ENVIRONMENTAL EMERGENCY
Exposure to Heat or Cold Can Occur in any Type of Weather. It Can Occur in any Type of Setting; Wilderness, Rural or Urban. The Greatest Number of Environmental Emergencies Happen in the Urban Setting. It Can Occur to any Individual; Age, Career or Social Status.
OVERVIEW
- Effects of Heat & Cold On the Body
- Treatment of Conditions Caused by Heat & Cold
- Safety Concerns in Water Emergencies
- Signs & Symptoms and Treatment of Near Drowning Patients
- Signs & Symptoms and Treatment of Patients That Have Been Bit or Stung
ENVIRONMENTAL EMERGENCY
- Temperature Regulation
- Hypothermia
- Low Body Temperature
- Body Core Temperature < 95°F
- Heat Loss Exceeds Heat Gain
- Hyperthermia
- High Body Temperature
- Body Core Temperature of 106 Extreme Danger
- Heat Gain Exceeds Heat Loss
ENVIRONMENTAL EMERGENCY
- How Heat Loss Occurs
- Radiation
- Convection
- Conduction
- Evaporation
- Breathing
- Your Main Objective is to Prevent Further Heat Loss
ENVIRONMENTAL EMERGENCY
- Important Questions to Ask
- What Was the Source?
- What Type of Environment?
- Any L.O.C.?
- What Effects Occurred
ENVIRONMENTAL EMERGENCY
- Predisposing Factors
- Injury
- Chronic Illness
- Exposure to Cold
- Immersion
- Non-Immersion
- Age
- Drugs, Alcohol, Poison
ENVIRONMENTAL EMERGENCY
- Exposure to Cold
- Dry
- Wet
- 25 Times Faster Than Dry
- Why Do We Use Water On Fire?
- Wind Chill Factor
- 10ºF + 20 MPH Wind = -25ºF
ENVIRONMENTAL EMERGENCY
- Age
- Elderly
- Young
- Large Surface Area
- Small Muscle Mass
- Shivering is Inefficient in Children
- Infants Don’t Shiver
- Poor Insulating Fat
- Unable to Dress Themselves
ENVIRONMENTAL EMERGENCY
- Medical Conditions
- Shock (Hypoperfusion)
- Head Injury
- Burns
- Generalized Infection
- Spinal Cord Injury
- Diabetes / Hypoglycemia
ENVIRONMENTAL EMERGENCY
- Signs & Symptoms of Generalized Hypothermia
- Suspect Temperature Problems
- Alcohol Ingestion
- Underlying Illness
- Overdose / Poisoning
- Major Trauma
- During Outdoor Resuscitations
- Decreased Ambient Temperatures
- Elderly Person’s Home – Unable to Afford Utilities
ENVIRONMENTAL EMERGENCY
- Signs & Symptoms of Generalized Hypothermia
- Obvious Exposure to Cold
- Cold Skin Temperature
- Shivering – Present or Absent
- Muscle Movement Produces Heat
- Present Only in Mild / Mod Hypothermia
- Decreasing Mental Status
- Correlates to Degree of Hypothermia
ENVIRONMENTAL EMERGENCY
- Mental Status During Hypothermia
- Poor Coordination
- Memory Disturbance
- Reduced Sensation to Touch
- Mood Changes
- Less Talking
- Speech Difficulty
- Dizziness
ENVIRONMENTAL EMERGENCY
- Signs & Symptoms of Hypothermia (cont.)
- Stiff or Rigid Posture
- Muscular Rigidity
- Breathing Variations
- Early – Rapid Breathing
- Late – Shallow, Slow or Absent
- Pupils Slow
ENVIRONMENTAL EMERGENCY
- Signs & Symptoms of Hypothermia (cont.)
- Pulse
- Early – Rapid
- Late – Slow, Barely Palpable, Irregular or Absent
- Low or Absent BP
- Poor Judgment
- Patient May Actually Remove Clothing
ENVIRONMENTAL EMERGENCY
- Signs & Symptoms of Hypothermia (cont.)
