Chapter Environmental Emergencies Eighteen
Chapter <ul><li>Effects of heat and cold on the body </li></ul><ul><li>Treatments for conditions caused    by heat and col...
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: <ul><li>Radiation </li></ul><ul><li>Convection </li></ul><ul><li>Conduction </li></ul><ul><...
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 <ul><li>Cold water immersion </li></ul><ul><li>Cold air exposure </li></ul><u...
<ul><li>Very old age </li></ul>Predisposing Factors <ul><li>Failing body systems </li></ul><ul><li>Chronic illness </li></...
<ul><li>Very young age </li></ul>Predisposing Factors <ul><li>Large skin surface   area/less fat </li></ul><ul><li>Little ...
Predisposing Factors Generalized Hypothermia <ul><li>Shock (hypoperfusion) </li></ul><ul><li>Head/spinal cord injury </li>...
Patient  ASSESSMENT Generalized Hypothermia Signs and Symptoms <ul><li>Obvious or subtle exposure </li></ul><ul><li>Cool o...
Patient  ASSESSMENT Generalized Hypothermia Signs and Symptoms <ul><li>Stiff or rigid muscles/posture </li></ul><ul><li>Sh...
Patient  ASSESSMENT Generalized Hypothermia Signs and Symptoms <ul><li>Breathing variations </li></ul><ul><li>Rapid (early...
Patient  ASSESSMENT Generalized Hypothermia Signs and Symptoms <ul><li>Pulse changes </li></ul><ul><li>Rapid (early) </li>...
Patient  ASSESSMENT Generalized Hypothermia Signs and Symptoms <ul><li>Skin </li></ul><ul><li>Red (early) </li></ul><ul><l...
Patient  CARE Generalized Hypothermia Emergency Care Steps <ul><li>Remove patient from environment  </li></ul>and prevent ...
Patient  CARE Generalized Hypothermia Emergency Care Steps <ul><li>Do not allow patient to walk or </li></ul>exert self. <...
Patient  CARE Generalized Hypothermia Emergency Care Steps <ul><li>Do not allow patient to eat or </li></ul>drink stimulan...
Patient  CARE Generalized Hypothermia Emergency Care Steps <ul><li>If patient responds appropriately, </li></ul>rewarm act...
Patient  CARE Generalized Hypothermia Emergency Care Steps <ul><li>If patient is unresponsive or responds </li></ul>inappr...
<ul><li>Predisposing factors </li></ul><ul><li>Usually occur in extremities </li></ul>and exposed ears, nose, face Local C...
Clear boundary separates injured/uninjured areas.
Patient  ASSESSMENT Superficial (Early) Local Cold Injury Signs and Symptoms <ul><li>Blanching of skin. </li></ul><ul><li>...
Patient  CARE Superficial (Early) Local Cold Injury Emergency Care Steps <ul><li>Remove patient from environment. </li></u...
Patient  CARE Superficial (Early) Local Cold Injury Emergency Care Steps <ul><li>Splint and cover extremity. </li></ul><ul...
Patient  ASSESSMENT Deep (Late) Local Cold Injury Signs and Symptoms <ul><li>White, waxy skin </li></ul><ul><li>Firm or fr...
Local Cold Injury
Patient  CARE Deep (Late) Local Cold Injury Emergency Care Steps <ul><li>Remove patient from environment. </li></ul><ul><l...
Patient  CARE Deep (Late) Local Cold Injury Emergency Care Steps <ul><li>Remove jewelry. </li></ul><ul><li>Cover with dry ...
Patient  CARE Deep (Late) Local Cold Injury Emergency Care Steps <ul><li>Do  not : </li></ul><ul><li>Break blisters </li><...
Patient  CARE Deep (Late) Local Cold Injury Emergency Care Steps <ul><li>If transport is delayed or extremely </li></ul>lo...
Immerse affected part in warm-water bath.
Patient  CARE Deep (Late) Local Cold Injury Emergency Care Steps <ul><li>Continuously stir water/monitor  </li></ul><ul><l...
Patient  CARE Deep (Late) Local Cold Injury Emergency Care Steps <ul><li>Dress area with dry, sterile dressings. </li></ul...
If there is any chance that a warmed body part that has sustained frostbite may refreeze in the time it takes to get the p...
E XPOSURE TO HEAT
Predisposing Factors <ul><li>Climate </li></ul><ul><li>High temperature </li></ul><ul><li>High humidity </li></ul><ul><li>...
