Environmental Emergencies
Environmental Emergencies <ul><li>Body Temperature </li></ul><ul><ul><li>96.4-99.8 degrees F </li></ul></ul><ul><li>Heat R...
Heat Production <ul><li>Metabolism </li></ul><ul><ul><li>ALL metabolic processes in body produce heat </li></ul></ul><ul><...
Heat Loss/Gain <ul><li>Radiation </li></ul><ul><li>Conduction </li></ul><ul><li>Convection </li></ul><ul><li>Evaporation <...
Radiation  <ul><li>Radiation </li></ul><ul><ul><li>Transfer of heat via infrared rays. </li></ul></ul><ul><ul><li>Heat ray...
Conduction  <ul><li>Conduction </li></ul><ul><ul><li>Transfer of heat to objects including air that are in direct contact ...
Convection  <ul><li>Convection </li></ul><ul><ul><li>Transfer of heat through movement of currents. </li></ul></ul><ul><ul...
Evaporation  <ul><li>Evaporation </li></ul><ul><ul><li>Loss of heat when moisture vaporizes on the body surface. </li></ul...
Breathing  <ul><li>Breathing </li></ul><ul><ul><li>Inhaled air is heated/cooled by body temp </li></ul></ul><ul><ul><li>Bo...
Mechanisms of Regulation  <ul><li>Brain </li></ul><ul><ul><li>Hypothalamus </li></ul></ul><ul><ul><ul><li>Body thermostat ...
Cardiovascular System  <ul><li>Cardiovascular </li></ul><ul><ul><li>Brings heated blood from core to extremities </li></ul...
 
Skin <ul><li>Skin </li></ul><ul><ul><li>Heat regulation </li></ul></ul><ul><ul><li>Insulation </li></ul></ul><ul><ul><li>V...
Questions to ask <ul><li>Source </li></ul><ul><li>Environment </li></ul><ul><li>Loss of consciousness </li></ul><ul><li>Ef...
Cold Emergencies: Predisposing Factors  <ul><li>Cold Environment </li></ul><ul><ul><li>Immersion </li></ul></ul><ul><ul><l...
Predisposing factor: Idiocy…..
Hypothermia <ul><li>Hypothermia </li></ul><ul><ul><li>Body core temp falls below 95 degrees F </li></ul></ul><ul><li>Envir...
Cold Emergencies S/S <ul><ul><li>Poor coordination </li></ul></ul><ul><ul><li>Memory disturbances </li></ul></ul><ul><ul><...
Assessment/Treatment <ul><li>Assessment: </li></ul><ul><ul><li>Place hand against pt abdomen </li></ul></ul><ul><ul><li>Co...
Active Vs. Passive Rewarming  <ul><li>Active rewarming </li></ul><ul><ul><li>Warm blankets </li></ul></ul><ul><ul><li>Heat...
Localized  Injuries <ul><li>Localized to one area of the body </li></ul><ul><li>Tend to happen in extremities and exposed ...
 
 
Localized  Injuries: Care <ul><li>Remove pt from the environment </li></ul><ul><li>Protect injured extremity from further ...
Prolonged/Delayed Transport <ul><li>Active Rapid Rewarming </li></ul><ul><ul><li>Immerse affected part in warm water bath ...
Changing Directions…
Heat Emergencies: Predisposing Factors <ul><li>Climate </li></ul><ul><ul><li>High ambient temp = Less evaporation </li></u...
Heat Emergencies S/S <ul><li>Muscular Cramps </li></ul><ul><li>Weakness </li></ul><ul><li>Exhaustion </li></ul><ul><li>Diz...
Treatment: Heat Exhaustion  <ul><li>Moist, pale, normal to cool skin </li></ul><ul><ul><li>Remove pt from hot environment ...
Treatment: Heat Stoke  <ul><li>Hot, dry or moist skin </li></ul><ul><ul><li>Remove pt from hot environment and place in co...
