Chapter 26 Environmental Emergencies

2. Chapter 26Environmental Emergencies

3. Objectives • There are no 1985 objectives for this chapter.

4. Environmental Emergencies • A medical condition caused or exacerbated by the weather, terrain, atmospheric pressure, or other risk factors • Risk factors include: • Age • General health • Fatigue • Predisposing medical condition • Medication: prescription and over the counter

5. Cold Exposure • Five ways the body loses heat: • Conduction • Convection • Evaporation • Radiation • Respiration • Heat loss can be modified in three ways: • Increase heat production • Move to an area where heat loss is decreased • Wear insulated clothing

6. Temperature Assessment • To assess a patient’s temperature: • Pull back your glove. • Place the back of your hand on the patient’s skin.

7. Hypothermia (1 of 2) • “Low temperature” • Occurs when core temperature of the body falls below 95°F • Signs and symptoms • Increase in severity as core temperature falls • Four general stages

8. Hypothermia (2 of 2) • Never assume that a cold, pulseless patient is dead. • Emergency medical care • Stabilize ABCs. • Prevent further heat loss. • Remove any wet clothing. • Place dry blankets; turn up the heat. • Provide warm, humidified oxygen.

9. ACLS Considerations • Advanced airway procedures initiated for apneic patients. • Ventricular fibrillation is the most common cardiac arrhythmia seen in hypothermic patients. • It is not possible to defibrillate a heart colder than 86°F. • Medical control may order BLS treatment only with rapid transport.

10. Management of Cold Exposure • Remove wet clothing. • Prevent conduction heat loss. • Insulate all exposed body parts. • Prevent convection heat loss. • Remove the patient from the cold environment as soon as possible.

11. Local Cold Injuries (1 of 2) • Investigate underlying factors including: • Exposure to wet conditions • Inadequate insulation from cold or wind • Restricted circulation • Fatigue • ETOH or drug use/abuse • Hypothermia • Cardiovascular disease • Diabetes

12. Local Cold Injuries (2 of 2) • In generalized hypothermia, blood is shunted away from the extremities in an attempt to maintain the core temperature. • Assess for frostbite or other local cold injuries.

13. Frostnip and Immersion Foot • After prolonged exposure to the cold, the skin may be freezing while the deeper tissues are unaffected. • This condition, which often affects the ears, nose, and fingers, is called frostnip. • Treatment includes: • Removing the patient from the environment • Rewarming the affected body part

14. Frostbite (1 of 2) • The most serious local cold injury because the tissues are actually frozen. • If gangrene occurs, the dead tissue must be surgically removed. • Can be identified by the hard, frozen feel of the affected tissues.

15. Frostbite (2 of 2)

16. Emergency Medical Care of Local Cold Injury • Remove the patient from further exposure to the cold. • Handle the injured part gently, and protect it from further injury. • Administer oxygen, if this was not already done during initial assessment. • Remove any wet or restricting clothing over the injured part.

17. Cold Exposure and You • As an EMT-I, you are also at risk for hypothermia if you work in a cold environment. • If you are involved in cold weather search and rescue operations, you should receive survival training and precautionary tips. • Make sure you have proper clothing, and make sure your vehicle is maintained.

18. Heat Exposure • Ambient temperature • Temperature of the surrounding environment • Thermolysis • Process of ridding the body of excess heat • Can cause the following problems: • Heat cramps • Heat exhaustion • Heatstroke

19. Heat Cramps • Painful muscle spasms that occur after vigorous exercise. • Electrolyte imbalances. • Treatment includes: • Remove the patient from the hot environment. • Rest the cramping muscles. • Replace fluids by mouth.

20. Heat Exhaustion • Signs and symptoms • Onset while working hard • Onset in elderly or very young in hot, humid, and poorly ventilated environments • Cool, clammy skin • Dry tongue and thirst • Dizziness, weakness, faintness with n/v • Normal vital signs (often with rapid pulse) • Normal or slightly elevated body temperature

21. Treatment of Heat Exhaustion • Remove excessive layers of clothing. • Move the patient out of the environment. • Give the patient oxygen. • Encourage the patient to lie down. • Encourage fluids by mouth if patient is alert. • Transport on his or her side if nauseated. • Gain IV access and give normal saline.

