Environmental Emergencies Flashcards
introduction
- medical emergencies can result from environmental factors
- certain populations are at higher risk:
- children- higher BSA/weight ratio
- older people- thinner skin
- people with chronic illnesses
- young adults who overexert themsevles
introduction
- environmental emergencies include:
- heat-and cold-related emergencies
- water emergencies
- pressure related injures- ascending or descending
- injuries caused by lightening
- envenomation
physical condition
-patients who are ill or in poor physical condition will not tolerate extreme temperatures well
age
-infants, children, and older adults are more likely to experience temperature related illnesses
nutrition and hydration
- a lack of food or water will aggravate hot or cold stress
- alcohol will change the bodys ability to regulate temperature
environmental conditions
- conditions that can complicate environmental situations:
- air temperature
- humidity level
- wind
- extremes in temperature and humidity are not needed to produce injuries
- most hypothermia occurs at temperature between 30-50
- most heat stroke occurs when the temperature is 80 and the humidity is 80%
- examine the environmental temperature of your patient
cold exposure
- cold exposure may cause injury to:
- feet
- hands
- ears
- nose
- whole body (hypothermia)
- there are five ways the body can lose heat
- falling and being stuck on the floor -> you lose heat to the ground overtime
conduction
- direct transfer of heat from a part of the body to a colder object by direct contact
- heat can also be gained if the substance being touched is warm
convection
- transfer of heat to circulating air
- when cool air moves across the body
evaporation
- conversion of any liquid to gas
- natural mechanism by which sweating cools the body
- when you run out of sweat (dehydration) you over heat
radiation
- transfer of heat by radiant energy
- heat loss caused when a person stands in a cold room
respiration
- loss of body heat during normal breathing
- warm air in the lungs is exhaled into the atmosphere and cooler air is inhaled
- if air temperature is above body temperature and individual can gain heat
the rate and amount of heat loss or gain by the body can be modified in 3 ways:
- increase or decrease in heat production
- move to an area where heat loss can be decreased or increased
- wear the appropriate clothing for the environment
-hypothermia
- normal- 98.6
- core temperature falls below 95 (35C)
- body loses the ability to regulate its temperature and generate body heat
- eventually, key organs such as the heart begin to slow down and mental status deteriorates
- can lead to death
- air temperature does not have to be below freezing for it to occur
- can develop quickly or gradually
people at risk for hypothermia
- homeless people and those whose homes lack heating
- swimmers- wet -> lose body heat to the water faster than air
- geriatric, pediatric, and ill individuals (circulatory issues)
mild hypothermia
- occurs when the core temperature is between 90-95 (32-35)
- patient is usually alert and shivering
- pulse rate and respirations are rapid
- skin may appear red, pale, or cyanotic
more severe hypothermia
- occurs when the core temperature is less than 90 (32)
- shivering stops- circulation is going more towards core -> vasoconstriction
- muscular activity decreases
- as core temperature drops to 85
- patients becomes lethargic and stops fighting the cold
- may show impaired judgement
- stroke mimic
- cardiac dysrhythmias -> ventricular fibrillation
local cold injuries
- most injuries from cold are confined to exposed parts of the body:
- extremities (especially feet and hands)
- ears
- nose
- face
important factors in determining the severity of a local cold injury
- duration of the exposure
- temperature to which the body part was exposed
- wind velocity during exposure
you should also investigate underlying factors for local cold injuries
- exposure to wet conditions
- inadequate insulation from cold or wind
- restricted circulation from tight clothing or shoes or circulatory disease
- fatigue
- poor nutrition
- underlying factors:
- alcohol or drug abuse
- hypothermia
- diabetes
- cardiovascular disease
- age
frostnip
- after prolonged exposure to the cold, skin may freeze while deeper tissues are unaffected
- usually affects the ear, nose, and fingers
- usually not painful, so the patients often is unaware that a cold injury has occurred
immersion foot
- occurs after prolonged exposure to cold water
- common in hikers and hunter
- pale, wrinkly
frostnip and immersion foot: signs and symptoms
- skin is pale and cold to the touch
- normal color does not return after palpation of the skin