<ul><li>Age: Elderly </li></ul>Predisposing Factors <ul><li>Poor thermoregulation </li></ul><ul><li>Medications </li></ul>...
Predisposing Factors <ul><li>Poor thermoregulation </li></ul><ul><li>Can’t remove own   clothing </li></ul>Heat Exposure (...
<ul><li>Preexisting illness </li></ul><ul><li>Heart disease </li></ul><ul><li>Dehydration </li></ul><ul><li>Obesity </li><...
Patient  ASSESSMENT Heat Exposure Signs and Symptoms <ul><li>Muscle cramps </li></ul><ul><li>Weakness </li></ul><ul><li>Ex...
Patient  ASSESSMENT Heat Exposure Signs and Symptoms <ul><li>Altered mental status  (may be unresponsive) </li></ul><ul><l...
Patient  CARE Heat Exposure Patient with Normal  to Cool Skin Emergency Care Steps <ul><li>Remove from hot environment. </...
Patient  CARE Heat Exposure Patient with Normal  to Cool Skin Emergency Care Steps <ul><li>Cool by fanning. </li></ul><ul>...
Patient  CARE Heat Exposure Patient with  Hot Skin Emergency Care Steps <ul><li>Remove from hot environment. </li></ul><ul...
Patient  CARE Heat Exposure Patient with  Hot Skin Emergency Care Steps <ul><li>Apply cool packs to neck, groin,  </li></u...
W ATER EMERGENCIES
Drowning Death associated with immersion in water K EY TERM
<ul><li>Reach </li></ul><ul><li>Throw and tow </li></ul><ul><li>Row </li></ul><ul><li>Go </li></ul>Order of Water Rescue P...
Near-Drowning <ul><li>Primary concern is everyone’s safety. </li></ul><ul><li>Treat for spine injury: </li></ul><ul><li>If...
Patient  CARE Near-Drowning (submersion) Emergency Care Steps <ul><li>If patient is responsive and spine  </li></ul><ul><l...
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 <ul><li>If no suspected spine injury: </li></ul><ul><li>Posi...
Patient  CARE Near-Drowning (submersion) Emergency Care Steps <ul><li>If gastric distention prevents  </li></ul><ul><li>Tu...
B ITES AND STINGS
Patient  ASSESSMENT Bites and Stings Signs and Symptoms <ul><li>History of spider/snake bite; insect, </li></ul>scorpion, ...
Patient  ASSESSMENT Bites and Stings Signs and Symptoms <ul><li>Dizziness and chills </li></ul><ul><li>Fever </li></ul><ul...
Patient  CARE Bites and Stings Emergency Care Steps <ul><li>If stinger is present </li></ul><ul><li>Scrape with blunt edge...
Patient  CARE Bites and Stings Emergency Care Steps <ul><li>Wash area gently. </li></ul><ul><li>Remove jewelry distal to a...
Patient  CARE Bites and Stings Emergency Care Steps <ul><li>Snakebites </li></ul><ul><li>Consult medical direction about  ...
1. List the 5 ways in which the body loses    heat. 2. What are the treatments for    hypothermia? 3. How should a person ...
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Environmental Emergenices

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Environmental Emergenices

  1. 1. Chapter Environmental Emergencies Eighteen
  2. 2. Chapter <ul><li>Effects of heat and cold on the body </li></ul><ul><li>Treatments for conditions caused by heat and cold </li></ul><ul><li>Personal safety concerns in water emergencies </li></ul><ul><li>Signs, symptoms, and treatment of near-drowning, bites, and stings </li></ul>Eighteen CORE CONCEPTS
  3. 3. The body tries to balance heat loss and heat gain to maintain normal temperature. T EMPERATURE REGULATION
  4. 4. Hypothermia (low temperature) Hyperthermia (high temperature)
  5. 5. The body loses heat in 5 ways: <ul><li>Radiation </li></ul><ul><li>Convection </li></ul><ul><li>Conduction </li></ul><ul><li>Evaporation </li></ul><ul><li>Respiration </li></ul>
  6. 6. Heat Loss from Radiation Heat Loss from Convection
  7. 7. Heat Loss from Conduction Heat Loss from Evaporation
  8. 8. Heat Loss from Respiration
  9. 9. E XPOSURE TO COLD
