Environmental Emergencies

Environmental Emergencies

• Body Temperature• 96.4-99.8 degrees F

• Heat Regulation• Based on heat lost v heat gained• Variation throughout body core and periphery • Cardiovascular System

• Transports heat through body• Skin

• Allow heat to be lost/gained to/from environment• Hypothalamus

• Temperature control center of the brain

Heat Production

• Metabolism• ALL metabolic processes in body produce heat• Basal metabolism

• Metabolic activity to maintain cell function at rest

• Generally more than enough heat to maintain core temp

Heat Loss/Gain

• Radiation• Conduction• Convection• Evaporation• Breathing

Radiation

• Radiation• Transfer of heat via infrared rays.• Heat rays are radiated by the

body and other objects in the environment.

• If body temp is greater than the surroundings heat is lost.

• We radiate 550 watts (5 light bulbs)

Conduction

• Conduction• Transfer of heat to

objects including air that are in direct contact with body.

Convection

• Convection• Transfer of heat through

movement of currents.• i.e. Wind chill factor

Evaporation

• Evaporation• Loss of heat when moisture

vaporizes on the body surface.

• Depends on temp/air movement/humidity

• Wind currents move saturated air away from body

• Drier air replaces it and takes up moisture

• Closer to 100% humidity = Less evaporation

Breathing

• Breathing• Inhaled air is

heated/cooled by body temp

• Body looses heat when air is cooler than the body

• Body gains heat when air is warmer that the body

Mechanisms of Regulation

• Brain• Hypothalamus

• Body thermostat• Metabolic Rate

• Heat production• Cardio

• Heat distribution• Skin

• Heat loss• Vasodilation

• Loss by conduction/convection/radiation/sweating

• Vasoconstricion• Inhibits sweating,

increased metabolic rate

Cardiovascular System

• Cardiovascular• Brings heated blood from

core to extremities• 5 % of cardiac output is in

skin• 250-300 ml/min

• Vasodilation• More blood contact

with skin• Conduction,

convection, radiation

• Can increase to 3000 ml/min!!!!

• Vasoconstriction• Heat conservation• Can decrease to

30 ml/min!!!!

Skin

• Skin• Heat regulation• Insulation• Vasoconstriction• Vasodilation• Evaporation form sweat

Questions to ask

• Source• Environment• Loss of consciousness• Effects• How long exposed

Cold Emergencies:Predisposing Factors

• Cold Environment• Immersion• Non Immersion

• Age• Very old• Very young

• Small with LARGE surface area• Small muscle mass – Poor in

children and not existent in infants• Less body fat• Younger children need help to

protect against environment• Medical Conditions

• Shock • Head injuries, Injuries to spinal cord• Burns• Generalized infection• Diabetes and hypoglycemia • Drugs/poisons

Predisposing factor: Idiocy…..

Hypothermia

• Hypothermia• Body core temp falls below

95 degrees F• Environmental conditions

• Ethanol ingestion• Underlying illness• Overdose/poisoning• Major trauma• Outdoor resuscitation• Ambient temperature

decrease ( i.e. home of elderly pt)

Cold EmergenciesS/S

• Poor coordination• Memory disturbances• Reduce/loss of sensation• Mood changes• Less communicative• Dizziness• Speech difficulty• Stiff/rigid posture• Muscular rigidity• Shivering/absence of shivering• Breathing changes

• Early -Rapid• Late – Shallow, slow, or absent

• Pulse changes• Early- Rapid• Late – Slow and barely palpable , irregular, absent

• Skin Changes• Red – early • Pale• Cyanotic• Stiff/hard

• Slowly responding pupils• Low to absent BP• Joint/muscle stiffness• Poor judgment

Assessment/Treatment

• Assessment:• Place hand against pt abdomen• Cool abdomen = Generalized hypothermia • Assess pulse 30-45 seconds before CPR

• Treatment:• Remove pt from environment• Remove wet clothing• Cover with blankets• Handle pt EXTREMELY carefully• Do not allow pt to walk/exert self• Admin O2 (warmed/humidified if able)• Do not let pt ingest stimulants• Do not massage extremity

