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3. 3 HYPOTHERMIA Definition: The body loses more heat than it gains or it produces: low body temperature.

4. 4 Heat loss occurs through 5 mechanisms: Radiation Convection Conduction Evaporation Respiration

5. 5 RADIATION Definition: The process of transfer of heat from object to the surface of another without physical contact. Most significant mechanism of heat loss. Most heat is lost from head, hands, and feet---this is why it is important to wrap a newborn’s head in a cap. Under normal conditions, 60% of a person’s heat production is lost by radiation.

6. 6 CONVECTION Definition: The process that causes cold air that is in immediate contact with the skin to be warmed. Heated air molecules move away, and cooler ones take their place---those in turn are warmed, and the process starts all over.

7. 7 CONDUCTION Definition: The process which causes body heat to be lost through direct contact. Water conducts heat 240 times than air Wet clothing conducts heat away from the body at a much higher rate than dry clothing, and much more rapidly than the body can produce heat.

8. 8 EVAPORATION Definition: The process in which a liquid or solid changes to a vapor. As the body perspires and the perspiration evaporates, the body surface is cooled. When air temperature equals or exceeds skin temperature, evaporation is the only way the body has of losing heat.

9. 9 RESPIRATION Definition: The process of breathing also produces heat loss. Cold air is inhaled and warm air is exhaled ---some of the body’s heat is carried away with the exhaled warm air.

10. 10 TWO TYPES OF COLD EMERGENCIES 1. Generalized hypothermia: overall reduction in body temperature affecting the entire body. 2. Local cold injury: damage to body tissue in a specific (local) part or parts of the body.

11. 11 PREDISPOSING FACTORS OF GENERALIZED HYPOTHERMIA Cold environment Age Medical conditions Drugs and poisons

12. 12 COLD ENVIRONMENT Temperatures do not have to be extreme for hypothermia to occur. It can occur in temperatures as high as 65o F Wetness, either from perspiration, immersion in water, or rain, always compounds the problem and increases the risk of hypothermia.

13. 13 AGE Patients who are in extreme ranges of age, such as infants, toddlers, and elderly are at increased risk for hypothermia. Infants and young children have large surface area which increases amount and speed of heat loss Elderly have impaired recognition of cold, a diminished basal metabolism, poor constriction of blood vessels in the extremities, and some have impaired mobility.

14. 14 MEDICAL CONDITIONS Conditions that increase risk for hypothermia are: Recent surgery Shock Head injury Burns Generalized infection Spinal cord injuries Thyroid gland disorders Diabetic emergencies

15. 15 DRUGS AND POISONS Alcohol, drugs, and poisons when ingested or injected can increase the patient’s risk of hypothermia.

16. 16 STAGES OF HYPOTHERMIA Stage 1: Shivering is a response by the body to generate heat; it does not occur below a body temperature of 90o F. Stage 2: Apathy and decreased muscle function. First, fine motor function is affected, than gross motor functions. Stage 3: Decreased level of responsiveness is accompanied by a glassy stare and possible freezing of the extremities.

17. 17 Stage 4: Decreased vital signs, including slow pulse and slow respiration rate Stage 5: Death STAGES OF HYPOTHERMIA

18. 18 PREDISPOSING FACTORS OF LOCAL COLD INJURY Any kind of trauma Extremes of age Tight or tightly laced footwear Use of alcohol during exposure to cold Wet clothing High altitudes Loss of blood

19. 19 LOCAL COLD INJURY Frostbite Generalized hypothermia always takes precedence over care for the local cold injury. Local cold injury occurs when ice crystals form between the cells of the skin and then expand as they extract fluid from the cells. Circulation is obstructed causing additional damage to the tissue. Hands, feet, ears, nose, and cheeks are mostly affected

20. 20 STAGES OF LOCAL COLD INJURY Stage 1: Early or superficial cold injury usually involves the tips of the ears, the nose, the cheekbones, tips of the fingers and toes, and the chin. Patient loses sensation and feelings; skin may turn a waxy gray or yellow color. Normal skin color does not return after palpation. As affected area is rewarmed, a tingling sensation is usually reported. :

