18: Environmental Emergencies

1. 18: Environmental Emergencies

2. Factors Affecting Exposure • Physical condition • Age • Nutrition and hydration • Environmental conditions

3. Conduction Transfer of heat from body to colder object Convection Transfer of heat through circulating air Evaporation Cooling of body through sweating Radiation Loss of body heat directly into a colder environment Respirations Loss of body heat during breathing Loss of Body Heat (1 of 2)

4. Loss of Body Heat (2 of 2) • Rate and amount of heat gain or loss can be modified in three ways: • Increase or decrease heat production. • Move to sheltered area where heat loss is increased or decreased. • Wear insulated clothing.

5. Hypothermia • Lowering of the body temperature below 95°F (35°C) • Weather does not have to be below freezing for hypothermia to occur. • Older persons and infants are at higher risk. • People with other illnesses and injuries are susceptible to hypothermia.

6. Shivering Rapid pulse and respirations Red, pale, cyanotic skin Signs and Symptomsof Mild Hypothermia

7. Shivering stops. Muscular activity decreases. Fine muscle activity ceases. Eventually, all muscle activity stops. Signs and Symptoms of More Severe Hypothermia

8. Patient may appear dead (or in a coma). Never assume that a cold, pulseless patient is dead. Core TemperatureLess Than 80°F

9. Scene Size-up • Note weather conditions. • Identify safety hazards such as icy roads, mud, or wet grass.

10. Initial Assessment • Check temperature on patient’s abdomen. • Mental status can be affected. • Ensure adequate airway. • Warmed, humidified oxygen helps warm from inside out. • Palpate for carotid pulse; wait 30–45 seconds. • Transport immediately or move to warmer location.

11. Focused History and Physical Exam • If unconscious, do a rapid physical exam. • If conscious, attempt to obtain SAMPLE history. • Determine how long the patient was exposed to the cold. • Medications can affect the patient’s metabolism. • Focused physical exam • Concentrate on areas of body directly affected by exposure.

12. Baseline Vital Signs • Can be altered by hypothermia • Monitor for changes in mental status. • Check for core body temperature.

13. Interventions • Move from cold environment. • Do not allow patient to walk, eat, use any stimulants, or smoke or chew tobacco. • Remove wet clothing. • Place dry blankets under and over patient. • Handle gently. • Do not massage extremities. • Give warm, humidified oxygen.

14. Detailed Physical Exam • Aimed at determining degree and extent of cold injury • Evaluate skin temperature, texture, and turgor.

15. Ongoing Assessment • Rewarming can be harmful; monitor carefully. • Communicate conditions at scene, clothing, changes in mental status.

16. Local Cold Injuries • Frostnip • Freezing of the skin but not the deeper surface • Immersion (trench) foot • Prolonged exposure to cold water • Frostbite • Freezing of a body part, usually an extremity

17. Emergency Carefor Local Cold Injury • Remove the patient from further exposure to the cold. • Handle the injured part gently. • Administer oxygen. • Remove any wet or restrictive clothing. • Never rub the area. • Do not break blisters. • Transport.

18. Warm-Water Bath • Water temperature should be between 100-112oF. • Recheck water temperature and stir to circulate. • Keep body part in water until warm and sensation returns. • Dress with dry, sterile dressings.

19. Cold Exposure and You • EMT-Bs are at risk for hypothermia when working in a cold environment. • Stay aware of local weather conditions. • Dress appropriately and be prepared. • Vehicle must be properly equipped and maintained. • Never allow yourself to become a casualty!

20. Heat Exposure • Normal body temperature is 98.6°F. • Body attempts to maintain normal temperature despite ambient temperature. • Body cools itself by sweating (evaporation) and dilation of blood vessels. • High temperature and humidity decrease effectiveness of cooling mechanisms.

21. Heat Cramps • Painful muscle spasms • Remove the patient from hot environment. • Rest the cramping muscle. • Replace fluids by mouth. • If cramps persist, transport the patient to hospital.

