Environmental
-
Upload
ben-lesold -
Category
Documents
-
view
588 -
download
1
Transcript of Environmental
Environmental Environmental EmergenciesEmergencies
SectionsSections
Pathophysiology of Heat and Cold Disorders
Heat Disorders Cold Disorders Near-Drowning and Drowning Diving Emergencies High-Altitude Illness Nuclear Radiation
Pathophysiology of Heat and Cold Disorders
Heat Disorders Cold Disorders Near-Drowning and Drowning Diving Emergencies High-Altitude Illness Nuclear Radiation
Environmental Environmental EmergenciesEmergencies
Risk Factors Age Poor General Health Fatigue Predisposing Medical Conditions Medications
Homeostasis Tendency of the body to maintain a steady and normal
internal environment
Risk Factors Age Poor General Health Fatigue Predisposing Medical Conditions Medications
Homeostasis Tendency of the body to maintain a steady and normal
internal environment
Mechanisms of Heat Gain and Loss Thermal Gradient
Wind Relative Humidity
Thermogenesis Work-Induced Thermoregulatory Diet-Induced
Mechanisms of Heat Gain and Loss Thermal Gradient
Wind Relative Humidity
Thermogenesis Work-Induced Thermoregulatory Diet-Induced
Pathophysiology of Pathophysiology of Heat and Cold Heat and Cold
DisordersDisorders
Thermolysis Conduction Convection Radiation Evaporation Respiration
Thermolysis Conduction Convection Radiation Evaporation Respiration
Pathophysiology of Pathophysiology of Heat and Cold Heat and Cold
DisordersDisorders
Thermoregulation Body Temperature
Core temperature Peripheral temperature
The Hypothalmus Heat Dissipation
Sweating, vasodilation
Heat Conservation Shivering,
vasoconstriction
Thermoregulation Body Temperature
Core temperature Peripheral temperature
The Hypothalmus Heat Dissipation
Sweating, vasodilation
Heat Conservation Shivering,
vasoconstriction
Pathophysiology of Pathophysiology of Heat and Cold Heat and Cold
DisordersDisorders
Thermoreceptors Peripheral thermoreceptors Central thermoreceptors
Metabolic Rate Basic metabolic rate Exertional metabolic rate Core temperature measurement
Thermoreceptors Peripheral thermoreceptors Central thermoreceptors
Metabolic Rate Basic metabolic rate Exertional metabolic rate Core temperature measurement
Pathophysiology of Pathophysiology of Heat and Cold Heat and Cold
DisordersDisorders
Heat DisordersHeat Disorders Hyperthermia
Signs of Thermolysis Diaphoresis, increased skin temperature
Signs of Thermolytic Inadequacy Altered mentation or altered level of consciousness
Manifestations Heat cramps Heat exhaustion Heat stroke
Hyperthermia Signs of Thermolysis
Diaphoresis, increased skin temperature Signs of Thermolytic Inadequacy
Altered mentation or altered level of consciousness Manifestations
Heat cramps Heat exhaustion Heat stroke
Heat DisordersHeat Disorders Predisposing Factors
Age of the Patient Health of the Patient Medications
Diuretics, beta-blockers, psychotropics, and antihistamines
Level of Acclimatization Length and Intensity of Exposure Environmental Factors
Predisposing Factors Age of the Patient Health of the Patient Medications
Diuretics, beta-blockers, psychotropics, and antihistamines
Level of Acclimatization Length and Intensity of Exposure Environmental Factors
Heat DisordersHeat Disorders
Preventive Measures Maintain adequate fluid intake. Allow time for gradual acclimatization. Limit exposure to hot environments.
Preventive Measures Maintain adequate fluid intake. Allow time for gradual acclimatization. Limit exposure to hot environments.
Heat DisordersHeat Disorders
Heat CrampsHeat Cramps
Heat ExhaustionHeat Exhaustion
HeatstrokeHeatstroke
Close Relationship to Heat Disorders Dehydration prevents thermolysis.
Signs & Symptoms Nausea, vomiting, and abdominal distress Vision disturbances, decreased urine output Poor skin turgor and signs of hypovolemic shock
Treatment Oral fluids if the patient is alert and oriented IV fluids if the patient has an altered mental status or
is nauseated
Close Relationship to Heat Disorders Dehydration prevents thermolysis.
