Copyright 2008 Seattle/King County EMS CBT/OTEP 385 Environmental Emergencies.
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Transcript of Copyright 2008 Seattle/King County EMS CBT/OTEP 385 Environmental Emergencies.
Copyright 2008 Seattle/King County EMS
Introduction
This course will refresh your This course will refresh your knowledge of heat illness, cold knowledge of heat illness, cold
injuries, diving emergencies, stings injuries, diving emergencies, stings and bites, and gas poisoning.and bites, and gas poisoning.
This course will refresh your This course will refresh your knowledge of heat illness, cold knowledge of heat illness, cold
injuries, diving emergencies, stings injuries, diving emergencies, stings and bites, and gas poisoning.and bites, and gas poisoning.
Heat and cold illnesses are triggered when the body is unable to maintain a constant temperature
Copyright 2008 Seattle/King County EMS
New Termsconduction – Transfer process by which heat moves between two touching objects from the warmer object to the colder object.
convection – Transfer of heat due to movement of a gas or liquid in response to a temperature or pressure differential.
radiation – Occurs when a warm body releases energy without direct contact with another body.
Copyright 2008 Seattle/King County EMS
Heat Production
• Metabolism • Shivering • Exercise • External heat sources
Copyright 2008 Seattle/King County EMS
Factors That Affect Heat Production • Core temperature • Medical conditions • Body fluid status (dehydration) • Drugs and chemicals
Copyright 2008 Seattle/King County EMS
Heat Loss Mechanisms
• Conduction • Convection • Radiation • Evaporation
Copyright 2008 Seattle/King County EMS
Conduction
Process by which heat moves between two touching objects
Image credit: Copyright 2005 Seattle/King County EMS
Copyright 2008 Seattle/King County EMS
Convection
Transfer of heat between body and air or water that surrounds it
Image credit: Copyright 2005 Seattle/King County EMS
Copyright 2008 Seattle/King County EMS
Radiation
• When warm body releases energy without direct contact
Image credit: Copyright 2005 Seattle/King County EMS
Copyright 2008 Seattle/King County EMS
Evaporation
• Conversion of liquid to a gas
Image credit: Copyright 2005 Seattle/King County EMS
Copyright 2008 Seattle/King County EMS
Heat Illness
Heat cramps, heat exhaustion, and heatstroke are progressive phases of heat illness
Copyright 2008 Seattle/King County EMS
Heat Cramps
• Result from an uneven distribution of body fluids and salts
• Muscle cramps can be mild to severe, involving extremities or the abdomen
• Dizziness, weakness, and nausea
Copyright 2008 Seattle/King County EMS
Heatstroke
• Occurs when body's heat-regulating ability fails
• Life-threatening• Early stages can look similar to heat
exhaustion
Copyright 2008 Seattle/King County EMS
Heatstroke – Clinical Findings • Altered LOC • Rapid, bounding pulse • Rapid, deep respirations • Hot, dry, flushed skin* • Dilated pupils • Seizures
*Can be damp if rapid onset
Copyright 2008 Seattle/King County EMS
Heat Illness – Treatment• Provide a cool environment• Apply cold packs• Remove or loosen clothing• Request medics (ALS indicators present)• Provide oxygen and/or ventilatory assistance• Position patient appropriately• Monitor vital signs
Copyright 2008 Seattle/King County EMS
Hypothermia
• Caused by loss of body heat or decrease heat production
• Altered LOC distinguishes mild from severe hypothermia
• Early recognition increases chances of survival
Copyright 2008 Seattle/King County EMS
Hypothermia – Treatment
• Remove patient from cold environment
• Protect from heat loss• Provide high flow oxygen
Copyright 2008 Seattle/King County EMS
Frostbite• Superficial Injury
• Blanching of skin • Loss of feeling and sensation in injured
area• Tingling sensation if re-warmed
Copyright 2008 Seattle/King County EMS
Frostbite• Deep Injury
• White, waxy skin• Swelling and/or blisters • Skin can appear flushed with areas of