  10. 10. Predisposing Factors Generalized Hypothermia <ul><li>Cold water immersion </li></ul><ul><li>Cold air exposure </li></ul><ul><li>Cold environment </li></ul>(Continued)
  11. 11. <ul><li>Very old age </li></ul>Predisposing Factors <ul><li>Failing body systems </li></ul><ul><li>Chronic illness </li></ul><ul><li>Lack of exercise </li></ul><ul><li>Certain medications </li></ul>Generalized Hypothermia (Continued)
  12. 12. <ul><li>Very young age </li></ul>Predisposing Factors <ul><li>Large skin surface area/less fat </li></ul><ul><li>Little or no shivering </li></ul><ul><li>Inability to put on or take off clothing </li></ul>Generalized Hypothermia (Continued)
  13. 13. Predisposing Factors Generalized Hypothermia <ul><li>Shock (hypoperfusion) </li></ul><ul><li>Head/spinal cord injury </li></ul><ul><li>Burns </li></ul><ul><li>Generalized infection </li></ul><ul><li>Diabetes and hypoglycemia </li></ul><ul><li>Drugs and poisons </li></ul><ul><li>Medical conditions </li></ul>
  14. 14. Patient ASSESSMENT Generalized Hypothermia Signs and Symptoms <ul><li>Obvious or subtle exposure </li></ul><ul><li>Cool or cold skin temperature </li></ul><ul><li>Decreasing mental status/ </li></ul>(Continued) motor function
  15. 15. Patient ASSESSMENT Generalized Hypothermia Signs and Symptoms <ul><li>Stiff or rigid muscles/posture </li></ul><ul><li>Shivering in mild cases (lack of, in more </li></ul>severe cases) <ul><li>Slow pupil reaction </li></ul>(Continued)
  16. 16. Patient ASSESSMENT Generalized Hypothermia Signs and Symptoms <ul><li>Breathing variations </li></ul><ul><li>Rapid (early) </li></ul><ul><li>Shallow, slow, absent (late) </li></ul><ul><li>Blood pressure (low to absent) </li></ul><ul><li>Poor judgment </li></ul>(Continued)
  17. 17. Patient ASSESSMENT Generalized Hypothermia Signs and Symptoms <ul><li>Pulse changes </li></ul><ul><li>Rapid (early) </li></ul><ul><li>Slow, weak, irregular, absent (late) </li></ul><ul><li>Muscle and joint stiffness </li></ul>(Continued)
  18. 18. Patient ASSESSMENT Generalized Hypothermia Signs and Symptoms <ul><li>Skin </li></ul><ul><li>Red (early) </li></ul><ul><li>Pale </li></ul><ul><li>Cyanotic </li></ul><ul><li>Stiff/hard (late) </li></ul>
  19. 19. Patient CARE Generalized Hypothermia Emergency Care Steps <ul><li>Remove patient from environment </li></ul>and prevent further heat loss. <ul><li>Remove wet clothing and cover </li></ul>with blanket. <ul><li>Handle patient gently. </li></ul>(Continued)
  20. 20. Patient CARE Generalized Hypothermia Emergency Care Steps <ul><li>Do not allow patient to walk or </li></ul>exert self. <ul><li>Give high-concentration oxygen </li></ul>(warmed and humidified). <ul><li>If apneic, check pulse 30 – 45 seconds </li></ul>before starting CPR. (Continued)
  21. 21. Patient CARE Generalized Hypothermia Emergency Care Steps <ul><li>Do not allow patient to eat or </li></ul>drink stimulants. <ul><li>Do not massage extremities. </li></ul>(Continued)
  22. 22. Patient CARE Generalized Hypothermia Emergency Care Steps <ul><li>If patient responds appropriately, </li></ul>rewarm actively: <ul><li>Apply blankets. </li></ul><ul><li>Apply heat to groin, armpits, neck. </li></ul><ul><li>Increase heat in ambulance. </li></ul>(Continued)
  23. 23. Patient CARE Generalized Hypothermia Emergency Care Steps <ul><li>If patient is unresponsive or responds </li></ul>inappropriately, rewarm passively: <ul><li>Apply blankets. </li></ul><ul><li>Increase heat in ambulance. </li></ul>
  24. 24. <ul><li>Predisposing factors </li></ul><ul><li>Usually occur in extremities </li></ul>and exposed ears, nose, face Local Cold Injuries
  25. 25. Clear boundary separates injured/uninjured areas.
