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Chapter 34Environmental Emergencies
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Overview
Temperature Regulation Cold Exposure Heat Exposure Water-Related Emergencies
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Overview
Altitude Emergencies Lightning Strikes Bites and Stings
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Temperature Regulation
Heat loss: Radiation– Heat transfers from warm
body to cool environment– 60% of body heat lost at
room temperature
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Temperature Regulation
Heat loss: Convection– Heat transfers away
from a warm surface via air currents
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Temperature Regulation
Heat loss: Conduction– Heat transfers from
warm object to cool object when they’re in direct contact with each other
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Temperature Regulation
Heat loss: Evaporation– Heat transfers into body
fluids, which then evaporate• Accounts for about 30%
of body’s normal heat loss
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Temperature Regulation
Heat gain– Metabolism generates heat internally– Muscle contraction generates heat internally– External sources such as a warm environment can
help body gain heat
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Temperature Regulation
Children and the elderly cannot protect themselves from temperature extremes
Certain medical conditions will alter the body’s ability to regulate temperature
Medications may also alter a person’s ability to maintain body temperature
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Stop and Review
Describe the ways the body loses heat. Describe the ways the body gains heat.
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Cold Exposure
Local cold injuries– Chilblains: painful, inflamed skin lesions– Trenchfoot: cold, pale, swollen feet with
diminished sensation
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Cold Exposure
Local cold injuries– Frostnip: blanched and numb skin that can
be easily rewarmed
Courtesy of Kevin Reilly, M.D., Albany Medical Center, Albany, NY
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Cold Exposure
Local cold injury– Frostbite: results in tissue damage
Courtesy of Kevin Reilly, M.D., Albany Medical Center, Albany, NY
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Cold Exposure
Management– Remove patient from cold environment– Remove cold, wet clothing– Rewarm injured part
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Cold Exposure
Hypothermia– Net heat loss is greater than net heat gain
resulting in a fall in body temperature– Core body temperature less than 95 degrees
Fahrenheit– The colder the body the worse the symptoms
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Cold Exposure
Hypothermia: Early signs and symptoms – Poor coordination– Memory disturbances– Reduced sensation– Mood changes– Dizziness– Difficulty with speech
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Cold Exposure
Hypothermia: Mild signs and symptoms– Pale, cool skin– Vasoconstriction– Shivering– Increase in heart and respiratory rate– Stiff muscles and joints– Organ systems lack function
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Cold Exposure
Hypothermia: Management– Check body temperature– Remove from cold environment– Remove cold, wet clothing and cover in blankets– Administer oxygen– Attempt rewarming
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Stop and Review
What are the types of local cold injuries? What are the signs and symptoms of
hypothermia? How is hypothermia managed?
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Heat Exposure
Heat cramps– Heat loss can result in dehydration of muscles,
causing muscle cramping – Remove patient from hot environment and
massage painful area– Encourage patient to drink water to rehydrate
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Heat Exposure
Heat exhaustion– Symptoms: dizziness, malaise, muscle aches,
headache, fatigue, nausea, vomiting, light-headedness
– May have elevated body temperature, heart rate, and respiratory rate
– Cooling and rehydration are key to treatment
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Heat Exposure
Heatstroke– Life-threatening form of heat illness– Results in altered mental status from brain
malfunction– Overall heat gain must greatly exceed heat loss– Body temperatures can exceed 106 degrees
Fahrenheit
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Stop and Review
Differentiate between heat exhaustion and heatstroke.
Describe the management of the patient with heat exhaustion and heatstroke.
