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BSO EMS Protocols > Environmental Emergencies > Flashcards

Environmental Emergencies Flashcards

1
Q

Decompression Sickness

Information

A

Signs and symptoms of decompression sickness include stroke-like signs and symptoms such
as: visual disturbances, AMS, paralysis or weakness, numbness/tingling, bowel/bladder dysfunction. Any patient with these signs and symptoms who has used SCUBA gear or compressed air within a 48-hour period shall be considered a dive emergency, unless it is
certain that the patient has had an unrelated trauma. Divers in cardiac arrest should be transported to the closet ED.

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2
Q

Decompression Sickness

Adult & Pediatric

A

• Apply high flow oxygen.
• Maintain the EtCO2 between 35-45 mmHg.
• If patient is apneic or obtunded, assist respirations and intubate prn.
• Place the patient in a supine position.
• Treat arrhythmias as per appropriate protocol.
• Consider a tension pneumothorax.
• NORMAL SALINE: 1L bolus
• If patient has SOB, decreased breath sounds or hemoptysis, fluids should be decreased to a KVO rate.
• Transport all patients with suspected decompression sickness to the nearest
emergency department with helipad
• Contact DAN (Diver Alert Network) at (800)662-3637 or (919) 684-4326, for medical consultation as needed.
• MERCY HOSPITAL MIAMI OR ST. MARY’S PALM BEACH
• Consider Air Rescue transport (Max 500 ft. )

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3
Q

Dive History

A

Try to obtain an accurate history of the dive; i.e., number of dives, depth of dives, interval between dives and type of air mixture in tanks.

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4
Q

Fatal Drowning/ Non-fatal Drowning

- Information

A

Spinal Motion Restriction: routine stabilization of the cervical spine is not
necessary in the absence of circumstances that suggest a spinal injury occurred, such as: diving, rough surf, vehicle accident with subsequent
submersion, etc.

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5
Q

Fatal Drowning

Adult

A

• Follow appropriate cardiac arrest protocol.
• Immediate VENTILATION is a priority.
• No drowning victim is to be pronounced dead at the scene if the possibility
of hypothermia exists. Remove patient’s wet clothes, dry, and cover with
blankets.

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6
Q

Non-Fatal Drowning

Adult

A

• All non-fatal drowning patients must be transported to the hospital.
• Follow appropriate cardiac arrhythmia protocol prn.
• CPAP: (10 cm H2O) for pulmonary edema secondary to near drowning (For
patients greater than 30 kg).

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7
Q

Non-Fatal Drowning

Adult - If patient is hypotensive with clear Lung Sounds.

A

NORMAL SALINE: 1L. Assess lung sounds and blood pressure every 500mL.

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8
Q

Non-Fatal Drowning

Adult - If patient is hypotensive with pulmonary edema

A

• Cardiogenic Shock protocol

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9
Q

Fatal Drowning

Pediatric

A
  • Follow appropriate cardiac arrest protocol.
  • No drowning victim is to be pronounced dead at the scene if the possibility of hypothermia exists. Remove patient’s wet clothes, dry, and cover with blankets.
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10
Q

Non-Fatal Drowning

Pediatric

A
  • All non-fatal drowning patients must be transported to the hospital.
  • Follow appropriate cardiac arrhythmia protocol prn.
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11
Q

Non-Fatal Drowning

Pediatric - If patient is hypotensive with clear Lung Sounds

A

NORMAL SALINE: 20ml/kg bolus IV/IO. May repeat 2x prn. Assess lung
sounds and blood pressure frequently.

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12
Q

Heat Emergencies

Information

A

Signs & Symptoms of heat stroke include: AMS, seizures, hypotension,
tachycardia, red, hot, flushed skin. Sweating may be absent.

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13
Q

Heat Emergencies

Adult - Heat Cramps & Heat Exhaustion

A

• Move patient into a shaded or air conditioned area. Remove excessive
clothing.
• Provide ORAL HYDRATION (preferably water) if available.
• Monitor patient for an altered mental status, which may indicate a heat
stroke.
• NORMAL SALINE: 1L IV/IO. Assess lung sounds and blood pressure every
500mL.

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14
Q

Heat Emergencies

Adult - Heat Stroke

A
  • Patients with a heat-related illness associated with an altered mental status should be considered to have heat stroke once all the other possibilities for the AMS have been ruled out (hypoglycemia, drugs/alcohol, trauma, etc.)
  • Move patient into the back of the rescue as soon as possible. Decrease the air-conditioning temperature in the patient compartment.
  • Obtain a temperature.
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15
Q

Heat Emergencies

Adult - If the patient is hypotensive with a temperature less than 103 Degrees F

A

NORMAL SALINE: 1L. Assess lung sounds and blood pressure every 500mL.

