Emergency

The ___________ and ___________ of hypoxia are two most important factors that determine the outcome of the drowning victim.

duration and severity

So _______ heat stroke has a sudden onset, and is often a result of some type of strenuous physical activity in the hot, humid conditions. They are not being used to the hot weather or wearing clothing too heavy for the environment, are common contributing factors.

exertional

The two major types of heat stroke are what they call

exertional or classic.

External hemorrhage is usually quite obvious, and best controlled with...

firm direct pressure on whatever is bleeding with dry dressing materials. This method is effective in decreasing blood flow for the major portions of the wounds. Even those caused by amputations. Tourniquets that occlude arterial blood flow distal to the injury are best reserved to control bleeding when hemorrhage is so severe that the risk to limb viability is justified to save the life. So you don't want to use a tourniquet, you want to use it as a last resort. But if you got a choice between saving the patient or saving that limb, you're going to put a tourniquet on that limb and stop that bleeding so you can save the patient.

edema and blister formation within 24 hours after ______, injury occurring in an area covered by tightly fitted boot. So this one they're out there in the weather in the tightly fit boot and that's what happens when it gets too cold.

frostbite

frostbite can be divided into:

frostbite occurs when body tissue freezes and causes damage. Just like burns, frostbite injuries can be labeled superficial, partial, or full thickness.

What is the saying for the snake that are poisonous?

"RED touches YELLOW will kill a fellow & RED touches Black is a friend of Jack"

interventions for the brown recluse spider=

- Hospitalization is rarely indicated unless complications are present. - Topical antiseptic and sterile dressings can be applied to wound. - Administer tetanus prophytaxis as needed. - Teach supportive care measures. - Teach to take full course of antibiotics, if prescribed. - Teach that débridemnent and skin grafting may be needed for extensive wounds -When the eschar sloughs, that is where you will have that open wound and ulcer there, And that can remain for weeks or even months, and you may have to pack the wound.

Interventions (hospital care) for the black widow spider=

- Monitor older adults, especially those with cardiovascular disease, for hypertensive complications. -Monitor vital signs; these are normal in most patients although hypertension, tachycardia, and tachypnea may arise from anxiety, pain, or venom effects(Swanson et al. 2020). -Administer opioid pain medication and muscle relaxants as prescribed -Administer tetanus prophylaxis as prescribed -Contact regional poison control for specific advice on antivenin dosing and further management. -Administer antivenin as prescriced. monitor for signs of anaphylaxis and serum sickness,The drug is also given to pregnant women because they may have uterine contractions from a black widow spider bite that could lead to premature release.

First aid/ prehospital care of coral snakes=

- Move to safety, away from snake - Call for immediate emergency assistance - Encourage rest to decrease venom circulation - Remove jewelry and constrictive clothing - Take photos of snake from a safe distance to aid in identification - Identify snake as a coral snake, If possible - Encircle affected extremity with an elastic bandage or roller gauze dressing do not wrap so tightly that arterial flow is impeded): then splint. Leave on until the patient is treated at an acute care facility.

First Aid/ Prehospital Care for Pit Vipers:

- Move to safety, away from snake - Call for immediate emergency assistance - Encourage rest to decrease venom circulation - Remove jewelry and constrictive clothing - Take photos of snake from a safe distance to aid in identification - Immobilize affected extremity in position of function- maintain at level of heart - Keep patient warm, provide calm environment - Do not incise or suck wound, apply ice, or use a tourniquet

Interventions: Take Action: Hospital Care for the Pit viper (rattlesnakes, cottonmouths, copperheads) =

- Obtain complete history of event (snake appearance, time of bite, prehospital interventions, and any past snakebites or antivenin therapy - Give supplemental oxygen - Insert two large -bore IV lines - Infuse fluids as prescribed -Monitor heart function and blood pressure -Administer opioids to decrease pain - Obtain coagulation panel, CBC, CK. type and crossmatch, urinalysis - Obtain ECG - Mark, measure, and record circumfererice of bitten extremity q15-30 minutes - See Table 11.1 for envenomation severity -Contact regional poison control for specific advice on antivenin dosing and further management - Administer crotalidae polyvalent immure fab (if prescribed)

Maintaining Patient and Staff Safety in the Emergency Departmen: Safety considerations =

- Patent identification - injury prevention for patients - Risk for errors and adverse events - Injury prevention for staff

Preventing, Recognizing, and Treating Altitude-Related Illnesses

- Plan a slow ascent to allow for acclimatization - Learn to recognize signs and symptoms of altitude-related illnesses - Avoid overexertion and overexposure to cold; rest at present altitude before ascending further - Ensure adequate hydration and nutrition - Avoid alcohol and sleeping pils when at high altitude - For progressive or advanced acute mountain sickness (AMS), recognize symptoms and implement an immediate descent, provide oxygen at high concentration - To prevent the occurrence of AMS, discuss the use of acetazolamide or dexamethsone as indicated with your health care provider • Protect skin and eyes from the harmful ultraviolet rays of the sun at high altitude. Wear sunscreen lat least SPF 30) and high quality wraparound sunglasses or goggles

first aid care/ prehospital care for bees & wasps=

- Quickly remove stinger with tweezers or by gently scraping or brushing it off with the edge of a knife blade, credit card, or needles (if present) (Auerbach, 2016) and apply ice pack. - Ensure that airway, breathing, and circulation are maintained. - If patient has history of allergic reactions to stings or has wheezing, facial swelling, and respiratory distress, epinephrine must be given immediately. Allergic adult patients typically carry an epinephrine autoinjector. (See Chapter 18 for further discussion of epinephrine administration for anaphylaxis management.) Follow with antihistamines (H1 and H2 blockers) and albuterol.if carried by the patient and available

What is the Pathophysiology care of coral snakes=

- Venom contains nerve and muscle toxins -Blocks neurotransmission - Toxic effects may be delayed up to 10-12 hours and then produce rapid clinical deterioration (Norris, 2019)

Interventions (hospital care for bees and wasps) =

-Administer oxygen. -Monitor cardiac function and blood pressure. - Administer epinephrine, antihistamines (both H1 and H2 blockers), albuterol and corticosteroids as prescribed. -Ensure that advanced life support drugs and resuscitation equipment are readily available -Observe anyone with multiple stings for several hours. - Anticipate admission to critical care if toxic venom effects are noted.

First aid/ prehospital care for black widow spider=

-Apply ice pack to decrease action of neurotoxin. -Monitor for systemic toxicity, support airway. breathing and circulation as needed -Transport to acute care facility as soon as possible

What is the characteristics of a coral snake?

