Environmental Emergencies Unit 6

Snakebite Prevention

- Do not keep venomous snake as pets -Be extremely careful in locations where snake may hide, such as tall grass, rock piles, ledges and crevices, woodpiles, brush, boxes, and cabinets. -Snakes are most active on warm nights -Don protective attire such as boots, heavy pants, and leather gloves. When walking or hiking, use a walking stick or trekking poles. -Inspect suspicious areas before placing hands and feet in them. -Do no harass any snakes you may encounter. Striking distance is at least the length of the snake, and often longer. Even young snakes pose a threat; they are capable of envenomation from birth. -Be aware that newly dead or decapitated snakes can inflict a bite for up to an hour after death because persistence of bite reflex. -Avoid transporting the snake with the victim to the medical facility to identification purposes, unless the snake can be placed a sealed container.

Heat-Related Illness

-Avoid alcohol and caffeine -Prevent overexposure to the sun; use a sunscreen with an SPF of at least 30 with UVA and UVB protection. -Rest frequently and take breaks from being in a hot environment. Plan to limit activity at the hottest time of the day. -Wear clothing suited to the environment. Lightweight, light-colored and loose-fitting clothing is the best. -Pay attention to your personal physical limitations; modify activities accordingly -Take cool baths or showers to help reduce body temperature -Stay indoors in air-condition building if possible. -Ask a neighbor, friend, or family member to check on the older adult at least twice a day during a heat wave.

Bees and Wasps Clinical manifestations/ Signs and Symptoms

-Bumblebees, Hornets, and wasps are capable of stinging repeatedly when disturbed. Honeybees can sting just once and when they do, the stinger and venom sac are pulled away from the bee. -Africanized bees- people should attempt to outrun the bees, keep their mouth and eyes protected from a swarm. -Multiple stings, reactions tend to be more severe. S/S: -Immediate pain and wheal-and flare skin reaction. Some people have swelling that is extensive that involves entire limbs. -Systemic effects depend on the venom load and the personal sensitivity to it. -Generalize edema, nausea, vomiting and diarrhea are reactions to the toxic effects, not necessarily an allergic reaction. -Other toxic reactions are destruction of red and white blood cells and platelets. Damage to blood vessel walls, acute renal failure, liver injury, and cardiac dysrhythmias. -If the person is allergic then urticaria (hives),pruritis (itching), and swelling of the lips and tongue which can rapidly progress to anaphylaxis. -Anaphylaxis is evidence by respiratory distress with bronchospasm, laryngeal edema, cardiac dysrhythmias, hypotension, deterioration in mental status.

Arthropod Bite/Sting Prevention

-Wear protective clothing, including gloves and shoes, when working in areas known to harbor venomous arthropods, such as spiders, bees, scorpions. -Cover garbage cans. Bees and wasps are attracted to uncovered garbage. -Use screens in windows and doors to prevent flying insects from entering buildings. -Inspect clothing, shoes, and gear for insects before putting on these items. -Shake out clothing and gear that have been on the ground to prevent arthropod "stowaways" and inadvertent bites and stings. -Consult an exterminator to control arthropod populations in and around the home. Eliminating insects that are part of the arthropod's food source may also limit their presence. - Identify nesting areas areas such as yard debris and rock piles; remove them whenever possible. -Do not place unprotected hands where the eyes cannot see. -Avoid handling insects or keeping them as "pets" -Do not swat insects, wasps, and Africanized bees because they can send chemical signals that alert other to attack. -Carry prescription epinephrine preparations and antihistamines if know to be allergic to bee and wasp stings.

Heat Exhaustion Clinical Manifestations/Signs and Symptoms

A syndrome resulting primarily from dehydration. Caused by: -Heavy perspiration -Inadequate fluid and electrolyte intake during heat exposure over hours to days. S/S: -Clinical manifestations resembling the flu. -Headache -Weakness -Nausea/Vomiting -Body temperature is not significantly elevated in this condition. -The patient may continue to perspire despite dehydration. -Not a true emergency condition if it is treated in a timely manner. If left to progress it could lead to heat stroke which is a medical emergency.

