Environmental Emergencies

Environmental Emergencies Exposures to the Cold How does the body lose heat

• Conduction-body heat lost to nearby objects through direct contact

• Convection- body heat lost to surrounding air• Radiation- body heat lost to nearby objects• Evaporation - perspiration lost from the body surface

when changed from a liquid to vapor• Respiration

Environmental Emergencies• Hypothermia

– Generalized cooling of the entire body

• Predisposition– Burns– Spinal injury– Infection– Diabetes– Drugs and alcohol

Environmental Emergencies• Often times the person most effected by

hypothermia are the very old and very young

Environmental Emergencies• Signs & Symptoms (general)

– Shivering (1st clinical indicator)– Cool, cold skin temperature– Indifference, apathy, Sleepiness– Lack of coordination– Poor judgement– Decreased mental status– Decreased vital signs– Muscular rigidity

Progressive Clinical Presentation of Hypothermia

oC oF Clinical Signs37.6 99.6 Normal rectal temp37 98.6 Normal oral temp35 95.0 Increased metabolic rate34 93.2 Maximum shivering33 91.4 Severe hypothermia below

this point32-31 89.6-87.8 Consciousness clouded, BP

difficult to obtain; pupilsdilated but reactive;shivering ceases

Progressive Clinical Presentation of Hypothermia

oC oF Clinical Signs30-29 86.0-84.2 Progressive loss of

consciousness; respiratory ratedecreases; pulse difficult toobtain; muscular rigidity

28 82.4 Ventricular fibrillation possible27 80.6 Voluntary motion ceases;

pupils non-reactive; deep tendon& superficial reflexes absent

25 77.0 Ventricular fibrillation mayoccur spontaneously

Progressive Clinical Presentation of HypothermiaoC oF Clinical Signs24 75.2 Pulmonary edema22-21 71.6-69.8 Maximum risk of ventricular

fibrillation20 68.0 Cardiac standstill18 64.4 Lowest accidental hypothermia

victim to recover9 48.2 Lowest artificially cooled

hypothermia patient to recover

Environmental EmergenciesPatient Care- Hypothermia• Scene size-up

• Activate EMS

• Perform initial assessment

• Remove patient from cold environment

• Protect from further heat loss

Environmental Emergencies

• Remove all wet clothing

• Handle patient gently

• Do not allow patient to exert themselves

• Do not give food or fluids

• O2

• Handle patient carefully

• Monitor vital signs

Environmental Emergencies

• Patient Care-

• O2 (warmed if possible)

• Wrap with blanket and handle gently can cause V-Fib with rough handling– Passive rewarming– Active rewarming

Environmental Emergencies

• Patient Care

• Extreme Hypothermia– Assess Carotid Pulse for 30-45 seconds – If no pulse begin CPR

Environmental Emergencies

• Immersion Hypothermia– Cold water?– Water conducts heat 25 X faster than air of

the same temperature– Most deaths in cold water are due to:

• rapid body heat loss• leading to unconsciousness• leading to drowning or cardiac failure

Environmental Emergencies

• Immersion hypothermia– Likely to become fatal when the core

temperature drops below 94oF

• Patient Care– Same as for other hypothermia patients– If long exposure time, keep patient

horizontal due to possible vascular collapse

Environmental Emergencies

• Increasing Survival Time– Drowning proofing– Treading water– Swimming– Holding still– HELP– Huddle

• (Note: survival times based on 50oF water temp)

Environmental Emergencies• Frostnip (early, superficial)

– Areas affected• tips of nose, ears, upper cheeks, fingers

• Signs and Symptoms– light skin reddens– dark skin lightens

• both blanch

– numbness of affected area– skin remains soft

Environmental Emergencies

• Frostnip - Emergency Care– Remove patient from cold environment– Slowly warm affected area

• Do Not rub or massage• Do Not re-expose to cold• Manually stabilize extremity, cover• Rewarm using own body heat

– Tingling & burning are common during rewarming

Environmental Emergencies

• Frostbite (late / deep)– Progressive from early (superficial) cold

injury– Areas affected

• skin, subcutaneous tissue, muscles, deep vessels, organ membranes, bones

Environmental Emergencies• Frostbite

– Signs and Symptoms• skin appears white & waxy• turning mottled or blotchy in appearance• color changes from white to grayish yellow to

grayish blue.• swelling• blistering

Environmental Emergencies

• Frostbite– Signs and Symptoms con’t.

