EMT Chapter 32: Environmental Emergencies

how does the body protect itself against heat loss

-constriction of the blood vessels in the skin; which results in the characteristic appearance of blue lips and/or skin -shivering

Pressure immobilization bandage/cuff

40-70mm Hg arms 55-70mm Hg legs

moderate hypothermia

86-93.2F s/sx: loss of coordination, muscle stiffness, possible coma, muscular functioning decreases stiffening/rigid cardiorespiratory: slowing respirations, weak respirations, slow pulse, dysrhythmias. LOC: confused, lethargic, sleepy, unresponsive

normal body temperature

98.6 F

immersion foot

A condition that occurs after prolonged exposure to cold water, in which the skin of the foot is pale, cold, and there is a loss of sensation; also called trench foot.

hymenoptera

A family of insects that includes bees, wasps, ants, and yellow jackets.

heat exhaustion

A heat emergency in which a significant amount of fluid and electrolyte loss occurs because of heavy sweating; also called heat prostration or heat collapse.

heat stroke

A life-threatening condition involving very high body temperature, lack of perspiration, and rapid pulse. severe hyperthermia caused by excessive heat marked by warm skin, dry skin, ALOC, irreversible coma

decompression sickness

A painful condition seen in divers who ascend too quickly, in which gas, especially nitrogen, forms bubbles in blood vessels and other tissues; also called "the bends."

antivenin

A serum that counteracts the effect of venom from an animal or insect.

scuba gear

A system that delivers air to the mouth and lungs at various atmospheric pressures, increasing with the depth of the dive; stands for self-contained underwater breathing apparatus.

reverse triage

A triage process in which efforts are focused on those who are in respiratory and cardiac arrest, and different from conventional triage where such patients would be classified as deceased. Used in triaging multiple victims of a lightning strike.

air embolism

Air bubbles in the blood vessels.

dysbarism injuries

Any signs and symptoms caused by the difference between the surrounding atmospheric pressure and the total gas pressure in various tissues, fluids, and cavities of the body. can affect the CNS and the pulmonary system.

bends

Common name for decompression sickness.

frostbite

Damage to tissues as the result of exposure to cold; frozen or partially frozen body parts are frostbitten. most serious local cold injury

moist, pale, cool skin indicates

Excessive fluid and salt loss

HACE

High Altitude Cerebral Edema: development after HAPE, can quickly become life threatening. s/sx include severe throbbing headache, ataxia, extreme fatigue, vomiting, loss of consciousness. HACE and HAPE may overlap.

HAPE

High Altitude Pulmonary Edema: collection of fluid in the lungs which hinders oxygen getting into the bloodstream. usually occurs at 8000ft or greater altitudes. s/sx include shortness of breath, cough with pink sputum, cyanosis, and rapid pulse.

diving reflex

Slowing of the heart rate caused by submersion in cold water.

checking a pulse in a patient with hypothermia

check for up to 60s to determine if they are truly pulseless or not. 1 or 2 BPM is still a pulse.

breath-holding syncope

Loss of consciousness caused by a decreased breathing stimulus.

heat cramps

Painful muscle spasms usually associated with vigorous activity in a hot environment.

turgor

The ability of the skin to resist deformation; tested by gently pinching skin on the forehead or back of the hand.

drowning

The process of experiencing respiratory impairment from submersion or immersion in liquid.

core temperature

The temperature of the central part of the body (eg, the heart, lungs, and vital organs).

ambient temperature

The temperature of the surrounding environment.

radiation

The transfer of heat to colder objects in the environment by radiant energy, for example heat gain from a fire.

s/sx hypothermia

vitals slow down, more severe as it progresses and core temperature drops; however, there is no clear correlation between temperature and stage: depends on the person

describe a splash effect (lightening)

when lightening strikes a larger, nearby object ad the patient is indirectly struck or affected

most common and most dangerous emergency in scuba diving

air embolism - the diver holds their breath during a rapid ascent and the air pressure in the lungs remains at a high level while the external pressure decreases. ass a result the air inside the lungs expands rapidly causing the alveoli in the lungs to rupture

air embolism vs. decompression sickness signs and symptoms

air embolism occurs immediately on return to the surface whereas decompression sickness may not occur for several hours later

Coelenterates

an aquatic invertebrate animal of a phylum that includes jellyfishes, corals, and sea anemones.

