Chapter 24 Environmental Emergencies.pptx

EMT

1. Chapter 24 Environmental Emergencies Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care , Ninth Edition Joseph J. Mistovich • Keith J. Karren

2. Heat and Cold Emergencies

3. Regulation of Temperature

4. Approximate core temperature: 98.6 degrees F or 37 degrees C Hypothalamus Thermoreceptors Heating and cooling the body

5. Regulation of Temperature When Heat Loss Exceeds Heat Gained

6. When Heat Lost Exceeds Heat Gain Wind Chill

7. Regulation of Temperature When Heat Gained Exceeds Heat Loss

8. When Heat Gained Exceeds Heat Lost

9. Exposure to Cold

10. Generalized Hypothermia

11. Increase in heat loss Decrease in heat production Mortality can be up to 87 percent Sudden or gradual onset

12. Pathophysiology of Generalized Hypothermia Predisposing Factors

13. Predisposing Factors Ambient temperature, wind chill, and moisture Age Medical conditions Alcohol, drugs, and poisons Duration Clothing Activity level

14. Pathophysiology of Generalized Hypothermia Stages of Hypothermia

15. Stages of Hypothermia

16. Pathophysiology of Generalized Hypothermia Immersion Hypothermia

17. Immersion Hypothermia Immersion in cool or cold water < 77° cold < 68° death Effect Priority treatment

18. Pathophysiology of Generalized Hypothermia Urban Hypothermia

19. Urban Hypothermia Those affected External and internal Elderly

20. Pathophysiology of Generalized Hypothermia Myxedema Coma

21. Myxedema Coma Causes Signs and symptoms Emergency medical care

22. Local Cold Injury “Nonfreezing Cold Injury” (NFCI)

23. Trench foot Immersion foot Cold but not freezing water

24. Local Cold Injury “Freezing Cold Injury” (FCI)

25. “ Frostbite ” Requires colder temperatures than are needed for generalized hypothermia

26. Pathophysiology of Local Cold Injury

27. Locations Predisposing factors Stages of injury

28. Assessment-Based Approach: Cold-Related Emergency Scene Size-Up

29. Scene Size-Up Safety Evidence of cold exposure

30. Assessment-Based Approach: Cold-Related Emergency Primary Assessment

31. Primary Assessment General impression Airway Breathing Circulation – May be difficult

32. Assessment-Based Approach: Cold-Related Emergency Secondary Assessment

33. Secondary Assessment History Physical exam Signs and symptoms

34. Assessment-Based Approach: Cold-Related Emergency Emergency Medical Care for Generalized Hypothermia

35. Emergency Medical Care Remove the patient from further heat loss Handle patient gently Administer O 2 Use AED if necessary Passive rewarm all pts Active rewarm if core temp less than 93.2’

36. Assessment-Based Approach: Cold-Related Emergency Emergency Medical Care for Immersion Hypothermia

37. Emergency Medical Care for Immersion Hypothermia Instruct patient to make the least effort to stay afloat Lift patient from water in a horizontal or supine position Remove wet clothing

38. Assessment-Based Approach: Cold-Related Emergency Emergency Medical Care for Local Cold Injury

39. Emergency Medical Care for Local Cold Injury Signs and symptoms Remove the patient from environment Never thaw if there is danger of refreezing Use rewarming procedures as protocol allows

40. Assessment-Based Approach: Cold-Related Emergency Reassessment

41. Reassessment Mental status ABCs CPR Vital signs every five minutes No reexposure to cold

42. Exposure to Heat

43. Hyperthermia

44. Heat cramps Heat exhaustion Heatstroke (© Michal Heron)

45. Pathophysiology of Heat-Related Emergencies

46. Pathophysiology of Heat-Related Emergencies Predisposing Factors

47. Predisposing Factors Climate Strenuous activity Age Preexisting illness Certain drugs and medications Lack of acclimation

48. Assessment-Based Approach: Heat-Related Emergency Scene Size-Up

49. Scene Size-Up Safety Ambient temperature Exercise/activity Medications

50. Assessment-Based Approach: Heat-Related Emergency Primary Assessment

51. Primary Assessment Mental status ABCs O 2 Skin color, temperature, and condition Priority patient

52. Assessment-Based Approach: Heat-Related Emergency Secondary Assessment

53. Secondary Assessment Remove from environment History Physical exam Vital signs Signs and symptoms

54. Assessment-Based Approach: Heat-Related Emergency Emergency Medical Care for a Heat Emergency Patient with Moist, Pale, Normal-to-Cool Skin

55. Emergency Medical Care for a Heat Emergency Patient with Moist, Pale, Normal-to-Cool Skin Move to a cool place Administer O 2 Remove clothing Apply cold, wet compresses Place patient in supine position Give water if no AMS or vomiting if local protocol allows Transport

56. Assessment-Based Approach: Heat-Related Emergency Emergency Medical Care for a Heat Emergency Patient with Hot Skin That is Dry (or Moist?)