- Skin
- Red – Early
- Pale – Vasoconstriction
- Cyanotic – Lack of O2
- Stiff / Hard – Freezing
HYPOTHERMIA CARE
- Protect From Further Heat Loss
- Move Gently
- Cold Heart is Prone to Cardiac Arrest **
- Remove Wet Clothing & Cover w/ Blanket
- Do Not Allow Pt. to Walk or Exert Himself
HYPOTHERMIA CARE
- O2 – Warmed & Humidified if Possible
- Assess Pulse Longer Before CPR
- 30 - 45 Seconds
- No Stimulant Intake
- Coffee/Tea/Chocolate
- Do Not Massage/Rub Extremities
HYPOTHERMIA CARE
- Mild Hypothermia – Pt. Alert & Appropriate
- Actively Rewarm
- Warm Blankets
- Crank Heat in Ambulance
- Hot Packs/Hot H2O Bottles
- Groin
- Pits
- Neck
HYPOTHERMIA CARE
- Significant Hypothermia – Unresponsive or Inappropriate
- Passively Rewarm (Slow)
- Blankets
- Crank Heat in Ambulance
- NO HEAT PACKS
- Your Patient is Not Dead Until Warm and Dead !!!
LOCAL COLD INJURY
- Distal Extremities
- Exposed Small Areas
- Nose
- Ears
- Face
- Note the Line of Demarcation
LOCAL COLD INJURY
- Signs & Symptoms of Early or Superficial Injury
- Blanched Skin
- Color Does Not Return When Touched
- Loss of Feeling / Sensation
- Skin Remains Soft
- When Rewarmed Develops Tingling
LOCAL COLD INJURY
- Signs & Symptoms of Late or Deep Injury
- White, Waxy Skin
- Firm or Frozen Feeling When Palpated
- Swelling May Be Present
- When Thawed Skin Will Be Discolored
- Red
- Mottled
- Cyanotic
- Blanched
- Purple
LOCAL COLD INJURY CARE
- Remove From Environment, Protect From Further Injury
- Remove Wet Clothing
- O2
- Early or Superficial
- Splint
- Dressing
- Do Not Rub, Massage or Re-Expose to Cold
LOCAL COLD INJURY CARE
- Late or Deep Injury
- Remove Jewelry if Possible
- Dry Dressings
- DO NOT:
- Break Blisters
- Rub or Massage
- Apply Heat
- Rewarm
- Let Pt Walk On Affected Part
LOCAL COLD INJURY CARE
- Long or Delayed Transport
- Active Rewarming Should Be Done
- Consult Medical Command for Instruction
- Immerse Part In Warm Water
- Monitor Water Temperature
- Continuously Stir Water
LOCAL COLD INJURY CARE
- Long or Delayed Transport
- Continue Until Part Is:
- Soft
- Color Returns
- Sensation Returns
- Dress with Dry Sterile Dressings
- If Hand or Foot - Individually Wrap Fingers & Toes
- Protect From Refreezing
- Expect Severe Pain
HEAT EMERGENCIES
- Heat Exhaustion
- Heat Stroke
- Factors
- Climate
- Activity & Exercise
- Age
- Pre-Existing Conditions
- Drugs / Alcohol
HEAT EMERGENCIES
- Climate
- High Ambient Temperature
- Reduces Radiation Heat Loss
- High Relative Humidity
- Reduces Evaporation Heat Loss
HEAT EMERGENCIES
- Exercise / Activity
- Can Lose > 1 Liter of Sweat per Hour
- Loss of Electrolytes
- Sodium, Potassium, Chloride
HEAT EMERGENCIES
- Age
- Elderly
- Poor Thermoregulation
- Medications
- Lack Mobility – Unable to Escape Environment
- Young
- Poor Thermoregulation
- Unable to Remove Excess Clothing
HEAT EMERGENCIES
- Pre-Existing Medical Condition
- Heart Disease
- Dehydration
- Obesity
- Fever
- Fatigue
- Diabetes
HEAT EMERGENCIES
- Signs & Symptoms
- Muscle Cramps
- Weakness / Exhaustion
- Dizziness / Faint
- Altered Mental Status
- Unresponsive
- Seen More With Heat Stroke
HEAT EMERGENCIES
- Signs & Symptoms
- Heat Exhaustion
- Moist (Sweaty), Pale, Normal or Cool Temp.
