THARMAL EMERGENCIES

HEAT STROKEDEFINITION

• Heat stroke is an acute medical emergencies caused by failure of the heat regulating mechanisms of the body. it

usually occurs during extended heat waves, especially when they are accompined by high humidity.

•People at risk are those not acclimatized to heat those who are elderly or very young, those unable to care for

themselves, those with chronic and debilitating diseases, and those taking certain medications [eg, major tranquilizers,

anticholinergics, diuretics, beta - adrenergic blocking agent] •Exertional heat stroke occurs in healthy individuals during sports or work activities [eg, exercising in exteme heat and

humidity].

INCIDENCE•Most heat related deaths occur in the elderly.

SIGN AND SYMPTOMS•CNS Disfunction [confusion , delirium, bizarre behavior , coma].

•Elevated body temperature [40.6c or 105f or higher].

•Hot or Dry skin.

•Anhidrosis [absence of sweating].

•Tachypnea.

•Hypotension.

•Tachy cardia.

•Heat stroke causes thermal at the cellular lavel, resulting in coagulopathies and widespread damage to the heart, liver, kidney. recent patient history reveals exposure to elevated ambient temperature or excessive exercise during extreme heat.

MANAGEMENT•The primary goal is to reduce the high temperature as quickly as possible, because mortality is directly related to the duration of hyperthermia. •simultaneous treatment focuses on stabilizing oxygenation using the ABCs (airway, breathing,circulation) of basic life support.•After the patient's clothing is removed, the core(internal) temperature is reduced to 39c (102f) as rapidly as possible.•Cool sheets and towels or continuous sponging with cool water.

DIAGNOSTIC FINDINGS

•Ice applied to the neck, groin, chest, axilla while spraying with tepid water.

•Cooling blankets

•Iced saline lavage of the stomach or colon if the temperature does not decrease

•Immersion of the patient in a cold water bath ( if possible )

•During cooling procedures, an electric fan is positioned so that it blows on the patient to augment heat dissipation by convection and evaporation.

•The patient's temperature is constantly monitored with a thermistor placed in the rectum,bladder, or esophagus to evaluate core temperature.

•Caution is used to avoid hypothermia and to prevent hyperthermia, which may recur spontaneously within 3 to 4 hours.

•Monitored carefully the patient's status is including vital signs, ECG findings, CVP, and level of responsiveness, all of which may change rapid alterations in body temprature.

•A seizure may be followed by recurrence of hyperthermia. 100% oxygen is administered.

•IV infusion therpy of NS OR RL solution is initiated as directed to replace fluid losses and maintain adequat circulation

• Urine output also measured frequently. •

PREVENTION

•Advise the patient to avoid immediate reexposure to high temperatures; hypersensitivity to high temperatures may remain for a considerable time.

•Emphasize the importance of maintaining adequate fluid intake, wearing loose clothing, and reducing activity in hot weather.

Advise athletes to monitor fluid losses and weight loss during workout activities or exercise and to replace fluids.

• Advise the patient to use a gradual approach to physical conditioninig, allowing sufficient time for return to baseline temperature.

•Direct frail elderly patient living in urban setting with high environmental temperatures to places where air conditioning is available [eg, shopping mall, library, church.]

•Advise patient to plan outdoor activities to avoid the hottest part of the body [between 10 a.m. and 2 p.m.]

•Emphasize the importance of maintaining adequate fluid intake, wearing loose clothing, and reducing activity in hot weather.

COLD INJURY

• Winter cold and snow provide a number of opportunities to get outside and participate in activities such as skiing, sledding,and snowmobiling. However, without proper protection cold weather related injuries can occur even when temperatures are above freezing [ 32F,0 C]. this is especially true if there are high winds or if clothing is wet.

•It is both the temperature and the duration of exposure that play a role in determining the extent and severity of cold weather related injuries.

•Exposure to cold can produce various injuries that occur as a result of the human inability to adapt to cold. these injuries can be divided into localized injury to a body part or parts [peripheral cold injuries], generalized cooling of the entire body [systemic hypothermia], or a combination of both

• Cold injuries divided into two categories;

•These are those that occur without the freezing of body tissue[chilblains and trench foot] and those that occur with the freezing of body tissue.[frost bite].

• CHILBLAINS• DEFINITION• • Chilblains are the painful inflammation of small blood vessels in skin that occur in response to sudden warming from cold temperature. also known as pernio, chilblains can cause itching, red patches, swelling and blistering on extremities, such as on toes, fingers, ears, and nose.

TYPES

•Acute, developing within 12-24 hours after exposure to the cold and getting better after one to two weeks if you keep warm.

•Chronic, lasting for a minimum of five months a years and causing persistent sores that can lead to scarring.

