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22environmentalemergencies-090910172531-phpapp02.pptx

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22environmentalemergencies-090910172531-phpapp02.pptx

  1. 1. Environmental Emergencies
  2. 2. Environmental Emergencies • Body Temperature • 96.4-99.8 degrees F • Heat Regulation • • • Based on heat lost v heat gained Variation throughout body core and periphery Cardiovascular System • Transports heat through body • Skin • Allow heat to be lost/gained to/from environment • Hypothalamus • Temperature control center of the brain
  3. 3. Heat Production • Metabolism • • • ALL metabolic processes in body produce heat Basal metabolism • Metabolic activity to maintain cell function at rest Generally more than enough heat to maintain core temp
  4. 4. Heat Loss/Gain • • • • • Radiation Conduction Convection Evaporation Breathing
  5. 5. Radiation • Radiation • • • • Transfer of heat via infrared rays. Heat rays are radiated by the body and other objects in the environment. If body temp is greater than the surroundings heat is lost. We radiate 550 watts (5 light bulbs)
  6. 6. Conduction • Conduction • Transfer of heat to objects including air that are in direct contact with body.
  7. 7. Convection • Convection • Transfer of heat through movement of currents. • i.e. Wind chill factor
  8. 8. Evaporation • Evaporation • • Loss of heat when moisture vaporizes on the body surface. Depends on temp/air movement/humidity • • Wind currents move saturated air away from body Drier air replaces it and takes up moisture • Closer to 100% humidity = Less evaporation
  9. 9. Breathing • Breathing • • • Inhaled air is heated/cooled by body temp Body looses heat when air is cooler than the body Body gains heat when air is warmer that the body
  10. 10. Mechanisms of Regulation • Brain • Hypothalamus • Body thermostat • Metabolic Rate • Heat production • Cardio • Heat distribution • Ski n • Heat loss • Vasodilation • Loss by conduction/convection/radi ation/sweating • Vasoconstricion • Inhibits sweating, increased metabolic rate
  11. 11. Cardiovascular System • Cardiovascular • • Brings heated blood from core to extremities 5 % of cardiac output is in skin • 250-300 ml/min • Vasodilation • • • More blood contact with skin Conduction, convection, radiation Can increase to 3000 ml/min!!!! • Vasoconstriction • • Heat conservation Can decrease to 30 ml/min!!!!
  12. 12. Skin • Skin • • • • • Heat regulation Insulation Vasoconstriction Vasodilation Evaporation form sweat
  13. 13. Questions to ask • • • • • Source Environment Loss of consciousness Effects How long exposed
  14. 14. Cold Emergencies: Predisposing Factors • Cold Environment • • Immersion Non Immersion • Age • • Very old Very young • • • • Small with LARGE surface area Small muscle mass – Poor in children and not existent in infants Less body fat Younger children need help to protect against environment • Medical Conditions • • • • • • Shock Head injuries, Injuries to spinal cord Burns Generalized infection Diabetes and hypoglycemia Drugs/poisons
  15. 15. Predisposing factor: Idiocy…..
  16. 16. Hypothermia • Hypothermia • Body core temp falls below 95 degrees F • Environmental conditions • • • • • • Ethanol ingestion Underlying illness Overdose/poisoning Major trauma Outdoor resuscitation Ambient temperature decrease ( i.e. home of elderly pt)
  17. 17. Cold Emergencies S/S • • • • • • • • • • • Poor coordination Memory disturbances Reduce/loss of sensation Mood changes Less communicative Dizziness Speech difficulty Stiff/rigid posture Muscular rigidity Shivering/absence of shivering Breathing changes • • Early -Rapid Late – Shallow, slow, or absent • Pulse changes • • Early- Rapid Late – Slow and barely palpable , irregular, absent • Skin Changes • • • • Red – early Pale Cyanotic Stiff/hard • • • • Slowly responding pupils Low to absent BP Joint/muscle stiffness Poor judgment
  18. 18. Assessment/Treatment • Assessment: • • • Place hand against pt abdomen Cool abdomen = Generalized hypothermia Assess pulse 30-45 seconds before CPR • Treatment: • • • • • • • • Remove pt from environment Remove wet clothing Cover with blankets Handle pt EXTREMELY carefully Do not allow pt to walk/exert self Admin O2 (warmed/humidified if able) Do not let pt ingest stimulants Do not massage extremity If pt responsive : Active rewarming • • If pt unresponsive : Passive rewarming • AFTERDROP…
