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Chapter 26

Environmental Emergencies

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Objectives

• There are no 1985 objectives for this chapter.

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Environmental Emergencies

• A medical condition caused or exacerbated by the weather, terrain, atmospheric pressure, or other risk factors

• Risk factors include:– Age– General health– Fatigue– Predisposing medical condition– Medication: prescription and over the counter

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Cold Exposure

• Five ways the body loses heat:– Conduction– Convection– Evaporation– Radiation– Respiration

• Heat loss can be modified in three ways:– Increase heat production– Move to an area where heat loss is decreased– Wear insulated clothing

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Temperature Assessment

• To assess a patient’s temperature:– Pull back your glove.– Place the back of your hand on the patient’s skin.

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Hypothermia (1 of 2)

• “Low temperature”• Occurs when core temperature of the body falls below

95°F• Signs and symptoms

– Increase in severity as core temperature falls• Four general stages

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Hypothermia (2 of 2)

• Never assume that a cold, pulseless patient is dead.

• Emergency medical care– Stabilize ABCs.– Prevent further heat loss.– Remove any wet clothing.– Place dry blankets; turn up

the heat.– Provide warm, humidified

oxygen.

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ACLS Considerations

• Advanced airway procedures initiated for apneic patients.

• Ventricular fibrillation is the most common cardiac arrhythmia seen in hypothermic patients.

• It is not possible to defibrillate a heart colder than 86°F.• Medical control may order BLS treatment only with rapid

transport.

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Management of Cold Exposure

• Remove wet clothing.• Prevent conduction heat loss.• Insulate all exposed body parts.• Prevent convection heat loss.• Remove the patient from the cold environment as soon

as possible.

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Local Cold Injuries (1 of 2)

• Investigate underlying factors including:– Exposure to wet conditions– Inadequate insulation from cold or wind– Restricted circulation – Fatigue– ETOH or drug use/abuse– Hypothermia– Cardiovascular disease– Diabetes

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Local Cold Injuries (2 of 2)

• In generalized hypothermia, blood is shunted away from the extremities in an attempt to maintain the core temperature.

• Assess for frostbite or other local cold injuries.

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Frostnip and Immersion Foot

• After prolonged exposure to the cold, the skin may be freezing while the deeper tissues are unaffected.

• This condition, which often affects the ears, nose, and fingers, is called frostnip.

• Treatment includes:– Removing the patient from the environment– Rewarming the affected body part

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Frostbite (1 of 2)

• The most serious local cold injury because the tissues are actually frozen.

• If gangrene occurs, the dead tissue must be surgically removed.

• Can be identified by the hard, frozen feel of the affected tissues.

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Frostbite (2 of 2)

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Emergency Medical Care of Local Cold Injury

• Remove the patient from further exposure to the cold.• Handle the injured part gently, and protect it from further

injury.• Administer oxygen, if this was not already done during

initial assessment.• Remove any wet or restricting clothing over the injured

part.

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Cold Exposure and You

• As an EMT-I, you are also at risk for hypothermia if you work in a cold environment.

• If you are involved in cold weather search and rescue operations, you should receive survival training and precautionary tips.

• Make sure you have proper clothing, and make sure your vehicle is maintained.

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Heat Exposure

• Ambient temperature– Temperature of the surrounding environment

• Thermolysis– Process of ridding the body of excess heat

• Can cause the following problems:– Heat cramps– Heat exhaustion– Heatstroke

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Heat Cramps

• Painful muscle spasms that occur after vigorous exercise.

• Electrolyte imbalances.• Treatment includes:

– Remove the patient from the hot environment.

– Rest the cramping muscles.

– Replace fluids by mouth.

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Heat Exhaustion

• Signs and symptoms– Onset while working hard– Onset in elderly or very young in hot, humid, and

poorly ventilated environments– Cool, clammy skin– Dry tongue and thirst– Dizziness, weakness, faintness with n/v– Normal vital signs (often with rapid pulse)– Normal or slightly elevated body temperature

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Treatment of Heat Exhaustion

• Remove excessive layers of clothing.• Move the patient out of the environment.• Give the patient oxygen.• Encourage the patient to lie down.• Encourage fluids by mouth if patient is alert.• Transport on his or her side if nauseated.• Gain IV access and give normal saline.

