EnvironmentalEnvironmentalEmergenciesEmergencies

Environmental EmergenciesEnvironmental Emergencies

Cold and heat exposuresDrowning and near-drowningDiving emergenciesLightning strikesBites and envenomations

Cold & Heat EmergenciesCold & Heat Emergencies

Factors that affect body temperature:– Physical Condition– Age– Nutrition/hydration– Environmental conditions

Body Heat LossBody 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

Body Heat LossBody 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

Exposure Exposure

HypothermiaHypothermia

Body temperature below 95 degrees FWeather does not have to be below freezing

for hypothermia to occurHigher risks for geriatric and pediatric

patientsPeople with other illnesses or injuries are at

increased risk

Mild HypothermiaMild Hypothermia

Core temperature between 90 – 95 FSigns and symptoms include:

– Shivering– Rapid pulse and respirations– Red, pale, cyanotic skin

Moderate to Severe Moderate to Severe HypothermiaHypothermia

Core temperature less than 90 FSigns and symptoms include:

– Shivering stops– Muscular activity decreases– Mood changes, lethargy, impaired judgement– Stiff muscles, joints– Trouble speaking– Eventually, all muscle activity stops

Severe HypothermiaSevere Hypothermia

Core temperatures below 80 FSigns and symptoms include:

– Decreased vital signs– Shallow, absent respirations– Cardiac arrhythmias– Slow pupillary reaction– Cessation of all cardiorespiratory activity

ALS IndicatorsALS Indicators

Decreased level of consciousnessTemperatures less than 95 FCessation of shiveringSignificant co-morbidities (age, illness)Cardiac arrestHypotension

Patient CarePatient Care

Remove patient from the cold environment and protect from further heat loss

O2 and/or ventilatory assistRemove wet clothingPosition of comfortWarm the patientMonitor vital signs and temperature

Frostnip & Immersion FootFrostnip & 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

FrostbiteFrostbite

Serious local cold injury

Cellular damage which can lead to permanent inflammation, tenderness, cold intolerance, or even gangrene

Local Cold Injury CareLocal Cold Injury Care

Remove patient from cold environmentProtect cold-injured part from further injuryRemove any constricting or wet clothing,

replace with dry bulky dressingSplint the injury, do not let patient walk or

use affected extremityDo not massage injury to re-warm!

Heat ExposureHeat 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

Risk FactorsRisk Factors

Newborns, infants, children, and the elderly

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

Patients with limited mobilityAlcohol and drug use

Heat CrampsHeat Cramps

Painful muscle spasmsRemove patient from heatRest the cramping muscleRe-hydrateTransport if cramps persist

Heat ExhaustionHeat Exhaustion

Dizziness, weakness, faintingDry tongue, mouth, increased thirstCold, clammy skinUsually normal vital signs, but pulse can

increaseNormal or slightly elevated body

temperature

Heat StrokeHeat Stroke

Hot, flushed skin (not sweating)Change in behavior, decreased LOC leading

to unresponsivenessRapid pulse then it slowsDrop in blood pressureDeath will occur if treatment not initiated

Heat Stroke vs. ExhaustionHeat Stroke vs. Exhaustion

ALS IndicatorsALS Indicators

Decreased or altered LOCHot, dry skin in the presence of elevated

temperaturesSustained tachycardiaHypotensionPositive postural changes

Patient CarePatient Care

Medics?Remove patient from the hot environment,

place in cool place, position of comfortCool patient with cold packs or wet

sheets/towels, fan aggressivelyO2, rehydrateLoosen or remove clothingMonitor vitals and temperature

Drowning and Near-drowningDrowning and Near-drowning

Most are preventableDrowning

– Death as a result of suffocation after submersion in water

Near-drowning– Survival, at least temporarily after

suffocation in water

Drowning ProcessDrowning Process

Panic, loss of controlDecreased buoyancyExhaustionLaryngospasms (diver’s reflex)Inefficient breathing

– CO2 retention, O2 deprivation

Cardiac or respiratory arrest

Drowning TypesDrowning Types

Dry Lung15% of casesSmall amount of

H20 aspirated

Laryngospasm occurs, closes airway

Patient asphyxiates

Wet Lung85% of casesLarge amounts of

water enter lungsFluid, electrolyte

imbalances occur

Wet Lung: Fresh WaterWet 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

Wet Lung: Salt WaterWet Lung: Salt Water

Water moves from bloodstream to alveoliHemoconcentration occurs resulting in

shockPulmonary edema occurs

ALS IndicatorsALS Indicators

Any underwater rescueAltered or decreased LOCRespiratory distress, labored breathingHypotensionHypothermiaSignificant co-morbidityCardiac or respiratory arrest

Patient CarePatient 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!

