EMT Chapter 32: Environmental Emergencies
how does the body protect itself against heat loss
-constriction of the blood vessels in the skin; which results in the characteristic appearance of blue lips and/or skin -shivering
Pressure immobilization bandage/cuff
40-70mm Hg arms 55-70mm Hg legs
moderate hypothermia
86-93.2F s/sx: loss of coordination, muscle stiffness, possible coma, muscular functioning decreases stiffening/rigid cardiorespiratory: slowing respirations, weak respirations, slow pulse, dysrhythmias. LOC: confused, lethargic, sleepy, unresponsive
normal body temperature
98.6 F
immersion foot
A condition that occurs after prolonged exposure to cold water, in which the skin of the foot is pale, cold, and there is a loss of sensation; also called trench foot.
hymenoptera
A family of insects that includes bees, wasps, ants, and yellow jackets.
heat exhaustion
A heat emergency in which a significant amount of fluid and electrolyte loss occurs because of heavy sweating; also called heat prostration or heat collapse.
heat stroke
A life-threatening condition involving very high body temperature, lack of perspiration, and rapid pulse. severe hyperthermia caused by excessive heat marked by warm skin, dry skin, ALOC, irreversible coma
decompression sickness
A painful condition seen in divers who ascend too quickly, in which gas, especially nitrogen, forms bubbles in blood vessels and other tissues; also called "the bends."
antivenin
A serum that counteracts the effect of venom from an animal or insect.
scuba gear
A system that delivers air to the mouth and lungs at various atmospheric pressures, increasing with the depth of the dive; stands for self-contained underwater breathing apparatus.
reverse triage
A triage process in which efforts are focused on those who are in respiratory and cardiac arrest, and different from conventional triage where such patients would be classified as deceased. Used in triaging multiple victims of a lightning strike.
air embolism
Air bubbles in the blood vessels.
dysbarism injuries
Any signs and symptoms caused by the difference between the surrounding atmospheric pressure and the total gas pressure in various tissues, fluids, and cavities of the body. can affect the CNS and the pulmonary system.
bends
Common name for decompression sickness.
frostbite
Damage to tissues as the result of exposure to cold; frozen or partially frozen body parts are frostbitten. most serious local cold injury
moist, pale, cool skin indicates
Excessive fluid and salt loss
HACE
High Altitude Cerebral Edema: development after HAPE, can quickly become life threatening. s/sx include severe throbbing headache, ataxia, extreme fatigue, vomiting, loss of consciousness. HACE and HAPE may overlap.
HAPE
High Altitude Pulmonary Edema: collection of fluid in the lungs which hinders oxygen getting into the bloodstream. usually occurs at 8000ft or greater altitudes. s/sx include shortness of breath, cough with pink sputum, cyanosis, and rapid pulse.
diving reflex
Slowing of the heart rate caused by submersion in cold water.
checking a pulse in a patient with hypothermia
check for up to 60s to determine if they are truly pulseless or not. 1 or 2 BPM is still a pulse.
breath-holding syncope
Loss of consciousness caused by a decreased breathing stimulus.
heat cramps
Painful muscle spasms usually associated with vigorous activity in a hot environment.
turgor
The ability of the skin to resist deformation; tested by gently pinching skin on the forehead or back of the hand.
drowning
The process of experiencing respiratory impairment from submersion or immersion in liquid.
core temperature
The temperature of the central part of the body (eg, the heart, lungs, and vital organs).
ambient temperature
The temperature of the surrounding environment.
radiation
The transfer of heat to colder objects in the environment by radiant energy, for example heat gain from a fire.
s/sx hypothermia
vitals slow down, more severe as it progresses and core temperature drops; however, there is no clear correlation between temperature and stage: depends on the person
describe a splash effect (lightening)
when lightening strikes a larger, nearby object ad the patient is indirectly struck or affected
most common and most dangerous emergency in scuba diving
air embolism - the diver holds their breath during a rapid ascent and the air pressure in the lungs remains at a high level while the external pressure decreases. ass a result the air inside the lungs expands rapidly causing the alveoli in the lungs to rupture
air embolism vs. decompression sickness signs and symptoms
air embolism occurs immediately on return to the surface whereas decompression sickness may not occur for several hours later
Coelenterates
an aquatic invertebrate animal of a phylum that includes jellyfishes, corals, and sea anemones.