- the skin of the foot may be wrinkled but can also remain soft
- the patient reports loss of feeling and sensation in the injured area
frostbite
- most serious local cold injury because the tissue are actually frozen
- gangrene requires surgical removal of dead tissue
signs and symptoms: frostbite
- most frostbitten parts are hard and waxy
- the injured part feels firm to frozen as you gently touch it
- blisters and swelling may be present
- in light skinned individuals with a deep injury, the skin may appear red with purple and white, or mottled and cyanotic
depth of skin damage: frostbite
- depth of skin damage will vary
- with superficial frostbite -> only the skin frozen
- deep frostbite -> deeper tissues are frozen
- you may not be able to tell superficial from deep frostbite in the field
primary assessment
- if the patient is in cardiac arrest, begin compressions
- airway and breathing:
- ensure that the patient has an adequate airway and is breathing
- warmed, humidified oxygen helps warm the patient from the inside out
primary assessment: circulation
- palpate for a carotid pulse and wait for up to 60 seconds to decide if the patient is pulseless
- the AHA recommends that CPR be started on a patients who has no detectable pulse or breathing
- perfusion will be compromised
- bleeding may be difficult to find
primary assessment: transport decision hypothermia
- complications can include cardiac dysrhythmias and blood clotting abnormalities
- all patients with hypothermia require immediate transport
- rough handling of a hypothermic patient may cause a cold, slow, weak heart to fibrillate
history taking
- investigate the chief complaint
- obtain a medical history
- be alert for injury specific signs and symptoms and any pertinent negatives
- SAMPLE history
- find out how long your patient has been exposed to the cold environment
- exposures may be short or prolonged
secondary assessment: vital signs
- may be altered by the effects of hypothermia and can be an indicator of its severity
- respirations may be slow and shallow
- low BP and a slow pulse indicate moderate to severe hypothermia
- evaluate for changes in mental status
resassessment
- repeat the primary assessment
- reassess vital signs and the chief complain
- monitor the patients level of consciousness and vital signs
- rewarming can lead to cardiac dysrhythmias
general management of cold emergencies
- move the patient from the cold environment
- remove any wet clothing
- place dry blankets over and under the patient
- if available give the patient warm humidified oxygen
- handle the patient gently
- do not massage the extremities
- do not allow the patient to eat or use and stimulants
mild hypothermia
- patient is alert, shivering, and responds appropriately
- place the patient in a warm environment and remove wet clothing
- apply heat packs or hot water bottles to the groin, axillary, and cervical regions
- give warm fluids by mouth
moderate or severe hypothermia
- do not try to actively rewarm the patient
- the goal is to prevent further heat loss
- remove the patient from the cold environment
- remove wet clothing, cover with blanket, and transport
main treatments for hypothermia
- remove the patient from further exposure to the cold
- handle the injured part gently, and protect it from further injury
- remove any wet or restricting clothing over the injured part
if transport will be delayed, consider active rewarming
- with frostnip, contact with a warm object may be all that is needed
- with immersion foot, remove wet shoes, boots, and socks and rewarm the foot gradually
- with a late or deep cold injury, do not apply heat or rewarm the part
- never rub or massage injured tissues
rewarming in the field
- immerse the frostbitten part in water between 102-104
- dress the area with dry, sterile dressings
- if blisters have formed, do not break them
- never attempt rewarming if there is any chance that the part may freeze again
cold exposure and you
- you are at risk for hypothermia if you work in a cold environment
- if cold weather search and rescue is possible in your area you need:
- survival training
- precautionary tips
- wear appropriate clothing
heat exposure
- in a hot environment the body tries to rid itself of excess heat
- sweating (and evaporation of the sweat)
- dilation of skin blood vessels
- removal of clothing and relocation to a cooler environment
hyperthermia
- core temperature of 101 (38.3) or higher
- risk factors of heat illness:
- high air temperature (reduces radiation)
- high humidity (reduces evaporation)
- lack of acclimation to the heat
- vigorous exercise (loss of fluid and electrolytes)
persons at greatest risk for heat illnesses
- children (especially newborns and infants)
- geriatric patients