Spider Bites Clinical manifestations/ Signs and Symptoms Brown Recluse

Also known as fiddlebacks or violin spiders. -Hide in areas that are dark and secluded such as boxes, closets, basements, sheds and garages. -Most indoor bites are due to donning clothing that contains the spider, when people are sleeping, reaching into boxes or closets. Few people ever see the spider that bit them. -Brown recluse spider venom causes cell damage. The only evidence of the bite may be a skin lesion;necrotic wound. Less often, systemic effects from the injected toxin, commonly referred to as loxoscelism. -The bite may be painless or stinging to sharp and painful. Some victims are unaware that they were bitten until intense local aching and pruritus develop over minutes to hours. S/S: -Central bite may appear as a belb or vesicle surrounded by edema and erythema, which may expand over the course of several hours as the toxin spreads. -The center of the bite becomes bluish purple. Some may not have changes in tissue and therefore do not require medical care. -Over 1-3 days the central part of the wound becomes dark and necrotic. Eschar (a necrotic, leathery, covering over the wound) eventually forms. -The combination of these changes is referred to as the classic "red, white, and blue sign" that is associated with brown recluse spider bites. -When the wound sloughs, an open wound or ulcer can remain for weeks to months. -In rare cases systemic toxicity can cause rash, fever, chills, nausea, vomiting, malaise, and joint pain. In the worst case, the bite could cause hemolytic reactions, renal failure, pulmonary edema, cardiovascular collapse, and death.

Spider Bites Clinical manifestations/ Signs and Symptoms Black Widow

Black Widow Spiders are found in cool, damp environments such as log piles, vegetation and rocks. They inhabit barns, shed, and garages as well. -The black widow carries a neurotoxic venom. Bites are usually defensive when the spider is at risk for being crushed. -Bites range from nearly painless to sharply painful. Typically the person notices a tiny papule or small red punctate mark. Some have pain out of proportion to the lesion. -In many cases, the symptoms do not progress beyond a local reaction in the area of the bite site. If systemic S/S occur they generally develop within 1 hour and involve the neuromuscular system. -The venom from the black widow produces a syndrome known as latrodectism. S/S include: -Severe abdominal pain -Muscle rigidity and spasm [typically involves large muscles of the abdomen, back and limbs.] -Hypertension -Nausea/ vomiting -Facial Edema -Ptosis (eyelid drooping) -Diaphoresis -Weakness -Increased salivation -Respiratory difficulty from excessive secretions -Fasciculatations (twitching) and paesthesias (painful tingling or numbness) *Older adults and Pregnant patients are at highest risk for complications from these bites*

Grades of Pit Viper Envenomation

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

Snake Bites Clinical manifestations/ Signs and Symptoms Coral Snakes

Coral Snakes: found from North Carolina, Florida, Gulf states through Texas & southwestern US. These snakes have broad bands of red and black rings, separated by yellow or cream rings. -Most bites occur when people attempt to handle the snake. -The snake envenomates with a nerve and muscle toxin. The amount of venom in an adult coral snake is enough to kill an adult. -"Red on Black, Venom Lacks" -"Red on Yellow can kill a fellow" *These memory aids only apply to coral snakes found in the US* Clinical Manifestations: -Pain from bites may be only mild and transient. Because venom is spread via the lymphatic system swelling is unlikely. Bite marks may be difficult to find because this snake has small teeth. -Toxic effects may be delayed up to 12 to 18 hours after a bite but then produces a rapid clinical deterioration. S/S: (Early)- nausea, vomiting, headache, pallor, abdominal pain. (Neurologic)- paresthesias (painful tingling), numbness, mental status changes, cranial nerve and peripheral nerve deficits. Total flaccid paralysis may occur later, the patient may have difficulty speaking, swallowing, and breathing. -Clotting changes do not occur. -Respiratory and cardiovascular collapse can occur in severe cases. Labs may reveal: ABGs- respritory insufficiency Elevation in creatine kinase (CK) - muscle breakdown producing myoglobinuria (release of muscle myoglobulin into the urine) -Death is rate is the patient receives timely management.

