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Module 6 Emergency Procedures. Dr. Laney Nelson . Snake Bites. Epidemiology 8000 bits a year Less than 12 deaths a year Usually victim die because poor health Victims usually have an allergic reaction Symptoms occur immediately after bite Most common is rattle snake

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snake bites
Snake Bites
  • Epidemiology
    • 8000 bits a year
    • Less than 12 deaths a year
    • Usually victim die because poor health
    • Victims usually have an allergic reaction
    • Symptoms occur immediately after bite
    • Most common is rattle snake
    • Younger snakes 3X more potent venenom
poisonous vs non poisonous
Poisonous vs. Non Poisonous
  • Large fangs
    • Except for coral snake
  • Vertical splits for pupils
    • Like cat
  • Pits on side of face
  • 2 hole bite mark
  • Not important to bring the snake in
    • All antivenin is same in North America
  • Small fangs
  • Round pupils
  • No pits
  • Horseshoe bit mark
  • If no burning sensation within 1 hour
    • Probably non poisonous
determining the severity of bite
Determining the Severity of Bite
  • Fatty vs. muscle Tissue
    • Fatty tissue is absorbed more slowly
  • Other Organisms in the venom
    • Mice or rat symbiotic infections
  • Size and weight of Victim
    • Children more pressed
  • General Health
  • Physical Activity after the bite
ss of pit viper snake bite
SS of Pit Viper Snake Bite
  • Immediate severe burning
  • Purplish discoloration and blood filled blisters
  • Numbness around site of injection bite
  • Nausea and vomiting
  • Weakness
  • Numbness of tongue and mouth
  • Excessive sweating
  • Fever and chills
  • Muscular Twitching
  • Dimmed Vision
  • A minty metallic or rubber taste in mouth
what is a pit viper
What is a Pit Viper?
  • Pit on the side of head
  • Temperature sensor
  • Tongue is tasting you
  • Pit is sensing your heat
coral snake bite
Coral Snake Bite
  • Black/Red/Yellow
    • Black on the head your dead
  • Horseshoe bite
  • Scratchy bite
  • Little or no pain
  • Slurred speech
  • Blurred vision dropping eyelids
  • Drowsiness , vomiting, nausea
  • Difficulty Breathing
  • Shock
  • Paralysis
  • Coma
first aid for snake bites
First Aid for Snake Bites
  • Antivenin must be given within 4 hours
    • Short shelf life, be prepared for desert camping
  • Never cut the skin, use an extractor for 30 minutes
  • Never use a tourniquet
  • Never Apply ice
  • Wash the area, then splint
  • Keep them quiet, calm and non weight bearing.
  • Keep limb below heart
  • Wrap limb with conical overlapping elastic bandages
    • Slow venom
black widow spider bite
Black Widow Spider Bite
  • Shinny black bodies (5 species 3 are black)
    • Others brown and grey
  • Crimson red on belly
  • Dry dimly lit areas
  • Barns, corners, funnel shaped webs
  • Painful bites,
  • Children under 16 and over 60 with HBP
black widow
Black Widow
  • Cool moist places
  • Irrigation law boxes
ss of spider bites
SS of Spider Bites
  • Sharp pinprick at site
  • Small red fang marks
  • Severe muscle spasm and rigidly
    • Shoulders, back and chest 1-4 hours later
  • Fever and Chills
  • Profuse Sweating
  • Headache and dizziness
  • Restlessness, Anxiety
  • Nausea and Vomiting
brown recluse spider bite
Brown Recluse Spider Bite
  • Brown
  • Violin shape mark on its back
  • Southern and Midwestern states
    • Non in pacific northwest
  • Serious medical emergency
    • Do not heal
    • Requires surgical repair
  • Only bite when trapped against skin
ss of brown recluse bite
SS of Brown Recluse Bite
  • Moderate itching and swelling
  • Blushing blood blister several hours after bite
    • White halo
    • 7-10 days blister becomes a ulcer
    • VOLCANO Lesion
    • Scab keep falling off until skin is grafted
common tic deer tic
Common Tic, Deer Tic
  • Carry disease
  • Rock mountain spotted fever
    • Spotted rash that develops on wrists and ankles then spreads
    • Headache, muscle aches, joint aches
    • Fever and chills
  • Lyme disease
    • 40 states, deer tics small as a poppy seed
    • May and June most common
