CHAPTER 30: ENVIRONMENTAL EMERGENCIES

PATIENT ASSESSMENT & CARE II

EMS 246

Dr.Bushra Bilal

ENVIRONMENTAL EMERGENCIES

• Environmental emergencies are defined as “sudden-onset disasters or accidents resulting from natural, technological or human-induced factors, or a combination of these, that causes or threatens to cause severe environmental damage as well as loss of human lives and property.

Factors Affecting Exposure

• Physical condition.

• Age (infants and older adults affected more)

• Nutrition and hydration

Alcohol will change the body’s ability to regulate temperature.

• Environmental condition:• Air temperature• Humidity level• Wind

Cold Exposure (1 of 3)

• Cold exposure may cause injury to:

Feet

Hands

Ears

Nose

Whole body (hypothermia)

• There are five ways the body can lose heat.

Cold Exposure (2 of 3)

• Conduction

Direct transfer of heat from a part of the body to a colder object by direct contact e.g. When a warm hand touches cold metal or ice

• Convection

is the circular motion that happens when warmer air or liquid — which has faster moving molecules, making it less dense — rises, while the cooler air or liquid drops down (weather).

Evaporation

is the process of a substance in a liquid state changing to a gaseous state due to an increase in temperature and/or pressure.

Cold Exposure (3 of 3)

• Radiation

Transfer of heat by radiant energy( a type of invisible light that transfers heat (microwave oven ).)

• Respiration

Loss of body heat during normal breathing

Hypothermia (1 of 4)

• Lowering of the core temperature below 95°F (35°C).

• Can lead to death

• People at risk:

Homeless people

Swimmers

Geriatric, young infants and children

Hypothermia (2 of 4)

Progresses through four general stages

Hypothermia (3 of 4)

• Assess general temperature.

Pull back your gloves and place the back of your hand on the patient’s abdomen.

Use a hypothermia thermometer.

Hypothermia (4 of 4)• Mild hypothermia

Occurs when the core temperature is between 90°F and 95°F (32°C and 35°C)

Patient is usually alert and shivering

Pulse rate and respirations are rapid.

• More severe hypothermia

Occurs when the core temperature is less than 90°F (32°C)

Shivering stops.

Muscular activity decreases.

Local Cold Injuries (1 of 2)

• Most injuries from cold are confined to exposed parts of the body.

Extremities (especially the feet)

Ears

Nose

Face

Local Cold Injuries (2 of 2)

• Underlying factors:

Exposure to wet conditions

Restricted circulation from tight clothing or shoes, or circulatory disease

Poor nutrition, Alcohol or drug abuse

Hypothermia

Diabetes

Cardiovascular disease

Older age/Fatigue

Frostnip and Immersion Foot (1 of 2)

• Frostnip

After prolonged exposure to the cold, skin is freezing but deeper tissues are unaffected. is a superficial cooling of tissues without cellular destruction.

Usually affects the ear, nose, and fingers

• Immersion foot

Also called trench foot

Occurs after prolonged exposure to cold water

Common in hikers and hunters

Frostnip and Immersion Foot (2 of 2)

• Signs and symptoms of both

Skin is pale and cold to the touch.

Normal color does not return after palpation of the skin.

The skin of the foot may be wrinkled but can also remain soft.

The patient reports loss of feeling and sensation in the injured area.

Frostbite

• Most serious local cold injury because the tissues are actually frozen

• Signs and symptoms

Most frostbitten parts are hard and waxy.

The injured part feels firm to frozen.

Blisters and swelling may be present.

the skin may appear red with purple and white, or mottled and cyanotic.

Assessment of Cold Injuries

• Patient assessment stepsScene size-up

Primary assessment

History taking

Secondary assessment

Reassessment

Scene Size-up

• Scene safetyNote the weather conditions.

Identify safety hazards such as icy roads, mud, or wet grass.

Use appropriate standard precautions.

• Mechanism of injury/nature of illnessLook for indicators of the MOI.

Primary Assessment

• Form a general impression.

Perform a rapid scan.

Evaluate mental status using the AVPU scale.

• Airway and breathing

Ensure that the patient has an adequate airway

• Circulation

Palpate for a carotid pulse and wait 30 to 45 seconds to decide if the patient is pulseless

• Transport decision

All patients with hypothermia require immediate transport

History Taking

• Investigate the chief complaint.

