1. Med-Surg
Environmental Emergencies

2. Heat Related Illnesses
 Heat exhaustion
 Heat stroke

3. Heat Related Prevention& (HRI) RN Focus
 Older Adult
 Avoid alcohol & caffeine
 Don’t stay in sun too much
 Use sunscreen SPF @ least 30 w/UVA & UVB protection
 Rest frequently
 Take breaks
 Limit activity @ most hottest times
 Wear light wt. Light colored & loose fitting clothes
 Know your physical limitations, modify activity
 Take cool baths or showers
 Stay in air conditioned environments
 Check on older adult @ least 2/daily during heat waves

4. Heat Exhaustion
 Syndrome
 From dehydration due to heavy
perspiration, inadequate fluid &
electrolyte intake during heat exposure
 From hours – days exposure
 Clinical manifestation resemble the flu
 Can lead to heat stroke

5. Heat Exhaustion
 Headache
 Weakness
 Nausea
 Body temp. not necessarily elevated
 May continue to perspire despite
dehydration
 Vomiting

6. Heat exhaustion
 Assessment
 Flu like symptom
 Orthostatic hypotension
 Tachycardia
 Confusion

7. Heat Exhaustion
 Ask 2 immediately stop physical activity
 Move to cool place
 Remove restrictive clothing
 Use cooling measures (cold packs on neck, abd.,
groin)
 Soak in cool water
 Fanning
 Spray w/H20
 Oral rehydration—sports drink
 Don’t give salt tab (cause irritation, N/V)
 Call 911 if symptom persists

8. Heat Exhaustion
 Clinical Setting
 Monitor VS
 Rehydrate IV 0.9% saline if N/V persist
 Draw blood (electrolyte analysis)
 Admission is for severe dehydration & those
worsened by HRI

9. Heat Stroke
 Medical emergency
 Body temp. exceed F (40 C)
 High mortality
 Heat regulation fails
 Organ dysfunction & death can result

10. Heat Stoke
 2 major types:
 Exertional
 sudden onset
 result of strenuous physical activity (hot, humid
condition)
 Not being used to hot weather
 Wearing clothing too heavy 4 environment
 Classic
 Non-exertional
 Occur over a period of time
 Chronic exposure hot humid environment

11. Heat Stroke
 Temp. 104 F
 CNS effects: acute confusion, anxiety, loss of
coordination, hallucination, agitation, seizures,
coma
 Hypotension
 Tachycardia
 Tachypnea
 Electrolyte imb. (Na, K+)
 Oliguria
 Coagulopathy
 Pulmonary edema (crackles)

12. Heat Stroke
 Assessment
 Skin hot dry w/diaphoresis
 CNS effects d/t thermal brain injury
 Cardiac troponin I (cTnl) elevated
>1.5ng/ml = severe myocardial damage

13. Heat Stroke
 Complications
 MODS
 Renal impairment
 Coagulopathy
 Electrolyte imb.
 Acid-base imb.
 PE
 Cerebral edema

14. Heat Stroke
 NPO d/t vomit & aspiration risks
 ABC
 O2
 IV 0.9% saline
 Rapid cooling until rectal temp. of 100 F
 Remove clothing
 cooling
 Ice packs (neck, axillae, chest, groin)
 Cold water immersion
 Wetting w/tepid H20 then fanning rapidly (cooling by evaporation)
 Drenching w/large amt. of icy water
 Clinical Setting: Cooling blanket
 Rectal probe then Q15 min
 Foley catheter
 Monitor VS
 Baseline lab (serum electrolyte, cardiac & liver enzymes, CBC
 ABG
 Give muscle relaxant (Benzodiazepine—Valium or Thorazine, an alternative) if shivering
 Measure UOP & spec. grav.
 Slow cooling wn./temp. lowers 2 102 F; stop wn. rectal temp. 100 F
 Obtain urinalysis & monitor UOP
 Core Temp: Rectally or Esophageal probes or urinary bladder catheter 2 prevent hypothermia

15. Thank You!!!