• cold weather related injuries can be divided into two general categories.

•These are those that occur without the freezing of body tissue[chilblains and trench foot] and those that occur with the freezing of body tissue.[frost bite]•

CAUSE•Exposure of skin to cold•A family history of chilblains•Being female•Being underweight•Area with high humidity•More common from november to april•Wearing ill fitting shoes•Having poor circulation•Having been diagnosed with Raynaud's phenomenon•Peripheral vascular disease due to diabetes, smoking, hyperlipidemia

• CLINICAL MANIFESTATION•Small, itchy red areas on your skin, often on your feet or hands•Possible blistering•Swelling of your skin•Burning sensation on your skin•Change in skin color from red to dark blue, accompanied by pain•Possible ulceration

• TREATMENT•Topical corticosteroids•Nifedipine [Adalat, Procardia]•Lanoline ointment•Antiseptic cream or lotion

TRENCH FOOT [Immersion Injury]• Exposure to damp, cold conditions can results in tissue damage of the foot. this condition called trench foot or immersion foot. it was named after the condition suffered by many soldiers in the trenches during world war I. trench foot develops after prolonged exposure to a wet, cold environment and is typically a more serious condition than chilblain.

• Trench foot is the term is used to described injuries of the foot due to water and cold exposure at sustained temperatures ranging from 32-65 degrees Fahrenheit.

CLINICAL MENIFESTATION

•Burning•Tingling of the foot•Loss of sensation•Foot and toes can appear cynotic[gray]and blotchy•Maceration and fissures•Blisters, erythema and peels

TREATMENT

•Antihistamin and Anticholinergic•Benadryl, Banthine or Pro-Banthine•Aluminum chloride•Formalin•Use talc or baby powder daily to wick away moisture•Rotate your shoes every other day to allow them to dry thoroughly•Avoid synthetic materials like rubber or vinyl. wear leather or cloth that can absorb moisture.•Frequent changes of socks to wick away moisture.

• Avoid synthetic materials like rubber or vinyl. wear leather or cloth that can absorb moisture.

•Frequent changes of socks to wick away moisture.

FROST BITE

• Frostbite occurs when there is freezing of the affected area and it is the most serious of the cold weather-related injuries.

•Frostbite usually affects the hands, feet, nose, or ears, though other parts of the body may also be affected. this type of injury results from decreased blood flow and heat delivary to body tissues resulting in damaging ice crystal formation.

1> Superficial frost bite :It is involves the skin ,subcutaneous tissues. skin is cold,waxy white, and nonblanching frozen part anesthetic but become painfuland flushed with thawing. edema develops and clear bullae filled with serous fluid appear with in 24hr. 2> Deep frost bite: It is involves in the muscle,tendons,neurovascular strctures, and bone, in addition to the skin and subcutaneous tissues.frozen part is hard, wood like, and anesthetic. it appear ashen gray, cynotic, or mottled and may remain unchanged even rewarming. edema develops, but bullae may be absent or delayed. bullae, ifpresent,are filled with hemorrhagic fluid.

CLASSIFICATION

RISK FACTORS

•Intoxication with alcohol or other substance•very young or very old age•cardiovascular disease•Peripheral vascular disease•outdoor work•windy or wet weather•homelessness•previous frostbite•skin damage•Poor circulation•Taking beta-blockers•Diabetes•Exhaustion,malnutrition, dehydration,sever injury,smoking,depression•constricting clothing and footwear•winter sports at high altitudes

SIGN AND SYMPTOMS •Pins and needles'' sensation followed by numbnees•Early throbbing or aching•Skin is hard, pale,cold,and has no feeling•Flushing from blood rushing to area it's rewarded•Burning sensation and swelling from collected fluid that may last four weeks•Blisters•Black scab like crust, which may develop several weeks after exposure•Damage to deep structures such as tendons, muscles,nerves and bone

TREATMENT

•Analgesics •NSAIDs•Antibiotics•Tetanus toxoids• coldand move him or her to a warmer place.•Remove constricting jewellery and wet clothing.•If immediate care is not available,rewarming first aid may be given.•soak the affected areas in warm water or repeatedly apply warm clothes to affected ears, nose or cheeks for 20 to 30 minutes.•keeps circulating the water to aid the warming process.

•Refreezing of thawed extremites can causes more severe damage. prevent refreezing by wrapping the thawed areas and keeping the person warm.

•If frost bite has caused tissue death in any area,such as a hand or foot,amputation may be necessary.

•If, however the person has serious infection,wet gangrene, or pain that won't respond to treatment, surgery may be required sooner.

•Apply dry sterile dressing to the frostbitten areas.Put dressing between frostbitten fingers or

toes to keep them separated.

Thank You