 
Water Related Emergencies <ul><li>Near drowning/drowning </li></ul><ul><ul><li>Ensure safety of crew </li></ul></ul><ul><u...
 
 
Bites and Stings
Bites and Stings: S/S <ul><li>Hx of bite (spider, snake) or sting (insect, scorpion, marine animal) </li></ul><ul><li>Pain...
Bites and Stings Treatment <ul><li>If stinger present remove it </li></ul><ul><ul><li>Scraping motion </li></ul></ul><ul><...
Remember… Scene Safe! Its already injured the patient. So…
 
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22)Environmental Emergencies

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22)Environmental Emergencies

  1. 1. Environmental Emergencies
  2. 2. Environmental Emergencies <ul><li>Body Temperature </li></ul><ul><ul><li>96.4-99.8 degrees F </li></ul></ul><ul><li>Heat Regulation </li></ul><ul><ul><li>Based on heat lost v heat gained </li></ul></ul><ul><ul><li>Variation throughout body core and periphery </li></ul></ul><ul><ul><li>Cardiovascular System </li></ul></ul><ul><ul><ul><li>Transports heat through body </li></ul></ul></ul><ul><ul><li>Skin </li></ul></ul><ul><ul><ul><li>Allow heat to be lost/gained to/from environment </li></ul></ul></ul><ul><ul><li>Hypothalamus </li></ul></ul><ul><ul><ul><li>Temperature control center of the brain </li></ul></ul></ul>
  3. 3. Heat Production <ul><li>Metabolism </li></ul><ul><ul><li>ALL metabolic processes in body produce heat </li></ul></ul><ul><ul><li>Basal metabolism </li></ul></ul><ul><ul><ul><li>Metabolic activity to maintain cell function at rest </li></ul></ul></ul><ul><ul><li>Generally more than enough heat to maintain core temp </li></ul></ul>
  4. 4. Heat Loss/Gain <ul><li>Radiation </li></ul><ul><li>Conduction </li></ul><ul><li>Convection </li></ul><ul><li>Evaporation </li></ul><ul><li>Breathing </li></ul>
  5. 5. Radiation <ul><li>Radiation </li></ul><ul><ul><li>Transfer of heat via infrared rays. </li></ul></ul><ul><ul><li>Heat rays are radiated by the body and other objects in the environment. </li></ul></ul><ul><ul><li>If body temp is greater than the surroundings heat is lost. </li></ul></ul><ul><ul><li>We radiate 550 watts (5 light bulbs) </li></ul></ul>
  6. 6. Conduction <ul><li>Conduction </li></ul><ul><ul><li>Transfer of heat to objects including air that are in direct contact with body. </li></ul></ul>
  7. 7. Convection <ul><li>Convection </li></ul><ul><ul><li>Transfer of heat through movement of currents. </li></ul></ul><ul><ul><ul><li>i.e. Wind chill factor </li></ul></ul></ul>
  8. 8. Evaporation <ul><li>Evaporation </li></ul><ul><ul><li>Loss of heat when moisture vaporizes on the body surface. </li></ul></ul><ul><ul><li>Depends on temp/air movement/humidity </li></ul></ul><ul><ul><ul><li>Wind currents move saturated air away from body </li></ul></ul></ul><ul><ul><ul><li>Drier air replaces it and takes up moisture </li></ul></ul></ul><ul><ul><li>Closer to 100% humidity = Less evaporation </li></ul></ul>