- patients with heart disease, COPD, diabetes dehydration, and obesity
- patients with limited mobility
heat cramps
- painful muscle spasms that occur after vigorous exercise
- do not occur only when it is hot outdoors
- exact cause is not well understood
- usually occur in the leg or abdominal muscles
heat exhaustion
- most common illness caused by heat:
- causes:
- heat exposure
- stress
- fatigue
- hypovolemia as the result of the loss of water and electrolytes
signs and symptoms of heat exhaustion
- dizziness, weakness, or syncope
- muscle cramping
- onset while working hard or exercising in a hot, humid, or poorly ventilated environment and sweating heavily
- onset, even at rest, in the older and infant age groups
- cold, clammy skin with ashen pallor
- dry tongue and thirst
- normal vital signs
- normal or slightly elevated body temperature
heat stroke
- least common but most serious illness caused by heat exposure
- occurs when the body is subjected to more heat that can handle and normal mechanisms are overwhelmed
- untreated heat stroke always results in death
heat stroke: typical onset
- during vigorous physical activity
- outdoors or in a closed, poorly ventilated humid space
- during heat waves without sufficient are conditioning or poor ventilation
- children left unattended in a locked care on a hot day
heat stroke: signs and symptoms
- hot, dry, flushed skin
- skin may be moist or wat due to exertion by the patient
- quickly rising body temperature
- falling level of consciousness
- change in behavior
- unresponsiveness
- seizures
- strong, rapid pulse at first, becoming weaker will falling BP
- increasing respiratory rate
- lack of perspiration
scene size up
- if the patient is immersed in a cold water immersion bath, monitor the patient and assist as necessary
- protect yourself from heat and stay hydrated
- use appropriate standard precautions, including gloves and eye protection
primary assessment: circulation
- if adequate assess for perfusion and bleeding
- assess the patients skin condition
- treat for shock
- moist, pale, cool skin- excessive fluid and salt loss
- hot,dry skin- body is unable to regulate core temperature
- hot, moist skin- body is unable to regulate core temperature
investigate the chief complaint
-Be alert for injury-specific signs and symptoms. • Absence of perspiration • Decreased level of consciousness • Confusion • Muscle cramping • Nausea • Vomiting
history taking: SAMPLE history
-Note any activities, conditions, or medications.
• Inadequate oral intake
• Diuretics
• Medications
-Determine exposure to heat and humidity and activities prior to onset
physical examinations
-Assess the patient for muscle cramps or
confusion.
-Examine the patient’s mental status and vital signs.
-Pay special attention to skin temperature, turgor, and level of moisture.
-Perform a careful neurologic examination
vital signs
-Patients who are hyperthermic will be
tachycardic and tachypneic.
-Falling blood pressure indicates that the patient is going into shock.
-In heat exhaustion, the skin temperature may be normal or cool and clammy.
-In heat stroke, the skin is hot
reassessment
-Watch for deterioration
-Patients with symptoms of heat stroke
should be transported immediately.
-Monitor vital signs at least every 5 minutes.
-Evaluate the effectiveness of interventions.
-Be careful not to overcool a patient.
heat cramps management
- Remove the patient from the hot environment and loosen clothing.
- Administer high-flow oxygen if indicated.
- Rest the cramping muscles.
- replace fluids by mouth.
- Cool the patient with water spray or mist
heat stroke management
- Move the patient out of the hot environment and into the ambulance.
- Set air conditioning to maximum cooling.
- Remove the patient’s clothing.
- Administer high-flow oxygen if indicated.
- Assist ventilations as needed
- Cover the patient with wet towels or sheets.
- Aggressively fan the patient.
- Exclude other causes of altered mental status.
- Check blood glucose level if possible.
- Transport immediately to the hospital.
- Notify the hospital.
- Call for ALS if the patient begins to shiver.
drowning
-process of experiencing respiratory impairment from submersion or immersion in liquid
-Some agencies may still use the term “near drowning” to refer to a patient who survives
at least 24 hours after suffocation in water
risk factors of drowning
- alcoholism consumption
- preexisting seizure disorders
- geriatric patients with cardiovascular disease
- unsupervised access to water
laryngospams
-inhaling water causes the muscles of the larynx and vocal cords to spasm
spinal injuries in submersion incidents
- Submersion incidents may be complicated by spinal fractures and spinal cord injuries.