ascent emergencies

ascending from bottom; air embolism; happens when diver holds his or her breath during a rapid ascend to the surface (most common; require aggressive resuscitation)

s/sx air embolism

blotching, froth from nose/mouth, severe pain in muscles joints and abdomen, dyspnea, chest pain, dizziness, nausea, vomiting, dysphasia, cough, cyanosis, vision problems, paralysis/coma, irreg. pulse, cardiac arrest

hot, dry or moist skin indicates

body is unable to regulate core temperature

what does your body do over a period of time exposed to the cold

body systems begin to slow down and weaken due to the cold and your mental status declines; can lead to death

treating a patient with a snake bite

calm, reassure, supine position, find out when the snake had bitten them, wash with soap and mild antiseptic, ice around the area, pressure or bandage immobilization, place below the heart, alert for anaphylaxis, give nothing by mouth, monitor ABC's and vitals, bring any information about the snake with you, notify receiving ED.

severe lightening strike

cardiopulmonary arrest, deeper burns

most common injuries of a patient who had been struck by lightening

cardiovascular problems, respiratory problems, burns - but cardiopulmonary will lead to most deaths

signs/development of heat stroke

change in behavior, unresponsive/ALOC, rapid strong pulse that will become weak as the become unresponsive, blood pressure will fall, respiratory increases to try to compensate for the body

hyperthermia vs. hypothermia

core temperatrue rises to 101+ core temperature falls below 95

cautions/considerations of Hymenoptera

could develop into anaphylaxis- treat and monitor accordingly.

what else happens when a person is struck by lightening?

could fracture bones and spinal vertebrae, so consider c-spine as well. open airway with the jaw thrust as needed. monitor ABC's and immobilize the patient.

Neurotoxicity

damage to the nervous system by a toxic substance

Centruroides sculpturatus

dangerous scorpion that poison produces a severe systemic reaction that leads to circulatory collapse, severe muscle contractions, excessive salvation, hypertension, convulsions, and cardiac failure

diving emergencies injuries are separated into three phases

descent, bottom, ascent

cytotoxic

destructive to cells

s/sx heat exhaustion

dizziness, weakness, syncope, ALOC, nausea, vomiting, headache, cramping, excessive sweating, dry tongue, thirst, normal vitals, slightly high pulse, slightly low systolic, elevated body temperature. may be up to 104F

how to handle a frostbitten extremity

do not massage, do not attempt to re-warm, but do try to remove it from the cold environment. re-warming is best done at the receiving ED. Make sure your patient does not use that extremity as they could damage it further. cover with a soft sterile dressing and transport.

Descent emergencies

due to sudden increase on the pressure of the body as they dive deeper; pain is managed by returning to the surface. common major problem is a ruptured eardrum.

how do heat cramps occur

excessive/vigorous exercise and hot outdoors. due to water/electrolyte loss

causes of heat exhaustion

exposure, stress, fatigue, hypovolemia

s/sx scorpion stings

extreme pain, localized swelling and discoloration, - however generally not life threatening

what spiders can deliver serious, life-threatening bites

female black widow (neurotoxic), brown recluse (cytotoxic)

s/sx Lyme diease

fever, flulike symptoms, associated with a bulls-eye rash that can spread. painful swelling of the joints, similar to arthritis. this may lead to permanent disability

why are tick bites potentially dangerous

from the organisms they carry, not the bite itself. the two common infectious disease they carry are rocky mountain spotted fever and lyme disease

mild hypothermia

greater than 93.2F s/sx: shivering, foot stamping, pulse rapid, breathing rapid, skin red or pale, may be slightly cyanotic cardiorespiratory: constricted blood vessels, tachypnea LOC: alert, possibly withdrawn

describe what a frostbitten area looks like

hard and waxy to the touch, inflamed, tender, possibly cyanotic

s/sx of high altitude or dysbarism injuries

headache, light headedness, fatigue, loss of appetite, nausea, difficulty sleeping, shortness of breath, swollen face

what are the three categories of a heat emergency

heat cramps, heat exhaustion, heat stroke

what is the most common heat emergency

heat exhaustion

what is the most serious heat emergency

heat stroke - untreated always results in death. may be 104F or higher

people who are at the greatest risk for heat emergencies

infants/children, geriatric patients, heart disease patients, COPD, diabetes, dehydration, obesity, limited mobility

s/sx of black widow spider bite

instant numbing, localized pain, agonizing muscle spasms, damage to nerve tissue, dizziness, sweating, nausea, vomiting, rashes, tight chest, difficulty breathing, severe cramps. these develop within 24 hours and subside within 48 if non life threatening.

