Chapter 34

Chapter 34Environmental Emergencies

Overview

Temperature Regulation Cold Exposure Heat Exposure Water-Related Emergencies

Overview

Altitude Emergencies Lightning Strikes Bites and Stings

Temperature Regulation

Heat loss: Radiation– Heat transfers from warm

body to cool environment– 60% of body heat lost at

room temperature

Heat loss: Convection– Heat transfers away

from a warm surface via air currents

Heat loss: Conduction– Heat transfers from

warm object to cool object when they’re in direct contact with each other

Heat loss: Evaporation– Heat transfers into body

fluids, which then evaporate• Accounts for about 30%

of body’s normal heat loss

Heat gain– Metabolism generates heat internally– Muscle contraction generates heat internally– External sources such as a warm environment can

help body gain heat

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

Stop and Review

Describe the ways the body loses heat. Describe the ways the body gains heat.

Cold Exposure

Local cold injuries– Chilblains: painful, inflamed skin lesions– Trenchfoot: cold, pale, swollen feet with

diminished sensation

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

Cold Exposure

Local cold injury– Frostbite: results in tissue damage

Courtesy of Kevin Reilly, M.D., Albany Medical Center, Albany, NY

Cold Exposure

Management– Remove patient from cold environment– Remove cold, wet clothing– Rewarm injured part

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

Cold Exposure

Hypothermia: Early signs and symptoms – Poor coordination– Memory disturbances– Reduced sensation– Mood changes– Dizziness– Difficulty with speech

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

Cold Exposure

Hypothermia: Management– Check body temperature– Remove from cold environment– Remove cold, wet clothing and cover in blankets– Administer oxygen– Attempt rewarming

Stop and Review

What are the types of local cold injuries? What are the signs and symptoms of

hypothermia? How is hypothermia managed?

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

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

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

Stop and Review

Differentiate between heat exhaustion and heatstroke.

Describe the management of the patient with heat exhaustion and heatstroke.

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

Management– Reach– Throw– Row– Go

Diving emergencies– Boyle’s law: the volume of a gas varies inversely

with the surrounding pressure

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

Ascent– Decompression sickness

• Occurs during rapid ascent• Gases cannot decompress appropriately• Symptoms occur 1 to 6 hours after the dive• Called the bends

Ascent– Pulmonary overpressurization syndrome

• As pressure decreases, air expands in the lungs– Volume of air in the lungs increases, causing

alveoli to rupture

Ascent– Air embolism

• Air bubble within the bloodstream that may cause a blood clot

– Patients with ascent injuries should be treated in hyperbaric chambers

Nitrogen narcosis– Also diving related

• Known as rupture of the deep

– Patient appears as though intoxicated during the dive

– Resolves upon ascent

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?

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

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

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

Stop and Review

List the signs and symptoms of altitude emergencies.

Describe the management of the patient suffering from an altitude emergency.

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

Lightning Strikes

Severe injury– Halts cardiac electrical activity– Results in cardiac arrest– Stuns the lungs, impairing breathing– Loss of consciousness– Permanent neurologic injury

Lightning Strikes

Management– Scene safety– Determine treatment

priority if multiple victims– Manage the ABCs– Assume blunt trauma

injuries and properly immobilize patient

Stop and Review

What are the effects of a lightning strike, and what are the priorities in treating victims?

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

Bites and Stings

Snakes – Coral snake

• Neurologic decompensation, tremor, salivation, seizures, respiratory paralysis

– 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.

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

Bites and Stings

Spiders– Black widow

• Redness, swelling, muscle cramping• More serious complications include hypertension,

respiratory failure, shock, coma

– 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

Bites and Stings

Scorpions– Rarely fatal– Reddened area, burning or stinging sensation,

local tissue damage– Severe reactions may occur in children

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

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.

Chapter 34

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