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16
Q

Heat Emergencies

Adult - If the patient has a temperature of greater than 103 Degrees F ____

A

Begin Rapid cooling
• Apply ICE PACKS to axilla and groin area. Do not cool to the point of shivering.
• CHILLED NORMAL SALINE: (if available) 1L IV/IO, assess lung sounds and blood pressure every 500mL

IF PATIENT IS SEIZING: follow Seizure protocol

17
Q

Heat Emergencies

Pediatric - Heat Cramps & Heat Exhaustion

A

• Move patient into a shaded or air conditioned area. Remove excessive
clothing.
• Provide ORAL HYDRATION (preferably water) if available.
• Monitor patient for an altered mental status, which may indicate a heat
stroke.
• NORMAL SALINE: 20ml/kg bolus IV/IO. May repeat 2x prn. Assess lung sounds
frequently.

18
Q

Heat Emergencies

Pediatric - Heat Stroke

A

• Patients with a heat-related illness associated with an altered mental status
should be considered to have heat stroke once all the other possibilities for
the AMShave been ruled out (hypoglycemia, drugs/alcohol, trauma, etc.)
• Move patient into the back of the rescue as soon as possible. Decrease the
air-conditioning temperature in the patient compartment.
• Obtain a temperature.

19
Q

Heat Emergencies

Pediatric - If the patient is hypotensive with a temperature less than 103 degrees F.

A

NORMAL SALINE: 20ml/kg bolus IV/IO. May repeat 2x prn. Assess lung sounds
and blood pressure frequently.

20
Q

Heat Emergencies

Pediatric - If the patient has a temperature of greater than 103 Degrees F ___

A

Begin Rapid Cooling
• Apply ICE PACKS to axilla and groin area. Do not cool to the point of shivering.
• CHILLED NORMAL SALINE: (If available) 20mL/kg IV/IO. May repeat 2x prn for hypotension. Assess lung sounds and blood pressure frequently.

IF PATIENT IS SEIZING
Follow Seizure Protocol

21
Q

Bites and Stings

Information

A

This protocol includes the treatment for snake bites, dog and cat bites, insect stings, and marine animal envenomation and stings.
Florida Poison Information Center may be contacted at 1-800-222-1222

22
Q

Bites and Stings
Adult
Snake Bites

A

• Mark area of edema with a pen.
• DO NOT apply ice packs, tourniquets or constrictive bands.
• Remove any constrictive jewelry or clothing.
• If the DEAD snake is on scene, take a picture of the body and head including the eyes with the ePCR device if possible.
• ADULT: If patient is hypotensive, NORMAL SALINE: 1L. Assess lung sounds and blood pressure
every 500mL.
- Benadryl 50mg IV, IO, IM,
- Solu-Medrol 125mg IV, IO, IM

23
Q

Bites and Stings
Pediatric
Snake Bite

A
  • Mark area of edema with a pen.
  • DO NOT apply ice packs, tourniquets or constrictive bands.
  • Remove any constrictive jewelry or clothing.
  • If the DEAD snake is on scene, take a picture of the body and head including the eyes with the ePCR device if possible.
  • If patient is hypotensive, NORMAL SALINE: 20ml/kg bolus IV/IO. May repeat 2x
    prn. Assesslung sounds and blood pressure frequently.
  • Benadryl 1mg/kg IV, IO, IM,
  • Solu-Medrol 2mg/kg IV, IO, IM
    • Splint any extremity that has received a bite and ensure it remains below the heart.
24
Q

Bites and Stings

Dog, Cat, and Wild Animal Bites

A

• Wound care as appropriate (DO NOT use hydrogen peroxide on deep puncture
wounds or wounds exposing fat).
• Clean the wound area with soap and water or sterile water.
• Advise dispatch to contact animal control and the police department for identification
and quarantine of the animal if necessary.
• Consider Pain Management Protocol.