ascent emergencies
ascending from bottom; air embolism; happens when diver holds his or her breath during a rapid ascend to the surface (most common; require aggressive resuscitation)
s/sx air embolism
blotching, froth from nose/mouth, severe pain in muscles joints and abdomen, dyspnea, chest pain, dizziness, nausea, vomiting, dysphasia, cough, cyanosis, vision problems, paralysis/coma, irreg. pulse, cardiac arrest
hot, dry or moist skin indicates
body is unable to regulate core temperature
what does your body do over a period of time exposed to the cold
body systems begin to slow down and weaken due to the cold and your mental status declines; can lead to death
treating a patient with a snake bite
calm, reassure, supine position, find out when the snake had bitten them, wash with soap and mild antiseptic, ice around the area, pressure or bandage immobilization, place below the heart, alert for anaphylaxis, give nothing by mouth, monitor ABC's and vitals, bring any information about the snake with you, notify receiving ED.
severe lightening strike
cardiopulmonary arrest, deeper burns
most common injuries of a patient who had been struck by lightening
cardiovascular problems, respiratory problems, burns - but cardiopulmonary will lead to most deaths
signs/development of heat stroke
change in behavior, unresponsive/ALOC, rapid strong pulse that will become weak as the become unresponsive, blood pressure will fall, respiratory increases to try to compensate for the body
hyperthermia vs. hypothermia
core temperatrue rises to 101+ core temperature falls below 95
cautions/considerations of Hymenoptera
could develop into anaphylaxis- treat and monitor accordingly.
what else happens when a person is struck by lightening?
could fracture bones and spinal vertebrae, so consider c-spine as well. open airway with the jaw thrust as needed. monitor ABC's and immobilize the patient.
Neurotoxicity
damage to the nervous system by a toxic substance
Centruroides sculpturatus
dangerous scorpion that poison produces a severe systemic reaction that leads to circulatory collapse, severe muscle contractions, excessive salvation, hypertension, convulsions, and cardiac failure
diving emergencies injuries are separated into three phases
descent, bottom, ascent
cytotoxic
destructive to cells
s/sx heat exhaustion
dizziness, weakness, syncope, ALOC, nausea, vomiting, headache, cramping, excessive sweating, dry tongue, thirst, normal vitals, slightly high pulse, slightly low systolic, elevated body temperature. may be up to 104F
how to handle a frostbitten extremity
do not massage, do not attempt to re-warm, but do try to remove it from the cold environment. re-warming is best done at the receiving ED. Make sure your patient does not use that extremity as they could damage it further. cover with a soft sterile dressing and transport.
Descent emergencies
due to sudden increase on the pressure of the body as they dive deeper; pain is managed by returning to the surface. common major problem is a ruptured eardrum.
how do heat cramps occur
excessive/vigorous exercise and hot outdoors. due to water/electrolyte loss
causes of heat exhaustion
exposure, stress, fatigue, hypovolemia
s/sx scorpion stings
extreme pain, localized swelling and discoloration, - however generally not life threatening
what spiders can deliver serious, life-threatening bites
female black widow (neurotoxic), brown recluse (cytotoxic)
s/sx Lyme diease
fever, flulike symptoms, associated with a bulls-eye rash that can spread. painful swelling of the joints, similar to arthritis. this may lead to permanent disability
why are tick bites potentially dangerous
from the organisms they carry, not the bite itself. the two common infectious disease they carry are rocky mountain spotted fever and lyme disease
mild hypothermia
greater than 93.2F s/sx: shivering, foot stamping, pulse rapid, breathing rapid, skin red or pale, may be slightly cyanotic cardiorespiratory: constricted blood vessels, tachypnea LOC: alert, possibly withdrawn
describe what a frostbitten area looks like
hard and waxy to the touch, inflamed, tender, possibly cyanotic
s/sx of high altitude or dysbarism injuries
headache, light headedness, fatigue, loss of appetite, nausea, difficulty sleeping, shortness of breath, swollen face
what are the three categories of a heat emergency
heat cramps, heat exhaustion, heat stroke
what is the most common heat emergency
heat exhaustion
what is the most serious heat emergency
heat stroke - untreated always results in death. may be 104F or higher
people who are at the greatest risk for heat emergencies
infants/children, geriatric patients, heart disease patients, COPD, diabetes, dehydration, obesity, limited mobility
s/sx of black widow spider bite
instant numbing, localized pain, agonizing muscle spasms, damage to nerve tissue, dizziness, sweating, nausea, vomiting, rashes, tight chest, difficulty breathing, severe cramps. these develop within 24 hours and subside within 48 if non life threatening.
