ChapterChapter

EnvironmentalEnvironmental

EmergenciesEmergencies

EighteenEighteen

ChapterChapter

Effects of heat and cold on the body Treatments for conditions caused by heat and cold Personal safety concerns in water emergencies Signs, symptoms, and treatment of near-drowning, bites, and stings

EighteenEighteenCORE CONCEPTSCORE CONCEPTS

The body tries to balance The body tries to balance heat loss and heat gain heat loss and heat gain

to maintain normal temperature.to maintain normal temperature.

TTEMPERATUREEMPERATUREREGULATIONREGULATION

HypothermiaHypothermia(low temperature)(low temperature)

HyperthermiaHyperthermia(high temperature)(high temperature)

The body loses heat in 5 ways:The body loses heat in 5 ways:

RadiationRadiation ConvectionConvection ConductionConduction EvaporationEvaporation RespirationRespiration

Heat Loss Heat Loss from Radiationfrom Radiation

Heat Loss Heat Loss from Convectionfrom Convection

Heat Loss Heat Loss from Conductionfrom Conduction

Heat Loss Heat Loss from Evaporationfrom Evaporation

Heat Loss from RespirationHeat Loss from Respiration

EEXPOSURE TOXPOSURE TOCOLDCOLD

PredisposingPredisposingFactorsFactors

Generalized HypothermiaGeneralized Hypothermia

• Cold water immersionCold water immersion• Cold air exposureCold air exposure

Cold environment

(Continued)(Continued)

Very old agePredisposingPredisposingFactorsFactors • Failing body systemsFailing body systems

• Chronic illnessChronic illness• Lack of exerciseLack of exercise• Certain medicationsCertain medications

Generalized HypothermiaGeneralized Hypothermia

(Continued)(Continued)

Very young agePredisposingPredisposingFactorsFactors • Large skin surfaceLarge skin surface

area/less fat area/less fat• Little or no shiveringLittle or no shivering• Inability to put on orInability to put on or

take off clothing take off clothing

Generalized HypothermiaGeneralized Hypothermia

(Continued)(Continued)

PredisposingPredisposingFactorsFactors

Generalized HypothermiaGeneralized Hypothermia

• Shock (hypoperfusion)Shock (hypoperfusion)• Head/spinal cord injuryHead/spinal cord injury• BurnsBurns• Generalized infectionGeneralized infection• Diabetes and hypoglycemiaDiabetes and hypoglycemia• Drugs and poisonsDrugs and poisons

Medical conditions

Patient Patient ASSESSMENTASSESSMENT

Generalized HypothermiaGeneralized Hypothermia

Signs and SymptomsSigns and Symptoms

Obvious or subtle exposureObvious or subtle exposure Cool or cold skin temperatureCool or cold skin temperature Decreasing mental status/Decreasing mental status/

(Continued)(Continued)

motor functionmotor function

Patient Patient ASSESSMENTASSESSMENT

Generalized HypothermiaGeneralized Hypothermia

Signs and SymptomsSigns and Symptoms

Stiff or rigid muscles/postureStiff or rigid muscles/posture Shivering in mild cases (lack of, in moreShivering in mild cases (lack of, in more

severe cases)severe cases) Slow pupil reactionSlow pupil reaction

(Continued)(Continued)

Patient Patient ASSESSMENTASSESSMENT

Generalized HypothermiaGeneralized Hypothermia

Signs and SymptomsSigns and Symptoms

Breathing variationsBreathing variations• Rapid (early)Rapid (early)• Shallow, slow, absent (late)Shallow, slow, absent (late)

Blood pressure (low to absent)Blood pressure (low to absent) Poor judgmentPoor judgment

(Continued)(Continued)

Patient Patient ASSESSMENTASSESSMENT

Generalized HypothermiaGeneralized Hypothermia

Signs and SymptomsSigns and Symptoms

Pulse changesPulse changes• Rapid (early)Rapid (early)• Slow, weak, irregular, absent (late)Slow, weak, irregular, absent (late)

Muscle and joint stiffnessMuscle and joint stiffness

(Continued)(Continued)

Patient Patient ASSESSMENTASSESSMENT

Generalized HypothermiaGeneralized Hypothermia

Signs and SymptomsSigns and Symptoms

SkinSkin• Red (early)Red (early)• PalePale• CyanoticCyanotic• Stiff/hard (late)Stiff/hard (late)

Patient Patient CARECARE

Generalized HypothermiaGeneralized Hypothermia

Emergency Care StepsEmergency Care Steps

Remove patient from environment Remove patient from environment and prevent further heat loss.and prevent further heat loss.