  9. 9. Breathing <ul><li>Breathing </li></ul><ul><ul><li>Inhaled air is heated/cooled by body temp </li></ul></ul><ul><ul><li>Body looses heat when air is cooler than the body </li></ul></ul><ul><ul><li>Body gains heat when air is warmer that the body </li></ul></ul>
  10. 10. Mechanisms of Regulation <ul><li>Brain </li></ul><ul><ul><li>Hypothalamus </li></ul></ul><ul><ul><ul><li>Body thermostat </li></ul></ul></ul><ul><ul><li>Metabolic Rate </li></ul></ul><ul><ul><ul><li>Heat production </li></ul></ul></ul><ul><ul><li>Cardio </li></ul></ul><ul><ul><ul><li>Heat distribution </li></ul></ul></ul><ul><ul><li>Skin </li></ul></ul><ul><ul><ul><li>Heat loss </li></ul></ul></ul><ul><ul><li>Vasodilation </li></ul></ul><ul><ul><ul><li>Loss by conduction/convection/radiation/sweating </li></ul></ul></ul><ul><ul><li>Vasoconstricion </li></ul></ul><ul><ul><ul><li>Inhibits sweating, increased metabolic rate </li></ul></ul></ul>
  11. 11. Cardiovascular System <ul><li>Cardiovascular </li></ul><ul><ul><li>Brings heated blood from core to extremities </li></ul></ul><ul><ul><li>5 % of cardiac output is in skin </li></ul></ul><ul><ul><ul><ul><li>250-300 ml/min </li></ul></ul></ul></ul><ul><ul><ul><li>Vasodilation </li></ul></ul></ul><ul><ul><ul><ul><li>More blood contact with skin </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Conduction, convection, radiation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Can increase to 3000 ml/min!!!! </li></ul></ul></ul></ul><ul><ul><ul><li>Vasoconstriction </li></ul></ul></ul><ul><ul><ul><ul><li>Heat conservation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Can decrease to 30 ml/min!!!! </li></ul></ul></ul></ul>
  12. 13. Skin <ul><li>Skin </li></ul><ul><ul><li>Heat regulation </li></ul></ul><ul><ul><li>Insulation </li></ul></ul><ul><ul><li>Vasoconstriction </li></ul></ul><ul><ul><li>Vasodilation </li></ul></ul><ul><ul><li>Evaporation form sweat </li></ul></ul>
  13. 14. Questions to ask <ul><li>Source </li></ul><ul><li>Environment </li></ul><ul><li>Loss of consciousness </li></ul><ul><li>Effects </li></ul><ul><li>How long exposed </li></ul>
  14. 15. Cold Emergencies: Predisposing Factors <ul><li>Cold Environment </li></ul><ul><ul><li>Immersion </li></ul></ul><ul><ul><li>Non Immersion </li></ul></ul><ul><li>Age </li></ul><ul><ul><li>Very old </li></ul></ul><ul><ul><li>Very young </li></ul></ul><ul><ul><ul><li>Small with LARGE surface area </li></ul></ul></ul><ul><ul><ul><li>Small muscle mass – Poor in children and not existent in infants </li></ul></ul></ul><ul><ul><ul><li>Less body fat </li></ul></ul></ul><ul><ul><ul><li>Younger children need help to protect against environment </li></ul></ul></ul><ul><li>Medical Conditions </li></ul><ul><ul><li>Shock </li></ul></ul><ul><ul><li>Head injuries, Injuries to spinal cord </li></ul></ul><ul><ul><li>Burns </li></ul></ul><ul><ul><li>Generalized infection </li></ul></ul><ul><ul><li>Diabetes and hypoglycemia </li></ul></ul><ul><ul><li>Drugs/poisons </li></ul></ul>
  15. 16. Predisposing factor: Idiocy…..