superficial vs. deep frostbite depends on
like burns, how deep the area is affected. you may not be able to tell how deep it is in the field
s/sx of brown recluse spider bite
local tissue damage, painful overtime, swollen, tender, pale modeled skin with a cyanotic center, blistering, dead skin and fat debris may be shown over time. however; they rarely show symptomatic s/sx's.
convection
loss of body heat by air movement
mild lightening strike
loss of consciousness, amnesia, confusion, tingling, burns typically superficial
conduction
loss of heat by direct contact
ataxia
loss of muscle coordination and balance
management of heat stroke
main goal: lower core body temperature. remove from environment and into a cool environment, monitor ABC's, cold water immersion/ice bath if possible until the patient reaches 101F (do not overcool), rapid transport
categories of lightening strikes
mild moderate severe
extent of hypothermia can range from
mild, moderate, to severe
s/sx snake bites
obvious puncture wounds, discoloration, swelling, pain, severe burning, weakness, nausea, vomiting, sweating, seizures, fainting, vision problems, ALOC, shock, paralysis, change in behavior, respiratory issues
Rocky Mountain Spotted Fever
occurs 7-10 days post bite. s/sx include nausea, vomiting, headache, weakness, paralysis, cardiorespiratory collapse
emergencies at the bottom
often include inadequate O2 and CO2 exchange, often caused by faulty gear.
treating HAPE and HACE
oxygen, return to low altitude, monitor ABC's, consider BVM or CPAP if indicated
what types of patients are more prone to hypothermia
pediatric, geriatric, ill, burns, head injury, stroke, infections, injuries to spine, diabetes, hypoglycemia.
gangrene (necrosis)
permanent cell death occurs when tissue is frozen and destructive chemical changes occur in the cells
what happens when cells freeze
permanent damage, possible death. it changes the chemistry of the cells
factors that will affect how a person deals with a cold or hot enviornment
physical condition, age, nutrition, hydration, environmental conditions
how to assess core temperature
pull back your glove and place the back of your hand on the patient's skin at the abdomen using a special hypothermia thermometer
Pit vipers
rattlesnakes, copperheads, cottonmouths
treatment of stinging from coelenterates
remove from area, scrape off any substances, monitor for shock/anaphylaxis, place below area of heart, monitor vitals and ABC's, prompt transport. consider soaking area in hot water for 30 minutes
treating a patient with hypothermia
remove from cold environment, remove any wet clothing, provide a warm blanket, administer warm humidified oxygen, slowly warm the patient patients can possibly go into v-fib, do not massage extremities, to not give any stimulants because stimulants are a vasoconstrictor your main goal is to prevent additional heat loss
management of heat cramps
remove from environment, loosen clothing monitor ABC's, rest the cramping muscles, give fluids (nothing with salt), cool the patient
Management of Heat Exhaustion
remove from environment, loosen clothing, monitor ABC's and LOC, cool the patient with a mist or ice packs, encourage the patient to relax, fluids (nothing with salt) most will recover in 30min
management of tick bites/ticks
remove tick, use fine tweezers and pull by the head, clean area with antiseptic, bring tick along for examination
moderate lightening strike
seizures, respiratory arrest, dysrhythmias, superficial burns
Nematocysts
stinging cells of coelenterates- small capsules that contain a toxin s/sx include headache, dizziness, muscle cramps, fainting
severe hypothermia
sub 86F s/sx: unconsciousness, death is likely (but do not asssume), slow pupil response cardiorespiratory: cardiac arrest, respiratory arrest, very slow vitals LOC: unresponsive
tetany
tension; prolonged, continuous muscle contraction/spasms
homeostasis
the balance of all systems of the body
why are the exposed parts of your body and extremities more affected during hypothermia
the body sends more blood to the vital organs and keep the core temperature warm
evaporation
the conversion of water or another fluid from a liquid to gas
respiration
the loss of body heat as warm air in the lungs is exhaled into the atmosphere and cooler air is inhaled
describe frostnip
the skin may freeze whereas the deeper tissues are unaffected; often affecting the ears nose and fingers. skin will be pale and cold to the touch, it may also be wrinkled. patients may have loss of sensation
laryngospasm
the sudden spasmodic closure of the larynx
significance of potential pit viper or coral snake bites
these venoms can cause paralysis; prompt transport to an appropriate receiving ED. contact hospital to ensure they have the correct antivenin