Diving EmergenciesDiving 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

Air EmbolismAir Embolism

Most common diving emergency and the most dangerous

Breath holding during rapid ascentAir pressure in lungs remains high while

external pressure decreases causing alveaoli to rupture

Pneumothorax, pneumomediastinum, air emboli

Air EmbolismAir 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

Decompression SicknessDecompression Sickness

Occurs when gas bubbles obstruct blood vessels

Rapid ascent, “the bends”Most commonly presents as abdominal or

joint painSymptoms may develop hours laterTreatment is hyperbaric chamber

Patient CarePatient Care

Consider c-spine precautionsRequest medics!Maintain airway, O2 by NRM or BVMPosition of comfort either supine or on side

to avoid cerebral edemaMonitor vital signs and temperatureTransport to hyperbariatric facility

Lightning StrikesLightning 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

Lightning StrikesLightning Strikes

Mild:– Loss of consciousness, amnesia, tingling,

superficial burnsModerate:

– Seizures, respiratory arrest, asystole (spontaneously resolves), superficial burns

Severe:– Cardiopulmonary arrest

Patient CarePatient Care

Protect yourselfMedics?Move patient to sheltered area or stay close

to groundUse reverse triageTreat for electrical injuriesTransport

Bites and EnvenomationsBites and Envenomations

Spider bitesSnakebitesScorpion stingsTick bitesInjuries from marine animals

SnakebitesSnakebites

In the U.S. approximately 40,000 to 50,000 snakebites are reported

7,000 bites from poisonous speciesFatalities are very rare, about 15 per year19 species of venomous snakes in North

America, none found in Western WA

Venomous SnakesVenomous Snakes

Snakebite Risk FactorsSnakebite Risk Factors

TequilaTestosteroneTattooTeeth (more missing = greater chance)Trailer parkT-shirt (heavy metal band)

Signs and SymptomsSigns and Symptoms

Severe burning at the bite siteSwelling and bluish discolorationBleeding at various distant sitesWatch for:

– Weakness– Fainting– Sweating– Shock

Pit Viper BitesPit Viper Bites

Pain, swellingProgressive edemaBruisingBlood-filled vesicles

Patient CarePatient Care

Calm and reassure the patientCleanse the bite areaDo not apply ice or constricting bandsSplint to minimize movementNothing by mouthMonitor vital signsSnake to hospital for ID if it has been killed

Spiders, Scorpions, and TicksSpiders, Scorpions, and Ticks

Spiders, Scorpions, and TicksSpiders, Scorpions, and Ticks

10 year period only 63 deaths reported from spider bites, only 2 from the brown recluse.

Scorpion sting deaths even rarer as there is only one deadly scorpion species.

Tick bites can transmit Rocky Mountain Spotted Fever or Lyme disease

Brown RecluseBrown RecluseLocal signs/symptoms

– No pain or only mild stinging– Within 2 hours: Local pain,

blue-gray halo– 12 to 18 hours: Bleb

formation, growing ischemic zone

– 5 to 7 days: Aseptic necrosis, necrotic ulcer

Patient CarePatient Care

Transport!

Marine AnimalsMarine Animals

Marine AnimalsMarine Animals

Coelenterates are responsible for most marine animal envenomations

Nemocysts (stinging cells) contact can result in painful, reddish lesions

Symptoms include headache, dizziness, muscle cramps, and fainting

Patient CarePatient Care

Limit further discharge by minimizing patient movement

Inactivate nemocysts with alcoholRemove the remaining tentacles by

scrapping them offTransport