- Assume spinal injury if:
- Submersion resulted from a diving mishap or fall.
- The patient is unconscious.
- The patient complains of weakness, paralysis, or numbness
- Most spinal injuries in diving incidents affect the cervical spine.
- Stabilize the suspected injury while the patient is still in the water.
water safety
- Water rescues are usually handled by specialized rescue personnel.
- “Reach, throw, and row, and only then go.”
recovery techniques: drowning
- If the patient is not floating or visible in the water, an organized rescue effort is necessary.
- Specialized personnel are required, with snorkel, mask, and scuba gear
resuscitation efforts
- Never give up on resuscitating a cold-water drowning victim.
- Hypothermia can protect vital organs from the lack of oxygen.
- the diving reflex may cause immediate bradycardia.
- Slowing of the heart rate caused by submersion in cold water
descent emergencies
- caused by the sudden increase in pressure as the person dives deeper into the water
- The pain forces the diver to return to the surface to equalize the pressures, and the problem clears up by itself.
- typical areas affected:
- lungs
- sinus cavities
- middle ear
- teeth
- face
descent emergencies: perforated tympanic membrane
- Cold water may enter the middle ear through a ruptured eardrum.
- The diver may lose his or her balance, shoot to the surface, and run into ascent problems
emergencies at the bottom
- rarely occur
- Caused by faulty connections in the diving gear
- Inadequate mixing of oxygen and carbon dioxide in the air the diver breathes
- Accidental feeding of poisonous carbon monoxide into the breathing apparatus
- Can cause drowning or rapid ascend
ascent emergenices
- usually requires aggressive resuscitation
- air embolism:
- most dangerous and most common scuba diving emergency
- bubbles of air in the blood vessels
- air pressure in the lungs remains at a high level while pressure on the chest decreases
decompression sickness: Ascent emergencies
- the “bends”
- bubbles of gas, especially nitrogen, obstruct the blood vessels
- conditions that can cause the bends:
- too rapid an ascent from a dive
- too long of a dive at too deep of a depth
- repeat dives within a short period
- complications:
- blockage of tiny blood vessels
- depriving parts of the body of their normal blood supply
- severe pain in certain tissues or spaces
- signs and symptoms:
- abdominal/joint pain so severe that the patient doubles up
you may find it difficult to distinguish between air embolism and decompression sickness
- air embolism generally occurs immediately on return to surface
- symptoms of decompression sickness may not occur for several hours
treatment: ascent emergencies
- same for both
- basic life support (BLS)
- recompression in a hyperbaric chamber
transport decision: ascending
- Always transport near-drowning patients to the hospital.
- Inhalation of any amount of fluid can lead to delayed complications.
- Decompression sickness and air embolism must be treated in a recompression chamber
history taking: ascending
- Investigate the chief complaint.
- Obtain a medical history.
- Be alert for injury-specific signs and symptoms.
- SAMPLE history
- Determine the depth of the dive, length of time the patient was underwater, time of onset of symptoms, and previous diving activity.
- Note any physical activity, alcohol or drug use, or other medical conditions
reassessment
- repeat the primary assessment.
- Drowning patients may deteriorate rapidly due to:
- Pulmonary injury
- Fluid shifts in the body
- Cerebral hypoxia
- Hypothermia
- Pneumothorax, air embolism, or decompression sickness patients may decompensate quickly.
reassessment: document
- Circumstances of drowning and extrication
- Time submerged
- Temperature and clarity of the water
- Possible spinal injury
- Bring a dive log or dive computer.
- Bring all dive equipment to the hospital.
for air embolism or decompression sickness in a conscious patient
- Remove the patient from the water.
- try to keep the patient calm.
- Administer oxygen.
- Consider the possibility of pneumothorax and monitor breath sounds.
- Provide prompt transport
other water hazards
-Pay close attention to the body temperature of a person who is rescued from cold water.
-Breath-holding syncope
-A person swimming in shallow water may
experience a loss of consciousness caused by a decreased stimulus for breathing.
- Treatment is the same as a drowning patient
prevention: immersion incidents
-appropriate precautions can prevent most
immersion incidents.