Signs & Symptoms Nausea, vomiting, and abdominal distress Vision disturbances, decreased urine output Poor skin turgor and signs of hypovolemic shock
Treatment Oral fluids if the patient is alert and oriented IV fluids if the patient has an altered mental status or
is nauseated
Role of Dehydration Role of Dehydration in Heat Disordersin Heat Disorders
Fever (Pyrexia)Fever (Pyrexia)
Pyrogens Differentiating Fever from
Heatstroke Cooling the Fever Patient
Consider antipyretic medication. Acetaminophen or ibuprofen
Avoid sponge baths.
Pyrogens Differentiating Fever from
Heatstroke Cooling the Fever Patient
Consider antipyretic medication. Acetaminophen or ibuprofen
Avoid sponge baths.
Cold DisordersCold Disorders Hypothermia Mechanisms of Heat Conservation
and Loss Predisposing Factors
Age of the Patient Health of the Patient Medications Prolonged or Intense Exposure Coexisting Weather Conditions
Hypothermia Mechanisms of Heat Conservation
and Loss Predisposing Factors
Age of the Patient Health of the Patient Medications Prolonged or Intense Exposure Coexisting Weather Conditions
Cold DisordersCold Disorders Preventative Measures
Dress warmly and ensure plenty of rest. Eat appropriately or at regular intervals. Limit exposure to cold environments.
Degrees of Hypothermia Mild Severe Compensated Hypothermia Acute, Subacute, and Chronic Exposure
Preventative Measures Dress warmly and ensure plenty of rest. Eat appropriately or at regular intervals. Limit exposure to cold environments.
Degrees of Hypothermia Mild Severe Compensated Hypothermia Acute, Subacute, and Chronic Exposure
Cold Cold DisordersDisorders
HypothermiaHypothermia
Signs & Symptoms Mild Severe
Signs & Symptoms Mild Severe
HypothermiaHypothermia ECG
Pathognomonic J waves (Osborn waves). Eventual onset of bradycardia. Ventricular fibrillation probable below 86º F.
ECG Pathognomonic J waves (Osborn waves). Eventual onset of bradycardia. Ventricular fibrillation probable below 86º F.
HypothermHypothermiaia
HypothermiaHypothermia
Treatment Active Rewarming
Active external rewarming Active internal rewarming
Rewarming Shock Cold Diuresis
Treatment Active Rewarming
Active external rewarming Active internal rewarming
Rewarming Shock Cold Diuresis
HypothermiaHypothermia Resuscitation
BCLS Perform pulse and respiration checks for longer periods. Administer up to 3 shocks with the AED. Follow with CPR, rewarming, and rapid transport.
ACLS Intubate and administer up to 3 shocks and initial
medications. Establish IV access, begin rewarming, and transport
rapidly.
Avoid further resuscitation until the core temperature is above 86º F.
Resuscitation BCLS
Perform pulse and respiration checks for longer periods. Administer up to 3 shocks with the AED. Follow with CPR, rewarming, and rapid transport.
ACLS Intubate and administer up to 3 shocks and initial
medications. Establish IV access, begin rewarming, and transport
rapidly.
Avoid further resuscitation until the core temperature is above 86º F.
FrostbiteFrostbite Superficial
Frostbite Freezing of
epidermal tissue Redness followed
by blanching and diminshed sensation
Deep Frostbite Freezing of
epidermal and subcutaneous layers
White, frozen appearance
Superficial Frostbite Freezing of
epidermal tissue Redness followed
by blanching and diminshed sensation
Deep Frostbite Freezing of
epidermal and subcutaneous layers
White, frozen appearance
FrostbiteFrostbite Treatment
Do not thaw the affected area if there is the possibility of refreezing.
Do not massage the affected area. Administer analgesia prior to thawing. Transport; rewarm by immersion only if transport is
lengthy or delayed. Cover the thawed part with a loose, sterile dressing. Elevate and immobilize the thawed part.
Do not puncture or drain blisters. Do not rewarm feet if walking will be required.
Treatment Do not thaw the affected area if there is the possibility
of refreezing. Do not massage the affected area. Administer analgesia prior to thawing. Transport; rewarm by immersion only if transport is
lengthy or delayed. Cover the thawed part with a loose, sterile dressing. Elevate and immobilize the thawed part.
Do not puncture or drain blisters. Do not rewarm feet if walking will be required.
Trench FootTrench Foot Trench Foot
Occurs above freezing. Typically occurs from standing in cold water.
Symptoms are similar to frostbite. Pain may be present, and blisters may form with
spontaneous rewarming. Treatment:
Warm, dry, and aerate the feet. Prevention is the best treatment.
Trench Foot Occurs above freezing.
Typically occurs from standing in cold water. Symptoms are similar to frostbite.