-Bands of black. red, and yellow that encircle the snake's body - Small maxillary fangs

How do we minimize risk with pt. identification in the ER

-Provide an identification (ID) bracelet for each patient. -Use two unique identifiers (e g., name, date of birth). -If patient identity is unknown, use a special identification system

Interventions: Take action: hospITAL CARE FOR coral snakes:

-Identify snake as a coral snake if possible. If unidentifiable, treat as if venom were injected. - Monitor for toxic effects that may be delayed. - Monitor for CK level elevation from muscle breakdown and myoglobinuria. - Monitor cardiac function, blood pressure, and pulse oximetry. - Anticipate admission to a critical care unit. - Be prepared to provide aggressive airway management if respiratory insufficiency or severe neurolagic impairment occurs. - Initiate interventions to decrease risk for aspiration. - Coral snake antivenin is not currently manufactured in the United States although some existing stock may remain). Supportive care is recom- mended Norris. 2019). - Teach that effects of a severe bite can persist for many days (Norris, 2019). - Contact regional poison contral for specific advice on management.

How do we minimize risk with injury prevention for pts. in the ER

-Keep rails up on stretcher. -Keep stretcher in lowest position. -Remind the patient to use call light for assistance. -Reorient the confused patient frequently -If patient is confused, ask a family member or significant other to remain with him or her. -Implement measures to protect skin integrity for patients at risk for skin breakdown

characteristic of Brown recluse spiders=

-Medium-size, brown fiddle-shaped mark from eyes down their back - Live in boxes, closets, basements, sheds, garages

interventions for scorpion sting=

-Monitor vital signs, especially heart rate and respiratory function. -Patients with Grade Ill or IV symptoms require admission for intensive supportive care. - Provide basic wound care with antiseptic agent and apply ice pack to sting site. - Administer tetanus prophylaxis as needed. - Use caution if administering sedative agents opioids, benzodiazepines, and barbiturates as these increase risk for respiratory failure. -Contact regional poison control for specific information on pharmacologic agents for scorpion stings.

first aid care/ prehospital care of Brown recluse spiders=

-Move to safety, away from snake -Call for immediate assistance - Encourage rest to decrease venom circulation -Remove jewelry and constrictive clothing - Take photos of snake from a safe distance to aid in identification - Apply cold compresses over site of bite. - Do not apply heat because it increases enzyme activity and potentially worsens wound. - Elevate affected extremity, provide local wound care, and rest.

How do we mimizre risk for Risk for errors and adverse events in the ER

-Obtain a thorough patient and family history - Check the patient for a medical alert bracelet or necklace -Search the patient's belongings for weapons or other harmful items such as drugs and drug paraphernalia when he or she has an altered mental status or presents with behavioral health concerns.

Reasons People Seek ED Care:

-This is just some of the reasons that people might come to the ED; you might have the abdominal pain and she shared that the doctor or the charge nurse called a huddle cause they're saying if an elderly person comes in with abdominal pain, you should get them seen because usually it is cardiac related. -Chest pains -Breathing Difficulty -Injuries (Especially Falls) -Headache -Fever -Pain (most common)

Pit viper (rattlesnakes, cottonmouths, copperheads) characteristics =

-Triangular head -Two retractable curved fangs -Single row of ventral subcaudal scales -Rattlesnakes have vibrating horny rings in their tails

How do we minimize injury prevention for staff in the ER:

-Use Standard Precautions at all times -Anticipate hostile, violent patient, family and/or visitor behavior -Plan and practice options if violence occurs, including assistance from the secunty department

Pit viper (rattlesnakes, cottonmouths, copperheads) pathophysiology =

-Venom immobilizes and aids in digestion of prey; may be lethal - Has local and systemic effects - Enzymes break down human tissue proteins, alter tissue integrity

_____ is a superficial cold injury that the patient represents with pain, it'll feel numb, pallor of the affected area but is easily relieved when you apply warmth. It does not cause tissue damage at all. Frostnip typically develops on skin; areas such as your face, your nose, fingers or toes. Untreated is a precursor to more severe forms of frostbite.

frostnip

Assessment: Recognize Cues for the Pit viper (rattlesnakes, cottonmouths, copperheads) =

Assess for: • Puncture wounds -Pain, swelling, redness, and/or bruising around bite(s) • Vesicles or hemorrhagic bullae (may form later) • Report of minty, rubbery, or metallic taste • Tingling or paresthesias on scalp, face, and lips. - Muscle twitching, weakness • Nausea and vomiting - Hypotension, seizures - Clotting abnormalities or DIC

bites result in ulcerative lesions.

Brown recluse spider brown recluse spider bites after 24 hours, (the picture above) that is what the bite can look like. It starts kinda sloughing that center portion out.

The anti venom is what they call Crofab- this is what they give for snake bites, should be given to your patients as soon as possible within six hours of the bite. The recommended dosage is ___1____ vials within ___2____minutes-during the first 10 minutes the infusions should be slow, because we want to see if they get an reaction (serum sickness). What must you monitor withe the serum sickness?

1. 4-6 2. 60 monitor the patient closely for any reactions such as hives, rashes, difficulty breathing and you will stop the the anti venom If symptoms are not controlled effectively with the first dose, an additional four to six may need to be given

Disability; the disability examination provides a rapid baseline assessment of neurologic status. A simple method to evaluate LOC is the AVPU mnemonic which is: Another common way of determining and documenting LOC is __________________, Now what is the lowest score? 3. What's the highest? 15. So what does 15 mean? They're good. What does 3 mean? They're bad. Metabolic abnormalities such as severe hypoglycemia, hypoxia, neurologic injury, and illicit drugs or alcohol can impair LOC. So you'll have to know all this. A lot of times they'll do blood draws to see if they're drunk, if they're on drugs, or what's going on.

1. A is alert. V is Responsive to voice, do they only open their eyes when you speak to them. P is responsive to pain when you rub that sternum real hard, do they respond to you then. or U is unresponsive. 2. Glasgow coma scale (GCS).

