EMT - Chapter 24

dizziness; fatigue

A Pt with heat exhaustion will commonly have slight alterations in mental status, such as _____ or _____, and will present with a normal body temp and diaphoretic skin.

d. has a history of medical problems

A heat emergency Pt with moist, pale, normal-to-cool skin needs transport if the Pt: a. is sweating b. has a temperature of 99°F c. has a headache d. has a history of medical problems

b. nothing by mouth

A heat emergency Pt with moist, pale, normal-to-cool skin who is responsive and vomiting should be given: a. cool water to drink b. nothing by mouth c. a half glass of water every 15 minutes d. warm water to drink

b. thunder "blast wave" and strong muscular contractions

Dislocations and fractures associated with lightning strikes result from the : a. thunder "blast wave" and the speed of the lightning strike b. thunder "blast wave" and strong muscular contractions c. burning effect of the lightning strike and strong muscular contractions d. burning effect and the speed of the lightning strike

air-conditioned buildings

Do not overlook the possibility of hypothermia in an elderly (or pediatric) Pt who has been subject to the cool ambient temperatures of _____________.

electrolyte

Heat cramps are caused by ______ imbalance to the muscles, most commonly from overexertion in hot temperatures with excessive diaphoresis.

large flexor

Heat cramps are the mildest form of the heat emergency and are rapidly identified by muscle spasms and pain to the __________ muscles of the body.

cooling mechanisms; CNS

Heat exhaustion occurs when the body's ____________ have been expended, and the ___ and other systems are starting to show the consequences of this depletion.

thermoregulatory; compensate

Heat stroke occurs when the ______ mechanism of the body fails to sense and _____ for elevations of the core temperature, and an extremely high core temperature results.

65

Hypothermia can occur after prolonged exposure when the ambient temperature goes no lower than ___°F.

tissue; heat

Marine life venoms differ from land animal venoms. Marine life venoms can cause more extensive _____ damage, but can be destroyed by _____.

cellular function; compensate

The body must maintain an optimum body temperature so that ______________ can continue normally. If at any time the body cannot _____ for the amount of heat that is either gained or lost, resulting cellular and organ damage may lead to an environmental emergency.

c. shivering e. apathy and decreased muscle function d. decreased level of responsiveness a. decreased vital signs b. death

The five stages of hypothermia are listed as follows. Place them in order from earliest to latest. a. decreased vital signs b. death c. shivering d. decreased level of responsiveness e. apathy and decreased muscle function

a. heat

The venom of aquatic organisms may be destroyed by the application of: a. heat b. rubbing alcohol c. ice d. tannic acid in the form of a tea bag

c. be prepared to manage seizures and to prevent aspiration

When cooling a heat emergency Pt with hot skin that is moist or dry, a. cooling takes priority over all other emergency care procedures b. one cooling method will generally be effective to cool the Pt c. be prepared to manage seizures and to prevent aspiration d. place cold packs on the Pt's hands and feet

b. increase the body temperature by no more than 1°F per hour

Which statement best describes an appropriate technique for active rewarming? a. all unresponsive patients should be actively rewarmed b. increase the body temperature by no more than 1°F per hour c. immerse the Pt in a hot tub of water or place in a hot shower d. apply heat first to the extremities, then the torso

hyperthermia

abnormally high core body temperature

hypothermia

abnormally low core body temperature

generalized hypothermia

an overall reduction in body temperature, affecting the entire body

1. large fangs; the coral snake is an exception that does not have fangs 2. elliptical pupils or vertical slits 3. pit between the eye and the mouth 4. variety of different-shaped blotches on backgrounds of pink, yellow, olive, tan, gray, or brown skin; coral is an exception which is ringed with red, yellow, and black 5. triangular head larger than the neck