22. Signs and Symptomsof Heat Exhaustion (1 of 2) • Dizziness, weakness, or fainting • Onset while working hard or exercising in hot environment • In older people and young, onset may occur while at rest in hot, humid, and poorly ventilated areas. • Cold, clammy skin

23. Signs and Symptomsof Heat Exhaustion (2 of 2) • Dry tongue and thirst • Patients usually have normal vital signs, but pulse can increase and blood pressure can decrease. • Normal or slightly elevated body temperature

24. Emergency Medical Care • Remove extra clothing and remove from hot environment. • Give patient oxygen. • Have patient lie down and elevate legs. • If patient is alert, give water slowly. • Be prepared to transport.

25. Signs and Symptoms of Heatstroke • Hot, dry, flushed skin • Change in behavior leading to unresponsiveness • Pulse rate is rapid, then slows. • Blood pressure drops. • Death can occur if the patient is not treated.

26. Care for Heat Stroke (1 of 2) • Move patient out of the hot environment. • Provide air conditioning at a high setting. • Remove the patient’s clothing. • Give the patient oxygen. • Apply cold packs to the patient’s neck, armpits, and groin.

27. Care for Heat Stroke (2 of 2) • Cover the patient with wet towels or sheets. • Aggressively fan the patient. • Immediately transport patient. • Notify the hospital of patient’s condition.

28. You are the Provider • You are dispatched to the Green Valley Mobile Home Park for a sick person. • An older woman found her husband on the couch not responding. • You note that it is very hot with no source of ventilation.

29. You are the Provider (continued) • The man is on the couch and conscious but disoriented. • Patent airway, breathing shallow at 22 breaths/min • Skin is red, hot, and dry. • What medical emergency could the patient be experiencing?

30. Scene Size-up • Do environmental assessment. • Protect yourself from heat and biological hazards. • ALS may need to give IV fluids.

31. You are the Provider (continued) • Your partner applies high-flow oxygen via nonrebreathing mask; you call for ALS backup. • Rapid, thready pulse; low BP; sluggish pupils; temp 104°F • No signs of traumatic injury • You remove constricting clothing, jewelry. • You move patient into ambulance. • Is this patient a priority?

32. Initial Assessment • The more altered the mental status, the more severe the exposure. • Keep airway patent. • Oxygen may decrease nausea. • Hot, dry, or moist skin may indicate elevated core temperature. • Treat for shock aggressively. • If any signs of heatstroke, transport immediately.

33. You are the Provider (continued) (1 of 2) • You set A/C on high, remove patient’s clothing, apply cool packs. • Patient’s wife states that husband came in after working outside 2 hours. Complained he was hot and dizzy. • She made him a sandwich and went to the neighbor’s for a few minutes.

34. You are the Provider (continued) (2 of 2) • He has an allergy to milk and cats. • Takes Lasix twice a day and a medication for high BP. • Do you expect this patient’s blood pressure to be high?

35. Focused History and Physical Exam • Note activities/medications that may make patient susceptible to heat-related problems. • Determine exposure and activities prior to symptoms. • Assess for muscle cramps, confusion. • Examine for mental status, skin temperature, wetness.

36. Baseline Vital Signs • May be tachycardic or tachypneic • In heat exhaustion, patient may have normal skin temp; may also be cool and clammy. • In heat stroke, patient will have hot skin.

37. Interventions • Remove from hot environment. • Give cool fluids by mouth. • Cover with sheet and soak with cool water. • Set A/C on high. • Place ice packs on groin and axillae. • Fan aggressively.

38. Detailed Physical Exam • Pay attention to skin temperature, turgor, wetness. • Turgor = skin’s ability to resist deformity • In dehydration, skin will tent when pinched on back of hand. • Perform careful neurologic exam.

39. You are the Provider (continued) • ALS is 25 minutes away. • You choose to rendezvous. • En route, you: • Elevate the patient’s legs. • Cover patient with wet sheet. • Fan him. • Reassess. • What actions should you take during transport to the hospital?

40. Ongoing Assessment • Watch for deterioration. • Reassess vital signs every 5 minutes. • Do not cause shivering. • Document weather conditions and activities prior to emergency.