • Position unresponsive patient on
      left side.
      • Suction as needed.
      • Administer high-concentration
      oxygen. (Continued)
    • Patient CARE Near-Drowning (submersion) Emergency Care Steps
      • If gastric distention prevents
      • Turn patient onto left side.
      • With suction ready, apply firm pressure
      adequate ventilation: over epigastric area.
    • B ITES AND STINGS
    • Patient ASSESSMENT Bites and Stings Signs and Symptoms
      • History of spider/snake bite; insect,
      scorpion, marine animal sting
      • Pain, redness, swelling
      (Continued)
    • Patient ASSESSMENT Bites and Stings Signs and Symptoms
      • Dizziness and chills
      • Fever
      • Nausea and vomiting
      • Bite marks or stinger
    • Patient CARE Bites and Stings Emergency Care Steps
      • If stinger is present
      • Scrape with blunt edge to remove.
      • Avoid tweezers. May squeeze more
      venom into wound. (Continued)
    • Patient CARE Bites and Stings Emergency Care Steps
      • Wash area gently.
      • Remove jewelry distal to affected
      • Position injection site slightly
      below heart.
      • Observe for allergic reaction.
      area. (Continued)
    • Patient CARE Bites and Stings Emergency Care Steps
      • Snakebites
      • Consult medical direction about constricting band.
      • Do not apply cold.
    • 1. List the 5 ways in which the body loses heat. 2. What are the treatments for hypothermia? 3. How should a person be turned over when found face down in water? 4. What are the signs and symptoms of a bite or sting? R EVIEW QUESTIONS