Chapter 31

About ___ percent of the people who die from drowning die just from the lack of air.

10

Although all spiders are venomous, most species cannot get their fangs through human skin. The black widow spider and the brown recluse, or fiddleback, spider are two that can, and their bites can produce medical emergencies. Almost all brown recluse spider bites are painless, and patients seldom recall being bitten. The characteristic lesion appears in only ___ percent of cases and only after up to 12 hours. EMTs are seldom called to respond to a brown recluse bite. However, black widow bites cause a more immediate reaction. Scorpion stings are common in the Southwest United States. They do not ordinarily cause deaths, but one rare species (Centruroides exilcauda) is dangerous to humans and can cause serious medical problems in children, including respiratory failure.

10

Snakebites require special care but are usually not life threatening. Nearly fifty thousand people in the United States are bitten by snakes each year. Although more than eight thousand of these cases involve venomous snakes, on the average fewer than ten deaths each year are reported from snakebites. (In the United States, more people die each year from bee and wasp stings than from snakebites.) The signs and symptoms of snakebite envenomation may take several hours to appear. If death does result, it is usually not a rapidly occurring event unless anaphylactic shock develops. Most patients who die survive at least ___ days.

2

In the United States, there are two types of native venomous snakes—pit vipers (including rattlesnakes, copperheads, and water moccasins) and coral snakes. Up to __ percent of pit viper bites and __ percent of coral bites are "dry bites" without venom injection. However, the venomous bite from a diamondback rattler or coral snake is considered very serious. Since each person reacts differently to a snakebite, you should consider the bite from any known venomous snake or any unidentified snake to be a serious emergency. Staying calm and keeping the patient calm and at rest are critical.

25 50

Although body heat transferred directly into cool air is a problem, water chill is an even greater problem because water conducts heat away from the body ___X times faster than still air.

25X

Decompression sickness is usually caused when a diver comes up too quickly from a deep, prolonged dive. The quick ascent causes nitrogen gas to be trapped in the body tissues then in the bloodstream. Decompression sickness in scuba divers takes from 1 to 48 hours to appear, with about 90 percent of cases occurring within ___ hours of the dive. Divers increase the risk of decompression sickness if they fly within ___ hours of a dive.

3 12

Some patients who drown in cold water can be resuscitated after ___ minutes or more in cardiac arrest. Once the water temperature falls below ___°F, biological death may be delayed. The colder the water, the better the patient's chances for survival, unless generalized hypothermia produces lethal complications.

30 70

In cases of extreme hypothermia, you will find the patient unconscious with no discernible vital signs. The heart rate can slow to less than 10 beats per minute, and the patient will feel very cold to your touch (core body temperature may be below 80°F). Even so, it is possible that a patient in this condition is still alive! Provide emergency care as follows: •Assess the carotid pulse for ____ to ____ seconds. If there is no pulse, start CPR immediately and prepare to apply the AED. •If there is a pulse, follow the care steps for a patient who is unresponsive or not responding appropriately as previously listed. Because the hypothermic patient may not reach biological death for more than 30 minutes, the hospital staff will not pronounce a patient dead until after they have rewarmed him and applied resuscitative measures. This means you cannot assume that a severe hypothermia patient is dead on the basis of body temperature and lack of vital signs. As medical personnel point out, "You're not dead until you're warm and dead!"