  26. 26. Patient ASSESSMENT Superficial (Early) Local Cold Injury Signs and Symptoms <ul><li>Blanching of skin. </li></ul><ul><li>Loss of feeling in affected area. </li></ul><ul><li>Skin remains soft. </li></ul><ul><li>When rewarmed, area tingles. </li></ul>
  27. 27. Patient CARE Superficial (Early) Local Cold Injury Emergency Care Steps <ul><li>Remove patient from environment. </li></ul><ul><li>Protect area from further injury. </li></ul><ul><li>Administer high-concentration </li></ul><ul><li>Remove wet or restrictive clothing. </li></ul>oxygen. (Continued)
  28. 28. Patient CARE Superficial (Early) Local Cold Injury Emergency Care Steps <ul><li>Splint and cover extremity. </li></ul><ul><li>Do not rub or massage. </li></ul><ul><li>Do not reexpose to cold. </li></ul>
  29. 29. Patient ASSESSMENT Deep (Late) Local Cold Injury Signs and Symptoms <ul><li>White, waxy skin </li></ul><ul><li>Firm or frozen when palpated </li></ul><ul><li>Swelling and blisters (especially when </li></ul><ul><li>thawed) </li></ul><ul><li>Flushed, red, mottled, or cyanotic skin </li></ul>(when thawed)
  30. 30. Local Cold Injury
  31. 31. Patient CARE Deep (Late) Local Cold Injury Emergency Care Steps <ul><li>Remove patient from environment. </li></ul><ul><li>Protect area from further injury. </li></ul><ul><li>Administer high-concentration </li></ul><ul><li>Remove wet or restrictive clothing. </li></ul>oxygen. (Continued)
  32. 32. Patient CARE Deep (Late) Local Cold Injury Emergency Care Steps <ul><li>Remove jewelry. </li></ul><ul><li>Cover with dry dressings or clothing. </li></ul>(Continued)
  33. 33. Patient CARE Deep (Late) Local Cold Injury Emergency Care Steps <ul><li>Do not : </li></ul><ul><li>Break blisters </li></ul><ul><li>Rub or massage area </li></ul><ul><li>Apply heat or rewarm </li></ul><ul><li>Allow patient to walk on </li></ul>affected extremity (Continued)
  34. 34. Patient CARE Deep (Late) Local Cold Injury Emergency Care Steps <ul><li>If transport is delayed or extremely </li></ul>long, rewarm actively and rapidly (e.g., wilderness situation) .
  35. 35. Immerse affected part in warm-water bath.
  36. 36. Patient CARE Deep (Late) Local Cold Injury Emergency Care Steps <ul><li>Continuously stir water/monitor </li></ul><ul><li>Add warm water to maintain </li></ul>temperature. temperature. <ul><li>Continue until area is soft, and color </li></ul>and sensation return. (Continued)
  37. 37. Patient CARE Deep (Late) Local Cold Injury Emergency Care Steps <ul><li>Dress area with dry, sterile dressings. </li></ul><ul><li>Protect against refreezing. </li></ul><ul><li>Expect complaint of severe pain. </li></ul>
  38. 38. 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
  39. 39. E XPOSURE TO HEAT
  40. 40. Predisposing Factors <ul><li>Climate </li></ul><ul><li>High temperature </li></ul><ul><li>High humidity </li></ul><ul><li>Exercise and activity </li></ul>Heat Exposure (Continued)
  41. 41. <ul><li>Age: Elderly </li></ul>Predisposing Factors <ul><li>Poor thermoregulation </li></ul><ul><li>Medications </li></ul><ul><li>Limited ability to escape heat </li></ul>Heat Exposure (Continued)
  42. 42. Predisposing Factors <ul><li>Poor thermoregulation </li></ul><ul><li>Can’t remove own clothing </li></ul>Heat Exposure (Continued) <ul><li>Age: Newborns/Infants </li></ul>
  43. 43. <ul><li>Preexisting illness </li></ul><ul><li>Heart disease </li></ul><ul><li>Dehydration </li></ul><ul><li>Obesity </li></ul><ul><li>Infections/fever </li></ul><ul><li>Fatigue </li></ul><ul><li>Diabetes </li></ul><ul><li>Drugs/medications </li></ul>Predisposing Factors Heat Exposure
  44. 44. Patient ASSESSMENT Heat Exposure Signs and Symptoms <ul><li>Muscle cramps </li></ul><ul><li>Weakness </li></ul><ul><li>Exhaustion </li></ul><ul><li>Dizziness, faintness </li></ul><ul><li>Rapid heart rate </li></ul>(Continued)
  45. 45. Patient ASSESSMENT Heat Exposure Signs and Symptoms <ul><li>Altered mental status (may be unresponsive) </li></ul><ul><li>Skin </li></ul>EMERGENCY <ul><li>Moist and pale, temperature normal to cool </li></ul><ul><li>Dry or moist, temperature hot </li></ul>
  46. 46. Patient CARE Heat Exposure Patient with Normal to Cool Skin Emergency Care Steps <ul><li>Remove from hot environment. </li></ul><ul><li>Administer high-concentration oxygen. </li></ul><ul><li>Loosen or remove clothing. </li></ul>(Continued)
  47. 47. Patient CARE Heat Exposure Patient with Normal to Cool Skin Emergency Care Steps <ul><li>Cool by fanning. </li></ul><ul><li>Put in supine position; elevate legs. </li></ul><ul><li>Patient is responsive/not nauseated </li></ul><ul><li>Give water. </li></ul><ul><li>Patient is unresponsive/vomiting </li></ul><ul><li>Transport/no water. </li></ul>
  48. 48. Patient CARE Heat Exposure Patient with Hot Skin Emergency Care Steps <ul><li>Remove from hot environment. </li></ul><ul><li>Remove clothing. </li></ul><ul><li>Administer high-concentration </li></ul>(Continued) oxygen.