  16. 17. Hypothermia <ul><li>Hypothermia </li></ul><ul><ul><li>Body core temp falls below 95 degrees F </li></ul></ul><ul><li>Environmental conditions </li></ul><ul><ul><li>Ethanol ingestion </li></ul></ul><ul><ul><li>Underlying illness </li></ul></ul><ul><ul><li>Overdose/poisoning </li></ul></ul><ul><ul><li>Major trauma </li></ul></ul><ul><ul><li>Outdoor resuscitation </li></ul></ul><ul><ul><li>Ambient temperature decrease ( i.e. home of elderly pt) </li></ul></ul>
  17. 18. Cold Emergencies S/S <ul><ul><li>Poor coordination </li></ul></ul><ul><ul><li>Memory disturbances </li></ul></ul><ul><ul><li>Reduce/loss of sensation </li></ul></ul><ul><ul><li>Mood changes </li></ul></ul><ul><ul><li>Less communicative </li></ul></ul><ul><ul><li>Dizziness </li></ul></ul><ul><ul><li>Speech difficulty </li></ul></ul><ul><ul><li>Stiff/rigid posture </li></ul></ul><ul><ul><li>Muscular rigidity </li></ul></ul><ul><ul><li>Shivering/absence of shivering </li></ul></ul><ul><ul><li>Breathing changes </li></ul></ul><ul><ul><ul><li>Early -Rapid </li></ul></ul></ul><ul><ul><ul><li>Late – Shallow, slow, or absent </li></ul></ul></ul><ul><ul><li>Pulse changes </li></ul></ul><ul><ul><ul><li>Early- Rapid </li></ul></ul></ul><ul><ul><ul><li>Late – Slow and barely palpable , irregular, absent </li></ul></ul></ul><ul><ul><li>Skin Changes </li></ul></ul><ul><ul><ul><li>Red – early </li></ul></ul></ul><ul><ul><ul><li>Pale </li></ul></ul></ul><ul><ul><ul><li>Cyanotic </li></ul></ul></ul><ul><ul><ul><li>Stiff/hard </li></ul></ul></ul><ul><ul><li>Slowly responding pupils </li></ul></ul><ul><ul><li>Low to absent BP </li></ul></ul><ul><ul><li>Joint/muscle stiffness </li></ul></ul><ul><ul><li>Poor judgment </li></ul></ul>
  18. 19. Assessment/Treatment <ul><li>Assessment: </li></ul><ul><ul><li>Place hand against pt abdomen </li></ul></ul><ul><ul><li>Cool abdomen = Generalized hypothermia </li></ul></ul><ul><ul><li>Assess pulse 30-45 seconds before CPR </li></ul></ul><ul><li>Treatment: </li></ul><ul><ul><li>Remove pt from environment </li></ul></ul><ul><ul><li>Remove wet clothing </li></ul></ul><ul><ul><li>Cover with blankets </li></ul></ul><ul><ul><li>Handle pt EXTREMELY carefully </li></ul></ul><ul><ul><li>Do not allow pt to walk/exert self </li></ul></ul><ul><ul><li>Admin O2 (warmed/humidified if able) </li></ul></ul><ul><ul><li>Do not let pt ingest stimulants </li></ul></ul><ul><ul><li>Do not massage extremity </li></ul></ul><ul><li>If pt responsive : Active rewarming </li></ul><ul><li>If pt unresponsive : Passive rewarming </li></ul><ul><ul><li>AFTERDROP… </li></ul></ul>
  19. 20. Active Vs. Passive Rewarming <ul><li>Active rewarming </li></ul><ul><ul><li>Warm blankets </li></ul></ul><ul><ul><li>Heat packs /warm water bottles </li></ul></ul><ul><ul><ul><li>Groin </li></ul></ul></ul><ul><ul><ul><li>Neck </li></ul></ul></ul><ul><ul><ul><li>Under arms </li></ul></ul></ul><ul><ul><li>Turn heat on in pt compartment </li></ul></ul><ul><li>Passive rewarming </li></ul><ul><ul><li>Warm blankets Turn heat on in pt compartment </li></ul></ul>
