chapter 12

Cold water drowning

You should begin CPR on a drowning victim as long as the patient does not exhibit the definitive signs of death. 2. When a person is submerged in cold water, a protective mechanism called the mammalian diving reflex may be activated.

Superficial frostbite

a. The affected body part becomes numb and then turns a bright red color. b. Eventually the area loses its color and changes to pale white.

Deep frostbite

a. The patient's skin will be white and waxy. b. The skin may be firm or frozen. c. Swelling and blisters may be present. d. If the skin has thawed, it may appear flushed with areas of purple and white or it may be mottled and cyanotic.

Predisposing factors may make some people more susceptible to heat-related illnesses.

a. Very young or old age b. Preexisting medical conditions c. Certain medications d. High ambient temperatures e. High humidity

The body parts most susceptible to frostbite

are the face, ears, fingers, and toes. Warming the frostbitten part must be done quickly and carefully.

Heatstroke results when a person has been in a hot environment

for a long period, overwhelming the body's sweating mechanism. The patient's body temperature rises until it reaches a level at which brain damage occurs.

Frostbite

Frostbite can result when exposed parts of the body are exposed to a cold environment.

Body parts most susceptible to frostbite:

a. Face b. Ears c. Fingers d. Toes

Signs and symptoms include: hypothermia

a. Feeling cold b. Shivering c. Decreased level of consciousness d. Sleepiness e. Lack of coordination f. Mental confusion g. Slowed reactions h. Unconsciousness

Signs and symptoms include: heat stroke

a. Flushed, dry skin that feels hot to the touch b. Semiconsciousness or unconsciousness c. Internal temperatures as high as 106°F (41.1°C)

Treatment for heatstroke

a. Maintain the patient's ABCs. b. Remove the patient from the hot environment and into a cool place as soon as possible. c. Remove the patient's clothes, down to the underwear. d. Soak the patient with water. e. If the patient is conscious and not nauseated, administer small amounts of cool water. f. Arrange for rapid transport.

Treatment of heat cramps

a. Move the patient to a cool place. b. Have the patient lie down in a comfortable position. c. Give the patient water to drink. d. If the cramps do not disappear, arrange to have the patient transported to an appropriate medical facility.

Signs and symptoms of heat exhaustion include:

a. Profuse sweating b. Lightheadedness c. Dizziness d. Nausea e. Weak pulse f. Low blood pressure

Submersion injuries result from being

beneath the surface of water or another liquid.

Treat patients who have been struck by lightning

by supporting the airway, breathing, and circulation.

Heat cramps are caused by electrolyte imbalance and dehydration.

dehydration. They usually involve muscles in the calf, leg, or abdomen. Usually the cramps disappear with rest and the administration of water.

Exposure to cold environments may result in conditions such as

frostbite or hypothermia.

Unintentional exposure to water can lead to

submersion and drowning.

Drowning is defined as

suffocation because of submersion in water or in other fluids.

A person experiencing heat exhaustion

sweats profusely and becomes light- headed, dizzy, and nauseated. Predisposing factors may make some people more susceptible to heat-related illnesses.

Bites and stings

vBites and stings are sometimes classified as environmental injuries or discussed under the topic of poisoning.

how many people die of drowning in the USA

3,000 people

When a person is exposed to excess heat, the body's mechanisms for regulating temperature can be overwhelmed, resulting in:

1. Heat cramps 2. Heat exhaustion 3. Heatstroke

Heat cramps

1. Heat cramps are involuntary spasms of the muscles. 2. They often occur after exercise, especially in hot weather. 3. The exact cause of heat cramps is not known, but is thought to be related partly to the change in the electrolyte levels that occurs during exercise and partly to the dehydration that accompanies exercise or working in a hot environment. 4. Heat cramps most commonly occur in the leg or calf muscles. 5. When abdominal cramps occur, it may appear that the patient is having an acute abdominal problem.

Your approach to a patient who has signs and symptoms of an environmental emergency should follow the patient assessment sequence.