57. Emergency Medical Care for a Heat Emergency Patient with Hot Skin that Is Dry (or Moist?) Move to a cool place Remove clothing Administer O 2 Cool the patient Passive/Active (PRIORITY) Be prepared for seizures or vomiting Transport

58. Assessment-Based Approach: Heat-Related Emergency Emergency Medical Care for Heat Cramps

59. Emergency Medical Care for Heat Cramps Move to a cool place Consult medical direction for orders for sips of low-concentration salt water Apply moist towels Explain to the patient what happened and how to avoid recurrence

60. Assessment-Based Approach: Heat-Related Emergency Reassessment

61. Reassessment Mental status ABCs Vital signs Treatment

62. Bites and Stings

63. Snakebite

64. Venomous Snakes in the Southeast

65. Aberrant Eastern Coral Snake Organ Pipe Shovel-nosed Snake 

66. Types of venomous and non-venomous snakes Severity Emergency medical care

67. Necrotic Tissue 2’ to Snake Bite

68. https://www.youtube.com/watch?v=l4AN8Vauah0

69. Insect Bites and Stings (ok… and arachnids, too)

70. Treated like other wounds Medical help is necessary only if: Itching lasts longer than two days Signs of infection Allergic reaction develop The insect is poisonous Signs of normal reaction Insect Bites and Stings

71. Insect Bites and Stings Black Widow Spider

72. Black Widow Spider Recognition Location found Signs and symptoms – A pinprick sensation – Severe muscle spasms – Rigid, board-like abdomen – Dizzy, N/V, resp distress

73. Insect Bites and Stings Brown Recluse Spider

74. Brown Recluse Spider Characteristics Appearance of bites Several hours, becomes bluish with white periphery, then a red halo or “ bulls-eye ” pattern 7-10 days, becomes large ulcer

75. Insect Bites and Stings Scorpion

76. Scorpion Types – A sharp pain at the injection site – Drooling – Poor coordination – Incontinence – Seizures

77. Animal/Insect Bites & Stings

78. Insect Bites and Stings Fire Ant

79. Fire Ant Appearance Fire ant bites produce extremely painful vesicles that are filled with fluid.

80. Insect Bites and Stings Tick

81. Tick Disease transmitter Locations found Tick removal (© Charles Stewart, MD & Associates)

82. (© Charles Stewart, MD & Associates) How to remove a tick Use fine-tipped tweezers to grasp the  tick  as close to the skin's surface as possible. Pull upward with steady, even pressure. ... After  removing  the  tick , thoroughly clean the bite area and your hands with rubbing alcohol or soap and water. Never crush a  tick  with your fingers

83. Insect in Ear

84. Insect in Ear EMS Insect removal

85. Insect in Ear Hospital Insect removal

86. Assessment-Based Approach: Bites and Stings Scene Size-Up

87. Scene Size-Up Scene safety Look for signs of insect activity near patient

88. Assessment-Based Approach: Bites and Stings Primary Assessment

89. Primary Assessment General impression Mental status ABCs

90. Assessment-Based Approach: Bites and Stings Secondary Assessment

91. Secondary Assessment Signs and symptoms of anaphylaxis Hives Upper airway obstruction Wheezing or stridor Hypotension

92. Assessment-Based Approach: Bites and Stings Emergency Medical Care for Anaphylactic Shock

93. Emergency Medical Care for Anaphylactic Shock Maintain airway Administer O 2 and support breathing Administer epinephrine by prescribed auto-injector Call for ALS Initiate early transport

94. Assessment-Based Approach: Bites and Stings Emergency Medical Care for a Bite or Sting

95. Emergency Medical Care for a Bite or Sting Remove stinger Wash area Remove any constricting objects Lower injection site below level of heart Apply cold pack Observe patient for signs of allergic reaction Keep patient calm

96. Assessment-Based Approach: Bites and Stings Reassessment

97. Reassessment ABCs Signs of anaphylactic shock

98. Marine Life Bites and Stings

99. Approx 2,000 poisonous marine animals found in virtually all waters Use forceps to remove material at the site, then irrigate with water Do not remove spines that are embedded in joints or deeply in the skin

100. Remove dried tentacles and pour vinegar on the affected area Apply heat and soak the affected area in hot water (use saltwater when possible)

101. NO. JUST…NO.

102. Lightning Strike Injuries

103. Statistics of strikes Deaths Common months Common situations

104. Pathophysiology of a Lightning Strike Injury

105. Lightning strike mechanisms Effects on the body systems (© David Effron, MD)

106. Assessment of the Lightning Strike Patient

107. Signs and symptoms Nervous Cardiac Respiratory Skin Musculoskeletal Ophthalmic Otologic

108. Emergency Care for the Lightning Strike Patient

109. Scene safety Manual stabilization Airway CPR, if needed Breathing Immobilization Transport

110. High Altitude Sickness

111. At high altitudes, ambient atmosphere decreases The pressure of oxygen also decreases High altitude is considered > 5,000 feet Signs and symptoms Medications taken to prevent altitude sickness Diamox Nifedipine High Altitude Sickness

112. Acute Mountain Sickness

113. Typically occurs with rapid ascent to 6,600 feet or greater Signs and symptoms Severe signs Emergency medical care Acute Mountain Sickness

114. High Altitude Pulmonary Edema

115. Also known as H.A.P.E. Can happen @ 8000 ft, usually > 14,500 ft Results from changes in the pressure in pulmonary vessels Causes fluid to be forced out of capillaries and collect around alveoli Signs and symptoms Emergency medical care High Altitude Pulmonary Edema

116. High Altitude Cerebral Edema (HACE)

117. Also known as H.A.C.E. Occurs from the collection of excessive fluid in the brain tissue Most often occurs at altitudes above 12,000 feet (can happen @ > 8200 ft) Signs and symptoms Emergency medical care High Altitude Cerebral Edema