  20. 21. Localized Injuries <ul><li>Localized to one area of the body </li></ul><ul><li>Tend to happen in extremities and exposed ears/nose/face </li></ul><ul><li>Early/Superficial Injury </li></ul><ul><ul><li>Blanching of the skin </li></ul></ul><ul><ul><li>Loss of feeling/sensation in area </li></ul></ul><ul><ul><li>Skin remains soft </li></ul></ul><ul><ul><li>If rewarmed – tingling sensation </li></ul></ul><ul><li>Late/Deep Injury </li></ul><ul><ul><li>White, waxy skin </li></ul></ul><ul><ul><li>Firm to frozen feeling on palpation </li></ul></ul><ul><ul><li>Swelling </li></ul></ul><ul><ul><li>Blisters </li></ul></ul><ul><ul><li>If thawed – Flushed with area of purple and blanching or mottled and cyanotic </li></ul></ul>
  21. 24. Localized Injuries: Care <ul><li>Remove pt from the environment </li></ul><ul><li>Protect injured extremity from further injury </li></ul><ul><li>Administer O2 </li></ul><ul><li>Remove wet/constrictive clothing </li></ul><ul><li>If early/superficial </li></ul><ul><ul><li>Splint extremity </li></ul></ul><ul><ul><li>Cover extremity </li></ul></ul><ul><ul><li>Do not massage </li></ul></ul><ul><ul><li>Do not re expose to cold </li></ul></ul><ul><li>If late/deep </li></ul><ul><ul><li>Remove jewelry </li></ul></ul><ul><ul><li>Cover with dry clothing/dressings </li></ul></ul><ul><ul><li>DO NOT: </li></ul></ul><ul><ul><ul><li>Break blisters – Rub/massage area – Apply heat – Rewarm – Allow pt to walk on affected extremity </li></ul></ul></ul>
  22. 25. Prolonged/Delayed Transport <ul><li>Active Rapid Rewarming </li></ul><ul><ul><li>Immerse affected part in warm water bath </li></ul></ul><ul><ul><li>Monitor water so that it doesnt cool from frozen part </li></ul></ul><ul><ul><li>Continuously stir water </li></ul></ul><ul><ul><li>Continue until the part is soft and sensation returns </li></ul></ul><ul><ul><li>Dress the area with dry sterile dressings </li></ul></ul><ul><ul><li>Protect against refreezing </li></ul></ul><ul><ul><li>Expect pt to c/o SEVERE pain </li></ul></ul>
  23. 26. Changing Directions…
  24. 27. Heat Emergencies: Predisposing Factors <ul><li>Climate </li></ul><ul><ul><li>High ambient temp = Less evaporation </li></ul></ul><ul><ul><li>High relative humidity = Less evaporation </li></ul></ul><ul><li>Exercise and activity </li></ul><ul><ul><li>Can lose 1+ Liter of sweat per hour </li></ul></ul><ul><ul><li>Loss of electrolytes (Na, Cl, H2O) </li></ul></ul><ul><li>Age </li></ul><ul><ul><li>Elderly </li></ul></ul><ul><ul><ul><li>Poor thermoregulation </li></ul></ul></ul><ul><ul><ul><li>Medications </li></ul></ul></ul><ul><ul><ul><li>Lack mobility- cannot escape environment </li></ul></ul></ul><ul><ul><li>Newborns </li></ul></ul><ul><ul><ul><li>Poor thermoregulation </li></ul></ul></ul><ul><ul><ul><li>Cannot remove own clothing </li></ul></ul></ul><ul><li>Pre existing illness </li></ul><ul><ul><li>Heart disease </li></ul></ul><ul><ul><li>Dehydrations </li></ul></ul><ul><ul><li>Obesity </li></ul></ul><ul><ul><li>Fever </li></ul></ul><ul><ul><li>Fatigue </li></ul></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><li>Drugs/medications </li></ul></ul>
  25. 28. Heat Emergencies S/S <ul><li>Muscular Cramps </li></ul><ul><li>Weakness </li></ul><ul><li>Exhaustion </li></ul><ul><li>Dizziness/faintness </li></ul><ul><li>Skin </li></ul><ul><ul><li>Moist, pale, normal to cool temp </li></ul></ul><ul><ul><ul><li>Heat Exhaustion </li></ul></ul></ul><ul><ul><li>Hot, dry or moist – Dire emergency </li></ul></ul><ul><ul><ul><li>Heat Stoke </li></ul></ul></ul><ul><li>Rapid Heart Rate </li></ul><ul><li>AMS </li></ul><ul><li>Unresponsive </li></ul>
