Chapter 30: Environmental Emergencies

Question 1

Discuss

Most common environmental factor to worry about?

Answer 1

Temperature; hot and cold.

Question 2

Discuss

Higher risk populations

Answer 2

Children, elderly, chronic ilness, young adults who overexert themselves

Question 3

Discuss

Human factors that determine response to environment

Answer 3

Physical condition, age, nutrition/dehydration, alcohol

Question 4

Discuss

What is considered hypothermia?

Answer 4

Core temp below 95 degrees

Question 5

Discuss

What are the four stages of hypothermia (temp, appearance, cardiopulmonary status, level of consciousness)?

Answer 5

• 93-95
  
  • Shivering, foot stamping
  • Peripheral vasoconstriction, tachypnea
  • Withdrawn
• 89-92
  
  • Loss of coordination, muscle stiffness
  • Progressing bradypnea, bradycardia
  • Confused, lethargic, sleepy
• 80-88
  
  • Coma
  • Weak pulse, arrhythmias, very slow respirations
  • Unresponsive
• <80
  
  • Apparent death
  • Cardiac arrest
  • Unresponsive

Question 6

Discuss

What modifications must you make to assessing pulse of cold pt?

Answer 6

Check carotid for 30-45 seconds to determine if there is a pulse

Question 7

Discuss

What’s frostnip?

Answer 7

Skin is freezing but deeper tissue unaffected, usually not painful

Question 8

Discuss

What’s immersion foot?

Answer 8

Prolonged exposure to cold water. Don’t rub it to get it warm

Question 9

Discuss

What should EMT do with a pt so cold they’re in cardiac arrest?

Answer 9

Don’t rewarm because it can lead to cardiac arrhythmias, let the rewarm in hospital

Question 10

Discuss

What should EMT keep in mind while transporting hypothermic pt?

Answer 10

Pt very sensitive to bumps etc causing cardiac arrest

Question 11

Discuss

What qualifies as heat exposure?

Answer 11

Hyperthermia is a core of 101 or higher

Question 12

Discuss

What’s a heat cramp?

Answer 12

Painful muscle spasms after vigorous exercise

Question 13

Discuss

What’s heat exhaustion and S/S?

Answer 13

Hypovolemia from excessive sweating. S/S: Shock: PCC skin, weakness, decreased LOC

Question 14

Discuss

What’s heat stroke and S/S?

Answer 14

Body’s compensation mechanisms, like sweating, are overwhelmed. Body can no longer cool itself. S/S Red hot dry skin, pt no longer sweating, falling LOC.

Question 15

Discuss

How to treat heat stroke?

Answer 15

AGRESSIVELY COOL PT. Do whatever it takes, cold packs in groin and axilla, dousing in water, etc.

Question 16

Discuss

Tx for pt with decompression sickness?

Answer 16

Give O2, place in left lateral recumbent position with head down, transport to recompression facility

Question 17

Discuss

Categories of lighting injuries

Answer 17

• Mild: loss of consciousness, amnesia, confusion, tingling, other nonspecific signs and symptoms. Burns if any are usually superficial.
• Moderate: Seizures, resp. arrest, asystole that spontaneously resolves, superficial burns.
• Severe: Cardiopulmonary arrest. Many of these pt’s don’t survive.

Question 18

Discuss

What type of toxin is black widow venom and who receives antivenin?

Answer 18

It’s neurotoxic, but most people only need relief from pain as the cramps etc will subside in about 48 hrs. Antivenin reserved for children (esp < 5) and elderly.

Question 19

Discuss

What kind of toxin is brown recluse venom?

Answer 19

Cytotoxic. Causes severe local tissue damage, ulcer, with effects developing over hours and days. Rarely causes systemic problems.

Question 20

Discuss

What are hymenoptera?

Answer 20

Bees, wasps, ants, and hellow jackets

Question 21

Discuss

What are pit vipers?

Answer 21

Rattlesnakes, copperheads, and cottonmouths, with triangular shaped, flat heads.

Question 22

Discuss

S/S envonemation from pit viper

Answer 22

Sever burning/pain at injury site, swelling and ecchymosis, spreading. Venom destroys local tissue and interferes with clotting mechanism systemically.

Question 23

Discuss

Tx for pit viper envonemation?

Answer 23

Calm the pt (decreasing movement limits spread). Document time of bite and boundaries of affected area. Clean area with soap and water. Do not apply ice. Splint extremity.

Question 24

Discuss

What’s the effect of coral snake venom?

Answer 24

Neurotoxin causing paralysis of nervous system.

Question 25

Discuss

Tx for coral snake bite

Answer 25

Calm pt, flush area with warm soapy water to remove surface venom. Don’t apply ice. Splint extremity. Let hospital know it’s a coral snake bite.

Question 26

Discuss

What are coelenterates?

Answer 26

Jellyfish, coral, man-of-war, etc

Question 27

Discuss

Tx for coelenterate sting?

Answer 27

Limit spread of toxin by limiting movement. Inactivate nematocysts by applying vinegar. Remove remaning tentacles with credit card. Pain may respons to immersion in hot water for 30 minites (110-115 F). Transport.