21. 21 Stage 2: Late or deep cold injury involves both the skin and tissue beneath. The skin itself is white and waxy in appearance; palpation of the affected area will reveal a firm to completely solid, frozen feeling. Swelling and blisters filled with clear or straw-colored fluid may be present. As the area thaws, it may become blotchy or mottled. Deep cold injury is an extreme emergency. STAGES OF LOCAL COLD INJURY

22. 22 ASSESSMENT OF COLD-RELATED EMERGENCY Scene size-up Initial assessment Focused history and physical exam Should be conducted in back of warmed ambulance; do not delay moving the patient out of the cold environment to conduct the exam. Unresponsive patient: perform a rapid assessment and attempt to gather information for the SAMPLE history from family or bystanders.

23. 23 SIGNS AND SYMPTIONS OF GENERALIZED HYPOTHERMIA Decreasing mental status Amnesia, memory lapses, and incoherence Mood changes Impaired judgement Reduced ability to communicate Dizziness Vague, slow, slurred, or thick speech Drowsiness, progressing even to unresponsiveness

24. 24 Decreasing motor and sensory function Stiffness, rigidity Lack of coordination Exhaustion Shivering, at first, little or no shivering later Loss of sensation SIGNS AND SYMPTIONS OF GENERALIZED HYPOTHERMIA

25. 25 Changing vital signs Breathing rapid at first; shallow, slow later; absent near end Pulse rapid at first; slow and barely palpable later; irregular, absent near end Skin red in early stages, changing to pale, to cyanotic, to gray, waxen, and hard; cold to the touch Slowly responding pupils Low to absent blood pressure SIGNS AND SYMPTIONS OF GENERALIZED HYPOTHERMIA

26. 26 EMERGENCY CARE GENERALIZED HYPOTHERMIA Preventing further heat loss Rewarming the patient as quickly and safely as possible Staying alert for complications

27. 27 STEPS FOR EMERGENCY CARE GENERALIZED HYPOTHERMIA 1. Remove the patient from cold environment to prevent further heat loss. 2. Handle the patient extremely gently. 3. Administer oxygen via nonrebreather mask at 15 lpm. DO NOT HYPERVENTILATE. 4. If patient goes into cardiac arrest, provide only 1 set of 3 defibrillation shocks if AED is available, or begin CPR.

28. 28 5. If the patient is alert and responding appropriately, actively rewarm him. Active rewarming is a technique of aggressively applying heat to warm the patient’s body and includes these measures: Wrapping the patient in warm blankets, placing heat packs or hot water bottles in the groin, armpits, and on the chest, and turning up the heat in the patient compartment of the ambulance. STEPS FOR EMERGENCY CARE GENERALIZED HYPOTHERMIA

29. 29 6. If the patient is unresponsive or is not responding appropriately, do not actively rewarm; use only passive rewarming. Seek medical direction and follow local protocols. 7. Do not allow the patient to eat or drink stimulants. 8. Never rub or massage the patient’s arms or legs. 9. Transport as quickly as possible. STEPS FOR EMERGENCY CARE GENERALIZED HYPOTHERMIA

30. 30 SIGNS AND SYMPTOMS OF LOCAL COLD INJURY Early or superficial local cold injury Blanching of the skin Loss of feeling and sensation in the injured area Continued softness in the skin Tingling sensation during rewarming

31. 31 Late or deep local cold injury White, waxy skin A firm to frozen feeling when the skin is palpated Swelling Blisters If partially, or wholly thawed, the skin appears flushed with areas of purple and blanching, or the skin appears mottled and cyanotic. SIGNS AND SYMPTOMS OF LOCAL COLD INJURY

32. 32 EMERGENCY CARE LOCAL COLD INJURY Remove the patient immediately from the cold environment. Never initiate thawing procedures if there’s any danger of refreezing. Administer oxygen at 15 lpm by nonrebreather mask. Prevent injury to the injured part.

33. 33 REWARMING FROZEN TISSUE: 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. 4. Keep the 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. 8. Transport as soon as possible.

34. 34 HYPERTHERMIA Definition: An increase in body temperature from a hot environment or from overexertion in such an environment. Most heat injuries occur early in the summer seasons, before people have become acclimated to the season’s temperatures. Various stages of hyperthermia: heat cramps, heat exhaustion, and heat stroke.