An important point to recognize is that triage concepts in a mass casualty incident is different from civilian triage method. Although disaster triage practices can vary widely based on the local EMS protocols, some concepts are fairly universal. Most mass casualty response teams both in the field, at the disaster site, in the hospital setting use a disaster triage tag system that categories triage priority by color and number=

1. Emergent, they call it class one; Patients are identified with a red tag. Patients have an immediate threat to life, such as airway obstruction or shock. 2. Yellow: Patients who can wait a short time for care is considered class two and are marked with a yellow tag. Patients have major injuries such as open fractures with a distal pulse, large wounds that need treatment within 30 minutes to two hours. 3. Non-urgent or walking wounded; they call this class three and patients are given a green tag. Patients have minor injuries that can be managed in a delayed fashion. Generally, more than two hours such as closed fractures, sprains, strains, abrasions and contusion. The green tag patients are often referred to as the "walking wounded" they may actually evacuate themselves from the mass casualty scene and go to the hospital in a private vehicle. Green tag patients usually make up the greatest number and the large scale of the mass casualty situations. They can overwhelm the system if provisions are not made to handle them as part of the disaster plan. So, they might say, "Well, I'm not hurt, I just got a little cut or sprain I'm hurting. I'm going to get my car or in somebody's car and they're going to drive me to the hospital" So what if 200 people do that? Also, because they often come to the hospital on their own, the hospital may not be able to determine how many actual casualties will arrive. A related concern is that green tag patients who accept transport may unknowingly carry contaminants from the scene into the hospital. Now the hospital is contaminated. ED staff must anticipate these issues and devise emergency response plans accordingly. 4. Patients who are expected to die or are dead are issued the black tag, which is class 4.

What are the interventions for heat exhaustion:

1. Have the person stop immediately whatever they're doing, stop any physical activity and move them to a cool place. 2. And use cooling measures such as placing cold packs on the neck, chest, abdomen, groin. So you place the cold packs in areas that helped reduce that fever. 3. Soaking the person in cold water or fanning them while spraying water to the skin- do anything to try to keep them cool. 4. Remove any constricted clothing 5. provide an oral re hydrating solution such as some kind of sports drink, 6. Do not give salt tablets do not, They can cause stomach irritation & nausea and vomiting. So just give them some kind of sports drink because thats got all your electrolytes in there.

_______1________, a carbonic anhydrase inhibitor, is commonly prescribed to prevent or treat AMS. It acts by causing a bicardonate diuresis, which rids the body of excess fluid and induces metabolic acidosis. The acidotic state increases respiratory rate & decreases the occurrence of periodic respiration during night. In this way it helps patients acclimate faster to a high altitude. For best results, the drug should be taken 24 hours before ascent and be continued for the first 2 days of the trip

1.Acciazolamide,

So the A is the airway or cervical spine, this is the highest priority intervention is to establish a patent airway. Even minutes without an adequate oxygenation can lead to brain injury and death. In general, they might can use a ____1___ is best for spontaneous breathing patient. They might have to use a ______2____, for ventilation. A patient with significant impaired consciousness requires the __________3___________

1.non-rebreather mask 2.bag valve mask, BVM, 3. endotracheal tube and then placed on the vent.

The most importati intervention to manage serious altitude-related illnesses is _________1__________, Patients must be monitored carefully for evidence of ______2_______ progression. The patient with mild AMS should be allowed to rest and acclimate at the current altitude. The person is instructed not to ascend to a higher altitude, especially for sleep, until symptoms lessen. If symptoms persist or worsen, he or she should be moved to a lower altitude as soon as possible. Even a descent of about 1600 feet may improve the patient's condition and reverse altitude-related pathologic effects. If available, oxygen should be administered to effectively treat symptoms of AMS One drug that is indicated in the treatment of moderate-to-severe AMS is ____________. The mechanism of action of this drug is unclear for AMS treatment, but it appears to reduce cerebral edema by acting as an anti-inflammatory in the CNS. It does not speed acclimatization like acetazolamide does, but it does relieve the symptoms of AMS. If the drug is stopped before acclimatization takes place, symptoms of AMS may recur (Centers for Disease Control and Prevention, 2017).

1. descent to a lower altitude 2. symptom dexamethasone

For all degrees of partial thickness and full thickness frostbite, rapid rewarming in a water bath at a temperature range of _____1_____ is indicated to help thaw that part out. If a warming tub is not available, you can use hot towels instead. Don't get it too hot, you don't want to burn them. Because patients experience severe pain during the rewarming process, this intervention is best accomplished in the hospital. Administer analgesics, especially IV opiates and IV rehydration. Do not apply ______2______or ____3_____ the frostbit areas as part of the rewarming process because this can further damage the injury. So do not apply____2_____ or ___3____ the frostbitten areas. When the rewarming process is complete, you want to handle the injured area gently and elevate them above the heart level if possible to decrease tissue edema. Splints can be used to immobilize the extremities during this process. Always assess the person every ____4_____ for developmental of compartment syndrome and this usually results from the bleeding or swelling after the injury. Remember that will cause no blood flow to go below the areao f the injury, and you don't want that cause then you got to amputate. Obs

1.104 to 108 2. dry heat 3. massage 4. hour 5. ibuprofen increasing pain even after analgesics are given, paresthesias (painful tingling and numbing). Compare that affected extremity with the unaffected one to assess for pallor, assess the pulses in the limb, and the muscle weakness.

_____ degree frostbite is the least severe type of frostbite; it involves hyperemia which is an increase blood flow with edema

1st

In ______ degree frostbite; large fluid filled blisters develop with partial thickness skin necrosis.

2nd

_______ degree frostbite appears as small blisters that contain dark fluid and an affected body part that is cool, numb, blue, it can be red, and it does not blanch. Full thickness and subcutaneous tissue necrosis occur and require debridement. They're going in and cutting all that necrotic tissue out. You will have numbness, cold and bloodless. The full thickness necrosis extends into the muscles and the bone. At this stage that's when gangrene can develop and then you'll probably have to have that limb amputated.

3rd

If the snake bite site does not show evidence of local tissue swelling, and redness within _____ hours, a systemic effect are less likely to develop. So if you're standing there _______ hours and no swelling, no issues occurring, they will probably send you home because you're not going to have a systemic effect.

8

In heat stroke, in pre-hospital you want to...

: do not give food or liquid by mouth, because vomiting and aspiration are a risk for those patients with neurological impairment, especially those older than 65 years of age.

Tx or moderate hypothermia=

; you'll want to apply external heat with heating blankets that can help promote that core temperature. The patient's trunk should be actively rewarmed before the extremities. Core rewarming methods for moderate hypothermia include administration of warm IV fluids, heated oxygenation, heated peritoneal, pleural, gastric or bladder lavage. So you putting that warm fluids in trying to get that warm fluids going through like the nasogastric or the urinary to get all that warmed up.

The initial assessment of the trauma patient is called the primary survey, which is an organized system to rapidly identify and effectively manage immediate threats to life. The primary survey is based on

ABC mnemonics plus the D and E for the trauma patient. So this is ABCDE:

what are some examples of urgent situations?

Abdominal pain (severe) Fractures (displaced or multiple) Renal colic Respiratory infection (especially pneunonia in older adults) Soft-tissue injuries (complex or multiple)

__________________________, training courses that include all the essential aspects of the natural response and management.