Near Drowning Clinical manifestations/ Signs and Symptoms

Drowning Injuries- Surfactant gets washed out of lungs, the quality of the water can cause infections as well. Cold water may have a protective effect [due to hypothermia] but many injuries can occur despite resuscitation. -The cause of the submersion should also be determined, if possible. The patient may have suffered a medical condition or injury that caused the drowning event such as a seizure, MI, stroke, or spinal cord injury. Fresh Water- Washes surfactant out of lungs. Salt Water- Works by an osmolar gradient, by pulling vital proteins away from the lungs. -Both water types pose the threat of contamination because of the quality of the water, microbes, toxins, mud, sand and pollutants that may be present in the water

Frost Bite Clinical manifestations/ Signs and Symptoms

Frostbite-freezing of body tissue that causes tissue damage. Like a burn(superficial, partial, or full thickness) People who smoke, consume alcohol or have impaired peripheral circulation have a higher incidence of frost bite. Look for early signs (white, waxy appearance on exposed skin) -Wet clothing in particular is a poor insulator and facilitates the development of frost bite. -Materials such as GORE-TEX that are windproof, water-proof, breathable should be worn outdoors. The inner layers should be materials such as polyester fleece which provides warmth and insulation. Frostnip - superficial cold injury producing pain, numbness, and pallor relieved by applying warmth - no tissue damage if treated. First degree - hyperemia and edema (swollen, red, tissue isn't exactly dead, just decreased blood flow and tissue edema) Second degree- large fluid-filled blisters with partial-thickness skin necrosis (can be partial tissue necrosis, runs a little deeper) Third degree- blisters with dard fluid affected body part is cool, numb, blue or red no blanching, full thickness and subQ necrosis - debridement required (blister tends to be smaller, cold, blue numb, red due to tissue damage. The tissues no longer blanches, lots of necrosis and will require debridement.) Fourth-degree - no blister, no edema, part is numb, cold and bloodless with full thickness necrosis extending into the muscle and bone - gangrene and amputation may be required. (usually requires amputation)

Heat Stroke Clinical manifestations/ Signs and Symptoms

Heat stroke is defined by body temp that may exceed 104. It has a high mortality rate is not treated promptly. There are 2 types: Exertional heat stroke: a sudden onset and is often the result of strenuous physical activity in hot, humid conditions. A common contributing factor is not being acclimated to the hot weather. Classic heat stroke: occurs over a period of time, as a result of chronic expose to hot, humid environment.[no AC in the summer time during high heat temps] Typically affects the ill, older adults. S/S: -Body temp more than 104 -Hot and dry skin; may or may not perspire -Mental status changes: Acute confusion Anxiety Loss of coordination Hallucinations Agitation Seizures Coma -Vital sign changes Hypotension Tachycardia Tachypena -Electrolyte imbalances, especially sodium and potassium -Decreased renal function (oliguria) -Coagulopathy (abnormal clotting) -Pulmonary edema (crackles)

Hypothermia Clinical manifestations/ Signs and Symptoms

Hypothermia is a core body temperature below 95 F. Common predisposing conditions that promote hypothermia include: -Cold water immersion -Acute illness -Traumatic injury -Shock states -Immobilization -Cold weather (especially for the homeless and people working outdoors) -Advance age -Selected medications (phenothiazines, barbiturates) -Alcohol intoxication -Malnutrition -Hypothyroidism -Inadequate clothing or shelter Temps below 82 F can produce hypothermia. Older adults are especially at risk on a year-round basis in most areas of the world. Wind chills affect the temp and the weather is the most common cause of hypothermia. Hypothermia is divided into 3 categories: Three categories - mild (90-970F), moderate (82o-92 oF), severe (< 82oF) Mild (90-95F)- Assessment - shivering, dysarthria, decreased muscle coordination, impaired cognition, diuresis Moderate (82.4o-90 oF) Assessment - muscle weakness, increased loss of coordination, acute confusion, apathy, incoherence, possible stupor, decreased clotting Severe (< 82.4oF) Assessment - Bradycardia, hypotension, decreased respiratory rate, cardiac dysrhythmias, including possible ventricular fib or asystole, decrease neuro reflexes and pain, acid - base imbalance.