Obtain a medical history..

• SAMPLE history

Find out how long your patient has been exposed to the cold environment.

Secondary Assessment

• Physical examinations

Assess the areas of the body directly affected by cold exposure and extent of damage

• Vital signs

Respirations may be slow and shallow.

Low blood pressure and a slow pulse indicate moderate to severe hypothermia.

Evaluate for changes in mental status.

• Monitoring devices

Determine a core body temperature using a thermometer.

Reassessment

• Repeat the primary assessment

• Monitor the patient’s vital signs.

• Interventions

Review all treatments that have been performed.

• Communication and documentation

Communicate all of the information you have gathered to the receiving facility

.

General Management of Cold Emergencies (1 of 2)

• Move the patient from the cold environment..

• Remove any wet clothing.• Place dry blankets over

and under the patient.

• When the patient has moderate or severe hypothermia, never try to actively rewarm the patient.

General Management of Cold Emergencies (2 of 2)

• Give the patient warm, humidified oxygen.

• Do not allow the patient to eat, smoke or chew tobacco.

• In case of mild hypothermia:

Apply heat packs or hot water bottles to the groin, axillary, and cervical regions.

Rewarm the patient slowly.

– Give warm fluids by mouth

Emergency Care of Local Cold Injuries

• Remove the patient from further exposure to the cold.

• Administer oxygen.

• Remove any wet or restricting clothing over the injured part.

• Consider active rewarming.

Heat Exposure

• Normal body temperature is 98.6°F

• Hyperthermia is a core temperature of 101°F (38.3°C) or higher.

• Risk factors :

High air temperature,High humidity,Vigorous exercise

Persons at greatest risk:

Children, Geriatric patients

Patients with heart disease, COPD, diabetes, dehydration, and obesity

1.Heat Cramps

• Painful muscle spasms that occur after vigorous exercise• Usually occur in the leg or abdominal muscles

2.Heat Exhaustion

• Causes :

Heat exposure, stress, Hypovolemia etc.

• Signs and symptoms

Dizziness, weakness, or faintness

Change in LOC with accompanying nausea, vomiting, or headache

Muscle cramping

Cold, clammy skin with ashen pallor

Dry tongue and thirst

3.Heatstroke (1 of 2)

• Typical onset situations

During vigorous physical activity

Outdoors

During heat waves without sufficient air conditioning or poor ventilation

Child left unattended in a locked car on a hot day

Heatstroke (2 of 2)

• Signs and symptoms

Hot, dry, flushed skin

Early on, skin may be moist or wet.

Quickly rising body temperature

Falling LOC (leading to unconsciousness)

Change in behavior , Unresponsiveness

Seizures

Strong, rapid pulse at first, becoming weaker with falling blood pressure

Increasing respiratory rate, Lack of perspiration

Assessment of Heat Injuries

• Patient assessment steps

Scene size-up

Primary assessment

History taking

Secondary assessment

Reassessment

Scene Size-up

• Scene safety

Protect yourself from heat and biologic hazards.

• Mechanism of injury/nature of illness

Look for indicators of the MOI.

• Form a general impression.

Perform a rapid scan and avoid tunnel vision.

Assess mental status

Primary Assessment

• Airway and breathing

Provide oxygen.

If unresponsive, insert an airway and provide bag-mask device ventilations.

• Circulation

Palpate a pulse..

Assess the patient’s skin condition.

Treat for shock

• Transport decision

– If your patient has any of the following signs of heatstroke, transport immediately.• High temperature• Red, dry skin• Altered mental

status• Tachycardia• Poor perfusion

History Taking

• Investigate the chief complaint.

– Be alert for injury-specific signs and symptoms. • Absence of perspiration• Decreased level of consciousness• Confusion• Muscle cramping• Nausea and vomiting

• SAMPLE History

Note any activities, conditions, medications. exposure to heat and activities prior to onset.

Secondary Assessment

• Physical examinations

Assess the patient for muscle cramps or confusion and take the patient’s vital signs

• Vital signs

Patients who are hyperthermic will be tachycardic and tachypneic.

In heat exhaustion, the skin temperature may be normal or cool and clammy.

In heatstroke, the skin is hot

Reassessment

• Watch for deterioration

• Monitor vital signs at least every 5 minutes.