Advance disaster life support

So this is ABCDE:

Airway, which is cervical spine is you're A. Then your breathing would be your B. Circulation is your C. Disability is your D. And exposure is your E.

Assessment for the black widow spider=

Assess for • Description of bite as nearly painless to sharply painful • Tiny papule or small, red punctate mark • Systemic muscular complications, which usually develop within an hour of bite • Severe abdominal pain muscle rigidity and spasm, hypertension, nausea, and vomiting. • Very rare complications may include ileus, priapism, cardiomyopathy, or pulmonary edema

Assessment of bees and wasp stings:

Assess for • Wheal-and-flare skin reactions; swelling can be extensive and involve an entire limb or body area. • Urticaria (hives), pruritus (itching), and lip/tongue edema in patients with venom allergy • Signs of anaphylaxis such as bronchospasm, laryngeal edema, hypotension, decreased mental status, and cardiac dysrhythmias. • Systemic effects that develop based on venom load and patient sensitivity, including generalized edema, nausea, vomiting, diarrhea, acute kidney injury, renal failure, liver injury, cardiac complications, and multisystem organ failure,

Assessment-Brown recluse spider =

Assess for: -The central bite site may appear as a wheal or vesicle surrounded by edema & erythema where it's going to be starting to get red & then it starts expanding over time. And then the toxins start spreading to other places. The center bite will become bluish purple looking, some people have few or no tissue changes & require no medical tx. • Center of bite to become bluish-purple or necrotic over the following 1-3 days (Fig. 11.5) in some patients. This is the classic red, white, and blue sign associated with severe bites. - Objective description of bite as painless, stinging, or sharp - Systematic toxicity, although rare, which includes rash, fever, chills, nausea, vomiting, malaise, joint pain • Rare, severe systemic complications (loxoscelism), which may include hemolytic anemia, thrombocytopenia, DiC, and death

assessment for scorpions =

Assess for: • Symptoms that arise immediately after the sting, reaching crisis level within 5 hours. • Gentle tapping at the site of sting, which usually causes increased pain. - A sting site that may not be reddened. • Grade I envenomation: Localized pain and paresthesias at the sting site • Grade Ill envenomation: Local and systemic pain and paresthesias - Grade |II envenomation: Cranial nerve dysfunction (dysphagia, drooling, abnormal eye movements, slurred speech) or somatic skeletal neuromuscular dysfunction (restlessness, abnormal movements, back arching) • Grade IV envenomation: Cranial nerve and somatic skeletal neuromuscular dysfunction

Assessment: recognize cues for coral snakes=

Assess for: • Weakness, cranial nerve deficits (ptosis, diplopia, swallowing diffi- culty), altered level of consciousness, and respiratory paralysis (Norris. 2019) • Pain at the site which may be mild and transient • Fang marks that are difficult to locate

what are some examples of emergent situations?

Chest pain with diaphoresis Hemorrhage Respiratory distress Stroke Vital sign instability

When providing health teaching include several points for near drowning=

Constantly observe people who cannot swim and are in or around water, especially little bitty ones, because they seeing everybody else jumping in the water and they think they can jump in the water too, and they can't even swim. Test the water depth before diving in headfirst, if you can't see the bottom, do not dive in. Never dive in shallow water. Avoid alcohol beverages when swimming and boating and while in proximity to the water. Ensure that water rescue equipment such as life jacket, flotation devices or rope is immediately available when around water. If you got five people in a boat, you need five life jackets.

signs of tension pneumothorax

Decreased or absent breath sounds over affected side Respiratory distress Hypotension JVD Tracheal deviation

Characteristics of the Black widow spiders=

Female: shiny black with a red hourglass pattern on abdomen (hourglass pattern is faint in males) Inhabit cool damp environments such as log piles. vegetation, and rocks: also live in barns, sheds and garages

________ workers must take measures such as obtaining prophylactic medications and vaccines, having a personal evacuation plan, and ensuring access to necessary supplies. Do I have all the PPE that I need? So you got to make sure that you have what you need before you can go out anywhere.

Disaster

offer basic life support interventions such as oxygen, basic wound care, they can splint, spinal immobilization, and monitor vital signs. Some units carry the AEDs and may be authorized to administer selected drugs such as an epi pen or nitro based on the established protocols. And every ambulance service has a doctor that is actually over them, that they have to go through and follow certain protocols.

EMTs

Three-Tiered Triage Systen and Examples of Patients Triaged in Each trier =

Emergent (life threatening ) Urgent (needs quick treatment, but not immediately life threatening) Nonurgent (could wait several hours if needed without fear of deterioration)

disaster is any event outside the healthcare facility or campus somewhere in the community, which requires the activation of the facilities' Emergency Management planning. The number of facilities' staff is not adequate for the incoming patients. External disasters can be a natural such as Hurricanes, technology or biological terror attack, or it could be a big bus that's coming through Thomasville, and it wrecked and had 100 people on there.

External

External cooling methods to that the heat stroke pt=

External continuous cooling methods include using cooling blankets, applying ice packs.

Bees & wasp characteristics:

Found all over United States; *Africanized of "Killer" bees found in southern United States

characteristics of a scorpion=

Found within the United States, although not typically in the Midwest or New England Bark scorpion lives in southwestern United States its sting can be potentially fatal (Fig. 11.6)

what are some examples of nonurgent situations?

Fracture (simple) Rashes Strains and sprains Urinary tract infection

ED physicians and nursing staff underwent what they call "____________" training and learning how to recognize patterns of illnesses in patients who have biological agents like anthrax and smallpox. They have certain protocols, antibiotics and stuff that you have to get.

HAZMAT

This is a primary form of dehydration, it is caused by heavy perspiration as well as inadequate fluid & electrolyte intake during heat exposure over hours to days. Body temperature is not significantly elevated, and the patient may continue to perspire, despite being dehydrated.

Heat-Related Illness: Heat Exhaustion

is a true medical emergency in which the body temperature will exceed 104. It is a high mortality rate if not treated in a timely manner. If the condition is not treated, or the person does not respond to the treatment, that is when you start having organ dysfunction and then death is going to follow.