Hypothermia Treatment in the field Treatment in the clinical setting

Mild (90-95F) Hypothermia - shelter, remove wet clothing, passive or active rewarming, heating blankets, warm high-carbohydrate drink. No alcohol or caffeine. If a heating blanket is used, monitor the patient's skin every 15 to 30 minutes to reduce the risk for burn injury. Convective air heaters or warmers may be used to speed rewarming. Moderate (82.4o-90 oF) Hypothermia- Rewarm the trunk of the body first. Core warming -Warmed IV fluids, heated O2, heated peritoneal, pleural, gastric or bladder lavage. -Defibrillation may not be effective until the core temperature is above 86 oF Provisions/treatment - -Admin. Drugs cautiously or longer intervals Watch for drug toxicity. -Withhold IV drugs until core temperature above 86o F After-drop is the continued decrease in core body temperature after the victim is removed from the cold environment; it is caused by the return of cold blood from the periphery to the central circulation. Severe (< 82.4oF) Hypothermia: Use internal rewarming for severe hypothermia Assessment - monitor for fluid, electrolyte and metabolic abnormalities, SRDS and acute renal failure and pneumonia after rewarming. *People who are severely hypothermic are at high risk for cardiac arrest. Avoid using active external rewarming with heating devices because it is dangerous and contraindicated in this population due to rapid vasodilation.*

Snake Bites Clinical manifestations/ Signs and Symptoms Pit Vipers

Pit Vipers: rattlesnakes, copperheads, cottonmouths [account for the majority of poisonous snakebites in the US] -heat-sensing -triangular head that indicates the presence of venom and elliptical pupils (cat's eye) [view diagram] -Typically injects Hemotoxic venom [breaks down tissues that aid in digestion.] -Two retractable, cruved fangs that have canals for venom flow -Envenomation (injection of venom) may actually be dry, but there may be distinctive fang marks on the patient. Clinical manifestations: -Puncture wounds -Severe pain, swelling and redness or ecchymosis (bruising) in the area around the bite. -Minty, rubbery, or metallic taste in the mouth and tingling or paesthesias of scalp, face and lips. -Muscle twitching (fasciculations) -Weakness -Nausea/Vomiting -Hypotension -Seizures -Coagulopathy (clotting abnormalities or DIC) *If the bite does not show evidence of local tissue swelling or redness within 8 hours, systemic effects are less likely to develop.* Pathophysiologic effects of the pit viper bite: -Tissue necrosis -Massive tissue swelling, leading to intravascular fluid shifts (compartment syndrome) -Hypovolemic shock -Pulmonary edema -Renal failure -Hemorrhagic complications due to DIC. -Death

Scorpions Clinical manifestations/ Signs and Symptoms Bark Scorpion

The bark scorpion is found in the southwestern US and it can inflict a sting associated with a potentially fatal system response. It is often found in trees, woodpiles, and around debris. Humans are usually stung when the scorpion gets into clothing, shoes, blankets, and personal items left on the ground. -The venom the the bark scorpion venom is neurotoxic. S/S: - cranial nerve and or skeletal muscle involvement. - The sting may or may not show s/s of venom release. There may be no redness or other obvious sign of inflammation. -Gentle tapping at the potential sting causing increased pain is associated with a bark scorpion. *The severity of the reaction varies from local pain to severe systemic manifestations such as:* Fever, hypertension, GI disorders, tachycardia, cardiac dysfunction, pulmonary edema, nervous system involvement. In rare cases death can occur. -Symptoms usually begin immediately after the sting and can reach a crisis level within 12 hours. Pain and paresthesias can remain for up to 2 weeks.

Lightning Injuries Clinical manifestations/ Signs and Symptoms

The patient who has sustained a lightning strike is at great risk for multi-system trauma. -CNS injury is common. Typically a temporary paralysis that affects the lower limbs to a greater extent than the upper limbs. This typically resolves within a few hours -Full thickness burns, charring and contact burns may be presence. A uncommon characteristic is the presence of Lichtenberg figures which is the branching or ferning marks on the skin. -The patient may have ECG and perfusion abnormalities such as angina and dysrhthmias. -The initial appearance of mottled skin pulses usually arises from arterial vasospasms and typically resolves spontaneously in several hours.