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Heatstroke (1 of 2)

• Treatment – Move the patient.– Set the air conditioning.– Remove the patient’s clothing.– Give the patient oxygen.– Apply cool packs.– Cover the patient with wet towels.– Aggressively and repeatedly fan the patient.

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Heatstroke (2 of 2)

• Treatment (cont.)– Provide immediate transport.– Gain IV access and give normal saline.– Notify the receiving hospital as soon as possible.

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Lightning Injuries

• 25 million cloud-to-ground lightning flashes occur in the U.S. each year.

• 200,000 amps/100 million volts.• Most deaths occur during the summer months.• Categorized as:

– Mild– Moderate– Severe

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Emergency Medical Care

• Safety is the priority.• Lightning can and does strike in the same place.• Move the patient to a sheltered area.• Signs of an impending strike include:

– Sudden tingling sensation– Hair stands on end

• Curl up into a ball and lie on the ground.• Reverse triage.

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Drowning and Near Drowning

• Drowning: death from suffocation because of submersion in water or other fluids.

• Near drowning: suffocation in water or other fluids with a recovery that lasts at least 24 hours.

• Laryngospasm• Hypothermia• Mammalian diving reflex

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Panic in the Water Often Precedes Drowning

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Emergency Medical Care

• Rescue and remove from the water.• Stabilize and protect the spine simultaneously.• If there is upper airway obstruction, remove manually or

by suction.• Administer oxygen.• Don’t perform abdominal thrusts unless FBAO is

present.

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Spinal Injuries in Submersion Incidents

• Result from a diving mishap or long fall.• Patient is unconscious and no information is available to

rule out neck injury.• The patient is conscious but complains of weakness,

paralysis, or numbness in the arms or legs.• You suspect spinal injury despite what witnesses say.

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Basic Rules of Water Rescue

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Recovery Techniques

• When a drowning victim is not floating or visible, an organized rescue effort uses personnel who are experienced with:– Recovery techniques– Equipment, including snorkel, mask, and scuba gear

• Use grappling hooks as a last resort

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Resuscitation Efforts

• You should never give up on resuscitating a cold-water drowning victim.

• Exposure to cold water will occasionally activate certain primitive reflexes, preserving basic body functions for prolonged periods.

• Diving reflex• Bradycardia

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Diving Emergencies

• Most serious water-related injuries are associated with diving.

• Some are related to the nature of the dive; others result from panic.

• Problems are separated into three phases of the dive:– Descent– Bottom– Ascent

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Descent Emergencies

• Usually due to the sudden increase in pressure on the body as a person dives deeper into the water.

• Severe pain results when some of the body cavities cannot adjust to the increased external pressure of the water.

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Emergencies at the Bottom

• Rarely seen• Inadequate mixing of oxygen and carbon dioxide in the

diver’s air, feeding poisonous carbon monoxide into the breathing apparatus

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Ascent Emergencies

• Most of the serious injuries associated with diving are related to the ascent.

• Usually require aggressive resuscitation.• Air embolism can cause:

– Pneumothorax– Pneumomediastinum– Air emboli

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Signs and Symptoms of Air Embolism

• Blotching• Froth at the nose and mouth• Severe pain in muscles, joints, or abdomen• Dyspnea• Pleuritic chest pain• Dizziness, nausea, and vomiting• Dysphasia• Visual disturbances

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Decompression Sickness

• Commonly called “the bends.”• Occurs when bubbles of gas, especially nitrogen,

obstruct the blood vessels.• When the diver ascends, external pressure is decreased

and the nitrogen forms small bubbles within the tissues.• Severe abdominal and joint pain causes the patient to

double over.

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Treatment for Embolism and Decompression Sickness

• Remove patient from the water.• Begin BLS and administer oxygen.• Place the patient in the left lateral recumbent position

with the head down.• Provide prompt transport.

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Other Water Hazards

• Breath-holding syncope– Loss of consciousness caused by a decreased

stimulus for breathing– Happens to swimmers who breathe rapidly and

deeply before entering the water in an effort to expand their capacity to stay underwater

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Prevention

• Appropriate precaution can prevent most immersion incidents.

• The most common problem is lack of adult supervision.• As a health care professional, you should be involved in

public education efforts to make people aware of the hazards of water recreation.