22)Environmental Emergencies
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22)Environmental Emergencies

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22)Environmental Emergencies 22)Environmental Emergencies Presentation Transcript

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