Upload
rodney-flynn
View
215
Download
0
Embed Size (px)
Citation preview
Environmental Emergencies
Heat/Cold Emergencies
Metabolism runs best at 98.6oF
• T0 - Metabolic rates; cell damage
• T0 - Metabolic rates; cell damage
Heat Loss
Conduction
Heat Loss
Convection
Heat Loss
Radiation
Heat Loss
Evaporation
Heat Loss
Respiration
Heat Production
1. Metabolism
2. Movement of Large Muscles
3. Shivering
Heat Production > Heat Loss = Body Temperature
Heat Loss > Heat Production = Body Temperature
Cold EmergenciesCold Emergencies
Hypothermia Risk Groups
1. Young children & elderly2. Shock patients3. Diabetics4. Head/spinal injury5. Overdose/poisoning
6. Homeless
7. Burn victims
8. Outdoor sports participants
Hypothermia
Generalized cooling of the body Can occur at temperatures above
freezing• Wet clothes
• Contact with cold surfaces
• Prolonged exposure to the cold
Stages of HypothermiaCore Body Temperature Symptoms
99°F-96°F 37.0°C-35.5°C Shivering.
95°F-91°F 35.5°C-32.7°C Intense shivering, difficulty speaking.
90°F-86°F 32.0°C-30.0°C Shivering decreases and is replaced by strong muscular rigidity. Muscle coordination is affected and erratic or jerky movements are produced. Thinking is less clear, general comprehension is dulled, possible total amnesia. Patient generally is able to maintain the appearance of psychological contact with surroundings.
85°F-81°F 29.4°C-27.2°C Patient becomes irrational, loses contact with environment, and drifts into stuporous state. Muscular rigidity continues. Pulse and respirations are slow and cardiac.
80°F-78°F 26.6°C-20.5°C Patient loses consciousness and does not respond to spoken words. Most reflexes cease to function. Heartbeat slows further before cardiac arrest occurs.
Signs & Symptoms of Hypothermia
Shivering in mild cases (lack of, in more severe cases)
Numbness Stiff or rigid posture Drowsiness or mental status
changes Breathing
• Rapid (early)• Shallow, slow, absent (late)
Blood pressure (low or absent)
Signs & Symptoms of Hypothermia Pulse
• Rapid (early)• Slow and barely palpable (late)
Skin• Red (early)• Pale• Cyanotic• Stiff/hard (late)
Hypothermia Treatment Remove pt. from environment and
prevent further heat loss Remove wet clothing and cover with
blanket Support airway, breathing 100% O2 – warmed/humidified, if
possible Handle patient gently
Hypothermia Treatment Do not allow pt. to walk or exert
self If apneic, check pulse 30-45
seconds before starting CPR Do not allow patient to eat or
drink stimulants or smoke Do not massage extremities
Emergency Care ofHypothermiaIf patient is responding appropriately,
rewarm actively: Cover with warm blankets Apply heat to groin, armpits, neck. Warm trunk/torso first. Do not warm too quickly. Increase heat in ambulance. Warm bath if delayed transport.
Emergency Care ofHypothermia
If patient unresponsive or responding inappropriately, rewarm passively:
Open airway; provide high-concentration oxygen.
Apply warm blankets. Increase heat in ambulance.
Frostbite Localized cold injury Subfreezing temperatures Vasoconstriction occurs
• Blood flow to distal circulation – usually occurs to nose, ears, fingers, toes
• Water in tissues freezes; tissue damage occurs
Frostbite Signs/Symptoms Mild (frost nip): Red, burning areas Superficial (early): Blanching of the
skin, loss of feeling/sensation Deep (late): white waxy, firm,
cyanotic, possibly blisters and swelling
Local Cold Injury
Emergency Care ofSuperficial (Early) LocalCold Injury Remove patient from environment. Administer oxygen Remove wet/restrictive clothing Protect area from further injury. Splint and cover extremity. Do not rub or massage. Do not re-expose to cold.
Emergency Care of Deep(Late) Local Cold Injury
Remove patient from environment. Protect area from further injury –
cover with dry clothing or dressing Remove jewelry Administer high-concentration
oxygen. Do not:
• Break blisters• Rub or massage area• Apply heat or rewarm• Allow patient to walk on affected
extremity
Passive vs. Active Rewarming Passive
• Allows the body to rewarm itself
• Remove wet clothing
• Cover with blankets Active
• Application of external heat sources to patient
For an extremely long or delayed transport (>30 min) active rapid rewarming should be done
Seldom recommended Large potential to permanently
injure frozen tissue
Active Rapid Rewarming of Frozen Parts Immerse the affected part in warm (tepid)
bath water (not to exceed 105°F) NYS
Ensure the water does not cool from the affected part
Continuously stir water Continue until the part is soft and color
and sensation return Dress area with dry, sterile dressings. Protect against refreezing. Expect complaint of severe pain.
Frostbite Treatment Do NOT rub frostbite Do NOT allow refreezing Do NOT allow patient to smoke
Hypothermia can cause apparent Hypothermia can cause apparent absence of vital signsabsence of vital signs
Always resuscitate
You’re not dead until you’re warm and dead!
Heat IllnessHeat Illness
High Risk Groups Classic Heat Stroke Elderly Chronic medical problems
• Heart Disease
• Obesity
• Diabetes
High Risk Groups Exertional Heat Stroke
Small children in closed vehicles
Athletes, military recruits, construction workers, on hot humid days
Heat Cramps
Due to salt loss from sweating Spasms in large muscle groups Patient awake, alert
Heat Cramps Treatment
Stop activity Cool environment
Heat Exhaustion Signs, Symptoms
Muscle Cramps Weakness Faintness, dizziness Headache Nausea, vomiting Pale, cool, moist skin Pt. is still sweating therefore body is
trying to cool down
Heat Exhaustion Treatment
Stop activity Cool environment Lie down, elevate legs
(trendelenberg) Transport if LOC or symptoms
do not clear rapidly Administer high concentration
oxygen
Heat Stroke
Most serious heat-related illness Body temperature > 106oF Damage occurs to temperature
regulating center in brainstem Sweating mechanism fails
Heat Stroke Signs/Symptoms Body temperature Hot, dry, flushed skin Absence of sweating Altered mental status
• Confusion, irritability
• LOC
• Coma Seizures Vomiting
Heat Stroke Treatment Remove from hot environment Remove clothing High concentration O2
Assist ventilations as needed Apply cool packs to neck, groin, armpits
(ancillary regions) Keep the skin wet by applying water by
sponge or wet towels Transport immediately