  19. 19. Active Vs. Passive Rewarming • Active rewarming • • Warm blankets Heat packs /warm water bottles • • • Groin Neck Under arms • Turn heat on in pt compartment • Passive rewarming • Warm blankets Turn heat on in pt compartment
  20. 20. Localized Injuries • • • Localized to one area of the body Tend to happen in extremities and exposed ears/nose/face Early/Superficial Injury • • • • Blanching of the skin Loss of feeling/sensation in area Skin remains soft If rewarmed – tingling sensation • Late/Deep Injury • • • • • White, waxy skin Firm to frozen feeling on palpation Swelling Blisters If thawed – Flushed with area of purple and blanching or mottled and cyanotic
  21. 21. Localized Injuries: Care • • • • • Remove pt from the environment Protect injured extremity from further injury Administer O2 Remove wet/constrictive clothing If early/superficial • • • • Splint extremity Cover extremity Do not massage Do not re expose to cold • If late/deep • • • Remove jewelry Cover with dry clothing/dressings DO NOT: • Break blisters – Rub/massage area – Apply heat – Rewarm – Allow pt to walk on affected extremity
  22. 22. Prolonged/Delayed Transport • Active Rapid Rewarming • • • • • • • Immerse affected part in warm water bath Monitor water so that it doesnt cool from frozen part Continuously stir water Continue until the part is soft and sensation returns Dress the area with dry sterile dressings Protect against refreezing Expect pt to c/o SEVERE pain
  23. 23. Changing Directions…
  24. 24. Heat Emergencies: Predisposing Factors • Climate • • High ambient temp = Less evaporation High relative humidity = Less evaporation • Exercise and activity • • Can lose 1+ Liter of sweat per hour Loss of electrolytes (Na, Cl, H2O) • Age • Elderly • • • Poor thermoregulation Medications Lack mobility- cannot escape environment • Newborns • • Poor thermoregulation Cannot remove own clothing • Pre existing illness • • • • • • • Heart disease Dehydrations Obesity Fever Fatigue Diabetes Drugs/medications
  25. 25. Heat Emergencies S/S • • • • • Muscular Cramps Weakness Exhaustion Dizziness/faintness Skin • • Moist, pale, normal to cool temp • Heat Exhaustion Hot, dry or moist – Dire emergency • Heat Stoke • • • Rapid Heart Rate AMS Unresponsive
  26. 26. Treatment: Heat Exhaustion • Moist, pale, normal to cool skin • • • • • • • Remove pt from hot environment and place in cool one Administer O2 Loosen or remove clothing Cool pt by fanning Put in shock position If pt responsive and not nauseated have them drink water If pt is unresponsive or vomiting transport pt left lateral recumbent
  27. 27. Treatment: Heat Stoke • Hot, dry or moist skin • • • • • • • Remove pt from hot environment and place in cool one Administer O2 Remove clothing Apply cold packs to neck, groin, armpits Keep skin wet by applying water by sponge/wet towels Fan aggressively Transport IMMEDIATELY
  28. 28. Water Related Emergencies • Near drowning/drowning • • • Ensure safety of crew Suspect spinal injury if diving injury Consider length of time in cold water • Any pulseless non breathing pt submerged in cold water should • • • • • be resuscitated C-Spine control and removal via LBB if pt responsive and spinal injury suspected If injury not suspected, place pt on L lateral recumbent Suction as needed Administer O2 If gastric distention interferes with ventilation: • • • • Roll pt to L side Have suction ready Apply firm pressure on abdomen (epigastric are) and decompress SUCTION
  29. 29. Bites and Stings
  30. 30. Bites and Stings: S/S • • • • • • • • • • • • Hx of bite (spider, snake) or sting (insect, scorpion, marine animal) Pain Redness Swelling Weakness Dizziness Chills Fever Nausea Vomiting Bite marks Stinger
  31. 31. Bites and Stings Treatment • If stinger present remove it • Scraping motion Wash area gently • • • • • • Remove jewelry from area before swelling occurs Place injection site slightly below pt heart Do not apply cold to snakebites Consult medical direction for constricting band for snake bite Observe and treat for S/S of allergic reaction
  32. 32. Remember… Scene Safe! Its already injured the patient. So…

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