Remove wet clothing and cover Remove wet clothing and cover with blanket.with blanket.

Handle patient gently.Handle patient gently.(Continued)(Continued)

Patient Patient CARECARE

Generalized HypothermiaGeneralized Hypothermia

Emergency Care StepsEmergency Care Steps

Do not allow patient to walk orDo not allow patient to walk orexert self.exert self.

Give high-concentration oxygenGive high-concentration oxygen(warmed and humidified).(warmed and humidified).

If apneic, check pulse 30If apneic, check pulse 30––45 seconds 45 seconds before starting CPR.before starting CPR.

(Continued)(Continued)

Patient Patient CARECARE

Generalized HypothermiaGeneralized Hypothermia

Emergency Care StepsEmergency Care Steps

Do not allow patient to eat orDo not allow patient to eat ordrink stimulants.drink stimulants.

Do not massage extremities.Do not massage extremities.

(Continued)(Continued)

Patient Patient CARECARE

Generalized HypothermiaGeneralized Hypothermia

Emergency Care StepsEmergency Care Steps

If patient responds appropriately,If patient responds appropriately,rewarm actively:rewarm actively:• Apply blankets.Apply blankets.• Apply heat to groin, armpits, neck.Apply heat to groin, armpits, neck.• Increase heat in ambulance.Increase heat in ambulance.

(Continued)(Continued)

Patient Patient CARECARE

Generalized HypothermiaGeneralized Hypothermia

Emergency Care StepsEmergency Care Steps

If patient is unresponsive or respondsIf patient is unresponsive or respondsinappropriately, rewarm passively:inappropriately, rewarm passively:

• Apply blankets.Apply blankets.• Increase heat in ambulance.Increase heat in ambulance.

Predisposing factorsPredisposing factors• Usually occur in extremitiesUsually occur in extremities

and exposed ears, nose, faceand exposed ears, nose, face

Local Cold InjuriesLocal Cold Injuries

Clear boundary separatesClear boundary separatesinjured/uninjured areas.injured/uninjured areas.

Patient Patient ASSESSMENTASSESSMENT

Superficial (Early) Local Cold InjurySuperficial (Early) Local Cold Injury

Signs and SymptomsSigns and Symptoms

Blanching of skin.Blanching of skin. Loss of feeling in affected area.Loss of feeling in affected area. Skin remains soft.Skin remains soft. When rewarmed, area tingles.When rewarmed, area tingles.

Patient Patient CARECARE

Superficial (Early) Local Cold Injury

Emergency Care StepsEmergency Care Steps

Remove patient from environment.Remove patient from environment. Protect area from further injury.Protect area from further injury. Administer high-concentration Administer high-concentration

Remove wet or restrictive clothing.Remove wet or restrictive clothing.

oxygen.oxygen.

(Continued)(Continued)

Patient Patient CARECARE

Superficial (Early) Local Cold Injury

Emergency Care StepsEmergency Care Steps

Splint and cover extremity.Splint and cover extremity. Do not rub or massage.Do not rub or massage. Do not reexpose to cold.Do not reexpose to cold.

Patient Patient ASSESSMENTASSESSMENT

Deep (Late) Local Cold Injury

Signs and SymptomsSigns and Symptoms

White, waxy skinWhite, waxy skin Firm or frozen when palpatedFirm or frozen when palpated Swelling and blisters Swelling and blisters (especially when(especially when

thawed)thawed) Flushed, red, mottled, or cyanotic skinFlushed, red, mottled, or cyanotic skin

(when thawed)(when thawed)

Local Cold InjuryLocal Cold Injury

Patient Patient CARECARE

Deep (Late) Local Cold Injury

Emergency Care StepsEmergency Care Steps

Remove patient from environment.Remove patient from environment. Protect area from further injury.Protect area from further injury. Administer high-concentration Administer high-concentration

Remove wet or restrictive clothing.Remove wet or restrictive clothing.

oxygen.oxygen.

(Continued)(Continued)

Patient Patient CARECARE

Deep (Late) Local Cold Injury

Emergency Care StepsEmergency Care Steps

Remove jewelry.Remove jewelry. Cover with dry dressings or Cover with dry dressings or clothing. clothing.