30 to 45

Chapter Glossary - application of an external heat source to rewarm the body of a hypothermic patient. - gas bubble in the bloodstream. The plural is air emboli. The more accurate term is arterial gas embolism (AGE). - application of heat to the lateral chest, neck, armpits, and groin of a hypothermic patient. - the transfer of heat from one material to another through direct contact. - carrying away of heat by currents of air, water, or other gases or liquids. - a condition resulting from nitrogen trapped in the body's tissues, caused by coming up too quickly from a deep, prolonged dive. A symptom of decompression sickness is "the bends," or deep pain in the muscles and joints. - the process of experiencing respiratory impairment from submersion/immersion in liquid, which may result in death, morbidity (illness or other adverse effects), or no morbidity. - the change from liquid to gas. When the body perspires or gets wet, evaporation of the perspiration or other liquid into the air has a cooling effect on the body. - an increase in body temperature above normal, which is a life-threatening condition in its extreme. - generalized cooling that reduces body temperature below normal, which is a life-threatening condition in its extreme. - cooling or freezing of particular (local) parts of the body. - covering a hypothermic patient and taking other steps to prevent further heat loss and help the body rewarm itself. - sending out energy, such as heat, in waves into space. - breathing. During respiration, body heat is lost as warm air is exhaled from the body. - substances produced by animals or plants that are poisonous to humans. - a toxin (poison) produced by certain animals such as snakes, spiders, and some marine life forms. - chilling caused by conduction of heat from the body when the body or clothing is wet. - chilling caused by convection of heat from the body in the presence of air currents.

Chapter Glossary active rewarming - application of an external heat source to rewarm the body of a hypothermic patient. air embolism - gas bubble in the bloodstream. The plural is air emboli. The more accurate term is arterial gas embolism (AGE). central rewarming - application of heat to the lateral chest, neck, armpits, and groin of a hypothermic patient. conduction - the transfer of heat from one material to another through direct contact. convection - carrying away of heat by currents of air, water, or other gases or liquids. decompression sickness - a condition resulting from nitrogen trapped in the body's tissues, caused by coming up too quickly from a deep, prolonged dive. A symptom of decompression sickness is "the bends," or deep pain in the muscles and joints. drowning - the process of experiencing respiratory impairment from submersion/immersion in liquid, which may result in death, morbidity (illness or other adverse effects), or no morbidity. evaporation - the change from liquid to gas. When the body perspires or gets wet, evaporation of the perspiration or other liquid into the air has a cooling effect on the body. hyperthermia - an increase in body temperature above normal, which is a life-threatening condition in its extreme. hypothermia - generalized cooling that reduces body temperature below normal, which is a life-threatening condition in its extreme. local cooling - cooling or freezing of particular (local) parts of the body. passive rewarming - covering a hypothermic patient and taking other steps to prevent further heat loss and help the body rewarm itself. radiation - sending out energy, such as heat, in waves into space. respiration - breathing. During respiration, body heat is lost as warm air is exhaled from the body. toxins - substances produced by animals or plants that are poisonous to humans. venom - a toxin (poison) produced by certain animals such as snakes, spiders, and some marine life forms. water chill - chilling caused by conduction of heat from the body when the body or clothing is wet. wind chill - chilling caused by convection of heat from the body in the presence of air currents.

Local cooling most commonly affects the: (5)

Ears, nose, face, hands/fingers, feet/toes

Since evaporative heat loss is reduced in a humid environment, moist heat can produce dramatic body changes in a short time. ______ heat usually tires people quickly and frequently stops them from harming themselves through overexertion. _____ heat, in contrast, often deceives people. They continue to work or remain exposed to excess heat far beyond what their bodies can tolerate.

Moist Dry

__________ rewarming allows the body to rewarm itself. It involves simply covering the patient and taking other steps, including removal of wet clothing, to prevent further heat loss. These actions allow the body to naturally regain its warmth. ____________ rewarming includes application of an external heat source to the body. All EMS systems permit passive rewarming. Although some allow the active rewarming of a hypothermic patient who is alert and responding appropriately, many do not. Follow your local protocols.

Passive Active

_____________ causes loss of body heat as a result of exhaled warm air. The amount of heat loss depends on the outside air temperature as well as the rate and depth of respirations.

Respiration

Define venom

a toxin (poison) produced by certain animals such as snakes, spiders, and some marine life forms.