characteristics of common venomous snakes

wind chill

combined cooling effect of wind speed and environmental temperature

evaporation

conversion of a liquid or solid into a gas

local cold injury

damage from cold exposure to tissues in a specific part of the body

1. remove Pt from cold environment and prevent further heat loss 2. handle the Pt gently as rough handling can cause a cardiac dysrhythmia, and never allow Pt to walk or exert himself; keep Pt supine if possible 3. administer O2, using warm, humidified O2 if possible; do not aggressively ventilate 4. if Pt goes into cardiac arrest from v-fib or pulseless v-tach, immediately initiate CPR beginning with chest compressions and apply AED 5. if Pt is alert and responding appropriately, actively rewarm him 6. if Pt is unresponsive or is not responding appropriately, do not actively rewarm 7. do not allow Pt to consume stimulants 8. never rub or massage the Pt's arms or legs 9. transport as quickly as possible

describe emergency medical care for generalized hypothermia

1. remove Pt from source of heat to a cool environment 2. consult medical direction before giving the Pt sips of low-concentration salt water at rate of half glassful every 15 minutes 3. apply moist towels to Pt's forehead and over the cramping muscles 4. explain to Pt what happened so he can avoid a recurrence of the problem

describe emergency medical care for heat cramps

in general, s/b treated same as Pts with generalized hypothermia with following steps also taken: 1. instruct Pt to make the least effort needed to stay afloat until you can reach him 2. lift Pt from the water in a horizontal or supine position to prevent vascular collapse and provide spinal stabilization if necessary 3. remove Pt's wet clothing carefully and gently

describe emergency medical care for immersion hypothermia

1. remove the Pt immediately from the cold environment 2. never initiate thawing procedures if there is any danger 3. if breathing is adequate, administer O2 based on the SpO2 reading and Pt s/s 4. prevent further injury to the injured part

describe emergency medical care for local cold injury

1. remove Pt from source of heat and place in a cool environment 2. remove as much of the Pt's clothing as is possible or reasonable 3. administer O2 4. immediately begin to cool the Pt: poor tepid water over Pt's body, place cold packs in Pt's groin, each side of the neck, in armpits, and behind each knee; fan Pt aggressively or direct an electric fan at the Pt; keep Pt's skin wet to promote cooling through evaporation 5. be prepared to manage seizures or prevent aspiration of vomitus 6. transport immediately

describe the emergency medical care for a heat emergency Pt with hot skin that is moist or dry

1. move Pt to a cool place 2. administer O2 3. remove as much of the Pt's clothing as you can and loosen what you can't remove 4. cool Pt by applying cold, wet compresses and/or by misting the Pt with water and then fanning lightly 5. Place Pt in supine position 6. if Pt is fully responsive and is not nauseated, have him drink cool water 7. if Pt is unresponsive or has AMS or is vomiting - do NOT give fluids 8. transport if any of the following apply: unresponsive or AMS; vomiting or nauseated and will not drink fluids; has a history of medical problems; core temperature above 101°F; continuously rising temperature; does not respond to therapy

describe the emergency medical care for a heat emergency Pt with moist, pale, normal-to-cool skin

1. thermal control is lost when the body temp is lowered to 95°F (35°C) 2. coma occurs when the body's core temp reaches approx. 79°F 3. death can occur within 2 hrs of the first s/s of generalized hypothermia

describe the pathophysiology of generalized hypothermia

1. heat cramps: result from body losing too much salt during profuse sweating and not enough salt is taken into the body, calcium levels being too low, or when too much water is consumed by the Pt 2. heat exhaustion: extreme physical exertion in a hot, humid environment can produce a disturbance of the body's blood flow, resulting in a mild state of shock; vasodilation results in pooling of blood in the vessels just below the skin and can cause excessive blood flow away from the major organs of the body 3. heat stroke: body becomes overheated, temp rises, and sweating ceases in about half the Pts; no cooling takes place, the body stores increasingly more heat, heat-producing mechanisms speed up, and eventually brain cells are damaged

describe the pathophysiology of heat-related emergencies

ice crystals form between the cells of the skin and then expand as they extract fluid from the cells

describe the pathophysiology of local cold injury

body produces heat through processes of metabolism, including digestion, shivering, hormones such as thyroxin and epinephrine; body conserves heat through vasoconstriction, piloerection, reducing perspiration; cools itself through vasodilation to the skin, sweat/evaporation, and respiration