Bark Scorpion Sting Treatment in the field Treatment in the clinical setting

Treatment [In general] -The first priority is patient management is vital sign assessment and continuous monitoring for several hours in a hospital emergency department or critical care unit. As symptoms worsen, the patient may develop respiratory failure and need intubation. -Provide supplemental O2 and IV fluids right away. -Apply a ice pack to the site to control pain. -Give analgesic and sedative agents with caution in the non-intubated, spontenously breathing patient. -Fever is treated with acetaminophen (tylenol) and an application of a cooling blanket as needed. -Provide tetanus prophylaxis and basic wound care with an antiseptic agent. -Contact the poison control center as soon as possible to assist with patient management, particularly in regard to use of pharmacologic agents for scorpion stings.

Black Widow Spider Bite Treatment in the field Treatment in the clinical setting

Treatment in the Field: -The priority intervention for a black widow spider bite is to apply an ice pack because cold application decreases the action of the neurotoxin. -Monitor the person for evidence of systemic toxicity. If this problem occurs, support the patient's airway, breathing, and circulation. Call 911 or get them to the nearest medical facility for advance life support. Treatment in the clinical setting: - Monitor vital signs closely, particularly blood pressure, respiratory function. -Administration of opioid pain medications and muscle relaxants such as diazepam (valium). Provide tetanus prophylaxis as needed. -Observe the patient for seizure related to rapidly rising blood pressure. For some patients antihypertensive agents may be necessary. -Although relapses may occur the patient usually recovers within a week. Less often pulmonary edema, uncontrollable hypertension, seizures, respiratory arrest, and shock occur. These patients require critical care management. -Antivenom is available for black widows although, it can cause anaphylaxis and serum sickness it is considered effective in treating severe infections. -The drug must be given to pregnant women because it could lead to premature delivery due to uterine and abdominal contractions. Contact the regional poison control center for info about antivenom dosing and management for women who are pregnant.

Lightening Injuries Treatment in the field Treatment in the clinical setting

Treatment in the field -Spinal immobilization with stabilization of airway, breathing, and circulation. -CPR is performed immediately when a person is in cardiac arrest. - Skin burns are not an initial priority, however, if time and resources permit, a sterile dressing may be applied to cover the sites. -The storm can present a continued threat to everyone in the vicinity who lacks adequate shelter. Treatment in the clinical setting -Cardiac monitoring to detect cardiac dysrhthmias and as 12 lead EKG. -Perform a complete and thorough physical diagnostic evaluation to find any hidden traumatic injuries. -Monitor Creatine Kinase (CK) levels if indicated to detect skeletal muscle damage resulting from the lightning strike.. -Monitor for s/s of rhabdomyolysis (circulation of by-products of skeletal muscle destruction) -Burns are treated per protocol -Administer Tetanus prophylaxis

Pit Viper Bites Treatment in the field Treatment in the clinical setting

Treatment in the field: - Move the person to a safe area away from the snake and encourage rest to decrease venom circulation. Next, remove jewelry and constrictive clothing before swelling worsens. -Immobilize the affected extremity in a position of function with a split, maintain the extremity at the level of the heart. -Keep the person warm -Provide calm reassurance -Do not offer alcohol, do not incise or suck the wound, apply ice or use a tourniquet. Treatment in the clinical setting: - Give supplemental oxygen - Start two large bore IV lines, and infusion of crystalloid fluids such as NS 0.9% or LR solution. -Continuous cardiac[EKG for myocardial ischemia or other cardiac abnormalities] and blood pressure monitoring. -Give opioids to control pain -Give tetanus prophylaxis and wound care. -Labs that are necessary are: CMP Coagulation profile CBC Creatine Kindase (CK) Type and crossmatch Urinalysis -Obtain Hx. related to the event with a full description of the snake. -Assess the development of tissue edema st the site. Measure and record the circumference of the bitten extremity every 15 to 30 minutes. -Contact the regional poison control center for antivenom dosing and medical management. Not all patients require antivenom. [See envenomation grading card] -Cortalidae Polyvalent Immune Fab (CroFab) is typically given if indicated. Do not give CroFab if the patient has a known hypersensetiviy to papin or papaya. Unless the benefits outweigh the risks CroFab is held for these patients. -Administer CroFab within 6 hours of the bite. Recommended dose is typically 4 to 6 vials infused over 60 minutes. During the first 10 minutes, the infusion should be slow (25-50mL/hr). Monitor for an allergic reaction. If symptoms are still not controlled an additional 4 to 6 vials are recommended. -Once symptoms are under control 2 more vials are administered every 6 hours for a total of 18 hours of administration. *Give CroFab cautiously to pts who:* -A previous allergic reaction to antivenom therapy -A hypersensitivity to bromelain (pineapple-derived enzyme) or sheep protein. -Prior CroFab therapy for a past envenomation (can become sensitized to the foreign sheep protein) -Pregnancy -Sensitivity to mercury containing products.