• Interventions

Remove the patient from the hot environment.

Patients with symptoms of heatstroke should be transported immediately.

• Communication and documentation

Inform the staff at the receiving facility early on that your patient is experiencing a heatstroke

Management of Heat Emergencies

• Heat crampsRemove the patient

from the hot environment.

Administer high-flow oxygen.

Rest the cramping muscles.

Replace fluids by mouth.

Cool the patient with water spray or mist.

Heatstroke

Move the patient out of the hot environment .

Set air conditioning to maximum cooling.

Remove the patient’s clothing.

Give 100% oxygen.

Cover the patient with wet towels or sheets.

Transport immediately to the hospital

Radiation Exposure

Causes of radiation exposure:

Cell phones

Microwave ovens

Ultraviolet (UV) light from the sun

• Long-term exposure to UV light is one of the main risk factors of skin cancer.

.

Drowning

• Risk factors

Alcohol consumption

Preexisting seizure disorders

Geriatric patients with cardiovascular disease

Unsupervised access to water

Spinal Injuries in Submersion Incidents

• Suspect spinal injury if:Submersion has resulted from a diving mishap or long fall.The patient is unconscious.The patient complains of weakness, paralysis, or

numbness.Stabilize the suspected injury while the patient is still in the

water.

Resuscitation Efforts

• Never give up on resuscitating a cold-water drowning victim.

Hypothermia can protect vital organs from the lack of oxygen.

• The diving reflex may cause immediate bradycardia.

Slowing of the heart rate caused by submersion in cold water

1.Descent Emergencies

• Caused by the sudden increase in pressure as the person dives deeper into the water

• Typical areas affected

– Lungs, Sinus cavities, Middle ear, Teeth, Face

• Perforated tympanic membrane

Cold water may enter the middle ear through a ruptured eardrum.

The diver may lose his or her balance and orientation

2.Emergencies at the Bottom

• Caused by faulty connections in the diving gear

• Can cause drowning or rapid ascent

3.Ascent Emergencies

• Air embolism

Most dangerous diving emergencies

Bubbles of air in the blood vessels

• . Decompression sickness

Also called “the bends”

Bubbles of gas, especially nitrogen, obstruct the blood vessels.

Causes:• Too rapid an ascent from a dive• Too long of a dive at too deep of a depth

Ascent Emergencies

Signs and symptoms

Severe abdominal or joint pain

Treatment is the same for both.

– Basic life support (BLS)

– Recompression in a hyperbaric chamber

Assessment of Drowning and Diving Emergencies

• Patient assessment steps

Scene size-up

Primary assessment

History taking

Secondary assessment

Reassessment

Scene Size-up

• Scene safety

Gloves and eye protection

Never attempt a water rescue without proper training and equipment.

Consider trauma and spinal stabilization..

• Mechanism of injury/nature of illness

Look for indicators of the MOI

Primary Assessment

• Form a general impression.

Pay attention to chest pain, dyspnea, and complaints of sensory changes.

Determine the LOC.

• Airway and breathing

Open the airway and assess breathing in unresponsive patients.

Consider spinal trauma and continually monitor breath sounds

• Circulation

If the pulse is unmeasurable, the patient may be in cardiac arrest.

Begin CPR

Evaluate for shock and perfusion.

• Transport decision

Always transport near-drowning patients to the hospital.

History Taking

• Investigate the chief complaint.

Obtain a medical history.

Be alert for injury-specific signs.

• SAMPLE history

Determine the length of time the patient was underwater or the time of onset of symptoms.

Note any physical activity, alcohol or drug use, or other medical conditions

Secondary Assessment

• Physical examinations

Examine lungs and breath sounds.

Look for trauma, indications of the bends or air embolism, and signs of hypothermia.

Obtain a Glasgow Coma Scale score.

Assess for:• Peripheral pulses, Skin

color and discoloration, Itching, Pain, Paresthesia (numbness and tingling).

• Vital signs

Pulse rate, quality, and rhythm

Respiratory rate, quality, and rhythm

Pupil size and reactivity

.

Reassessment

• Repeat the primary assessment.

• Interventions

Artificial ventilation should begin as soon as possible, even before the victim is removed from the water.