• If pt responsive : Active rewarming• If pt unresponsive : Passive rewarming

• AFTERDROP…

Active Vs. Passive Rewarming

• Active rewarming• Warm blankets• Heat packs /warm water

bottles• Groin• Neck• Under arms

• Turn heat on in pt compartment

• Passive rewarming• Warm blankets

Turn heat on in pt compartment

Localized Injuries

• Localized to one area of the body• Tend to happen in extremities and exposed ears/nose/face • Early/Superficial Injury

• Blanching of the skin• Loss of feeling/sensation in area• Skin remains soft• If rewarmed – tingling sensation

• Late/Deep Injury• White, waxy skin• Firm to frozen feeling on palpation• Swelling• Blisters• If thawed – Flushed with area of purple and blanching or mottled and

cyanotic

Localized Injuries: Care

• Remove pt from the environment• Protect injured extremity from further injury• Administer O2• Remove wet/constrictive clothing• If early/superficial

• Splint extremity• Cover extremity• Do not massage• Do not re expose to cold

• If late/deep• Remove jewelry • Cover with dry clothing/dressings• DO NOT:

• Break blisters – Rub/massage area – Apply heat – Rewarm – Allow pt to walk on affected extremity

Prolonged/Delayed Transport

• Active Rapid Rewarming• Immerse affected part in warm

water bath• Monitor water so that it doesnt

cool from frozen part• Continuously stir water• Continue until the part is soft

and sensation returns• Dress the area with dry sterile

dressings• Protect against refreezing • Expect pt to c/o SEVERE pain

Changing Directions…

Heat Emergencies: Predisposing Factors

• Climate• High ambient temp = Less evaporation• High relative humidity = Less evaporation

• Exercise and activity• Can lose 1+ Liter of sweat per hour• Loss of electrolytes (Na, Cl, H2O)

• Age• Elderly

• Poor thermoregulation• Medications• Lack mobility- cannot escape environment

• Newborns• Poor thermoregulation• Cannot remove own clothing

• Pre existing illness• Heart disease• Dehydrations• Obesity• Fever• Fatigue• Diabetes • Drugs/medications

Heat Emergencies S/S

• Muscular Cramps• Weakness• Exhaustion• Dizziness/faintness• Skin

• Moist, pale, normal to cool temp• Heat Exhaustion

• Hot, dry or moist – Dire emergency • Heat Stoke

• Rapid Heart Rate• AMS• Unresponsive

Treatment: Heat Exhaustion

• Moist, pale, normal to cool skin• Remove pt from hot

environment and place in cool one

• Administer O2• Loosen or remove clothing• Cool pt by fanning• Put in shock position• If pt responsive and not

nauseated have them drink water

• If pt is unresponsive or vomiting transport pt left lateral recumbent

Treatment: Heat Stoke

• Hot, dry or moist skin• Remove pt from hot

environment and place in cool one

• Administer O2• Remove clothing• Apply cold packs to neck,

groin, armpits• Keep skin wet by applying

water by sponge/wet towels• Fan aggressively • Transport IMMEDIATELY

Water Related Emergencies

• Near drowning/drowning• Ensure safety of crew• Suspect spinal injury if diving injury• Consider length of time in cold water

• Any pulseless non breathing pt submerged in cold water should be resuscitated

• C-Spine control and removal via LBB if pt responsive and spinal injury suspected

• If injury not suspected, place pt on L lateral recumbent

• Suction as needed• Administer O2• If gastric distention interferes with

ventilation: • Roll pt to L side• Have suction ready• Apply firm pressure on abdomen

(epigastric are) and decompress• SUCTION

Bites and Stings

Bites and Stings: S/S

• Hx of bite (spider, snake) or sting (insect, scorpion, marine animal)• Pain• Redness• Swelling• Weakness• Dizziness• Chills• Fever• Nausea• Vomiting• Bite marks• Stinger

Bites and Stings Treatment

• If stinger present remove it• Scraping motion

• Wash area gently• Remove jewelry from area

before swelling occurs• Place injection site slightly

below pt heart• Do not apply cold to snakebites• Consult medical direction for

constricting band for snake bite• Observe and treat for S/S of

allergic reaction

Remember… Scene Safe! Its already injured the patient.

So…