-All pools should be surrounded by a fence.
-The most common problem in child drownings is lack of adult supervision.
-Half of all teenage and adult drownings are associated with the use of alcohol
high altitude
- altitude illness
- caused by diminished oxygen in the air at high altitudes
- affects the central nervous system and pulmonary system
acute mountain sickness
-Diminished oxygen in the blood
-Caused by ascending too high, too fast or not being acclimatized to high altitudes
-Signs and symptoms:
• Headache
• Lightheadedness
• Fatigue
-Loss of appetite
-Nausea
-Difficulty sleeping
-Shortness of breath during physical exertion
-Swollen face
high altitude pulmonary edema (HAPE)
-Fluid collects in the lungs, hindering the passage of oxygen into the bloodstream
-Signs and symptoms:
• Shortness of breath
• Cough with pink sputum
• Cyanosis
• Rapid pulse
high altitude cerebral edema (HACE)
-may accompany HAPE and can quickly become life threatening
-signs and symptoms:
-Severe, constant, throbbing headache
• Ataxia
• Extreme fatigue
• Vomiting
• Loss of consciousness
treatment of HAPE/HACE
- provide oxygen
- descend from the height
- transport promptly
- provide positive pressure ventilation with bag valve mask for inadequate respirations
lightening
- Lightning is acommon cause of death from isolated environmental phenomena.
- Targets of direct lightning strikes:
- People engaged in outdoor activities (boaters, swimmers, golfers)
- Anyone in a large, open area
- Many individuals are indirectly struck when standing near an object that has been struck by lightning, such as a tree.
- The cardiovascular and nervous systems are most commonly injured.
- Respiratory or cardiac arrest is the most common cause of lightning-related deaths
categories of lightening injuries
- mild- loss of consciousness, amnesia, confusion, tingling, superficial burns
- moderate- seizures, respiratory arrest, dysrhythmias, superficial burns
- severe- cardiopulmonary arrest
lightening: emergency medical care
-Protect yourself.
-Move the patient to a sheltered area.
-Use reverse triage.
-Treatment:
• Stabilize the spine and open the airway.
• Assist ventilations or use an AED.
• Control bleeding and transport
spider bites
- Spiders are numerous and widespread in the United States.
- Many species of spiders bite.
- Only the female black widow spider and the brown recluse spider deliver serious or life threatening bites.
- Be alert to the possibility that the spider may still be in the area.
black widow spider
- The female is fairly large, measuring approximately 2 inches across.
- Usually black with a distinctive, bright red-orange marking in the shape of an hourglass on its abdomen
- found in every state except alaska
- prefer dry, dim places
- generally these symptoms subside over 48 hours
- emergency treatment consist of BLS for the patient in respiratory distress
- transport as soon as possible
- the bite is sometimes overlooked:
- most bites cause localized pain and symptoms, including agonizing muscles spasms
- the main danger is the venom, which his poisonous to nerve tissue
black widow spider: systemic symptoms
-Dizziness – Sweating – Nausea – Vomiting – Rashes – Tightness in the chest – Severe cramps
brown recluse spider
- Dull brown in color and 1 inch long
- Violin-shaped mark on its back
- Lives mostly in the southern and central parts of the country
- tends to live in dark areas
- The venom is not neurotoxic, but cytotoxic.
- It causes severe local tissue damage.
- Typically, the bite is not painful at first but becomes so within hours.
- The area becomes swollen and tender, developing a pale, mottled, cyanotic center
hymenoptera stings
- Bees, wasps, yellow jackets, ants
- Stings are painful but are not a medical emergency.
- Remove the stinger and venom sac using a firm-edged item such as a credit card to scrape the stinger and sac off the skin.
- Anaphylaxis may occur if the patient is allergic to the venom
snakebites
- Of the approximately 115 different species of snakes in the United States, only 19 are venomous.
- Rattlesnake, copperhead, cottonmouth or water moccasin, and coral snakes
- snakes usually do not bite unless provoked, angered, or accidentally injured.
- Protect yourself from getting bitten.
- Use extreme caution and wear proper PPE.