Heat-Related Illness: Heat Stroke:

Usually located in large teaching hospitals in densely populated areas Provides a full continuum of trauma services for adult and/or pediatric patients Conducting research is a requirement for trauma center verification

Level 1 Trauma center

Hospital intreventions for near drowning =

In the clinical setting, gastric decompression with an NG tube or oral tube is needed to prevent aspiration of gastric contents. So, then you got to worry about all that, what was in their stomach fixing to go into their lungs. After a period of artificial ventilation by mask, the victim typically has a distended abdomen, which impairs movement of the diaphragm and decreased lung ventilation. So, they usually have to have an NG tube to help decompress.

interventions for lighting injuries=

Initial care involves spinal immobilization with priority attention to the airway, breathing and circulation. Cardiopulmonary resuscitation or CPR is performed immediately when a person is in cardiac arrest. Victims of lightning strikes are not electrically charged, so the rescuer is not in trouble or can't be shocked from the physical contact. Hospital care; in the hospital setting the focus of care is advanced life support management which will include cardiac monitoring, they may have to be placed on the vent, they will do A creatinine kinase cause this is due to the skeletal muscle damage. Rhabdomyolysis can lead to renal failure. We need to assess all those burns, they'll be given a tetanus

internal cooling methods to that the heat stroke pt=

Internal cooling methods may include ice gastric or bladder lavage. So they actually can put an NG tube in and put cold solutions down. And then they will suck it back out, So they're trying to get your internal area cool. And they actually can do that with catheters, Also. I don't know if y'all ever notice when a patient comes back from surgery, a lot of times they will have an extra little cord from the catheter, that is a probe that they can check the temperature of that patient while they gotten surgery.

Both typically located in community hospitals

Level I and Level III trauma center

Usually located in rural and remote areas Provides basic trauma patient stabilization and advanced life support within resource capabilities Arranges transfer to higher trauma center levels as necessary

LEVEL lV trauma center

So assessment; the hypothermia is commonly divided into three categories by the severity of the coldness:

Mild would be 90 to 97 (book says 90-95), Moderate is 82-90, and severe is below 82. Treatment decisions are based on the severity of the hypothermia. On page 216 that gives you some key features there's that mild, moderate and severe.

The term "_______" was coined to describe nuclear, biological and chemical threats. In response, emergency medical service agencies and hospitals upgrade their decontamination facilities and equipment. So all hospitals have to have some kind of decontamination area for you to go to cause when you get out there to help somebody, first you got to think about scene safety. You can't just run out there and get involved cause then you could harm yourself, and now they got to worry about the patients plus you. So even if you're riding down the road and there's a wreck, you need to be always thinking about scene safety, is electrical cords down, you know will I go over that. So if you're not sure, stay away until help gets there that knows how to deal with that.

NBC

Grades of Pit Viper Envenomation

None = Fang marks, but no local or systemic reactions minimal= Fang marks, local swelling and pain, but no systemic reactions Moderate= Fang marks and swelling progressing beyond the site of the bite; systemic signs and symptoms such as nausea, vomiting, paresthesias or hypotension Severe = Fang marks present with marked swelling of the extremity; subcutaneous ecchymosis; severe symptoms including coagulopathy

Hospital acquired infections; In addition to falls, and pressure ulcers development, another adverse event that could result from long stays in the ED is hospital acquired infections. ____________ in particular are at risk for urinary tract and respiratory infections. So, patients who are immune suppressed, especially those with chronic steroid therapy are also at high risk. Nurses and other personnel need to wash their hands frequently and thoroughly and use hand sanitizers before you're going from this person to this person. Because what lives on you might not can live on somebody else. It might cause a major infection. So always, always wash your hands thoroughly.

OAs

Although most snakes species are non poisonous and harmless, there are 2 families of poisonous snakes in North america:

Pit Vipers (Crotalidae) & Coral Snakes (Elapilade).

general management principles apply to both moderate and severe hypothermia:

Protect patients from further heat loss, handle them gently to prevent V Fib. Positioning the patient in a supine position prevents orthostatic changes in blood pressure from cardiovascular instability. Administer drugs with caution and/or spaced at longer intervals because metabolism is unpredicted in hypothermic conditions. Because your body is cold, it's not going to be carrying that medicine to the organs and stuff, so it can actually become toxic so be real careful about giving medications until they're not warm. Remember that drugs can accumulate without obvious therapeutic effect while the patient is cold but may become active and potentially lead to drug toxicity when the warming starts happening. Consider withholding IV drugs until the core temp is at least above 86. Initiate CPR for patients without spontaneous circulation. Be aware that defibrillation attempts may be ineffective until the core temp is above 86. So what they always say, you're not dead until you're warm and dead because if you like fall into a cold water and they get you out and you're cold, they'll just try to keep you warm until they get you to the hospital, but they won't pronounce you dead until you're warm.

when the heat stroke patient is in the hospital you want to..

heir first priority is collaborative care is to monitor and support the patient's airway, breathing and circulation as anything else, and provide high concentration of oxygen. Start several IV lines with normal saline. Insert a urinary catheter. Continue aggressive interventions to cool the patient until the rectal temp is 100.

The process of adapting to high altitude is called acclimatization. Acclimatization involves physiologic changes that help the body adapt to less available oxygen in the atmosphere. As the carotid bodies sense a decline in PaO, at about 5000 feet, they increase the ___1_____ to improve oxygen delivery. This mechanism is called the hypoxic-ventilatory response. Increased ______1______ causes hypocapnia (decreased carbon dioxide) and respiratory alkalosis, which limit further increases in ______1_______ and thus:

RR Rapid eye movement (REM) sleep is impaired. Hypoxia can occur from periods of apnea. Within 24 to 48 hours of being at high altitude, the kidneys excrete the excess bicarbonate, which helps the pH to return to normal and ventilatory rate to again increase.

Now some of these, if they come into the hospital and they have a stroke or chest pain or pneumonia, there is a certain things that have to be done within an ______. And if they're not the hospitals can actually get deemed for it, so you have certain protocols and they've got to make sure that they are followed or the hospital can pay for that.

hour

Internal bleeding is more hidden complications that must be suspected in injured patients or those who present in a shock state. In a resuscitation situation, blood pressure can quickly and easily be estimated before a manual cuff pressure can be obtained by palpating for presence or absence of peripheral and central pulses and that is resulted like.. By the time hypotension occurs, compensatory mechanisms used by the body in an attempt to maintain that vital signs in a shock state has been exhausted. Timely effective interventions is critical to preserve the life and vital organs. IV access is best achieved by inserting a large bore __________________________. This is for emergency situation because its easily obtained. That's the reason a lot of times when the paramedics get to a trauma, they always have an AC IV because they're a lot easier to get to than trying to find one in the hand or the forearm etc. Additional access can be obtained via central lines in the femoral, subclavian, or jugular sites using a large bore central venous catheter. Now that's usually when they come into the ED, they might pop a central line in. As I said, the triple lumen is the one that they usually use

So if you got a presence of a radial pulse, you can say that blood pressure is at least 80 systolic, and if you got a presence of a femoral pulse you can say the blood pressure is at least 70 systolic, and if you get a presence of a carotid you can say the blood pressure is at least 60 systolic. So you might not have time to pop a blood pressure cuff on and listen, but if you feel all these different pulses, you can say they got a systolic blood pressure of these. 16 gauge peripheral IV line in the AC.

