Environmental Emergencies Flashcards
Environmental emergencies may include
- Poisoning
- Hypothermia
- Hyperthermia
- Snakebites
- Spider bites
- Drowning
Heat Exhaustion
- Prolonged exposure to heat over hrs or days
> Leads to heat exhaustion
☞ Thermoregulatory mechanisms like sweating, vasodilation, & incr resp cannot compensate for exposure to incr ambient temps
☞ Usually occurs in individuals engaged in strenuous activity in hot, humid weather, but also in sedentary indiv
Clinical synd characterized by
☞ Fatigue
☞ Light-headedness
☞ n/v
☞ Diarrhea
☞ Feelings of impending doom
☞ Tachypnea
☞ Tachycardia
☞ Dilated pupils
☞ Mild confusion
☞ Ashen color
☞ Profuse diaphoresis
☞ Hypotension & mild to severe temp elevation (99.6°-104°F d/t dehydration)
♥ Place pt in cool area & remove constrictive clothing
♥ Place moist sheet over pt to decr core temp
♥ Provide oral fluids
♥ Replace electrolytes
♥ Initiate NS IV solution if oral solutions not tolerated
♥ Monitor ABCs incl cardiac dysrhythmias (d/t electrolyte imbalances)
♥ Consider hosp admission for the elderly, the chronically ill, or those who don’t improve within 3-4 hrs
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☞ Is the most serious form of heat stress; failure of the hypothalamic regulatory process
☞ Vasodilation, incr sweating & RR deplete fluids & electrolytes, spec sodium
- Sweat glands stop functioning & core temp incr (>104°F)
☞ Skin hot, dry, & ashen; cerebral edema & hemorrhage may occur as a result of direct thermal inj to the brain & decr cerebral blood flow
Heat stroke
✓ Treatment: stabilize pt’s ABCs & rapidly reduce temp
✓ Admin of 100% O2 compensates for the pt’s hypermetabolic state
✓ Ventilation w/a BVM or intubation & mech vent may be req’d
✓ Cooling methods
- Remove clothing
- Cover w/wet sheets
- Place pt in front of large fan
- Immerse in ice water bath
- Admin cool fluids or lavage w/cool fluids
The muscle breakdown leads to ___, which places the kidneys @ risk for acute failure
myoglobinuria
Excretion of myoglobin in the urine; results from muscle degradation, which releases myoglobin into the blood; occurs in certain types of trauma (crush synd), adv or protracted ischemia of muscle, or as a paroxysmal process of unk etiology
💫 Shivering: increases core temp, complicates cooling efforts, treated w/IV chlorpromazine
💫 Aggressive temp reduction until core temp reaches 102°F
💫 Monitor for signs of rhabdomyolysis, myoglobinuria, & DIC
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Is a synd c/b inj to skeletal muscle & involves leakage of large quantities of potentially toxic intracellular contents into plasma; its final common pathway may be a dist in myocyte calcium homeostasis
- Myoglobin is an important myocyte compound released into plasma
Rhabdomyolysis
After muscle inj, massive plasma myoglobin lvls exceed protein binding (of haptoglobin) & can precipitate in glomerular filtrate
Excess myoglobin may thus cause renal tubular obstruction, direct nephrotoxicity (ischemia & tubular inj), intrarenal vasoconstriction, & AKI
Hypothermia
Core temp < ___°F
Risk factors
- Elderly
- Certain drugs
- Alcohol
- Diabetes
Core temp < ___°F is potentially life-threatening
95
86
___ hypothermia (<86° F)
Makes the person appear dead
☞ Bradycardia
☞ Asystole
☞ Ventricular fibrillation
Severe
___ hypothermia (93.2-96.8°F)
☞ Shivering
☞ Lethargy
☞ Confusion
☞ Rational to irrational behavior
☞ Minor HR changes
Mild
___ hypothermia (86-93.2°F)
☞ Rigidity
☞ Bradycardia, bradypnea
☞ BP by Doppler
☞ Metabolic & resp acidosis
☞ Hypovolemia
☞ Shivering disappears @ temp 86°F
Moderate
✔️ Warm pt to @ least 90°F before pronouncing dead
> Cause of death - refractory ventricular fibrillation
Treatment of hypothermia
✔️ Manage & maintain ABCs
✔️ Rewarm pt
✔️ Correct dehydration & acidosis
✔️ Treat cardiac dysrhythmias
Mild hypothermia: passive or active external rewarming
✓ Passive external rewarming: move pt to warm, dry place; remove damp clothing; place warm blankets on pt
✓ Active external rewarming: body-to-body contact; fluid or air-filled warming blankets, radiant heat lamps
Moderate to severe hypothermia: active core rewarming
✓ Use of heated, humidified O2
✓ Warmed IV fluids
✓ Peritoneal, gastric, or colonic lavage w/warmed fluids
! Risks of rewarming
- Afterdrop, a further drop in core temp (occurs when cold peripheral blood returns to the central circulation)
- Hypotension
- Dysrhythmias
! Rewarming should be discontinued once the core temp reaches 95°F
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Is somewhat like burns in that the inj can be superficial, partial, or full thickness
1st - 4th degrees
Frostbite
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Occurs usually on superficially exposed areas such as nose, face, fingers, toes
Causes pain, numbness, pallor; left untreated, can be a precursor to frostbite
Frost nip
1°
☞ Increases circulation to the area
2°
☞ Large, fluid-filled blisters form w/partial thickness skin necrosis
3°
☞ Small blisters appear w/dark fluid & the affected body part is cool numb, blue, or red & does not blanch