(Continued)(Continued)

Patient Patient CARECARE

Deep (Late) Local Cold Injury

Emergency Care StepsEmergency Care Steps

Do Do notnot::• Break blistersBreak blisters• Rub or massage areaRub or massage area• Apply heat or rewarmApply heat or rewarm• Allow patient to walk on Allow patient to walk on

affected extremityaffected extremity

(Continued)(Continued)

Patient Patient CARECARE

Deep (Late) Local Cold Injury

Emergency Care StepsEmergency Care Steps

If transport is delayed or extremelyIf transport is delayed or extremelylong, rewarm actively and rapidly long, rewarm actively and rapidly (e.g., wilderness situation)(e.g., wilderness situation)..

Immerse affected part in warm-water bath.Immerse affected part in warm-water bath.

Patient Patient CARECARE

Deep (Late) Local Cold Injury

Emergency Care StepsEmergency Care Steps

Continuously stir water/monitor Continuously stir water/monitor

Add warm water to maintain Add warm water to maintain

temperature.temperature.

temperature.temperature.

Continue until area is soft, and colorContinue until area is soft, and colorand sensation return.and sensation return.

(Continued)(Continued)

Patient Patient CARECARE

Deep (Late) Local Cold Injury

Emergency Care StepsEmergency Care Steps

Dress area with dry, sterile dressings.Dress area with dry, sterile dressings. Protect against refreezing.Protect against refreezing. Expect complaint of severe pain.Expect complaint of severe pain.

If there is any chance that a warmed body part that has sustained frostbite may refreeze in the time it takes to get the patient out of the backwoods, the experts say we should delay on the initial warming. When the tissue refreezes, the cells can be severely damaged.

PPRECEPTOR RECEPTOR PPEARLEARL

EEXPOSUREXPOSURETO HEATTO HEAT

PredisposingPredisposingFactorsFactors Climate

• High temperatureHigh temperature• High humidityHigh humidity

Exercise and activity

Heat ExposureHeat Exposure

(Continued)(Continued)

Age: Elderly

PredisposingPredisposingFactorsFactors

• Poor thermoregulationPoor thermoregulation

• MedicationsMedications

• Limited ability to Limited ability to escape heat escape heat

Heat ExposureHeat Exposure

(Continued)(Continued)

PredisposingPredisposingFactorsFactors

• Poor thermoregulationPoor thermoregulation

• Can’t remove ownCan’t remove own clothing clothing

Heat ExposureHeat Exposure

(Continued)(Continued)

Age: Newborns/Infants

Preexisting illness• Heart diseaseHeart disease• DehydrationDehydration• ObesityObesity• Infections/feverInfections/fever• FatigueFatigue• DiabetesDiabetes• Drugs/medicationsDrugs/medications

PredisposingPredisposingFactorsFactors

Heat ExposureHeat Exposure

Patient Patient ASSESSMENTASSESSMENT

Heat ExposureHeat Exposure

Signs and SymptomsSigns and Symptoms

Muscle crampsMuscle cramps WeaknessWeakness ExhaustionExhaustion Dizziness, faintnessDizziness, faintness Rapid heart rateRapid heart rate

(Continued)(Continued)

Patient Patient ASSESSMENTASSESSMENT

Heat ExposureHeat Exposure

Signs and SymptomsSigns and Symptoms

Altered mental status Altered mental status (may be unresponsive)(may be unresponsive)

SkinSkin

EMERGENCYEMERGENCY

• Moist and pale, temperature normal to coolMoist and pale, temperature normal to cool• Dry or moist, temperature hotDry or moist, temperature hot

Patient Patient CARECARE

Heat Exposure Patient with Normal to Cool Skin

Emergency Care StepsEmergency Care Steps

Remove from hot environment.Remove from hot environment. Administer high-concentration oxygen.Administer high-concentration oxygen. Loosen or remove clothing.Loosen or remove clothing.

(Continued)(Continued)

Patient Patient CARECARE

Heat Exposure Patient with Normal to Cool Skin

Emergency Care StepsEmergency Care Steps

Cool by fanning.Cool by fanning. Put in supine position; elevate Put in supine position; elevate legs.legs. Patient is responsive/not Patient is responsive/not nauseatednauseated

• Give water.Give water. Patient is unresponsive/vomitingPatient is unresponsive/vomiting

• Transport/no water.Transport/no water.

Patient Patient CARECAREHeat Exposure Patient with Hot Skin

Emergency Care StepsEmergency Care Steps

Remove from hot environment.Remove from hot environment. Remove clothing.Remove clothing. Administer high-concentration Administer high-concentration

(Continued)(Continued)

oxygen.oxygen.

Patient Patient CARECARE

Heat Exposure Patient with Hot SkinEmergency Care StepsEmergency Care Steps

Apply cool packs to neck, groin, Apply cool packs to neck, groin,

Keep skin wet.Keep skin wet. Fan aggressively.Fan aggressively. Transport immediately.Transport immediately.

armpits.armpits.