    • Begins as a rash looks like black & blue bruise
    • Flu like symptoms
    • Un treated: memory loss, vision disturbances, arthritis
removing tic s
Removing Tic’s
  • Never squeeze the tic to get it out
  • Force infected blood back into victim
  • Use fine tweezers and grab it as close to skin as possible
  • Pull slowly and constant
  • Wash with soap and water
  • Use calamine or cortisone to relive itching
scorpion sting
Scorpion Sting
  • Utah and Nevada Desert (3 species 1 bad)
  • 90% of stings are in hands
  • Occur at night when most active
  • SS: sharp pain, numbness, blister can progress to salivation, poor coordination, seizures
    • There is antivenin
when is medical help needed for a insect bite
When is medical help needed for a insect bite?
  • 2 million people allergic to bees, wasps, hornets
    • 15% of population have had previous allergic reaction
    • Always remove the stinger: limited venom injection use credit card or knife
  • Medical Care:
    • Tongue swells, eyelids swell
    • Wheezing and Labored breathing
    • Abdominal Cramps
    • Convulsions
    • Low Blood Pressure
    • Loss of Consciousness
signs of anaphylactic shock
Signs of Anaphylactic Shock
  • 20-30 seconds and symptoms occur
    • They are in trouble
    • Greater chance of death
    • 100 people a year die
      • Usually air way obstruction
  • Remember 85% of people have not had a previous reaction
marine animals vs land animals
Marine Animals vs. Land Animals
  • 2,000 poisonous marine animals
  • Shark bites: resemble a chain saw
  • Marine more extensive tissue damage
  • Venom of marine animals are destroyed by heat
    • Apply hot packs to stings and bites
first aid care for marine life poisoning
First Aid Care for Marine Life Poisoning
  • Get them to dry ground
  • Flush with water
    • Can use sea water
  • Soak in hot water 30 minutes
    • Clean and cover
  • Jelly fish, man of war
    • Apply vinegar, rubbing alcohol, baking soda paste
    • No Fresh Water increase fire
    • No meat tenderizer
  • Octopus, Sea Snake
    • Use extractor to suck venom
burn emergencies
Burn Emergencies
  • 2,000,000 burn victims a year
    • 12,000 die
    • 1,000,000 long term hospitalization
    • Complex injury
  • 3 classifications
    • First= superficial
    • Second= partial thickness
    • Third= full thickness
how burns affect the body
How burns affect the body
  • Fluids accumulate in upper airway
  • Proteins clot, enzymes break down
  • Heart rate increases, then plunges
  • Liver Swells
  • Hormones disrupted
  • Fluid accumulates in body from plasma release
  • Red cells die causing anemia
  • Muscle Degenerates
  • Body cells die
  • Arteries dilate, fluid leaks from capillaries
  • Kidney function disrupted, urinary output decreased
first degree
First Degree
  • Epidermal layer only
  • Skin is dry and red no blisters
  • Painful 2-5 days no scarring
  • Sun burn
second degree
Second Degree
  • Hot liquids, solids, flash of electricity, flame, chemicals, sun
  • Skin is moist & mottled
    • White to cheery red
    • Blistered
  • Extremely painful
  • 5-21 days
  • scarring
3 rd degree
3rd Degree
  • Hot liquids, solids, flame, electricity, chemicals
  • Gets to the bone
  • Skin is dry and leathery
    • Charred blood vessels visible
    • Skin is white dark and charred
  • No pain - no nerve endings
  • Recovery weeks to years
  • Requires surgery and skin grafting
rule of nine adult
Rule of Nine Adult
  • Head and neck 9%
  • Posterior Trunk 18%
  • Anterior trunk 18%
  • Each Upper Extremity 9%
  • External Genitalia 1%
  • Each lower Extremity 18%
rule of nine children
Rule of Nine Children
  • Head and neck 18%
  • Upper Extremities 9%
  • Font Torso 18%
  • Back Torso 18%
  • Lowe Extremities 14%
critical thinking in burn victims
Critical Thinking in Burn Victims
  • First Degree
    • Greater than 75% of body
    • Greater than 20% of child
  • Second Degree
    • Greater than 30% of body surface adults
    • 20% in child
  • Third Degree
    • Greater than 10% adult
    • 2-3 % in child
electrical burns
Electrical burns
  • Medical emergency
    • Deep unseen damage
    • Apparent minor superficial changes, welded together vital organs