Scuba-diving accidents include all types of body injuries and drownings. In many cases the scuba-diving accident was brought about by medical problems that existed prior to the dive. There are two special problems seen in scuba-diving accidents:

air emboli in the diver's blood and decompression sickness.

Define respiration

breathing. During respiration, body heat is lost as warm air is exhaled from the body.

Define convection

carrying away of heat by currents of air, water, or other gases or liquids.

Define water chill

chilling caused by conduction of heat from the body when the body or clothing is wet.

Define wind chill

chilling caused by convection of heat from the body in the presence of air currents.

Define local cooling

cooling or freezing of particular (local) parts of the body.

Since infants and young children are small with large skin surface areas in relation to their total body mass and have little body fat, they are especially prone to hypothermia. Because of their small muscle mass, infants and children do not shiver very much or at all—another reason the very young are susceptible to the cold. You will learn that a crucial part of the care for newborn infants is to ____ them (to prevent heat loss from evaporation) and cover their ________ (to prevent heat loss by radiation and convection).

dry heads

Define hypothermia

generalized cooling that reduces body temperature below normal, which is a life-threatening condition in its extreme.

Keep in mind that the greatest area of heat loss may be the ______, so provide some sort of head covering for the patient.

head

In conduction and convection, heat is "picked up" by the surrounding (still or moving) air or water. In radiation the body's atoms and molecules send out rays of heat as they move and change. If you were in the vacuum of outer space with no air or water around to pick up heat, you would still lose heat by radiating it out into space. Most radiant heat loss occurs from a person's __________ and ____________.

head and neck

Prolonged exposure to excessive heat can create an emergency in which the patient presents with moist, pale skin that may feel normal or cool to the touch, a condition generally known as _________ __________. The individual perspires heavily, often drinking large quantities of water. As sweating continues, the body loses salts, bringing on painful muscle cramps (sometimes called _________ ___________). Healthy individuals who have been exposed to excessive heat while working or exercising may experience a form of shock brought about by fluid and salt loss. This condition is often seen among firefighters, construction workers, dockworkers, and those employed in poorly ventilated warehouses. It is a particular problem during prolonged heat waves early in the summer, before people have become acclimatized to summer heat.

heat exhaustion heat cramps

When a person's temperature-regulating mechanisms fail and the body cannot rid itself of excessive heat, you will see a patient with hot and dry or possibly moist skin. When the skin is hot—whether dry or moist—this condition, generally known as _________ ____________, is a true emergency. The problem is compounded when, in response to loss of fluid and salt, the patient stops sweating, which prevents heat loss through evaporation.

heat stroke

heat is lost through the ______ and ______.

lungs and skin

Define Morbidity

means the patient experiences illness or other adverse effects, such as unconsciousness or pneumonia.

cervical-spine injuries are the ___________ common of the spine injuries seen in water-related accidents.

most

You may encounter airway resistance as you ventilate the drowning patient. However, you will probably have to ventilate more forcefully than you would other patients. A patient with water in the lungs usually has water in the stomach, which will add resistance to your efforts to provide rescue breathing or CPR ventilations. Since the patient may have spasms along the airway or swollen tissues in the larynx or trachea, you may find that some of the air you provide will go into the patient's stomach. Remember, the same problem will occur if you do not properly open the airway or if your ventilations are too forceful. If gastric distention interferes with artificial ventilation, place the patient on his left side. With suction immediately available, the EMT should place his hand over the epigastric area of the abdomen and apply firm __________ to relieve the distention. This procedure should be done only if the gastric distention interferes with the EMT's efforts to artificially ventilate the patient in an effective manner.

pressure

Research indicates that the use of a ___________ ____________ _____________ may be the most effective technique to slow the spread of venom after a snakebite. This technique involves immediately wrapping the bitten extremity with an elastic (ACE-type) bandage and immobilizing the wrapped extremity with a rigid splint or a sling on the upper extremity. The wrap should be only as snug as if you were wrapping a sprained ankle. The purpose of the pressure immobilization bandage is to restrict the flow of lymph, not of blood. The wrap should be snug but not tight enough to cut off circulation. Monitor for a pulse at the wrist or ankle. Check to be certain that tissue swelling does not cause the constricting bands to become too tight.