WWATERATEREMERGENCIESEMERGENCIES

DrowningDrowning

Death associated with immersionDeath associated with immersionin waterin water

KKEY TERMEY TERM

ReachReach Throw and towThrow and tow RowRow GoGo

Order of Water RescueOrder of Water RescueProceduresProcedures

Near-DrowningNear-Drowning

Primary concern is everyone’s safety.Primary concern is everyone’s safety. Treat for spine injury:Treat for spine injury:

• If diving injury cannot be ruled out.If diving injury cannot be ruled out. Attempt resuscitation ofAttempt resuscitation of

submerged cardiac arrest patientsubmerged cardiac arrest patientunless medical direction rules out.unless medical direction rules out.

(Patient Submerged But Survives)(Patient Submerged But Survives)

Patient Patient CARECARE

Near-Drowning (submersion)Near-Drowning (submersion)

Emergency Care StepsEmergency Care Steps

If patient is responsive and spine If patient is responsive and spine

• Immobilize head manually.Immobilize head manually.• Use backboard to remove Use backboard to remove

injury is not ruled out:injury is not ruled out:

from water.from water.

Patient is found Patient is found face down inface down inshallow water.shallow water.

Extend patient’s Extend patient’s arms straight up.arms straight up.

Rotate torso toward you as you lowerRotate torso toward you as you loweryourself into the water.yourself into the water.

Maintain stabilization by holding theMaintain stabilization by holding thepatient’s head between his arms.patient’s head between his arms.

Patient Patient CARECARE

Near-Drowning (submersion)Near-Drowning (submersion)

Emergency Care StepsEmergency Care Steps

If no suspected spine injury:If no suspected spine injury:

• Position unresponsive patient on Position unresponsive patient on left side.left side.

• Suction as needed.Suction as needed.• Administer high-concentration Administer high-concentration

oxygen.oxygen.

(Continued)(Continued)

Patient Patient CARECARE

Near-Drowning (submersion)Near-Drowning (submersion)

Emergency Care StepsEmergency Care Steps

If gastric distention prevents If gastric distention prevents

• Turn patient onto left side.Turn patient onto left side.• With suction ready, apply firm pressureWith suction ready, apply firm pressure

adequate ventilation:adequate ventilation:

over epigastric area.over epigastric area.

BBITES ANDITES ANDSTINGSSTINGS

Patient Patient ASSESSMENTASSESSMENT

Bites and StingsBites and Stings

Signs and SymptomsSigns and Symptoms

History of spider/snake bite; insect,History of spider/snake bite; insect,scorpion, marine animal stingscorpion, marine animal sting

Pain, redness, swellingPain, redness, swelling

(Continued)(Continued)

Patient Patient ASSESSMENTASSESSMENT

Bites and StingsBites and Stings

Signs and SymptomsSigns and Symptoms

Dizziness and chillsDizziness and chills FeverFever Nausea and vomitingNausea and vomiting Bite marks or stingerBite marks or stinger

Patient Patient CARECARE

Bites and StingsBites and Stings

Emergency Care StepsEmergency Care Steps

If stinger is presentIf stinger is present• Scrape with blunt edge to remove.Scrape with blunt edge to remove.

• Avoid tweezers. May squeeze moreAvoid tweezers. May squeeze morevenom into wound.venom into wound.

(Continued)(Continued)

Patient Patient CARECARE

Bites and StingsBites and Stings

Emergency Care StepsEmergency Care Steps

Wash area gently.Wash area gently. Remove jewelry distal to affected Remove jewelry distal to affected

Position injection site slightlyPosition injection site slightlybelow heart.below heart.

Observe for allergic reaction.Observe for allergic reaction.

area.area.

(Continued)(Continued)

Patient Patient CARECARE

Bites and StingsBites and Stings

Emergency Care StepsEmergency Care Steps

SnakebitesSnakebites• Consult medical direction aboutConsult medical direction about constricting band.constricting band.• Do not apply cold.Do not apply cold.

1. List the 5 ways in which the body loses 1. List the 5 ways in which the body loses heat. heat.2. What are the treatments for 2. What are the treatments for hypothermia? hypothermia?3. How should a person be turned over 3. How should a person be turned over when found face down in water? when found face down in water?4. What are the signs and symptoms of a 4. What are the signs and symptoms of a bite or sting? bite or sting?

RREVIEW QUESTIONSEVIEW QUESTIONS