25
Q

Bites and Stings

Insect Stings

A

• Consider the need for Allergic Reaction Protocol if appropriate.
• Remove the stinger by scraping the patient’s skin with the edge of a flat surface (i.e. a
credit card). DO NOT attempt to pull the stinger out, as this action may release more
venom.
• Clean the wound area with soap and water or sterile water.
• Consider Pain Management Protocol.
• Apply Zerym Spray

26
Q

Bites and Stings
Marine Animal Envenomations:
Stingray, Scorpionfish, Lionfish, Zebrafish, Stonefish, Catfish, Weeverfish, Starfish, Sea Urchin

A
  • Consider the need for Allergic Reaction Protocol if appropriate.
  • Immerse the punctures in non-scalding hot water (if available) to achieve pain relief.
  • Gently wash the wound with soap and water, and then irrigate it vigorously with sterile water (avoid scrubbing).
  • Apply Zerym Spray
  • Consider Pain Management Protocol.
27
Q

Bites and Stings
Marine Animal Stings:
Jellfish, Man-of-war, Sea Nettle, Irukandji, anemone, Hydroid, Fire Coral

A
  • Consider the need for Allergic Reaction Protocol if appropriate.
  • Rinse the skin with sea water (if available). (DO NOT use fresh or sterile water; DO NOT apply ice; DO NOT rub the skin.)
  • Apply Zerym Spray
  • Remove large tentacle fragments using forceps. Make sure to have proper PPE on and be standing upwind when performing this procedure.
  • Consider Pain Management Protocol.
28
Q

Bites and Stings

Human Bites

A

• Clean the wound area with soap and water or sterile water. (DO NOT use hydrogen
peroxide on deep puncture wounds or wounds exposing fat).
• Consider contacting the police department for investigation if appropriate.
• Consider Pain Management Protocol.

29
Q

Carbon Monoxide Exposure

Information

A 
Carbon Monoxide (CO) is a chemical asphyxiate, it is a colorless, odorless and tasteless gas that is slightly less dense than air. It is toxic to humans when encountered in concentrations above 35 parts per million (ppm). Lower doses of CO can also be harmful due to a cumulative effect. Patients exposed to carbon monoxide (smoke inhalation, etc.) require a full head to toe patient examination with SpCO monitoring with the rainbow sensor if available.
• Consider CO Exposure when multiple patients unconscious near a combustible engine
30
Q

Carbon Monoxide Exposure

Adult and Pediatric

A

Remove from Hazardous atmosphere prior to treatment
• All rescuing crew members shall wear their SCBA if the patient is in a hazardous
environment
• Consider Cyanide Toxicity

31
Q

Carbon Monoxide Exposure

Measuring SpCo Levels

A 
This requires the Rainbow Sensor
* If 20% OR greater OR less than 20% with any of the following Symptoms of Carbon Monoxide poisoning, administer high flow oxygen and transport to CLOSEST EMERGENCY DEPARTMENT WITH HELIPAD
• Headache
• Nausea/Vomiting
• Dizziness
• Altered Mental Status
• Chestpain
• Dyspnea
• Visual Disturbances
• Seizures
• Syncope
32
Q

Carbon Monoxide Exposure

SpO2 readings

A

Patients with CO poisoning can have normal pulse oximetry readings and still
be hypoxic. Strong consideration for hyperbaric treatment should be given to
all pediatric and obstetrical patients with confirmed CO exposure due to their
higher susceptibility to the effects of CO poisoning regardless of SpCO level
or symptoms.

33
Q

Cyanide Exposure

Information

A

AMS and/or pupil dilation are highly suggestive of a true cyanide poisoning. Other
symptoms may include: general weakness, confusion, bizarre behavior, excessive
sleepiness, coma, shortness of breath, headache, dizziness and seizures.

34
Q

Cyanide Exposure

Adult

A

CONFIRMED OR SUSPECTED CYANIDE POISONING
• OXYGEN: NRB @ 15 liters/min
• ALERT BATTALION CHIEF
• CYANOKIT: 5g IV/IO, infused over 10-15 minutes. May repeat 1x prn for a max total dose
of 10g for severe cases. (If available or contact EMS 17)
• The CYANOKIT should be administered through a separate/dedicated IV/IO line.

35
Q

Cyanide Exposure

Pediatric

A

CONFIRMED OR SUSPECTED CYANIDE POISONING
• OXYGEN: NRB @15 L/min
• CYANOKIT: 70mg/kg max single dose 5g may repeat 1x prn
• The CYANOKIT should be administered through a separate/dedicated IV/IO line.

36
Q

Cyanide Exposure

Cardiac Arrest

A

All patients that are suspected to be in cardiac
arrest secondary to cyanide poisoning should be administered the
CYANOKIT.

37
Q

Cyanide Exposure

Poisoning may result from ____

A

inhalation, ingestion or
absorption from various cyanide containing compounds, including
exposure to fire or smoke in an enclosed space.

38
Q

Cyanide Exposure

* Direct cyanide exposure (non-smoke inhalation) is ____

A

a Hazardous Materials Incident.

BSO EMS Protocols (13 decks)

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