  49. 49. Patient CARE Heat Exposure Patient with Hot Skin Emergency Care Steps <ul><li>Apply cool packs to neck, groin, </li></ul><ul><li>Keep skin wet. </li></ul><ul><li>Fan aggressively. </li></ul><ul><li>Transport immediately. </li></ul>armpits.
  50. 50. W ATER EMERGENCIES
  51. 51. Drowning Death associated with immersion in water K EY TERM
  52. 52. <ul><li>Reach </li></ul><ul><li>Throw and tow </li></ul><ul><li>Row </li></ul><ul><li>Go </li></ul>Order of Water Rescue Procedures
  53. 53. Near-Drowning <ul><li>Primary concern is everyone’s safety. </li></ul><ul><li>Treat for spine injury: </li></ul><ul><li>If diving injury cannot be ruled out. </li></ul><ul><li>Attempt resuscitation of </li></ul>submerged cardiac arrest patient unless medical direction rules out. (Patient Submerged But Survives)
  54. 54. Patient CARE Near-Drowning (submersion) Emergency Care Steps <ul><li>If patient is responsive and spine </li></ul><ul><li>Immobilize head manually. </li></ul><ul><li>Use backboard to remove </li></ul>injury is not ruled out: from water.
  55. 55. Patient is found face down in shallow water. Extend patient’s arms straight up.
  56. 56. Rotate torso toward you as you lower yourself into the water.
  57. 57. Maintain stabilization by holding the patient’s head between his arms.
  58. 58. Patient CARE Near-Drowning (submersion) Emergency Care Steps <ul><li>If no suspected spine injury: </li></ul><ul><li>Position unresponsive patient on </li></ul>left side. <ul><li>Suction as needed. </li></ul><ul><li>Administer high-concentration </li></ul>oxygen. (Continued)
  59. 59. Patient CARE Near-Drowning (submersion) Emergency Care Steps <ul><li>If gastric distention prevents </li></ul><ul><li>Turn patient onto left side. </li></ul><ul><li>With suction ready, apply firm pressure </li></ul>adequate ventilation: over epigastric area.
  60. 60. B ITES AND STINGS
  61. 61. Patient ASSESSMENT Bites and Stings Signs and Symptoms <ul><li>History of spider/snake bite; insect, </li></ul>scorpion, marine animal sting <ul><li>Pain, redness, swelling </li></ul>(Continued)
  62. 62. Patient ASSESSMENT Bites and Stings Signs and Symptoms <ul><li>Dizziness and chills </li></ul><ul><li>Fever </li></ul><ul><li>Nausea and vomiting </li></ul><ul><li>Bite marks or stinger </li></ul>
  63. 63. Patient CARE Bites and Stings Emergency Care Steps <ul><li>If stinger is present </li></ul><ul><li>Scrape with blunt edge to remove. </li></ul><ul><li>Avoid tweezers. May squeeze more </li></ul>venom into wound. (Continued)
  64. 64. Patient CARE Bites and Stings Emergency Care Steps <ul><li>Wash area gently. </li></ul><ul><li>Remove jewelry distal to affected </li></ul><ul><li>Position injection site slightly </li></ul>below heart. <ul><li>Observe for allergic reaction. </li></ul>area. (Continued)
  65. 65. Patient CARE Bites and Stings Emergency Care Steps <ul><li>Snakebites </li></ul><ul><li>Consult medical direction about constricting band. </li></ul><ul><li>Do not apply cold. </li></ul>
  66. 66. 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
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