describe the process by which the body maintains normal temp

1. early/superficial cold injury - usually involves ears, nose, cheekbones, tips of toes/fingers, and chin; Pt usually unaware; Pt loses feeling and sesnation in the affected area; skin may begin to turn waxy gray or yellow; skin soft and cold to the touch and normal skin color does not return after palpation; rewarming may result in a tingling sensation 2. late/deep cold injury - involves both the skin and tissue beneath; skin is white & waxy witha firm to completely solid, frozen feeling; swelling and blisters filled with clear or straw-colored fluid may be present; as it thaws, it may become blotchy or mottled; extreme emergency and can result in permanent tissue loss

describe the stages of local cold injury

1. external - patients who are subject to hypothermia because they do not have access to a warm environment during cold months 2. internal - Pts are subject to colder temps in the winter months when they attempt to minimize heating bills to save money

describe the two categories of urban hypothermia

1. venom of marine life may cause more extensive tissue damage than that of land animals 2. venoms of aquatic organisms are destroyed by heat so heat, not ice, should be applied to marine bites and stings

differences in the bites and stings of marine animals vs. land animals

1. asystole or v-fib 2. irregular pulse

effects of a lightning strike to the cardiac system

1. ruptured tympanic membrane 2. tinnitus 3. deafness

effects of a lightning strike to the ear

unequal pupils; drooping eyelid (ptosis)

effects of a lightning strike to the eye

dislocations & fractures

effects of a lightning strike to the musculoskeletal system

1. AMS 2. retrograde amnesia 3. anterograde amnesia 4. weakness 5. pain, tingling, and numbness 6. pale, cool, and clammy skin 7. temporary paralysis 8. dizziness 9. loss of pupillary function 10. seizures 11. vertigo

effects of a lightning strike to the nervous system

1. respiratory distress 2. apnea

effects of a lightning strike to the respiratory system

1. burns 2. linear burns appearing as streaks down the body and associated with sweat on the surface of the body heating up 3. feathering 4. punctuate burns appear similar to cigarette burns 5. thermal burns if clothing catches on fire

effects of a lightning strike to the skin

1. maintain a patent airway 2. administer O2 and support breathing 3. administer epi by prescribed auto-injector 4. call for ALS 5. initiate early transport

emergency care for anaphylactic shock resulting from a bite or sting

1. in general, treat the same as soft tissue injuries 2. use forceps to remove any material that sticks to the sting site on the surface of the flesh, then irrigate wound with tap water 3. do not attempt to remove spines that are embedded in joints or that are deeply embedded in skin 4. if Pt was stung by jellyfish, coral, hydra, or anemone, carefully remove dried tentacles and pour vinegar on the affected area to denature the toxin; sprinkle meat tenderizer on the wound if available to stop the stinging 5. apply heat or soak the affected area in hot water for at least 30 minutes throughout transport

emergency care for marine life poisoning

1. if stinger is still present, remove it by gently scraping against it in the direction of the base of the stinger to avoid breaking it off below the skin 2. wash the area around the bite or sting 3. remove any jewelry or other constricting objects asap 4. lower the injection site below the level of the heart 5. apply a cold pack to an insect bite or sting 6. some experts advise the use of a constricting band in the treatment of a snakebite, proximal to the bite 7. observe the Pt carefully for the s/s of an allergic reaction 8. keep Pt calm, limit his physical activity, and keep him warm; transport asap

emergency medical care for a bite or sting

1. immediately move Pt to lower altitude and administer supplemental O2 2. in severe cases, PPV with O2 may be necessary

emergency medical care for high-altitude cerebral edema (HACE)

1. move Pt to lower altitude and administer O2 2. if descent not possible, O2 may eliminate HAPE within 36-72 hrs

emergency medical care for high-altitude pulmonary edema (HAPE)