35. 35 PREDISPOSING FACTORS FOR HYPERTHERMIA Climate: Hot temperature effects heat loss by radiation Exercise and strenuous activity: body can only lose one liter of sweat per hour. Age: Individuals at the extremes of ages. Pre-existing illness: list on page 427. Certain drugs and medications: including alcohol, cocaine, diuretics, barbiturates, hallucinogens, and medications that hamper sweating.

36. 36 SIGNS AND SYMPTOMS HEAT EMERGENCY Muscle cramps Weakness or exhaustion Dizziness or faintness A rapid heartbeat that is strong at first, but becomes weak and rapid as damage progresses Initial deep, rapid breathing that becomes shallow and weak as damage progresses Headache Seizure

37. 37 EMERGENCY CARE HEAT EMERGENCY Patient with moist, pale, normal-to-cool skin 1. Move the patient to a cool place. 2. Administer oxygen at 15 lpm via nonrebreather mask. 3. Remove as much of the patient’s clothing as possible. 4. Cool the patient by applying cold, wet compresses and/or by fanning lightly.

38. 38 5. Place the patient in a supine position and raise his feet and legs 8 to 12 inches. 6. If the patient is fully responsive and is not nauseated, have him drink cool water. 7. If the patient is unresponsive or has an altered mental status or is vomiting, do not give fluids. 8. Transport the patient. EMERGENCY CARE HEAT EMERGENCY

39. 39 Patient with hot skin, moist, or dry Dire Medical Emergency 1. Remove the patient from the source of heat and place him in a cool environment 2. Remove as much of the patient’s clothing as is possible or reasonable 3. Administer oxygen at 15 lpm via a nonrebreather mask 4. Immediately begin to cool patient EMERGENCY CARE HEAT EMERGENCY

40. 40 5. Because the patient’s entire body is involved in the heat emergency, several complications may result from the condition or from the treatment of it 6. Transport immediately EMERGENCY CARE HEAT EMERGENCY

41. 41 HEAT CRAMPS Usually occur in the legs and abdomen. Remove the patient from the source of heat. Consult medical direction before giving the patient sips of low concentrated salt water. Apply moist towels to the patient’s forehead and cramping muscles. Explain to the patient what happened so he can avoid a reoccurrence of the problem.


43. 43 SIGNS AND SYMPTOMS OF ANAPHYLACTIC SHOCK Hives Flushing Upper airway Faintness Dizziness Generalized itching Generalized swelling Difficulty swallowing SOB, wheezing, or stridor Labored breathing Abdominal cramps Confusion Loss of responsiveness Convulsions Hypotension

44. 44 EMERGENCY CARE ANAPHYLACTIC SHOCK Maintain a patent airway. Support breathing. Administer epinephrine by prescribed auto-injector. Consider calling for ALS. Initiate early transport.

45. 45 SIGNS AND SYMPTOMS BITES AND STINGS History of a spider or snake bite or a sting from an insect, scorpion, or marine animal Pain that is often immediate and severe burning or stinging Redness Swelling Weakness or faintness Dizziness Chills Fever Nausea or vomiting Bite marks Stinger

46. 46 EMERGENCY CARE BITES AND STINGS If the stinger is still present, gently remove it. Wash the area around the bite or sting. Remove any jewelry or other constricting objects. Lower the injection site slightly below the level of the heart. Apply a cold pack to a bite or sting. Observe the patient carefully for signs and symptoms of an allergic reaction. Keep the patient calm, limit his physical activity, and keep him warm.

47. 47 SNAKEBITE 45,000 bites per year in the United States 7,000 receive bites from poisonous snakes: coral snakes, rattlesnakes, copperheads, and water moccasins Nonpoisonous snake bites are considered minor wounds---poisonous snake bites are considered medical emergencies.

48. 48 BLACK WIDOW SPIDER Shiny black body, thin legs, and a crimson red marking on its abdomen, usually in the shape of an hourglass or two triangles. Leading cause of death from spider bites in the U.S. Those at highest risk for severe reactions include: children under the age of 16, people over the age of 60, people with chronic illness, and anyone with hypertension.