• Communication and documentation

– Document:• Circumstances of drowning and extrication• Time submerged• Temperature and clarity of the water• Possible spinal injury

Emergency Care for Drowning or Diving Emergencies

• For air embolism or decompression sickness:

Remove the patient from the water.

Try to keep the patient calm.

Administer oxygen.

Place the patient in a left lateral recumbent position with the head down.

Provide prompt transport.

2.Emergencies at the Bottom

• Caused by faulty connections in the diving gear

• Can cause drowning or rapid ascent

3.Ascent Emergencies

• Air embolism

Most dangerous diving emergencies

Bubbles of air in the blood vessels

• . Decompression sickness

Also called “the bends”

Bubbles of gas, especially nitrogen, obstruct the blood vessels.

Causes:• Too rapid an ascent from a dive• Too long of a dive at too deep of a depth

Ascent Emergencies

Signs and symptoms

Severe abdominal or joint pain

Treatment is the same for both.

– Basic life support (BLS)

– Recompression in a hyperbaric chamber

Assessment of Drowning and Diving Emergencies

• Patient assessment steps

Scene size-up

Primary assessment

History taking

Secondary assessment

Reassessment

Scene Size-up

• Scene safety

Gloves and eye protection

Never attempt a water rescue without proper training and equipment.

Consider trauma and spinal stabilization..

• Mechanism of injury/nature of illness

Look for indicators of the MOI

Primary Assessment

• Form a general impression.

Pay attention to chest pain, dyspnea, and complaints of sensory changes.

Determine the LOC.

• Airway and breathing

Open the airway and assess breathing in unresponsive patients.

Consider spinal trauma and continually monitor breath sounds

• Circulation

– If the pulse is unmeasurable, the patient may be in cardiac arrest.

– Begin CPR

– Evaluate for shock and perfusion.

• Transport decision

– Always transport near-drowning patients to the hospital.

History Taking

• Investigate the chief complaint.

Obtain a medical history.

Be alert for injury-specific signs.

• SAMPLE history

Determine the length of time the patient was underwater or the time of onset of symptoms.

Note any physical activity, alcohol or drug use, or other medical conditions

Secondary Assessment

• Physical examinations

Examine lungs and breath sounds.

Look for trauma, indications of the bends or air embolism, and signs of hypothermia.

Obtain a Glasgow Coma Scale score.

Assess for:• Peripheral pulses, Skin

color and discoloration, Itching, Pain, Paresthesia (numbness and tingling).

• Vital signs

Pulse rate, quality, and rhythm

Respiratory rate, quality, and rhythm

Pupil size and reactivity

.

Reassessment

• Repeat the primary assessment.

• Interventions

Artificial ventilation should begin as soon as possible, even before the victim is removed from the water.

• Communication and documentation

– Document:• Circumstances of drowning and extrication• Time submerged• Temperature and clarity of the water• Possible spinal injury

Emergency Care for Drowning or Diving Emergencies

• For air embolism or decompression sickness:

Remove the patient from the water.

Try to keep the patient calm.

Administer oxygen.

Place the patient in a left lateral recumbent position with the head down.

Provide prompt transport.

SUMMARY

• Local cold injuries include frostbite, frostnip, and immersion foot. Frostbite is the most serious because tissues actually freeze.

• Do not consider a patient dead until he or she is “warm and dead.” Local protocol will dictate whether or not such patients receive cardiopulmonary resuscitation or defibrillation in the field.

• Heat illness can take three forms: heat cramps, heat exhaustion, and heatstroke.

SUMMARY

• The first rule in caring for drowning victims is to be sure not to become a victim yourself. Protect the spine when removing patients from the water because spinal cord injuries often occur in drowning. Be aware of the possibility of hypothermia.

• Injuries associated with scuba diving may be immediately apparent or may show up hours later. Patients with air embolism or decompression sickness may have pain, paralysis, or altered mental status. Be prepared to transport such patients to a recompression facility with a hyperbaric chamber.

• Poisonous spiders include the black widow spider and the brown recluse spider.

• Poisonous snakes include pit vipers and coral snakes.

UNIT ASSESSMENT

• How does frostbite differ from frostnip?

• What are the two most efficient ways the body can cool itself?

• What is the most common and dangerous scuba diving emergency?

• What type of spider has venom that is neurotoxic?