The venom causes local and systemic toxic effects. The enzyme in venom breakdowns ____________, _____________, and they ____________.

human tissue proteins, alter membrane integrity, and they impair blood clotting.

This is a core body temperature of 95 degrees below.

hypothermia

__________ might offer some protection to the hypoxic brain during the drowning.

hypothermia

they will provide extra training to people. These courses include mass casualty triage education.

The FEMA (the Federal Emergency Medical Agency)

assessment of lightening injuries=

The initial appearance of mottled skin and decreased to absent peripheral pulses usually arise from the arterial vasospasm and typically resolves spontaneously in several hours. The central nervous system injury is common in lightning strike victims, they will present with temporary paralysis that affect the lower limbs to greater extent than the upper limb, so it's the legs and then the arms. This condition usually resolves within hours. They can have burns on the skin. Most burns are superficial and heal without incident or will have full thickness burn, they might have charring, or contact burns from metal objects like if you're wearing a underwire bra or you got some kind of metal objects on like necklaces, rings or whatever.

RF for frost bite

The main risk factor is inadequate insulation against cold weather. When either the skin is exposed to the cold or the person's clothing offers insufficient protection. Like us, we usually don't have too much cold weather down here. So if we go up north, we probably couldn't handle all that snow and cold and what they have to live through. So, we would have to be taught how to dress. Wet clothing is a poor insulator and facilitates the development of frostbite. Fatigue, dehydration and poor nutrition are other factors. People who smoke, consume alcohol, or have impaired peripheral circulation have a higher incidence of frostbite and any previous history of frostbite further increases a person's susceptibility.

the only evidence of brown recluse spider bites =

The only evidence of the bite may be a skin lesion, necrotic wounds or less often systemic effects from the injected toxin, commonly referred to as what they call loxoscelism.

Some of the signs and symptoms that patients are present with in heat exhaustion = This is not really a true emergency condition but if not treated, heat exhaustion can turn to _________ and then we got an emergency happening.

They just don't feel good. Feeling ill Might say "I feel like I got the flu." Headache Weakness N&V Heat stroke

causes pathophysiologic responses in The body as a result of exposure to low partial pressure of oxygen at high elevations. Although most consider high altitude to he an elevation over 5000 feet, millions of people worldwide who ascend to or live at altitudes above 2500 feet are at risk for acute and chronic high-altitude illness. For purposes of consistency in definition, high-altitude environments are considered to be at an elevation of 1500 feet or higher (Prince & Huber, 2019). As altitude increases, atmospheric (barometric) pressure decreases. Oxygen makes up 21% of the pressure. Therefore as this pressure falls, the partial pressure of oxygen in the air decreases resulting in less available oxygen to breathe. The pathophysio. logic consequence is hypoxia, which is more pronounced as ele vation increases. Elevations higher than 18,000 feet are considered extreme altitudes. Supplemental oxygen is necessary at these lev els in nonacclimatized people to prevent altitude-related illnesses including death, from occurring during abrupt ascent. Of note. unrecognized or untreated HAD can cause death in susceptible individuals even at lower altitudes.

Tish altitude illness, also known as high altitude disease HAD) or altitude sickness,

first aid care/ prehospital for scorpions=

Transport to acute care facility as soon as possible.

Patho of Brown recluse spiders=

Venom causes cellular damage and impaired tissue integrity

patho of bees and wasps:

Venom injected through stings; most can sting repeatedly when disturbed: only honeybees can sting just once

patho of black widow spider =

Venom is neuro- toxic, produces a syndrome known as latrodectism in which the venom causes neurotransmitter release from nerve terminals

What are pre-hospital care providers?

are the first people that patients see before transported to the ED by the ambulance or by the helicopter. It could be an EMT or it can be a paramedic. I always use the EMT as an LPN and the paramedic is your RN because they can advanced care that the EMTs cannot do.

An evacuation plan is also part of fire prevention preparedness plans for healthcare facilities. Each health care facility is required to practice____________ fire drill or actual fire response once a year.

at least one

Lightning produces injury by ....... Although people die from this, many survivors are left with permanent disabilities.

by directly striking the victim, splashing off a nearby object, or by traveling through the ground.

Superficial frostbite is easily managed using ________ to warm the affected area.

body heat Teach patients to place their warm hands over the affected area, on their face, or cold hands under their arm cause that will help kind of warm them up.

The facility level organization model for disaster management is the hospital incident command system, which is part of the National Incident Management System. They will implement that. FEMA will come in and assist. In this system, roles are formally structured under the hospital or long-term care facility with clear lines of authority and accountability with specific resources. They will have who needs to go get the supplies and bring the supplies in. Because mass casualty events typically involve large numbers of people and can create chaotic work environment, many EMS agencies and healthcare facilities use _______________________ on there so everybody will know if you got a question talk with them.

brightly colored vests with large printing

Notification that a multicausality or mass casualty situation exists usually occurs by radio, cellular, electronic communication between the ED and the EMS providers at the scene. A state or regional emergency management agency may also notify the ED of the event. Each hospital has its own policy that specifies who has authority to activate and how to activate the disaster or emergency plan. There's usually one person, it's usually the ...... But they will base that on who they've given rights.

doctor, the trauma doctor or ER doctor that's on call. They actually can do that or the CEO of the hospital.

Circulation; once the nurse gets breathing under control, then we have to worry about circulation. The adequacy of heart rate, blood pressure, overall perfusion becomes the focus then. Common threats to circulation include... Some interventions are linked to restore the effective circulation =\ Resuscitation solutions of choice are ringers lactate or NS. Fluids and blood products should be warmed before administered to prevent hypothermia in these pts. A good rule of thumb is to consider the need for blood product administration in hemorrhagic shock state when significant hypotension persists after infusion of ____ of solution.

cardiac arrest, myocardial dysfunction, hemorrhaging. like CPR, hemorrhage control, holding that bleeding, IV vascular access with fluid and blood products, drug therapy. 2L

Both the _________ & the _________ are profoundly affected by the lightning injuries.

cardiopulmonary & the CNS . Therefore when attempting to manage multiple victims of a lightning strike provide care to those who are in cardiopulmonary arrest first. Initiate resuscitation measures with immediate airway respiratory management, chest compressions, & other appropriate life saving measures.

