environmental emergencies. cold and heat exposures drowning and near-drowning diving emergencies...

Download Environmental Emergencies. Cold and heat exposures Drowning and near-drowning Diving emergencies Lightning strikes Bites and envenomations

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  • Slide 1
  • Environmental Emergencies
  • Slide 2
  • Cold and heat exposures Drowning and near-drowning Diving emergencies Lightning strikes Bites and envenomations
  • Slide 3
  • Cold & Heat Emergencies Factors that affect body temperature: Physical Condition Age Nutrition/hydration Environmental conditions
  • Slide 4
  • Body Heat Loss Conduction Heat transfer form body to another object Convection Heat transfer through circulating air Evaporation Body cooling through sweating Radiation Heat loss directly into the environment Respirations
  • Slide 5
  • Body Heat Loss Rate and amount of heat loss modified: Increasing heat production Move to a sheltered area where heat loss is decreased Wearing insulated clothing
  • Slide 6
  • Exposure
  • Slide 7
  • Hypothermia Body temperature below 95 degrees F Weather does not have to be below freezing for hypothermia to occur Higher risks for geriatric and pediatric patients People with other illnesses or injuries are at increased risk
  • Slide 8
  • Mild Hypothermia Core temperature between 90 95 F Signs and symptoms include: Shivering Rapid pulse and respirations Red, pale, cyanotic skin
  • Slide 9
  • Moderate to Severe Hypothermia Core temperature less than 90 F Signs and symptoms include: Shivering stops Muscular activity decreases Mood changes, lethargy, impaired judgement Stiff muscles, joints Trouble speaking Eventually, all muscle activity stops
  • Slide 10
  • Severe Hypothermia Core temperatures below 80 F Signs and symptoms include: Decreased vital signs Shallow, absent respirations Cardiac arrhythmias Slow pupillary reaction Cessation of all cardiorespiratory activity
  • Slide 11
  • ALS Indicators Decreased level of consciousness Temperatures less than 95 F Cessation of shivering Significant co-morbidities (age, illness) Cardiac arrest Hypotension
  • Slide 12
  • Patient Care Remove patient from the cold environment and protect from further heat loss O2 and/or ventilatory assist Remove wet clothing Position of comfort Warm the patient Monitor vital signs and temperature
  • Slide 13
  • Frostnip & Immersion Foot Frostnip Freezing of the skin but not the deeper surface Usually not painful, but patient is aware Immersion foot Also known as trench foot Caused by prolonged exposure of foot to cold water
  • Slide 14
  • Frostbite Serious local cold injury Cellular damage which can lead to permanent inflammation, tenderness, cold intolerance, or even gangrene
  • Slide 15
  • Local Cold Injury Care Remove patient from cold environment Protect cold-injured part from further injury Remove any constricting or wet clothing, replace with dry bulky dressing Splint the injury, do not let patient walk or use affected extremity Do not massage injury to re-warm!
  • Slide 16
  • Heat Exposure Normal body temperature is 98.6 F Body attempts to maintain core temperature despite ambient temperature Cooling by seating and dilation of blood vessels High temperatures and humidity decease the effectiveness of cooling mechanism Severity increase when core rises above 101 F
  • Slide 17
  • Risk Factors Newborns, infants, children, and the elderly Patients with heart disease, COPD, diabetes, dehydration, obesity Patients with limited mobility Alcohol and drug use
  • Slide 18
  • Heat Cramps Painful muscle spasms Remove patient from heat Rest the cramping muscle Re-hydrate Transport if cramps persist
  • Slide 19
  • Heat Exhaustion Dizziness, weakness, fainting Dry tongue, mouth, increased thirst Cold, clammy skin Usually normal vital signs, but pulse can increase Normal or slightly elevated body temperature
  • Slide 20
  • Heat Stroke Hot, flushed skin (not sweating) Change in behavior, decreased LOC leading to unresponsiveness Rapid pulse then it slows Drop in blood pressure Death will occur if treatment not initiated
  • Slide 21
  • Heat Stroke vs. Exhaustion
  • Slide 22
  • ALS Indicators Decreased or altered LOC Hot, dry skin in the presence of elevated temperatures Sustained tachycardia Hypotension Positive postural changes
  • Slide 23
  • Patient Care Medics? Remove patient from the hot environment, place in cool place, position of comfort Cool patient with cold packs or wet sheets/towels, fan aggressively O2, rehydrate Loosen or remove clothing Monitor vitals and temperature