- Looks Drained
HEAT EMERGENCIES
- Signs & Symptoms
- Heat Stroke
- Hot, Dry, Red Skin
- TRUE EMERGENCY
- Cases Have Been Reported at 102°F
- Extreme Danger at 106°F
- Brain Damage
HEAT EMERGENCY CARE
- Heat Exhaustion
- Moist, Pale, Normal or Cool Temperature
- Remove From Heat, Place In Cool
- O2
- Remove or Loosen Clothing
- Fan Patient
HEAT EMERGENCY CARE
- Heat Exhaustion (continued)
- Moist, Pale, Normal or Cool Temperature
- Supine w/ Legs Elevated
- Drink H2O, if Able
- If Unresponsive or Vomiting Tx to Hospital
- Passively Cool the Patient
- The Body is Taking Care of Itself
- Slow Down Activity
- Refresh the Patient
HEAT EMERGENCY CARE
- Heat Stroke
- Hot Dry Skin, Altered Mental Status
- Remove From Heat, Crank A/C
- O2
- Remove Clothing
- Cold Packs
HEAT EMERGENCY CARE
- Heat Stroke (continued)
- Hot Dry Skin, Altered Mental Status
- Apply Water to Skin
- Fan Aggressively
- Transport in the S&G Method
- Actively Cool Patient
- The Body Can Not Take Care of Itself
- Prevent Brain Damage From "Cooking"
WATER EMERGENCIES
- Ensure Your Safety
- Pt’s Day is Ruined, Don’t Ruin Yours
- Diving Accident -Suspect Spinal Injury
- Cold Water Drowning
- Consider Length
- Attempt Resuscitation if Reasonable
WATER EMERGENCY CARE
- Suspected Spinal Injury, Immobilize
- Before Removing From Water
- Spine Board
- If No Spinal Injury Suspected
- Remove, Place on Side
- Drain Water & Emesis
WATER EMERGENCY CARE
- Ventilate if Not Breathing
- Suction if Needed
- O2 if Breathing
- If Warm Water Drowning
- Do Your Cardiac Arrest Thing
WATER EMERGENCY CARE
- If Gastric Distention Interferes with Ventilations
- Suction Ready
- Roll Patient on Side
- Your Hand, Apply Firm Pressure
- Over Epigastric Area
WATER EMERGENCY CARE
- Decompression Syndrome
- "The Bends"
- Any Diver - Any Depth - Any Where
- Nitrogen Bubbles
WATER EMERGENCY CARE
- Treatment for:
- The Bends
- Carbon Monoxide
- 2 Locations
- UPMC Presby
- AGH
CREEPY & CRAWLY
- Toxin & Venom
- Poison to Human
- Bites
- Spiders
- Snakes
- Ticks
- Stings
- Bees / Wasps
- Scorpions
- Marine Creatures
CREEPY & CRAWLY
- Signs & Symptoms
- History of Known Bite or Sting
- Pain, Redness, Swelling
- Weak
- Dizzy
- Chills
- Fever
- Nausea, Vomiting
- Bite Mark or Stinger
CREEPY & CRAWLY CARE
- If Stinger is Present, Scrape, Don’t Pinch
- Wash Area Gently w/ Soap & Water
- Remove Jewelry B4 Swelling Starts
- Injection Site Below Heart Level
CREEPY & CRAWLY CARE
- Do Not Apply Cold to Snake Bite
- Consult Medical Command About Constricting Band – No Tourniquet
- Observe For Allergic Reaction
- Treat as Needed