1. Review the dispatch information to help you decide on possibilities for the patient's problem. 2. Asses the scene to determine safety issues for you and the patient. 3. As you perform the primary assessment: a. Try to form an impression of the patient's problem. b. Determine the patient's responsiveness c. Introduce yourself. d. Check the patient's ABCs. e. Acknowledge the patients chief complaint. 4. Usually, it is best to collect a medical history on the patient experiencing medical problem before you perform a secondary assessment. a. The SAMPLE history format will help you secure the necessary information: i. Signs/symptoms ii. Allergies iii. Medications iv. Pertinent past history v. Last oral intake vi. Events associated with or leading to the illness or injury 5. The secondary patint assessment focuses on the areas related to the patient's current illness a. The patient may not always be aware of all the various aspects of his or her problem. b. Obtain the patient's vital signs.

Treatment of submersion injuries

Assess scene safety. a. If the patient is still in the water, do not exceed the limits of your training in an attempt to rescue him or her. b. Call for additional help if needed. c. If there is evidence of trauma and you need to move the patient, protect the spine from further injury. 2. Perform a primary assessment. 3. As soon as possible, perform a secondary assessment to check for other injuries. a. Correct any airway, breathing, and circulation problems. b. Begin CPR if indicated. c. If the patient is breathing adequately, administer high-flow oxygen. d. As soon as the ABCs are stabilized, dry the patient. e. Cover the patient with towels or blankets to help preserve body temperature. 4. Obtain the patient's medical history from the patient if possible, or from any family members present. 5. Perform regular reassessments.

The following hazards for drowning in infants and young children are present in every house:

Bathtubs b. Toilets c. Mop buckets

Signs and symptoms of submersion injury include:``

Coughing b. Vomiting c. Difficulty breathing d. Respiratory arrest e. Cardiac arrest f. Broken bones or spinal injuries g. Hypothermia

Heat exhaustion

Heat exhaustion occurs when a person is exposed to temperatures higher than 80ºF (27ºC), usually in combination with high humidity. 2. It can also occur as the result of vigorous exercise at lower temperatures.

Heatstroke

Heatstroke occurs when the body is subjected to more heat than it can handle and the normal mechanisms for getting rid of the excess heat are overwhelmed. 2. The patient's body temperature rises until it reaches a level at which brain damage occurs. a. Without prompt and proper treatment, a patient with heatstroke will die.

Hypothermia

Hypothermia occurs when a person's body temperature drops to less than 95ºF (35ºC).

The feeling of panic produces an inefficient breathing pattern.\

If a swimmer is not able to take in full breaths, buoyancy is lost and exhaustion sets in. b. Small quantities of water reaching the larynx cause a spasm of the larynx (laryngospasm), which makes it hard or impossible to breath.

Cardiac arrest and hypothermia

If the patient's body temperature falls to less than 83°F (28°C), the heart may stop and you will need to begin cardiopulmonary resuscitation (CPR). b. Always start CPR and use an automated external defibrillator, if available, on hypothermic patients even if you believe they have been "dead" for several hours. c. Hypothermia patients should never be considered dead until they have been warmed in an appropriate medical facility.

Treatment of heat exhaustion

Move the patient to a cooler place and treat him or her for shock. b. Unless the patient is unconscious, nauseated, or vomiting, give fluids by mouth. c. Monitor the ABCs. d. Arrange transport to a medical facility.

Treatment of hypothermia

Move the patient to a warm location. b. Remove wet clothing. c. Place warm blankets over and under the patient. d. If the patient is conscious, give warm fluids to drink. e. If you do not have access to a building, move the patient into a heated vehicle. f. If transport is delayed or extended, you may need to use your own body heat to warm the patient.

Treatment

Remove any jewelry the patient is wearing and cover the extremity with dry clothing or dry dressings. ii. Do not break blisters, rub the injured area, apply heat, or allow the patient to walk on an affected lower extremity. iii. Provide prompt transport to a medical facility.

Likely locations of drowning include:Streams

Streams b. Lakes c. Swimming pools d. Hot tubs e. Wading pools f. Public fountains g. Storm drain ponds

Lightning injuries

The electrical injury resulting from a lightning strike can cause cardiac irregularities or cardiac arrest.

Lightning injuries can also cause electrical burns.

This type of burn is mainly internal, so the extent of burn damage will not be visible immediately after the injury occurs.

The process of drowning progresses through several stages.

Usually the initial stage is panic as the person realizes that something is wrong. 2. In other instances, the person: a. Becomes fatigued, injured, cold, or entangled in seaweed or kelp b. Experiences a loss of orientation c. Becomes ill