☞ Full thickness & SC tissue necrosis occurs & req debridement
4°
☞ Most severe; are no blisters or edema; part is cold, numb, & bloodless
☞ Full thickness then extends into the muscle & bone
☞ Gangrene develops which may req amputation
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Results when person becomes hypoxic d/t submersion in substance, usually water
R/t inability to swim, use of alcohol or drugs, trauma, seizures, hypothermia, stroke, & child neglect
Submersion injury
Drowning: death from suffocation after submersion in fluid
☞ Immersion syndrome occurs w/immersion in cold water, which leads to stimulation of the vagus nerve & potentially fatal dysrhythmias
☞ Near-drowning: survival from potential drowning
Pathophysiology of Submersion Injury
✦ Treatment of submersion injuries
☞ Correct hypoxia
☞ Correct acid-base & fluid imbalances
☞ Support basic physiologic functions
☞ Rewarm if hypothermia present
✦ Initial evaluation: ABCD
✦ Mechanical vent w/PEEP or CPAP to improve gas exchange when pulm edema is present
☞ Mannitol or furosemide is used to decr free water & treat cerebral edema
✦ Deterioration in neurologic status: cerebral edema, worsening hypoxia, profound acidosis
✦ Observe for min of 4-6 hrs
✦ Secondary drowning is a concern w/pts who are essentially sx free - refers to delayed death from drowning d/t pulm comp
Proper tick removal
Bees & Wasps
☞ Potential for anaphylactic reaction
☞ Emergency care to remove stinger & apply ice pack
☞ Advanced emergency hosp care to ensure ABC
☞ EpiPen admin esp vulnerable for allergic pts
Lightning Injuries
☞ Cardiopulmonary & central nervous systems profoundly affected
☞ Asystole is most lethal initial effect on cardiopulmonary system
☞ Treatment is immediate CPR
☞ No danger to rescuer from contact w/victim
Animal Bites
☞ Children @ greatest risk
☞ Animal bites from dogs & cats are most common, followed by bites from wild or domestic rodents
Complications
☞ Infection
☞ Mech destruction of skin, muscle, tendons, blood vessels, bone
☞ Bite may cause a simple laceration or be assoc w/crush inj, puncture wound, or tearing of mult layers of tissue
Dog bites
☞ Usually occur on extremities
☞ May involve sig tissue damage
> Deaths are reported, usually children
☞ Facial bites common in small children
Cat bites
☞ Deep puncture wounds that can involve tendons & joint capsules
> Greater incidence of infection
- Septic arthritis
- Osteomyelitis
- Tenosynovitis
Human bites
☞ Result in puncture wounds or lacerations
☞ High risk of infection
☞ Oral bacteria flora (Staphylococcus aureus, Streptococcus, hepatitis virus)
☞ Sites: hands, fingers, ears, nose, vagina
Animal & Human Bites
☞ Initial treatment: clean w/copious irrigation, debridement, tetanus prophylaxis, & analgesics
> Prophylactic abx for bites @ risk for infection
- Wounds over joints
- Wounds less than 6-12 hrs old
- Puncture wounds
- Bites on hand or foot
☞ Puncture wounds left open
☞ Lacerations loosely sutured
☞ Wounds over joints splinted
@ greatest risk are infants, older adults, immunocompromised pts, alcoholics, diabetics, & people taking corticosteroids
> Incr incidence of cellulitis, osteomyelitis, & septic arthritis in these pts
☞ Rabies prophylaxis essential in management of animal bites
- Initial injection: rabies immune globulin
- Series of 5 injections of human diploid cell vaccine: days 0, 3, 7, 14, & 28
Poisonings
☞ Chemicals that harm the body accidentally, occupationally, recreationally, or intentionally
☞ Severity depends on type, conc, & route of exposure
Management
☞ Decr absorption
☞ Enhance elimination
☞ Implement toxin-spec interventions per poison control center
Decreasing absorption
☞ Gastric lavage
> Intubate before lavage if altered LOC or diminished gag reflex
> Perform lavage within 2 hrs of ingestion of most poisons
! Contraindicated
- Caustic agents
- Co-ingested sharp objects
- Ingested nontoxic substances
☞ Activated charcoal
> Most effective intervention: administer orally or via gastric tube within 60 min of poison ingestion
! Contraindications
- Diminished bowel sounds
- Paralytic ileus
- Ingestion of substance poorly absorbed by charcoal
> Charcoal can absorb & neutralize antidotes: do not give immediately before, with, or shortly after charcoal
☞ Dermal cleansing/eye irrigation
> Skin & ocular decontamination: removal of toxins from skin & eyes using water or saline
> W/the exception of mustard gas, toxins can be removed w/water or saline
! Water mixes w/mustard gas & releases chlorine gas
> Decontamination takes priority over all interventions except BLS measures
☆ Enhance elimination
☞ Cathartics (e.g., sorbitol)
> Give w/1st dose of charcoal to stimulate intestinal motility/incr elimination
☞ Whole bowel irrigation
> For swallowed objects like cocaine-filled balloons or condoms, lead, mercury
☞ Hemodialysis/hemoperfusion
> Reserved for severe acidosis from ingest of toxic subst (e.g., asa)
> Urine alkalinization
> Chelating agents
> Antidotes
- Calcium EDTA for lead poisoning
- Vit C added to IVFs to enhance excretion of amphetamines & quinidine