_____________ heatstroke occurs over a period of time as a result of chronic exposure to hot, humid environment, such as homes without air conditioner in the high heat of the summer. It generally affects ill & older adults.

classic

Common predisposition is conditions that promote hypothermia include:

cold water immersion, flu symptoms, traumatic injury, shock states, immobilization, cold weather especially if they are homeless out in the open or people working outdoors, advanced age, selected medications such as barbiturates, alcohol intoxication, malnutrition, inadequate clothing, and environment temperature below 82 and wind chill is a significant factor that can lead to hypothermia. It is also a problem for the older adult, the homeless and the poor who cannot afford heating.

Alright, when the number of casualties exceed the usual resource capabilities, ____________ situation occurs then. What may be a routine day in the emergency department of a large, like in Atlanta, can be defined as a disaster down here in the south. Because we don't have the personnel, staff, the PPEs that Atlanta's got. Each facility then decides what a disaster situation is. Flexibility is needed because resources may change by time, in a day, in a day of the week. For instance, hospitals typically have fewer staff at nighttime and on weekends then during the day. So if a certain thing that happens that night on the weekend, that might be considered a disaster.

disaster

This is an event in which illness or injury exceeds the resources capabilities of the healthcare facility or the community due to some type of destruction. It could be internal or external. Y'all just think of the ones that we've had here lately.

disaster

When providing emergency care for a snake bite person, determine if the venom has been injected into the body. The primary function of venom are to...

immobilize, kill, & aid in digestion of the prey. So what the snakes do, if it was a little rat, is they will bite the little rat & that venoms goes in, it starts breaking that down so they actually can eat the little rat. So if they bite you, all that venom is in you and will start breaking everything down.

disaster is any event inside a health care facility or campus that could endanger the patients or students or the staff. The event creates a need for evacuation or relocation. It often requires extra personnel and the activation of the facilities' emergency preparedness or response plan. This could be a fire, it could be an explosion, it could be a shooting. Each healthcare facility develops policies and procedures for preventing these events through organized security management planning. The most important outcome for any internal disaster is to maintain patient, staff, visitors you know if it was the hospital, If it was here on the campus we worry about the instructors or the students.

internal

priority interventions for allergic bee stiings=

is to ensure that airway, breathing and circulation are maintain Other kits include a prefilled epi syringe, the IM route is recommended over the sub-Q route because it has more predictable and rapid absorption. The dose should be repeated in 50 minutes if S&S are still there. After epinephrine administration, an anti histamine such as Benadryl can be given. In the field setting oral liquid benadryl may be easier for the people to swallow than the tablet so you might have to give a liquid form If epinephrine IM fails to relieve the life threatening reaction, a stronger solution may be requested at a very slow IV bolus.

For treatment of choice for severe hypothermia

is to use internal rewarming methods such as cardiopulmonary bypass, hemodialysis, venous or arterial venous rewarming. So they might even put you on dialysis and put that dialysate through your veins and arteries to make sure it gets real warm. Monitor for early signs of complications that can occur after rewarming such as fluid and electrolyte and metabolic abnormalities, lookout for ARDS in these patients, and acute renal failure and pneumonia. Prolong resuscitation efforts may not be reasonable in cases in which survival appears highly unlikely such as in an anoxic event followed by a hypothermic cardiac arrest. So if they was on a boat .and they had a cardiac arrest, and they fell in the cold water, you're probably not going to get them back. But they're not considered dead until they are warm and dead.

It is caused by electrical charge generated within thunder clouds that may become cloud-to-ground lightning, the most dangerous form to people and structures.

lighting injuries

overwhelms the local medical capabilities it may require other agencies and other hospitals to come in and assist. Various state, regional, and national resources may be needed to support the areas that are affected.

mass casualty event

event can be managed by a hospital using local resources

multi casualty event

Heat Stroke Complications:

multiple organ dysfunction syndrome renal impairment electrolyte & acid-base disturbances coagulopathy- clotting issues pulmonary edema cerebral edema and even a stroke

It occurs when a person suffers primary respiratory impairment from submersion or immersion in liquid medium using some type of water. Prevention is the key to avoid drowning incidents.

near-drowning

And then for the patients who require care that exceeds the BLS resources ___________ are usually dispatch. They are advanced life support providers who can perform advanced techniques such as cardiac monitoring, advanced airways and innovation. They establish IVs and administer drugs on route to the ED.

paramedics

Multi casualty and mass casualty disasters events are not the same. The main difference is based on the...

scope and the scale of the incident. Consider the number of severity of victims or casualties involved. Both requires specific response plans to activate necessary resources.

Spine stabilization with a board or flotation device should be considered only for those victims who are high risk for _______ trauma such as if they are diving into the water, using a water slide, signs of injury of alcohol intoxication. So, you got to worry about what am I going to do. But sometimes when you go out there and get them, you'll worry about that when you get them on land. Do not attempt to get the water out of the victim's lung, deliver abdominal or chest thrusts only if airway obstruction is suspected. Once the person is safely removed from the water, airway and cardiopulmonary support should begin

spine

In heat stroke, Although the patient's skin is hot and dry, the presence of _________ does not rule out a heat stroke. People with heatstroke may continue to perspire.

sweating

If the s&s of heat exhaustion persists:

u want to call the ambulance and get them transported to the hospital. In the hospital, you want to monitor their vital signs of course, they will rehydrate that patient with an IV meds such as 0.9% normal saline, if N&V persists. They are drawing blood for serum electrolyte analysis and we call that a metabolic panel at the hospital.

patho of scorpions=

venom injected via stinging apparatus on tail, effects are neurotoxic

Specific job action sheets are distributed to all personnel with leadership roles. The roles and responsibility of healthcare personnel in a mass casualty event are defined within the institution's plan. Each plan will go through and tell what each one will have to do. Usually every floor has something to do also. In smaller hospitals with limited specialty resources, ______________ might also help determine which patients should be transported out of the facility to get better care, such as a burn center or whatever. Closely affiliated with the medical command physician is the _________________, This person generally is a physician of a large hospital who is assisted by the triage nurses. When the physician resources are limited, an experienced nurse may assume this role. The triage officer rapidly evaluates each person who presents to the hospital, even those who come in with triage tags in place. Nurses play key roles before, during, and after a disaster. Before an event, they contribute to development. So, when y'all get out there and get your RN and you start working., They might ask you to serve on the disaster committee. What they do, they get together and they go through differen

the Medical Command physician triage office

mild hypothermia tx=

the patient or person needs to be sheltered from the cold environment, have all wet clothing removed, and undergo passive or active external rewarming. Applying warm clothing or blankets like heating blankets, warm packs, convective air heaters or warmers to speed the warming process. If a heating blanket is used, monitor the patient's skin at least every 15 to 30 minutes to reduce the burn injury. That happens a lot of times in the elderly especially because their skin is so thin, so you got to be real careful and watch that skin so it won't burn. Having the victim drink warm, high carb liquids that do not contain alcohol or caffeine can aid in rewarming. Alcohol is a peripheral vasodilator, both alcohol and caffeine are diuretics. These effects can potentially worsen dehydration and hypothermia. Always assess for shivering.