pressure immobilization bandage

Local cooling most commonly affects the ears, nose, face, hands and fingers, and feet and toes. When a part of the body is exposed to intense cold, blood flow to that part is limited by the constriction of blood vessels. When this happens, tissues freeze. Ice crystals can form in the skin and, in the most severe cases, gangrene (localized tissue death) can set in, which may ultimately lead to the loss of the body part. As you read the following pages, notice how the signs and symptoms of early or superficial cold injuries are progressive. First, the exposed skin _________ in light-skinned individuals. In dark-skinned individuals, the skin color lightens and approaches a _______ (reduced-color or whitened) condition. As exposure continues, the skin takes on a gray or white blotchy appearance. Exposed skin becomes numb because of reduced circulation. If the freezing process continues, all sensation is lost and the skin becomes dead white.

reddens blanched

Drowning is the process of experiencing _________________ ______________ from submersion/immersion in liquid. Drowning outcomes are classified as death, morbidity, and no morbidity. Morbidity means the patient experiences __________ or other adverse effects, such as unconsciousness or pneumonia.

respiratory impairment illness

Define radiation

sending out energy, such as heat, in waves into space.

Define toxins

substances produced by animals or plants that are poisonous to humans.

Most diving accidents involve the head and neck, but you will also find injuries to the spine, hands, feet, and ribs in many cases. In the majority of these accidents, the patient is a __________.

teenager

For infants or young children, cooling is started using _______ (lukewarm) water. This water can then be replaced with cooler water at the recommendation of medical direction.

tepid

Define evaporation

the change from liquid to gas. When the body perspires or gets wet, evaporation of the perspiration or other liquid into the air has a cooling effect on the body.

Define drowning

the process of experiencing respiratory impairment from submersion/immersion in liquid, which may result in death, morbidity (illness or other adverse effects), or no morbidity.

Define conduction

the transfer of heat from one material to another through direct contact.

Insect stings, spider bites, and scorpion stings are typical sources of injected poisons, or ___________—substances produced by animals or plants that are poisonous to humans. (________ is a term for a toxin produced by some animals such as snakes, spiders, and certain marine life forms.) Commonly seen insect stings are those of wasps, hornets, bees, and ants. Insect stings and bites are rarely dangerous. However, ___ percent of the U.S. population will have an allergic reaction to them, which may result in shock.

toxins Venom 5

Venomous marine life forms producing sting injuries include the jellyfish, the sea nettle, the Portuguese man-of-war, coral, the sea anemone, and the hydra. For most victims, the sting produces pain with few complications. Some patients may show allergic reactions and possibly develop anaphylactic shock. These cases require the same care as rendered for any case of anaphylactic shock. Stings to the face, especially those near or on the lip or eye, require a physician's attention. Rinsing the affected area with ___________ will reduce the pain of the sting. However, be careful not to let vinegar get into the patient's mouth or eyes. Once the site has been rinsed with vinegar to inactivate the venom, immersion of the site in hot but nonscalding water (maximum temperature 45°C or 113°F) may further reduce the ______. Puncture wounds can occur when someone steps on or grabs a stingray, sea urchin, spiny catfish, or other form of spiny marine animal. Although it is true that soaking the wound in nonscalding hot water for 30 to 90 minutes will _________ ___________ the venom, you should not delay transport. Puncture wounds must be treated by a physician, and the patient may need a tetanus inoculation. Remember, the patient could react to the venom by developing anaphylactic shock.

vinegar pain break down

Do not allow the drowning patient to _______. Transport the patient. A significant number of patients who appear normal after a drowning episode have delayed effects, so persuade the patient to accept transport to a hospital.

walk