49. 49 BROWN RECLUSE SPIDER Usually brown, but can range from yellow to dark chocolate brown. Brown violin shaped marking on the upper back. The bite is often painless at first---several hours after the bite, it becomes bluish surrounded by white periphery, then a red halo or “bull’s-eye”pattern. Within 7-10 days, the bite becomes a large ulcer.

50. 50 SCORPION Only one type of scorpion in the U.S. is fatal. 90% of all scorpion stings occur on the hand. Other s/s include sharp pain at injection site, drooling, poor coordination, incontinence, and seizures.

51. 51 FIRE ANT Intense, fiery, burning pain at the site of the bite. The bites produce extremely painful vesicles that are filled with fluid. Can cause local reactions which include swelling, redness, and pain that affect the entire extremity.

52. 52 TICK Tick bites are serious because they can carry tick fever, Rocky Mountain spotted fever, and other bacterial infections Only prehospital treatment for a tick bite is removing the tick and washing the area afterwards. Avoid squashing an engorged tick since infected blood may enter the patient.


54. 54 WATER-RELATED INJURIES Drownings are responsible for only 1 in 20 water-related deaths. Most are caused by diving and deep-water exploration, boating, and water skiing. Water-related deaths may also result from motor vehicle accidents. An adult can drown in a few inches; an infant in even less. 1/4 of all infants who drown do so in 5-gallon buckets, bathtubs, and toilets.

55. 55 COULD WATER RELATED ACCIDENTS BE PREVENTED? Statistics show that wearing personal flotation devices could prevent many of the deaths. Proper supervision of swimming pools Locked fences around pools Prompt and proper application of basic life support could also reduce deaths.

56. 56 NEAR-DROWNING AND DROWNING Near-drowning is defined as survival, at least 24 hours, from near-suffocation due to submersion. Drowning is defined as death from suffocation due to submersion. Drowning is the third leading cause of accidental death in the U.S. Drowning is the leading cause of accidental death for children under 5.

57. 57 CAUSES OF DROWNING Becoming exhausted in the water Losing control and getting swept into water that is too deep Losing a support---sinking a boat Getting trapped or tangled while in the water Drugs or alcohol Seizures Poor judgement in the water Hypothermia Trauma Diving accident

58. 58 SIGNS AND SYMPTOMS OF THE WATER-RELATED EMERGENCY PATIENT Airway obstruction Absent or inadequate breathing Pulselessness Spinal injury or head injury Soft tissue injuries Musculoskeletal injuries External or internal injuries Shock Hypothermia Alcohol or drug abuse Drowning/near-drowning

59. 59 DIVING AND WATER-RELATED EMERGENCIES Always assume that a diver has sustained neck and spine injuries. Never go out into the water to attempt a rescue unless you meet certain requirements. Responsive patient: reach, throw, row, go strategy Unresponsive patient: row or swim to the patient.

60. 60 EMERGENCY CARE NEAR-DROWNING Remove the patient from the water as quickly and safely as you can. If you do not suspect spine injury, place the patient on his left side so that water, vomitus, and secretions can drain from the upper airway. Suction as needed. Establish an airway. Gastric distention---if ventilation gets difficult, with suction available, apply pressure to the epigastric area. Transport patient.

61. 61 AIR EMBOLISM Often appears 15 minutes after the diver surfaces.

62. 62 SIGNS AND SYMPTOMS OF AN AIR EMBOLISM Itchy, blotchy, or mottled skin Difficulty in breathing Dizziness Chest pain Deep aching pain in the muscles Blurred or distorted vision Partial deafness, distortion of senses Nausea and vomiting Numbness or paralysis Staggering gait or lack of coordination Frothy blood in the nose or mouth Swelling of crepitus in the neck Loss of memory Cardiac or respiratory arrest Behavioral changes

63. 63 DECOMPRESSION SICKNESS AND BAROTRAUMA Decompression Sickness (Bends): usually occurs when the diver ascends too quickly from a deep, prolonged dive. S/S usually occur about 12-24 hours after the dive. Barotrauma: called “the squeeze” during ascent or descent when the air pressure in the body’s air cavities (such as the sinuses or the middle ear) becomes too great.


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