  26. 29. Treatment: Heat Exhaustion <ul><li>Moist, pale, normal to cool skin </li></ul><ul><ul><li>Remove pt from hot environment and place in cool one </li></ul></ul><ul><ul><li>Administer O2 </li></ul></ul><ul><ul><li>Loosen or remove clothing </li></ul></ul><ul><ul><li>Cool pt by fanning </li></ul></ul><ul><ul><li>Put in shock position </li></ul></ul><ul><ul><li>If pt responsive and not nauseated have them drink water </li></ul></ul><ul><ul><li>If pt is unresponsive or vomiting transport pt left lateral recumbent </li></ul></ul>
  27. 30. Treatment: Heat Stoke <ul><li>Hot, dry or moist skin </li></ul><ul><ul><li>Remove pt from hot environment and place in cool one </li></ul></ul><ul><ul><li>Administer O2 </li></ul></ul><ul><ul><li>Remove clothing </li></ul></ul><ul><ul><li>Apply cold packs to neck, groin, armpits </li></ul></ul><ul><ul><li>Keep skin wet by applying water by sponge/wet towels </li></ul></ul><ul><ul><li>Fan aggressively </li></ul></ul><ul><ul><li>Transport IMMEDIATELY </li></ul></ul>
  28. 32. Water Related Emergencies <ul><li>Near drowning/drowning </li></ul><ul><ul><li>Ensure safety of crew </li></ul></ul><ul><ul><li>Suspect spinal injury if diving injury </li></ul></ul><ul><ul><li>Consider length of time in cold water </li></ul></ul><ul><ul><ul><li>Any pulseless non breathing pt submerged in cold water should be resuscitated </li></ul></ul></ul><ul><ul><li>C-Spine control and removal via LBB if pt responsive and spinal injury suspected </li></ul></ul><ul><ul><li>If injury not suspected, place pt on L lateral recumbent </li></ul></ul><ul><ul><li>Suction as needed </li></ul></ul><ul><ul><li>Administer O2 </li></ul></ul><ul><ul><li>If gastric distention interferes with ventilation: </li></ul></ul><ul><ul><ul><li>Roll pt to L side </li></ul></ul></ul><ul><ul><ul><li>Have suction ready </li></ul></ul></ul><ul><ul><ul><li>Apply firm pressure on abdomen (epigastric are) and decompress </li></ul></ul></ul><ul><ul><ul><li>SUCTION </li></ul></ul></ul>
  29. 35. Bites and Stings
  30. 36. Bites and Stings: S/S <ul><li>Hx of bite (spider, snake) or sting (insect, scorpion, marine animal) </li></ul><ul><li>Pain </li></ul><ul><li>Redness </li></ul><ul><li>Swelling </li></ul><ul><li>Weakness </li></ul><ul><li>Dizziness </li></ul><ul><li>Chills </li></ul><ul><li>Fever </li></ul><ul><li>Nausea </li></ul><ul><li>Vomiting </li></ul><ul><li>Bite marks </li></ul><ul><li>Stinger </li></ul>
  31. 37. Bites and Stings Treatment <ul><li>If stinger present remove it </li></ul><ul><ul><li>Scraping motion </li></ul></ul><ul><li>Wash area gently </li></ul><ul><li>Remove jewelry from area before swelling occurs </li></ul><ul><li>Place injection site slightly below pt heart </li></ul><ul><li>Do not apply cold to snakebites </li></ul><ul><li>Consult medical direction for constricting band for snake bite </li></ul><ul><li>Observe and treat for S/S of allergic reaction </li></ul>
  32. 38. Remember… Scene Safe! Its already injured the patient. So…
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