  • Slide 24
  • Drowning and Near-drowning Most are preventable Drowning Death as a result of suffocation after submersion in water Near-drowning Survival, at least temporarily after suffocation in water
  • Slide 25
  • Drowning Process Panic, loss of control Decreased buoyancy Exhaustion Laryngospasms (divers reflex) Inefficient breathing CO2 retention, O2 deprivation Cardiac or respiratory arrest
  • Slide 26
  • Drowning Types Dry Lung 15% of cases Small amount of H 2 0 aspirated Laryngospasm occurs, closes airway Patient asphyxiates Wet Lung 85% of cases Large amounts of water enter lungs Fluid, electrolyte imbalances occur
  • Slide 27
  • Wet Lung: Fresh Water Water moves from alveoli to bloodstream to red blood cells Hemodilution occurs causing cell rupture Potassium release causes arrhythmias Hemoglobin release causes renal failure Loss of surfactant causes alveolar collapse greatly diminishes O2 carrying ability
  • Slide 28
  • Wet Lung: Salt Water Water moves from bloodstream to alveoli Hemoconcentration occurs resulting in shock Pulmonary edema occurs
  • Slide 29
  • ALS Indicators Any underwater rescue Altered or decreased LOC Respiratory distress, labored breathing Hypotension Hypothermia Significant co-morbidity Cardiac or respiratory arrest
  • Slide 30
  • Patient Care Medics? C-spine precautions (suspect spinal injury) Remove patient form water Left, lateral recumbent position O2, BVM, suctioning Monitor vital signs, temperature Follow resuscitation protocols if in arrest All immersion incidents get transport to ED!
  • Slide 31
  • Diving Emergencies Descent problems Usually due to the sudden increase in pressure on the diving body, perforated eardrum Bottom problems Not commonly seen (equipment problems) Ascent problems Air embolism and decompression sickness
  • Slide 32
  • Air Embolism Most common diving emergency and the most dangerous Breath holding during rapid ascent Air pressure in lungs remains high while external pressure decreases causing alveaoli to rupture Pneumothorax, pneumomediastinum, air emboli
  • Slide 33
  • Air Embolism Blotching Froth at mouth and nose, dysphasia Severe muscle, joint, abdominal pain Dyspnea, chest pain Dizziness, nausea, vomiting Vision problems Paralysis, coma Irregular pulse or cardiac arrest
  • Slide 34
  • Decompression Sickness Occurs when gas bubbles obstruct blood vessels Rapid ascent, the bends Most commonly presents as abdominal or joint pain Symptoms may develop hours later Treatment is hyperbaric chamber
  • Slide 35
  • Patient Care Consider c-spine precautions Request medics! Maintain airway, O2 by NRM or BVM Position of comfort either supine or on side to avoid cerebral edema Monitor vital signs and temperature Transport to hyperbariatric facility
  • Slide 36
  • Lightning Strikes Estimated 25 million cloud-to-ground strikes in the U.S. each year Third most common cause of death from isolated environmental phenomena Most common strikes hit boaters, golfers, swimmers, anyone in large, open areas Cardiac arrest and tissue damage
  • Slide 37
  • Lightning Strikes Mild: Loss of consciousness, amnesia, tingling, superficial burns Moderate: Seizures, respiratory arrest, asystole (spontaneously resolves), superficial burns Severe: Cardiopulmonary arrest
  • Slide 38
  • Patient Care Protect yourself Medics? Move patient to sheltered area or stay close to ground Use reverse triage Treat for electrical injuries Transport
  • Slide 39
  • Bites and Envenomations Spider bites Snakebites Scorpion stings Tick bites Injuries from marine animals
  • Slide 40
  • Snakebites In the U.S. approximately 40,000 to 50,000 snakebites are reported 7,000 bites from poisonous species Fatalities are very rare, about 15 per year 19 species of venomous snakes in North America, none found in Western WA
  • Slide 41
  • Venomous Snakes
  • Slide 42
  • Snakebite Risk Factors Tequila Testosterone Tattoo Teeth (more missing = greater chance) Trailer park T-shirt (heavy metal band)
  • Slide 43
  • Signs and Symptoms Severe burning at the bite site Swelling and bluish discoloration Bleeding at various distant sites Watch for: Weakness Fainting Sweating Shock
  • Slide 44
  • Pit Viper Bites Pain, swelling Progressive edema Bruising Blood-filled vesicles
  • Slide 45
  • Patient Care Calm and reassure the patient Cleanse the bite area Do not apply ice or constricting bands Splint to minimize move