  • Always hospitalized for 2 days for observation
assessing the severity of burns
Assessing the Severity of Burns
  • Depth of burn
  • Percentage of Body burned
  • Severity of the burn
  • Location of the burn
    • Head & face
    • Circumferential burns of arms and legs- tourniquet
    • Chest, back and neck= strangulate expansion
  • Accompanying complications
    • Physical or mental conditions
  • Age of victim
    • Under 5 over 60
management of thermal burns
Management of Thermal Burns
  • Caused by flame, or radiant heat
  • Death by airway closure
  • Infection and fluid loss will follow
  • Immediately: Stop the Burning,
  • Manage the airway:ABpCDE
  • Cool down the burn
    • Cool water
    • Infection is a major killer of burn victims
    • Wet sterile dressings is best
    • Never apply butter or grease
    • Never apply ice or ice pack
management of inhalation injuries
Management of Inhalation Injuries
  • Smoke inhalation
    • Heat scorches mucous membranes
    • Edema blocks airway
  • Facial burns, singed nasal hairs
  • Burned speck in saliva
  • Sooty burn smell on breath
  • Respiratory distress – restriction of chest wall
  • Horseness, noisy breathing
  • Coughing, Cyanosis
carbon monoxide
Carbon Monoxide
  • CO is released during combustion of most things
  • Colorless, odorless, tasteless
    • Tents at elevation
  • Key: burns do not usually render someone unconscious, if unconscious then think CO poisoning
chemical burns
Chemical Burns
  • Sulfuric acid
    • Battery explodes
    • Cell phones, Laptops
  • Phenols (carbolic acid)
  • Use low pressure fresh water
    • High pressure drives it in deeper
  • Irrigate 20 minites
electrical burns1
Electrical Burns
  • 3 types
    • Thermal
      • Electricity causes flame
      • Electricity does not pass through body
    • Contact
      • Where current is most intense
    • Arcing
      • Current jumps form one surface to another
      • Does not pass through the body
amperage and seriousness
Amperage and Seriousness
  • .9-1 mA no effect
  • 1-10 mA sensation /pain
  • 10-30 mA paralysis of arm
  • 30-75 mA respiratory arrest
  • 75 mA -4 A ventricular fibrillation, cardiac arrest
  • 4A and up heart paralysis, death
management of electrical shock
Management of Electrical Shock
  • Protect yourself
  • ABpCDE
  • Check for spinal injuries
    • Victims can be thrown
  • Check for burn wounds
  • Treat for Shock
signs of electrocution
Signs of Electrocution
  • Dazed and confused
  • Obvious and severe skin surface
  • Unconsciousness
  • Weak irregular pulse
  • Shallow or absent respiration
  • Possibly multiple fracture form AC current causing contractoins
lighting strike burns
Lighting Strike / Burns
  • Goal is to oxygenate the heart and brain until the heart regains its function
    • Provide CPR longer than you would victims of other traumas
      • Victims have greater chance of resuscitation that victims of cardiac respiratory arrest
maintaining normal temperature
Maintaining normal temperature
  • 98.5 degrees F
  • Radiation
    • No contact = primary body loss of heat
  • Conduction
    • Direct contact
  • Convection
    • Indirect contact: skin heat the cold air, air takes away the heat and the process
  • Evaporation
  • Respiration
body conserves heat
Body Conserves Heat
  • Blood vessels constrict
    • Keeps blood in core
  • Hairs stand up trapping air next to skin
  • Little or no perspiration is released for evaporation
management of heatstroke
Management of heatstroke
  • Sometimes called sun stroke
  • No cooling so body stores the heat
  • Heat producing mechanisms speed up
    • Body Temp >105
    • Hot Red skin, moist or dry
    • Rapid strong pulse initially
    • Constricted pupils
    • Tremors
    • Confusion Anxiety
    • Rapid breathing initially
    • Dry mouth
    • Shortness of breath
    • Loss of appetite
    • Seizure or collapse
  • Brain swells
    • Convulsions
    • Coma
    • Seizures
  • Heart Rate Increases
  • Kidneys fail
  • Liver fail
wet bulb law of 1 3 s
Wet Bulb – Law of 1/3’s
  • Step 1: Outside temp – dew point = dew point depression
  • Step 2: DDP = x

