Chapter 31: Environmental Emergencies

Question 1

Conduction

Answer 1

the transfer of heat from one material to another through direct contact; heat will flow from a warmer material to a cooler one

Question 2

Water chill

Answer 2

chilling caused by conduction of heat from the body when the body or clothing is wet; pt’s w/ wet bodies or clothing are susceptible to this in cold environments

Question 3

Convection

Answer 3

carrying away of heat by currents of air, water, or other gases or liquids

Question 4

Wind chill

Answer 4

chilling caused by convection of heat from the body in the presence of air currents; the faster the wind speed, the greater the heat loss

Question 5

Radiation

Answer 5

sending out energy, such as heat, in waves into space; most radiant heat loss occurs from a person’s head and neck

Question 6

Evaporation

Answer 6

the change from liquid to gas; when the body perspires or gets wet. As perspiration or water on the skin or clothing vaporizes, the body experiences a generalized cooling effect

Question 7

Respiration

Answer 7

breathing; during respiration, body heat is lost as warm air is exhaled from the body

Question 8

Hypothermia

Answer 8

generalized cooling that reduces body temp below normal, which is a life-threatening condition in its extreme

Question 9

Consider the possibility of hypothermia in these situations:

Answer 9

• ethanol (alcohol) ingestion
• underlying illness
• overdose or poisoning
• major trauma
• outdoor resuscitation
• decreased ambient temp

Question 10

Passive Rewarming

Answer 10

covering a hypothermic patient and taking other steps to prevent further heat loss and help the body rewarm itself

Question 11

Active Rewarming

Answer 11

application of an external heat source to rewarm the body of a hypothermic pt

Question 12

Patient care for a hypothermic pt who is alert and responding appropriately

Answer 12

1. Remove all of the pt’s wet clothing. Keep the pt dry, and dress the pt in dry clothing or wrap in dry warm blankets. Keep the pt still, and handle them very gently. Do not allow the patient to walk or exert themself. Do not massage his extremities.
2. During transport, actively rewarm the pt. Gently apply heat to the pt’s body in the form of heat packs, hot water bottles, electric heating pads, warm air, radiated heat, and even your own body heat. Do not warm the pt too quickly. Rapid warming will circulate peripherally stagnated cold blood and rapidly cool the vital central areas of the body, possibly causing cardiac arrest. If transport is delayed, move the pt to a warm environment if at all possible
3. Provide care for shock, Provide O2, warmed and humidified if possible.
4. Give the alert pt warm liquids at a slow rate. When warm fluids are given too quickly, the pt’s circulation patterns change. Blood is sent away from the core and instead routed to the skin and extremities. Do not allow the pt to eat or drink stimulants.
5. Except in the mildest of cases (shivering), transport the pt. Continue to provide O2 and monitor vital signs. Never allow a pt to remain in or return to a cold environment

Question 13

Central Rewarming

Answer 13

application of heat to the lateral chest, neck, armpits, and groin of a hypothermic pt

Question 14

Patient care for a pt who is unresponsive or not responding appropriately

Answer 14

1. Ensure an open airway
2. Provide high-concentration O2 that has been passed through a warm water humidifier. If necessary, you can use O2 that has been kept warm in the ambulance passenger compartment. If there is no other choice, you can use O2 from a cold cylinder
3. Wrap the pt in blankets. If available, use insulating blankets. Handle the pt as gently as possible, as rough handling may cause ventricular fibrillation. Do not allow the pt to eat or drink stimulants, Do not massage his extremities.
4. Transport the to immediately

Question 15

Local cooling

Answer 15

cooling or freezing of particular (local) parts of the body

Question 16

Signs and symptoms of early or superficial local cold injury

Answer 16

• the affected area in pts w/ light skin reddens; in pts w/ warm skin, it lightens. Both then blanch (whiten). Once blanching begins, the color change can take place very quickly
• the affected area feels numb to the pt

Question 17

Early or superficial local cold injury pt care

Answer 17

1. Get the pt out of the cold environment
2. Warm the affected area
3. If the injury is to an extremity, splint and cover it. Do not rub or massage the area, and do not reexpose it to the cold
   - pt can apply warmth w/ bare hands, blow warm air on the site, hold fingers in armpits

Question 18

Signs and symptoms of late or deep local cold injury

Answer 18

• affected skin appears white and waxy. When the condition progresses to actual freezing, the skin turns mottled or blotchy, and the color turn from white to grayish yellow and finally to grayish blue. Swelling and blistering may also occur
• the affected area feels frozen but only on the surface. The tissue below the surface is still soft and has its normal resilience, or “bounce”. With freezing, the tissues are not resilient and feel frozen to the touch

Question 19

Late or deep local cold injury pt care

Answer 19

1. If there are signs of hypoxia, or the pt’s vital signs indicate or suggest the potential for shock, administer O2
2. Transport to a medical facility w/o delay, protecting the frost bitten or frozen area by covering it and handling it as gently as possible,
3. If transport must be delated, get the pt indoors and keep them warm. Do not allow the pt to drink alcohol or smoke because constriction of blood vessels and decreased circulation to the injured tissues may result. Rewarm the frozen part as per local protocol, or request instructions from medical direction

Question 20

Active rapid rewarming of frozen parts

Answer 20

1. Heat water to between 100 and 105 degrees Fahrenheit. You should be able to put your finger in into the water without experiencing discomfort
2. Fill the container with the heated water, and prepare the injured part by removing clothing, jewelry, bands, or straps. Thawed areas often swell, so you need to remove potentially constricting items beforehand
3. Fully immerse the injured part. Do not allow the injured area to touch the sides or bottom of the container. Do not place any pressure on the affected part. Continuously stir the water. When the water cools below 100, remove the affected part and add more warm water. The pt may complain of moderate pain as the affected area rewarms, or he may experience intense pain. Pain is usually a good indicator of a successful rewarming
4. If you complete rewarming of the part, gently dry the affected area, and apply a dry sterile dressing. Place dry sterile dressings between the pt’s fingers and toes before dressing his hands and feet. Next cover the site with blankets or whatever is available to keep the area warm. Do not allow these coverings to come in direct contact w/ the injured area or to put pressure on the site. First try to build some sort of framework on which the coverings can be placed.
5. Keep the pt at rest. Do not allow the pt to walk if a lower extremity injury has been frostbitten or frozen
6. Make certain that you keep the entire pt warm as possible w/o overheating them. Cover the pt’s head w/ a towel or small blanket to reduce heat loss.