1. ensure that the scene is safe 2. if Pt's clothes are on fire, put out the fire 3. establish in-line manual stabilization 4. establish airway if Pt has AMS 5. if Pt in cardiac arrest, immediately provide CPR and provide AED; provides aggressive ventilation 6. if Pt has pulse but is not breathing or not breathing adequately, begin aggressive PPV, supplying high-flow O2 7. completely immobilize Pt to a backboard 8. transport while continuously monitoring the Pt's condition

emergency medical care for the lightning strike patient

respiration

exchange of gases between an organism and its environment; mechanism of heat loss

the body produces more heat than it is losing to the environment, increasing body temperature

explain the mechanisms by which the body gains heat

1. radiation 2. convection 3. respiration 4. evaporation 5. conduction

explain the mechanisms by which the body loses heat

1. rapid explosion and implosion of the superheated and then cooled air which creates thunder will propel the person and lead to blunt trauma 2. rapid change in air pressure can cause pressure changes in the body's air-containing cavities 3. lightning will overwhelm and short circuit the body's electrical system 4. the medulla is shut down by the lightning strike and the Pt stops breathing 5. all the muscles contract severely and for a long period of time

explain the pathophysiology of lightning strike injuries

1. exposure to a cold environment 2. age (very young or elderly) pre-existing medical conditions 4. use of drugs (including meds such as beta blockers or antipsychotics), alcohol, or poisons

factors predisposing people to hypothermia

1. climate 2. exercise & stenuous activity 3. age 4. pre-existing illnesses 5. certain drugs and medications 6. lack of acclimation

factors that contribute to a Pt's risk for hyperthermia

1. how much poison was injected 2. how rapidly symptoms develop 3. location of the bite since fatty tissue absorbs the venom more slowly than muscle tissue 4. whether pathogens are present in the venom 5. Pt's size and weight 6. Pt's general health and condition 7. how much physical activity the Pt engaged in immediately following the bite

factors that determine the severity of a snakebite

urban hypothermia

hypothermia precipitated by a too cool indoor or outdoor environment

water chill

increase in rate of cooling in the presence of water or wet clothing

myxedema coma

life-threatening late complication of hypothyroidism

Stage 1: shivering Stage 2: apathy and decreased muscle function Stage 3: decreased level of responsiveness Stage 4: decreased vital signs Stage 5: Death

list the stages of hypothermia

convection

loss of body heat to the atmosphere when air passes over the body

1. any kind of trauma 2. extremes of age 3. tight or tightly laced footwear 4. use of alcohol during exposure to cold 5. wet clothing 6. high altitudes 7. loss of blood 8. arteriosclerosis

predisposing factors for local cold injury

1. ambient temperature, wind chill, and moisture 2. medical conditions 3. alcohol, drugs, and poisons 4. duration of exposure 5. clothing 6. clothing 7. activity level

recognize factors that contribute to a Pt's risk for generalized hypothermia

1. women have greater resistance to heat loss in cold water than men 2. adults can withstand the cold longer than children 3. layers of clothing can help insulate

recognize factors that contribute to a Pt's risk for immersion hypothermia

hypothyroidism

recognize factors that contribute to a Pt's risk for myxedema coma

1. very young or very old with a lower amount of body fat 2. interference with heat production from medical illnesses or medication use, AMS, or limited mobility making a person unable to take protective measures

recognize factors that contribute to a Pt's risk for urban hypothermia

1. pinprick sensation at the bite site, becoming a dull ache within about 30 minutes 2. severe muscle spasms, especially in the shoulders, back, chest, and abdomen 3. rigid, boardlike abdomen 4. dizziness, nausea and vomiting, and respiratory distress in severe cases 5. children <15, adults >60, chronic illness, and hypertensive people are at highest risk for developing severe reactions

s/s and history associated with bites or stings of black widow spiders

1. bite does not usually heal and requires surgical repair 2. bite is often painless at first 3. after several hours, it becomes bluish surrounded by a white periphery, then a red halo 4. within 7-10 days, the bite becomes a large ulcer

s/s associated with bites or stings of brown recluse spiders

1. intense, fiery, burning pain 2. circular pattern of bites 3. extremely painful vesicles that are filled with fluid that is at first clear and then becomes cloudy 4. large local reaction characterized by swelling, pain, and redness that affect entire extremity