3

Step 3: Outside temp – X = WBT

monitoring heat index
Monitoring Heat Index
  • Dew Point: point where air is saturated with water
  • P4SR: predicted 4 hour sweat rate
  • WBGT: Wet bulb and Globe Temperatures
  • ACSM guidelines: with WBGT at 82.4 degrees no events longer than 16 km should be conducted
thermal comfort
Thermal Comfort
  • Temperature 68-75 degrees
  • Velocity of Wind = .2 m/sec
  • Relative Humidity 30-70%
management of heat cramps
Management of Heat Cramps
  • 1000 mg salt loss if taste salt on lips
  • Electrolyte loss
  • Calcium levels are low
  • Too much water not enough electrolytes
  • SS: Sweaty Skin
    • Rapid heart beat
    • Normal body Temp
    • Faintness and Dizziness
    • Exhaustion and fatigue
hypothermia
Hypothermia
  • Core Temperature below 95 degrees F
  • Comma occurs below 80 degrees F
  • SS: Skin cold to touch
    • Uncontrolled shivering
    • Vague slurred speech
    • Amnesia incoherence
    • Disorientation, confusion
    • Poor judgment
    • Stiff and hard muscles
    • Dehydration
    • Exhaustion
    • Sluggish pupils
stages of hypothermia
Stages of Hypothermia
  • Stage 1: Shivering.
    • Not below 90 degrees F
  • Stage 2: Apathy & Decreased Muscle Function
    • Loss of fine motor, then gross motor
  • Stage 3: Decreased level of consciousness
    • Glassy stare, possible freezing extremities
  • Stage 4: Decreased Vital Signs
    • Decreased pulse and respiration
  • Stage 5: Death
management of hypothermia
Management of Hypothermia
  • Check Vitals for a full minute
    • Resp = 4 per minute, HR 5-10 bpm
  • Keep them supine – do not elevate legs
    • Cold blood to the heart – cardiac arrest
  • Prevent further heat loss
  • Remove wet clothing
    • If coat, remove arms from sleeves place next to body
    • Insulate victim from ground
  • Do not massage arms and legs
    • Move cold blood to core
  • Warm fluids only after sivering stops
severe hypothermia
Severe Hypothermia
  • Patient looks dead- fixed and dilated pupils
  • 1-2 bpm, 1-2 respirations
  • Not dead until they are warmed up and no signs of life
    • Assume always alive
  • Handle gently, CPR
  • Mouth to mouth 10-12 adult, child 12-20
frostbite vs frostnip
Frostbite vs. Frostnip
  • Frostbite: freezing of skin tissues
    • Ice crystals form between the cells of skin
    • Crystals get larger by extracting fluid from cells
  • Frostnip: freezing of skin surfaces
grade 1 frostbite
Grade 1 Frostbite
  • Grade 1: “nipped”
    • Ears, nose, cheeks, fingers toes
    • Warm by touch
    • Warm breath
    • Submerging in warm water
grade 2 frostbite
Grade 2 Frostbite
  • Grade 2:
    • Affects skin and tissue below surface
    • Skin is firm and waxy
    • Tissue below is soft & numb
    • Turns purple when warned
    • Warm water bath
3 rd degree frostbite
3rd Degree Frostbite
  • 3rd degree:
    • Affects entire tissue depth
    • Tissue below skin is solid
    • Waxy white with purple underneath
    • Warm bath 100-110 F
    • Do not use dry heat
    • Do not unthaw if need to walk or chance of re freeze
    • Dark skin 3X more likely to experience than light skin
drowning vs near drowning
Drowning vs. Near Drowning
  • 9000 people die each year
  • ¼ of al infants drown do so in a 5 gallon bucket
  • ¾ in tub, toilets
  • Cardinal signs:
    • Sudden splashing
    • Screams
    • Call for help
    • Swimmer who is thrashing
near drowning
Near Drowning
  • Secondary Drowning
    • Resituated but die within 96 hours
    • Develop aspiration pneumonia
    • Pneumonia does not develop until 48-72 hours
    • All near drowning should see medical care
wet and dry drowning
Wet and Dry Drowning
  • Wet Drowning
    • Victim aspirates fluid into lungs
      • Water, vomit
  • Dry Drowning
    • Muscle spasm of larynx cuts off respiration but does not allow aspiration of a significant amount of fluid into the lungs
    • 10-15%
two ways to drown
Two ways to Drown

Active Drowning

Passive Drowning

No breathing

Victim is laying face down in the water

  • Victim is struggling
  • Bobbing in the water
  • Panic
  • Inefficient breathing
  • Decreased buoyancy
  • Exhaustion
  • Cardiac arrest
cold water drowning
Cold water Drowning
  • Cold water < 68 degrees
    • Mammalian diving reflex
      • Prevents death with submersion in cold
      • Face is submerged
      • Breathing is inhibited
      • Heart rate slows
      • Blood vessel constrict
      • Blood flow to heart and brain is maintained
      • O2 is used to preserve life
  • The colder the water the more 02 is diverted
rescue resuscitation
Rescue & Resuscitation
  • Victims who have been submerged in cold water for > 30 minutes or longer in cardiac arrest can be resuscitated.
  • Protect yourself first
    • Use personal flotation
    • Trained to water rescue
    • Have them grab something
      • Not you
    • Head Splint
    • Hip shoulder
diving emergencies
Diving emergencies
  • Air Embolism
    • Air bubbles in the bloodstream
  • Decompression Sickness
    • Nitrogen enters the blood stream
    • The bends
  • Barotrauma
    • The squeeze within middle ear
guidelines for moving victims
Guidelines for Moving Victims
  • Facedown
  • Immediate danger to victim or yourself
  • Uncontrolled traffic
  • Unstable structure
  • Fire
  • Hostile crowds
  • Weather
firefighters carry
Firefighters carry

Step 1

Step 2

fireman s carry
Fireman’s Carry

Step 3

Step 4