- The classic appearance of the poisonous snakebite is two small puncture wounds, with discoloration, swelling, and pain.
pit vipers
- Rattlesnakes, copperheads, and cottonmouths are all pit vipers, with triangular-shaped, flat heads.
- Small pits that contain poison located just behind each nostril and in front of each eye
rattlesnakes: pit vipers
- most common form of pit viper
- many patterns of color, diamond pattern
- can grow to 6 feet or longer
copperheads: pit vipers
- usually, 2-3 feet long
- red copper color crossed with brown and red bands
- their bites are almost never fatal, but the venom can cause significant damage to extremities
cottonmouths: pit vipers
- Olive or brown with black cross-bands and a yellow undersurface
- Water snakes with aggressive behavior
- Tissue destruction may be severe
signs of envenomation: pit vipers
- Severe burning pain at the site of injury
- Swelling and bluish discoloration
- Weakness
- Nausea and vomiting
- Sweating
- Seizures
- Fainting
- vision problems
- changes in LOC
- shock
pit vipers: treatment
- Calm the patient and place in a supine position.
- Locate the bite area and clean it gently with soap and water.
- Be alert for an anaphylactic reaction and treat with an epinephrine auto-injector as appropriate.
- Do not give anything by mouth, and be alert for vomiting.
- If the bite occurred on the trunk, keep the patient supine and quiet, and transport as quickly as possible.
- If there are any signs of shock, treat for it.
- if the snake has been killed, bring it with you.
- Notify the hospital that you are bringing in a patient with a snakebite.
- Transport promptly
coral snakes
- Small reptile with a series of bright red, yellow, and black bands completely encircling the body
- Lives in most southern states
- Injects the venom with its teeth and tiny fangs by a chewing motion, leaving puncture wounds
- Usually bites victims on a finger or toe
- Coral snake venom is a powerful toxin that causes paralysis of the nervous system.
- Within a few hours of being bitten, a patient will exhibit bizarre behavior, followed by progressive paralysis of eye movements and respiration.
- Antivenin is available, but most hospitals do not stock it.
- Emergency care is the same as for a pit viper bit
scorpion stings
- Scorpions are eight-legged arachnids with a venom gland and a stinger at the end of their tail.
- They are rare and live primarily in the southwestern United States and in deserts.
- With one exception, a scorpion’s sting is usually very painful, but not dangerous
- smaller one is venomous
scorpion stings
-the exception is the centruoides sculpturatus
-venom may cause:
-Circulatory collapse
• Severe muscle contractions
• Excessive salivation
• Hypertension
• Convulsions and cardiac failure
tick bites
- Tiny insects that usually attach themselves directly to the skin
- Found most often in brush, shrubs, trees, sand dunes, or other animals
- Only a fraction of an inch long
- Danger comes from infectious diseases spread through the tick’s saliva
- Tick bites occur most commonly during the summer months.
- If transport will be delayed, remove the tick by using fine tweezers to grasp the head and pull it straight out of the skin.
- Once the tick is removed, cleanse the area with antiseptic and save the tick for identification.
rocky mountain spotted fever: tick bites
-Occurs within 7 to 10 days after the bite
-Symptoms:
• Nausea
• Vomiting
• Headache
• Weakness
• Paralysis
• Cardiorespiratory collapse
lyme disease: tick bites
- Reported in all states except Hawaii
- The first symptoms are generally fever and flulike symptoms, sometimes associated with a bull’s-eye rash that may spread to several parts of the body.
- Painful swelling of the joints occurs.
- May be confused with rheumatoid arthritis
injuries from marine animals
- Coelenterates are responsible for more envenomations than any other marine animals.
- Fire coral, Portuguese man-of-war, sea wasp, sea nettles, true jellyfish, sea anemones, true coral, and soft coral
signs and symptoms of injuries from marine animals
- Very painful, reddish lesions in light skinned individuals
- Headache
- Dizziness
- Muscle cramps
- Fainting
emergency treatment: injuries from marine animals
- Limit further discharge of nematocysts by avoiding fresh water, wet sand, showers, or careless manipulation of the tentacles.
- Keep the patient calm.
- Reduce motion of the affected extremity.
- Remove the remaining tentacles by scraping them off with the edge of a sharp, stiff object.
- Provide transport to the emergency department