Bees and Wasp Sting Treatment in the field Treatment in the clinical setting

Treatment in the field: - Quick removal of the stingers - Airway, breathing, circulation are maintained. Determine whether the patient has a history of allergic reaction to bee stings. -Ask if the patient has a bee kit [epipen & antihistamine tablet] or epipen. - Epi is given immediately if the patient has a severe allergic reaction with wheezing, facial swelling and respiratory distress. -IM is given vs subcutaneous because it has a more predictable and rapid absorption. -After epi administration an antihistamine is also given. Liquid Benadryl is easier to swallow vs tablets. -Call 911 Treatment in clinical setting -Apply O2 -Apply continous cardiac and blood pressure monitoring. -Start an IV with an infusion of NS 0.9% to support blood pressure. -Advance life support drugs should be made available, because Epi may or may not be effective enough. -IV Epi administration has much greater risk for adverse cardiovascular effects than IM epi. Use IV epi with extreme caution, especially in older adults with cardiovascular disease, because it can increase pulse rate and blood pressure. Monitor the patient's vitals ever 10 to 15 minutes for 1 hour after IV administration. -Bronchospasm can be treated with albuterol -Parenteral antihistamines are administered -Coricosteroids are administered to decrease the immune response. These are tapered dses and they are given to manage or prevent delayed allergic effects (biphasic reaction: within 4-6hrs) -All patients who have sustained more than 50 stings are observed in the ER to monitor for development of toxic effects. -Teach to carried a bee kit and wear a medical alert tag or bracelet.

Brown Recluse Spider Bite Treatment in the field Treatment in the clinical setting

Treatment in the field: -Apply ice intermittenly during the first 4 days after the bite. Do not use heat. -Elevate the affected extremity at the level of the heart. -Local wound care, and rest. Treatment in the clinical setting: -For patients with wounds that appear infected, a topical antiseptic and sterile dressing are necessary. Antibiotics may also be ordered. -Debridement and skin grafting may be necessary if the wound is severe. -Tetanus shot is given prophylatically.

Heat Exhaustion Treatment in the field Treatment in the clinical setting

Treatment in the field: -Ask the patient to stop physical activity immediately, move them to a cool place and use cooling measures. -Place cold packs on: neck, chest, abdomen, and groin. -Soaking the person in cool water; or fanning them while spraying water on the skin. -Provide an oral rehydration solution such a sport drink. Do not give salt tablets, they can cause stomach irritation, nausea, vomiting. -If s/s persist call 911. Treatment in clinical setting: -Monitor vital signs -Rehydrate the patient with IV 0.9% NS if nausea and vomiting persists. -Draw blood for serum electrolyte analysis. -Hospital admission is typically reserved for those who have health conditions that are exacerbated by heat-related illness or for severe dehydration. -For the elderly, assess the patient for orthoststic hypotension and tachycardia, especially those who are predisposed to rapid dehydration. Older adults who are already dehydrated often experience acute confusion and are at risk for falls.

Heat Stroke Treatment in the field Treatment in the clinical setting

Treatment in the field: -Ensure a patient airway -Remove the patient from the hot environment (into air-condition or into the shade) -Remove the patient's clothing -Pour or spray water on the patient's body and scalp -Fan the patient (get people to assist in this, and use whatever is available such as newspapers, magazines) -If ice is available, place ice in cloth or bags and position the packs on the patient's scalp, in the groin area, behind the neck, and in the armpits. -Call 911 or get the patient to the nearest ER. -Drenching the victim with large amounts of icy water may be the fastest, most effective means to reduce core body temp. -Do not give food or liquid by mouth. Treatment in clinical setting: -Give oxygen by mask or nasal cannula -Start at least one IV with a large-bore needle or cannula. -Administer 0.9% NS as rapidly as possible, using cooled solutions if available. -Use a cooling blanket -Do not give aspirin or any other antipyretics -Insert a rectal probe to measure core body temperature continuously, or use a rectal thermometer and assess temperature every 15 minutes. -Insert a Foley catheter -Monitor vital signs frequently as clinically indicated. -Obtain baseline laboratory test as quickly as possible: serum electrolytes, cardiac enzymes, liver enzymes, and CBC -Assess ABGs -Administer muscle relaxants (benzodiazepines) if the patient begins to shiver. -Measure urine output and specific gravity to determine fluid needs. -Slow cooling interventions when core body temp is reduced to 102; stop cooling when rectal temp is 100. -Obtain urinalysis and monitor I&Os