22. Heatstroke (1 of 2) • Treatment • Move the patient. • Set the air conditioning. • Remove the patient’s clothing. • Give the patient oxygen. • Apply cool packs. • Cover the patient with wet towels. • Aggressively and repeatedly fan the patient.

23. Heatstroke (2 of 2) • Treatment (cont.) • Provide immediate transport. • Gain IV access and give normal saline. • Notify the receiving hospital as soon as possible.

24. Lightning Injuries • 25 million cloud-to-ground lightning flashes occur in the U.S. each year. • 200,000 amps/100 million volts. • Most deaths occur during the summer months. • Categorized as: • Mild • Moderate • Severe

25. Emergency Medical Care • Safety is the priority. • Lightning can and does strike in the same place. • Move the patient to a sheltered area. • Signs of an impending strike include: • Sudden tingling sensation • Hair stands on end • Curl up into a ball and lie on the ground. • Reverse triage.

26. Drowning and Near Drowning • Drowning: death from suffocation because of submersion in water or other fluids. • Near drowning: suffocation in water or other fluids with a recovery that lasts at least 24 hours. • Laryngospasm • Hypothermia • Mammalian diving reflex

27. Panic in the Water Often Precedes Drowning

28. Emergency Medical Care • Rescue and remove from the water. • Stabilize and protect the spine simultaneously. • If there is upper airway obstruction, remove manually or by suction. • Administer oxygen. • Don’t perform abdominal thrusts unless FBAO is present.

29. Spinal Injuries in Submersion Incidents • Result from a diving mishap or long fall. • Patient is unconscious and no information is available to rule out neck injury. • The patient is conscious but complains of weakness, paralysis, or numbness in the arms or legs. • You suspect spinal injury despite what witnesses say.

30. Basic Rules of Water Rescue

31. Recovery Techniques • When a drowning victim is not floating or visible, an organized rescue effort uses personnel who are experienced with: • Recovery techniques • Equipment, including snorkel, mask, and scuba gear • Use grappling hooks as a last resort

32. Resuscitation Efforts • You should never give up on resuscitating a cold-water drowning victim. • Exposure to cold water will occasionally activate certain primitive reflexes, preserving basic body functions for prolonged periods. • Diving reflex • Bradycardia

33. Diving Emergencies • Most serious water-related injuries are associated with diving. • Some are related to the nature of the dive; others result from panic. • Problems are separated into three phases of the dive: • Descent • Bottom • Ascent

34. Descent Emergencies • Usually due to the sudden increase in pressure on the body as a person dives deeper into the water. • Severe pain results when some of the body cavities cannot adjust to the increased external pressure of the water.

35. Emergencies at the Bottom • Rarely seen • Inadequate mixing of oxygen and carbon dioxide in the diver’s air, feeding poisonous carbon monoxide into the breathing apparatus

36. Ascent Emergencies • Most of the serious injuries associated with diving are related to the ascent. • Usually require aggressive resuscitation. • Air embolism can cause: • Pneumothorax • Pneumomediastinum • Air emboli

37. Signs and Symptoms of Air Embolism • Blotching • Froth at the nose and mouth • Severe pain in muscles, joints, or abdomen • Dyspnea • Pleuritic chest pain • Dizziness, nausea, and vomiting • Dysphasia • Visual disturbances

38. Decompression Sickness • Commonly called “the bends.” • Occurs when bubbles of gas, especially nitrogen, obstruct the blood vessels. • When the diver ascends, external pressure is decreased and the nitrogen forms small bubbles within the tissues. • Severe abdominal and joint pain causes the patient to double over.

39. Treatment for Embolism and Decompression Sickness • Remove patient from the water. • Begin BLS and administer oxygen. • Place the patient in the left lateral recumbent position with the head down. • Provide prompt transport.

40. Other Water Hazards • Breath-holding syncope • Loss of consciousness caused by a decreased stimulus for breathing • Happens to swimmers who breathe rapidly and deeply before entering the water in an effort to expand their capacity to stay underwater

41. Prevention • Appropriate precaution can prevent most immersion incidents. • The most common problem is lack of adult supervision. • As a health care professional, you should be involved in public education efforts to make people aware of the hazards of water recreation.