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Water-Related Emergencies
Near-drowning– Victim holds breath, causing carbon-dioxide levels
in the blood to rise– Then victim takes a breath, allowing water to enter
the airway– Water in the airway causes laryngospasm and
bronchospasm– Heart rate slows, blood pressure falls,
cardiopulmonary arrest may develop
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Water-Related Emergencies
Management– Reach– Throw– Row– Go
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Water-Related Emergencies
Diving emergencies– Boyle’s law: the volume of a gas varies inversely
with the surrounding pressure
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Water-Related Emergencies
Descent– Called squeeze-related problems– Results in compression of air in body spaces such
as the ears and sinuses– Will cause pain during descent– Usually managed with pain medication
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Water-Related Emergencies
Ascent– Decompression sickness
• Occurs during rapid ascent• Gases cannot decompress appropriately• Symptoms occur 1 to 6 hours after the dive• Called the bends
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Water-Related Emergencies
Ascent– Pulmonary overpressurization syndrome
• As pressure decreases, air expands in the lungs– Volume of air in the lungs increases, causing
alveoli to rupture
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Water-Related Emergencies
Ascent– Air embolism
• Air bubble within the bloodstream that may cause a blood clot
– Patients with ascent injuries should be treated in hyperbaric chambers
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Water-Related Emergencies
Nitrogen narcosis– Also diving related
• Known as rupture of the deep
– Patient appears as though intoxicated during the dive
– Resolves upon ascent
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Stop and Review
What are the signs and symptoms of the diving-related emergencies discussed in this chapter?
What are the principles of management of diving-related emergencies discussed within this chapter?
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Altitude Emergencies
Acute mountain sickness – Occurs during rapid ascent
2,000 to 6,600 feet above sea level
– Initial symptoms include light-headedness and mild breathlessness
– Symptoms progress to headache, nausea, weakness, and fatigue
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Altitude Emergencies
High-altitude cerebral edema (HACE)– Results from further progression of untreated
acute mountain sickness– Symptoms: altered mental status, trouble walking,
decrease in level of consciousness, focal neurologic weakness
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Altitude Emergencies
High-altitude pulmonary edema (HAPE)– Progression to this state may be fatal– Symptoms: dry cough, dyspnea upon exertion– Further progression
• Dyspnea while at rest • Fluid buildup in the alveoli
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Stop and Review
List the signs and symptoms of altitude emergencies.
Describe the management of the patient suffering from an altitude emergency.
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Lightning Strikes
Minor injuries– Confusion– Amnesia– Short-term memory
difficulties– Headache– Muscle pain
– Numbness– Temporary visual and
auditory problems– Ruptured eardrum– Superficial burns– Blunt trauma
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Lightning Strikes
Severe injury– Halts cardiac electrical activity– Results in cardiac arrest– Stuns the lungs, impairing breathing– Loss of consciousness– Permanent neurologic injury
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Lightning Strikes
Management– Scene safety– Determine treatment
priority if multiple victims– Manage the ABCs– Assume blunt trauma
injuries and properly immobilize patient
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Stop and Review
What are the effects of a lightning strike, and what are the priorities in treating victims?
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Bites and Stings
Snakes– Pit vipers
• Two fang marks• Local pain and swelling• Severe envenomation results in edema, nausea,
tachycardia, altered mental status, respiratory distress
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Bites and Stings
Snakes – Coral snake
• Neurologic decompensation, tremor, salivation, seizures, respiratory paralysis
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– A pit viper can be recognized by the sunken pit in front of each eye. The bite produces local pain and swelling.
Courtesy of Dr. Sean Bush, Loma Linda University Medical Center, Loma Linda, CA
Courtesy of PhotoDisc
– Despite its beautiful coloring, the coral snake is quite venomous.
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Bites and Stings
Spiders– Brown recluse
• Mildly red lesion that can develop severe pain, blister, and bluish discoloration
• Severe bites can result in necrosis of tissue
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Bites and Stings
Spiders– Black widow
• Redness, swelling, muscle cramping• More serious complications include hypertension,
respiratory failure, shock, coma
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– The venomous brown recluse spider is found most commonly in the southern and western United States.
– The black widow spider has been found throughout the United States in crevices, woodpiles, stables, and garbage piles.
Courtesy of Dr. Sean Bush, Loma Linda University Medical Center, Loma Linda, CA
Courtesy of Dr. Sean Bush, Loma Linda University Medical Center, Loma Linda, CA
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Bites and Stings
Scorpions– Rarely fatal– Reddened area, burning or stinging sensation,
local tissue damage– Severe reactions may occur in children
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Bites and Stings
Marine animals– A variety of marine animals can produce
harmful injuries– If marine-animal bites and stings are
prevalent in the area, acquire further training
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Stop and Review
What are the various types of animals that can cause harmful emergent injuries?
Describe the care of a patient suffering from a bite or a sting.