• firm to frozen (affected area feels frozen on surface, soft beneath surface initially, normal resilience, progresses to firm frozen feeling)

• do not squeeze or poke tissue• assess as it fractured• if thawed skin may appear flushed with purple

areas

Environmental Emergencies• Frostbite Emergency Care

– Provide same care as for frostnip– Protect frostbitten or frozen area

• handle as gently as possible

– Arrange for transport (if transport is delayed)

• move patient indoors

– Remove jewelry– Cover with dry sterile dressings

Environmental Emergencies

• Frostbite Emergency Care– Do Not:

• break blisters• rub or massage area• apply heat• allow use of alcohol consumption• allow patient to smoke• allow patient to walk on affected extremity• rewarm *

Environmental Emergencies

• Frostbite Emergency Care– Rewarming

• seldom recommended• risk of causing permanent injury• rewarm ONLY if to to do so by EMS or severely

delayed transport• complete submersion of the affected area in

heated water (100 - 105oF)• dress & bandage as if burned (dry sterile

dressings)

Environmental Emergencies

• Heat Emergencies– Hyperthermia

• Excessive body heat

– Types of Emergencies• Heat Cramps• Heat Exhaustion• Heat Stroke

Environmental Emergencies• Heat cramps

– Muscle cramps– Weakness– Respirations - normal to slightly increased– Pulse - normal to increased & weak– Skin color/temp - normal to pale/cool &

moist– Heavy perspiration– Dizziness possible, seldom altered mental

status

Environmental Emergencies

• Heat Exhaustion– Most commonly treated heat emergency– Weakness– Respirations - rapid & shallow– Pulse - Rapid & weak– Skin color/temp - pale to slightly flushed /

cool & moist– Heavy perspiration– Possible altered mental status

Environmental Emergencies

• Care for Heat Cramps/Exhaustion– Move patient to a cool environment– Loosen or remove clothing to cool (do not

chill patient)– Oxygen– Place patient in supine position– Small amounts of water IF patient is fully

conscious

Environmental Emergencies• Heat Stroke

– Generalized weakness– Respirations - rapid & shallow– Pulse - rapid & full– Skin color/temp - red, hot, dry– Little or no perspiration– Altered mental status– Dilated pupils– Seizures

Environmental Emergencies

• Care for Heat Stroke– Activate EMS ASAP– Move patient to a cool environment– Remove clothing– Rapidly cool patient (without chilling)– Place patient in recovery position– Oxygen– Monitor vitals

Environmental Emergencies

Water Related Emergencies

• Near Drowning, Drowning

• Diving accidents– AGE– DCS

Environmental Emergencies• Near Drowning / Drowning

– estimated 80,000 submersion incidents yearly

– 9,000 deaths annually in US (140,000 WW)– 4th leading cause of accidental death for

all age groups– 2nd leading cause of accidental death in

children– 64% of all victims under 30 YOA

Environmental Emergencies

• Drowning – Risk Factors (Contributing Factors)

• Location• Swimming ability• Drugs /alcohol• Underlying disease / injury• Age• Gender• Race

Environmental Emergencies

• Near Drowning– At least temporary survival. Death more

than 24 hours later

• Drowning – Death within 24 hours

Environmental Emergencies

• Sequence of Events (Conscious Patient) – Dry Drowning

• Immersion, breath holding, panic, hypoxia, loss of consciousness, spasm of epiglottis & larynx, asphyxia

– Wet Drowning• Immersion, breath holding, panic, hypoxia, loss of

consciousness, relaxation of epiglottis & larynx, inhalation of water

Environmental Emergencies

• Sequence of Events (Unconscious patient)– Immersion, relaxation of epiglottis & larynx,

inhalation of water

Environmental Emergencies• Special Considerations

– All cold water submersions should be worked– Documented cases of successful resuscitation

after 1 hour of submersion in cold water – The lower the water temp the better the

chances of survival

• Spinal injury should be considered

• All near drowning patients must be evaluated in ER

Environmental Emergencies

• Scuba Diving Emergencies– Decompression Illness

• Dysbaric injuries related to scuba diving• Includes both

– Arterial Gas Embolism (AGE)– Decompression Sickness (DCS)

Environmental Emergencies

• Air Embolism- AGE– Gas bubbles (usually air) entering the

circulatory system through the alveoli

• Causes• Breath holding on ascent• Ascending to rapidly• Air trapping in alveoli (from asthma, chest

congestion, etc.)

• Time of onset - within 5 minutes

Environmental Emergencies• Decompression Sickness

• Bubbles of inert gas (nitrogen) forming in the tissues & bloodstream

• Causes• Rapid ascent from compressed gas

diving• Reduction in surrounding pressure such

as flying in an aircraft after diving

• Time of onset - 1 to 48 hours

Environmental Emergencies• Common Signs & Symptoms of DCI

– Pain– Numbness– Dizziness– Unusual fatigue– Headache– Weakness– Nausea– Difficulty walking

Environmental Emergencies

• Other Signs & Symptoms of DCI– Difficulty breathing– Visual disturbances– Decreased skin sensation– Restlessness– Itching / Rash– Paralysis– Muscular twitching– Unconsciousness

Environmental Emergencies

• Other Signs & Symptoms of DCI– Speech disturbances– Personality changes– Altered mental status– Convulsions– Hearing loss / ringing ears– Bladder / bowel problems– Coughing blood

Environmental Emergencies

• Care for DCI– Maintain airway– Oxygen (Demand Valve)– Rapid transport nearest ER– Followed by care ASAP at hyperbaric

chamber– Contact DAN (Diver Alert Network)

• Emergency 919-684-8111 or (919-684-4DAN)• Medical information line 919-684-2948