s/s associated with bites or stings of fire ants

1. 90% of stings occur on hands 2. general s/s of bites and stings 3. sharp pain at the injection site 4. drooling, poor coordination, incontinence, and seizures due to neurotoxin

s/s associated with bites or stings of scorpions

1. location of bites are typically warm, moist areas, such as the scalp, other hairy area, armpits, groin, and skin creases 2. many Pts are unaware of the bite

s/s associated with bites or stings of ticks

hives; flushing; upper airway obstruction; faintness; dizziness; generalized itching; generalized swelling, including eyelids, lips, and tongue; difficulty swallowing; shortness of breath, wheezing, or stridor; labored breathing; abdominal or uterine cramps; confusion; loss of responsiveness; convulsions; hypotension

s/s for anaphylactic shock resulting from a bite or sting

1. history of a bite from a spider or snake, or a sting from an insect, scorpion, or marine animal 2. pain that is often immediate and severe or burning; within several hours the area may become numb 3. redness or other discoloration around the bite 4. swelling around the bite, sometimes gradually spreading 5. weakness/faintness/dizziness 6. chills/fever 7. nausea/vomiting 8. bite marks 9. stinger

s/s of a bite or sting

1. weakness (can be severe) 2. nausea 3. headache 4. SOB (increased in severe) 5. light-headedness 6. loss of appetite 7. fatigue 8. difficulty sleeping 9. decreased urine output (severe) 10. vomiting (severe) 11. AMS (severe)

s/s of acute mountain sickness, which occurs in people who rapidly ascend to 6600 ft or greater; can develop from 6-24 hours after ascent; will often resolve itself within 1-2 days if Pt does not ascend any higher

1. general ill feeling 2. loss of appetite 3. headache 4. disturbance in sleep 5. respiratory distress upon exertion

s/s of altitude illness (typically above 8000 ft, especially with rapid ascent)

1. elevated core temperature 2. muscle cramps 3. weakness/exchaustion 4. dizziness or faintness 5. rapid pulse that is usually strong at first, but becomes weak 6. initial deep, rapid breathing that becomes shallow and weak as damage progresses 7. headache 8. seizures 9. loss of appetite, nausea, or vomiting 10. AMS, possibly unresponsiveness 11. skin that is either moist and pale with normal-to-cool temperature, or hot and either dry or moist

s/s of generalized hyperthermia

1. severe headache 2. uncoordination (ataxia) 3. nausea/vomiting 4. AMS 5. seizures 6. coma

s/s of high-altitude cerebral edema (HACE), which occurs from collection of an excessive amount of fluid in the brain tissue that increases pressure within skull and puts pressure on brain; mostly happens above 12,000 ft

1. SOB at rest 2. cough 3. fatigue 4. headache 5. loss of appetite 6. tachypnea 7. tachycardia 8. cyanosis 9. crackles or wheezing in at least one lobe of the lung 10. weakness

s/s of high-altitude pulmonary edema (HAPE), a condition affecting the lungs and gas exchange; children and men are more prone and condition can occur above 8000 feet, but usually occurs above 14,500 ft

thermoreceptor

sensory receptor that is stimulated by temperature

heat stroke

should always be considered in a Pt with a heat-related emergency coupled with unresponsiveness

1. immerse the affected tissue in a warm-water bath 2. monitor the water to make sure it stays at an even temperature 3. continuously stir the water to keep heat evenly distributed and constant about the frozen extremity 4. keep tissue in warm water until it is soft and color and sensation return to it 5. dress the area with dry sterile dressings 6. elevate the affected extremity 7. protect against refreezing of the warmed part 8. transport ASAP with a warm ambient temp in the Pt compartment

steps to rewarm frozen tissue

heart; nervous tissue

structures that are most sensitive to lightning strikes

active rewarming

technique of aggressively applying external sources of heat to a patient to rewarm his body

skin; cardiovascular; respiratory

the three body systems that the body relies on to help maintain a normal temperature when the body becomes too warm

passive rewarming

the use of the Pt's own heat production and conservation mechanisms to rewarm him

radiation

transfer of heat from one surface to another without physical contact

conduction

transfer of heat through direct physical touch with nearby objects