Triage continues, there are different systems but you if you work in the ED, you're going to have to learn what system they use and that's what you got to follow, and it's got to be followed consistently. Many triage system can be used by hospital ED. Any system must be applied consistently by triage nursing staff and endorsed by the physician that is there. Based on the severity of the patient's condition, a well-known triage scheme is used in the United States it's what they call a ______________ and you will have to know this to answer questions on this test.

three-tiered model

Assessment findings for the typical patient with AMS include

throbbing headache, anorexia, nausea, vomiting, chills, irritability, and apathy. The syndrome produces effects similar to an alcohol-induced hangover, and the patient may report a feeling of extreme illness. Vital signs are variable: the patient can be tachycardic or bradycardia, have normal blood pressure, or have postural hypotension. He or she may experience dyspnea both on exertion and at rest. Exertional dyspnea is expected as a person adjusts to high altitude. However dyspnea at rest is abnormal and may signal the onset of HAPE

A key process in any multicausality or mass casualty response is effective _________ to rapidly sort the ill or injured patients into priority categories based on their acuity and their survival potential

triage

To maintain ongoing disaster preparedness, hospital personnel participate in emergency training and drills regularly. In the United States, the Joint commission mandates that hospital have an emergency preparedness plan that is tested through drills and actual participation in real event at least ____1____ a year. So they have to participate in active shooting drills, fire drills, you know how to get the people off the floors. Usually, it's to whatever happens in your area, like you're here up in the mountains, they might do avalanches, you know, to try to do that. Like if they're on the beach area, they might do hurricanes, so they will do different things, whatever your area is known to have. And that's what you normally participate in. Hospitals are not the only health agencies that require to practice disaster drills. Nursing homes have to do this. And you think about the nursing homes. There's a lot of those patients that cannot get up and walk. They are bed bound or chair bound. If there was a fire or tornado, you got to worry about getting them to safety. So you have to practice, you can't just wait till the event happens. So, part of the response plans must include a method for e

twice

"B" breathing; After the airway is successfully secured, breathing becomes the next priority in the primary survey. This assessment determines whether or not... The main indication for chest decompression is clinical evidence of _________________, which can pose a critical threat to both circulation and their breathing.

ventilator efforts are effective, not only whether or not a patient is breathing. Once they are breathing, are they breathing sufficiently to bring their oxygen in and get that carbon dioxide out? Listen to breath sounds, look at that chest expansion, What kind of respiratory rate do they have? Any evidence of chest wall trauma or physical abnormalities? Is their left side going up but their right side is not? both apneic patients and those with poor ventilatory efforts need a BVM ventilation for support, until the endotracheal tube can be placed. If cardiopulmonary resuscitation becomes necessary, the mechanical ventilator is disconnected and the patient is manually ventilated with the BVM. Lung compliance can be assessed through sensing the degree of difficulty in ventilating. So if they go where they're not breathing by their self and have to have their pulse, the ventilator gets turned off and you disconnect the ET tube and then you breath by the mask. You may have to perform in this phase chest decompressing using a needle or chest tube fluoroscopy to vent trapped air. So if there's air in here that is pushing that lung to one side of the other, you got to get that air out of there. TENSION PNEUMOTHORAX

Asking a partner to observe for early signs of frostbite such as

white waxy appearance to the exposed skin, especially on the nose, the cheeks and the ears.

hypothermia severe s&s=

• Bradycardia • Severe hypotension • Decreased respiratory rate • Cardiac dysrhythmias, including possible ventricular fibrillation or asystole • Decreased neurologic reflexes to coma • Decreased pain responsiveness • Acid-base imbalance

Hypothermia Moderate S/S

• Muscle weakness • Increased loss of coordination • Acute confusion • Apathy • Incoherence • Possible stupor • Decreased clotting (caused by impaired platelet aggregation and thrombocytopenia)

Lightning Strike Prevention=

• Observe weather forecasts when planning to be outside • A lightning strike is imminent if your hair stands on end, you see a blue halo around objects, and you hear high-pitched or crackling noises. If you cannot move away from the area immediately, crouch on the balls of your feet and tuck your head down to minimize the target size; do not lie on the ground or make contact with your hands to the ground. - Seek shelter when you hear thunder. Go inside the nearest building or an enclosed vehicle. Avoid isolated sheds and cave entrances. Do not stand under an isolated tall tree or structure (e.g., ski lift, flagpole, boat mast, power line) in an open area such as a field, ridge, or hilltop; lightning tends to strike high points. Instead, seek a low area under a thick growth of saplings or small trees. • Leave water immediately (including an indoor shower or bathtub) and move away from any open bodies of water. • Avoid metal objects such as chairs or bleachers; put down tools, fishing rods, garden equipment, golf clubs, and umbrellas, stand clear of fences, exposed pipes, motorcycles, bicycles, tractors, and golf carts. • If inside a car with a solid hood, close the windows and stay inside. If in a convertible, leave the car at least 49 yards (45 meters) away and huddle on the ground. • Il inside a tent, stay away from the metal tent poles and wet fabric of the tent walls. • If you are caught out in the open and cannot seek shelter, attempt to move to lower ground such as a ravine or valley; stay away from any tall trees or objects that could result in a lightning strike splashing over to you; place insulating material between you and the ground (e.g., sleeping pad, rain parka, life jacket). • If inside a building, stay away from open doors, windows, fireplaces, metal fixtures, and plumbing. • Tum off electrical equipment, including computers, televisions, and stereos to avoid damage • Stay off land-line telephones. Lightning can enter through the telephone line and produce head and neck trauma, including cataracts and tympanic membrane disruption. Death can result. Avoid use of cellular phones, which can transmit loud static that can cause acoustic damage

Level Il provides:

• Provides care to most injured patients • Transfers patient if needs exceed resource capabilities

hypothermia mild S&S =

• Shivering • Dysarthria (slurred speech) • Decreased muscle coordination • Impaired cognition ("mental slowness • Diuresis (caused by shunting of blood to major organs)

Level III provides:

• Stabilizes patients with major injuries • Transfers patient if needs exceed resource capabilities