purple and blanching or mottled and cyanotic
Copyright 2008 Seattle/King County EMS
Frostbite – Treatment• Protect affected area from further
injury• Remove constricting or wet clothing
and jewelry • Cover with dry bulky dressing• Splint affected extremity, prevent use
Copyright 2008 Seattle/King County EMS
Drowning and Near Drowning
• Water can stimulate spasms in larynx and bronchi
• Victim can aspirate water into lungs
Photo credit: Dena Steiner
Copyright 2008 Seattle/King County EMS
Drowning and Near Drowning
Determine: • Length of submersion• Temperature of water• Depth of water
Copyright 2008 Seattle/King County EMS
Drowning/Near Drowning – Tx • Safely remove victim from water• Stabilize c-spine and backboard• Follow protocols for cardiac or pulmonary arrest• Administer oxygen and/or ventilatory assistance• Supine position to avoid cerebral edema• Prepare suction and expect vomiting • Warm up aid unit• Monitor vital signs
Copyright 2008 Seattle/King County EMS
Air Embolism
• Gas bubbles in bloodstream that obstruct circulation
Photo credit: Katrin Iken, NOAA Office of Ocean Exploration
Copyright 2008 Seattle/King County EMS
Air Embolism – Clinical Findings• Dyspnea• Unconsciousness• Paralysis• Mottling of the skin• Severe pain in muscles, joints or abdomen• Irregular pulse• Red, frothy sputum
Copyright 2008 Seattle/King County EMS
Decompression Illness
• Nitrogen in the blood forms bubbles due to a rapid ascent
• Bubbles collect in the tissues and interfere with blood flow
Copyright 2008 Seattle/King County EMS
Decompression Illness – History Significant history:• Number of dives in past 24 hours• Depth of dive• Length of time underwater• Problems encountered while diving• Significant medical history (meds)
Copyright 2008 Seattle/King County EMS
Stings and Bites • Severity of reaction depends on type of animal and
age, size, and health of victim
Significant history:• Type of animal or insect• Behavior of animal• Time of day bite occurred• Location of animal
Copyright 2008 Seattle/King County EMS
Allergic Reaction
Two primary components of anaphylaxis:
• Severe respiratory distress• Hypotension
Copyright 2008 Seattle/King County EMS
Stings/Bites – Treatment • Request paramedics if indicated• Scrape sting site to remove stinger • Wash area• Remove jewelry from affected limb before
swelling begins, if possible• Bandage and immobilize site of injury• Treat for shock• Administer epinephrine via EpiPen if indicated
Copyright 2008 Seattle/King County EMS
Anaphylaxis – Treatment
• Request paramedics• Provide oxygen and/or ventilatory
assistance• Position patient appropriately• Administer epinephrine via EpiPen• Monitor vital signs
Copyright 2008 Seattle/King County EMS
Gas Poisoning
• Carbon monoxide • Exposure to cleaning products,
industrial chemicals and gases
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CO Poisoning – Clinical Findings • Headache• Tachypnea• Nausea and vomiting• Altered LOC• Pink, flushed mucus membranes• Coma
Copyright 2008 Seattle/King County EMS
Inhaled Poisoning – Treatment • Scene safety• Remove from toxic environment• ABCs• Monitor airway, provide high flow oxygen• Request paramedics, if necessary• Contact poison control, if needed
Copyright 2008 Seattle/King County EMS
Summary
• 4 mechanisms that cause heat loss: conduction, convection, radiation, and evaporation
• Heat cramps, heat exhaustion, and heatstroke are managed by reducing core temperature
• Key to distinguishing mild and severe hypothermia is altered LOC
Copyright 2008 Seattle/King County EMS
Summary, continued
Care for hypothermia:• Remove from cold environment• Protect from heat loss• Provide high flow oxygen
Copyright 2008 Seattle/King County EMS
Summary, continued
Management of drowning/near drowning: • Safely remove victim from water• Stabilize c-spine and backboard• Protocols for cardiac/pulmonary arrest• Administer O2 and/or ventilatory assistance• Supine position• Prepare suction • Warm aid unit• Monitor vital signs