superficial vs. deep frostbite depends on

like burns, how deep the area is affected. you may not be able to tell how deep it is in the field

s/sx of brown recluse spider bite

local tissue damage, painful overtime, swollen, tender, pale modeled skin with a cyanotic center, blistering, dead skin and fat debris may be shown over time. however; they rarely show symptomatic s/sx's.

convection

loss of body heat by air movement

mild lightening strike

loss of consciousness, amnesia, confusion, tingling, burns typically superficial

conduction

loss of heat by direct contact

ataxia

loss of muscle coordination and balance

management of heat stroke

main goal: lower core body temperature. remove from environment and into a cool environment, monitor ABC's, cold water immersion/ice bath if possible until the patient reaches 101F (do not overcool), rapid transport

categories of lightening strikes

mild moderate severe

extent of hypothermia can range from

mild, moderate, to severe

s/sx snake bites

obvious puncture wounds, discoloration, swelling, pain, severe burning, weakness, nausea, vomiting, sweating, seizures, fainting, vision problems, ALOC, shock, paralysis, change in behavior, respiratory issues

Rocky Mountain Spotted Fever

occurs 7-10 days post bite. s/sx include nausea, vomiting, headache, weakness, paralysis, cardiorespiratory collapse

emergencies at the bottom

often include inadequate O2 and CO2 exchange, often caused by faulty gear.

treating HAPE and HACE

oxygen, return to low altitude, monitor ABC's, consider BVM or CPAP if indicated

what types of patients are more prone to hypothermia

pediatric, geriatric, ill, burns, head injury, stroke, infections, injuries to spine, diabetes, hypoglycemia.

gangrene (necrosis)

permanent cell death occurs when tissue is frozen and destructive chemical changes occur in the cells

what happens when cells freeze

permanent damage, possible death. it changes the chemistry of the cells

factors that will affect how a person deals with a cold or hot enviornment

physical condition, age, nutrition, hydration, environmental conditions

how to assess core temperature

pull back your glove and place the back of your hand on the patient's skin at the abdomen using a special hypothermia thermometer

Pit vipers

rattlesnakes, copperheads, cottonmouths

treatment of stinging from coelenterates

remove from area, scrape off any substances, monitor for shock/anaphylaxis, place below area of heart, monitor vitals and ABC's, prompt transport. consider soaking area in hot water for 30 minutes

treating a patient with hypothermia

remove from cold environment, remove any wet clothing, provide a warm blanket, administer warm humidified oxygen, slowly warm the patient patients can possibly go into v-fib, do not massage extremities, to not give any stimulants because stimulants are a vasoconstrictor your main goal is to prevent additional heat loss

management of heat cramps

remove from environment, loosen clothing monitor ABC's, rest the cramping muscles, give fluids (nothing with salt), cool the patient

Management of Heat Exhaustion

remove from environment, loosen clothing, monitor ABC's and LOC, cool the patient with a mist or ice packs, encourage the patient to relax, fluids (nothing with salt) most will recover in 30min

management of tick bites/ticks

remove tick, use fine tweezers and pull by the head, clean area with antiseptic, bring tick along for examination

moderate lightening strike

seizures, respiratory arrest, dysrhythmias, superficial burns

Nematocysts

stinging cells of coelenterates- small capsules that contain a toxin s/sx include headache, dizziness, muscle cramps, fainting

severe hypothermia

sub 86F s/sx: unconsciousness, death is likely (but do not asssume), slow pupil response cardiorespiratory: cardiac arrest, respiratory arrest, very slow vitals LOC: unresponsive

tetany

tension; prolonged, continuous muscle contraction/spasms

homeostasis

the balance of all systems of the body

why are the exposed parts of your body and extremities more affected during hypothermia

the body sends more blood to the vital organs and keep the core temperature warm

evaporation

the conversion of water or another fluid from a liquid to gas

respiration

the loss of body heat as warm air in the lungs is exhaled into the atmosphere and cooler air is inhaled

describe frostnip

the skin may freeze whereas the deeper tissues are unaffected; often affecting the ears nose and fingers. skin will be pale and cold to the touch, it may also be wrinkled. patients may have loss of sensation

laryngospasm

the sudden spasmodic closure of the larynx

significance of potential pit viper or coral snake bites

these venoms can cause paralysis; prompt transport to an appropriate receiving ED. contact hospital to ensure they have the correct antivenin