Coral Snakes Treatment in the field Treatment in the clinical setting

Treatment in the field: -Identify the snake as a coral snake is the first priority because a lot of harmless snakes can resemble this snake. If the patient cannot ID the snake it is treated as if venom has been injected. - Limit the spread of venom by encircling the bite site snugly with an elastic bandage or roller gauze to impede lymphatic flow and then split. Ensure that the bandage does not impairs arterial flow, and do not remove until tie victim is managed at an acute care facility. -The venom from this snake does not destroy tissue, so the idea is to limit the spread of venom via the lymphatic system. Treatment in the clinical setting: -Continuous cardiac, blood pressure, pulse oximetry monitoring, and admitted to a critical care unit. -Prepare to provide aggressive airway management via ET intubation if respiratory insufficiency or severe neurologic impairment occurs. Aspiration of secretions is a significant risk for this patient. -Early antivenom administration is recommended. The antivenom for this name is Antivenin (Micrurus fulvius [Wyeth]). This drug is no longer in active production. -The same precautions are applied when administering pit viper antivenom. The most significant risk to the victim is an anaphylactic response to the antivenom. Ensure that the patient's IV lines are patent and emergency drugs and resuscitation equipment are immediately available. -Contact the regional poison control for specific advice on antivenom administration and patient management. -The onset of symptoms after coral snake bites can be delayed but can persist for a week in spite of treatment. -A patient may survive a coral snake bite without antivenom but may require prolonged mechanical ventilation and supportive care.

Near Drowning Treatment in the field Treatment in the clinical setting

Treatment in the field: -If the patient drowns due to a spinal cord injury, we want to immobilize and stabilize the spine. When the patient is pulled out of water, stabilize the spine and establish the airway. -Once the patient is stabilized, listen to the lung sounds for crackles, consolidation. -Do not attempt to clear the fluid from the lungs, only deliver abdominal or chest thrusts if airway obstruction is suspected. Treatment in the hospital: -Once the person is safely out of the water, cardiopulmonary interventions begin, including O2 administration, endotracheal intubation, CPR and defibrillation, if necessary. -Gastric decompression is needed for prevent aspiration of gastric contents and improve ventilatory function. -The patient typically receives critical care management to prevent complications such as CNS impairment, ARDS, and pulmonary infection.

Frostbite Treatment in the field Treatment in the clinical setting

Treatment in the field: Recognition of frostbite is essential to early, effective intervention and prevention of further tissue damage. -Observe for signs such as white, waxy appearance to exposed skin, especially on the nose, cheeks, and ears. Identify the problem before it worsens. -Have the person seek shelter from the wind and cold and attend to the affected body part. -Superficial frostbite is easily managed using body heat to warm the affected area. Teach patients to place their warm hands over the affected areas on their face or two place cold hands under arms. Treatment in the clinical setting: -Rewarming in 104-108* for water bath to thaw. If a water bath is not available - use hot towel. -Rewarming is very painful, administer analgesics especially IV opioids and IV rehydration. -NO DRY HEAT! -Post rewarming- handle tissue gently putting injured areas above the heart to prevent edema from setting in. -Assess hourly for compartment syndrome:if the tissue is not allowed to expand impaired circulation occurs (assess for pain, paresthesia, numbness even after opioids, pallor (compare extremities), and pulses. -Administer tetanus shot if indicated -Administer Ibuprofen to treat inflammation. -Do not message the frostbitten areas as part of the rewarming process. -Avoid compression of the injured tissue and handle the tissue very gently. -Antibiotics (both systemic and topical) and debridement of necrotic tissue or amputation may be necessary for those who develop gangrene or severe compartment syndrome.