Pain may be present, and blisters may form with spontaneous rewarming.
Treatment: Warm, dry, and aerate the feet. Prevention is the best treatment.
Near-Drowning vs. Drowning Pathophysiology of Drowning and
Near-Drowning Dry vs. Wet Drowning Fresh-Water vs. Saltwater Drowning
Fresh water causes the alveoli to collapse from a lack of surfactant.
Salt water causes pulmonary edema and eventual hypoxemia due to its hypertonic nature.
Near-Drowning vs. Drowning Pathophysiology of Drowning and
Near-Drowning Dry vs. Wet Drowning Fresh-Water vs. Saltwater Drowning
Fresh water causes the alveoli to collapse from a lack of surfactant.
Salt water causes pulmonary edema and eventual hypoxemia due to its hypertonic nature.
Near-Drowning Near-Drowning and Drowningand Drowning
Near-Drowning Near-Drowning and Drowningand Drowning
Factors Affecting Survival Cleanliness of Water Length of Time Submerged Victim’s Age and General Health Water Temperature
Cold-water drowning. Mammalian diving reflex. The cold-water drowning patient is not dead until
he is warm and dead.
Factors Affecting Survival Cleanliness of Water Length of Time Submerged Victim’s Age and General Health Water Temperature
Cold-water drowning. Mammalian diving reflex. The cold-water drowning patient is not dead until
he is warm and dead.
Near-Drowning Near-Drowning and Drowningand Drowning
Treatment for Near-Drowning Remove the patient from the water.
Attempt rescue only if properly trained and equipped. Initiate ventilation while the patient is still in the water. Suspect head and neck injury if the patient
experienced a fall or was diving. Place the victim on a long spine board and use c-spine precautions throughout care.
Protect the patient from heat loss. Evaluate ABCs. Begin CPR and defibrillation if
indicated.
Treatment for Near-Drowning Remove the patient from the water.
Attempt rescue only if properly trained and equipped. Initiate ventilation while the patient is still in the water. Suspect head and neck injury if the patient
experienced a fall or was diving. Place the victim on a long spine board and use c-spine precautions throughout care.
Protect the patient from heat loss. Evaluate ABCs. Begin CPR and defibrillation if
indicated.
Near-Drowning Near-Drowning and Drowningand Drowning
Manage the airway using proper suctioning and airway adjuncts.
Administer oxygen at 100% concentration. Use respiratory rewarming, if available. Establish IV of lactated Ringer’s or normal saline at
75 mL/hr. Follow ACLS protocols if the patient is normothermic.
Treat hypothermic patients according to hypothermia guidelines.
Adult Respiratory Distress Syndrome
Manage the airway using proper suctioning and airway adjuncts.
Administer oxygen at 100% concentration. Use respiratory rewarming, if available. Establish IV of lactated Ringer’s or normal saline at
75 mL/hr. Follow ACLS protocols if the patient is normothermic.
Treat hypothermic patients according to hypothermia guidelines.
Adult Respiratory Distress Syndrome
Near-Drowning Near-Drowning and Drowningand Drowning
Diving Diving EmergenciesEmergencies Scuba
The Effects of Air Pressure on Gases Boyle’s Law
The volume of a gas is inversely proportional to its pressure if the temperature is kept constant.
Dalton’s Law The total pressure of a mixture of gases is equal to the
sum of the partial pressures of the individual gases. Henry’s Law
The amount of gas dissolved in a given volume of liquid is proportional to the pressure of the gas above it.
Scuba The Effects of Air Pressure on Gases
Boyle’s Law The volume of a gas is inversely proportional to its
pressure if the temperature is kept constant. Dalton’s Law
The total pressure of a mixture of gases is equal to the sum of the partial pressures of the individual gases.
Henry’s Law The amount of gas dissolved in a given volume of liquid
is proportional to the pressure of the gas above it.
Diving Diving EmergenciesEmergencies Pathophysiology of Diving
Emergencies Increased dissolution of gases during descent due to
Henry’s law. Boyle’s law dictates that these gases have a smaller
volume. In a controlled ascent, the process is reversed and the
gases escape through respiration. A rapid ascent causes gases to come out of solution
quickly, forming gas bubbles in the blood, brain, spinal cord, skin, inner ear, muscles, and joints.
Pathophysiology of Diving Emergencies Increased dissolution of gases during descent due to
Henry’s law. Boyle’s law dictates that these gases have a smaller
volume. In a controlled ascent, the process is reversed and the
gases escape through respiration. A rapid ascent causes gases to come out of solution
quickly, forming gas bubbles in the blood, brain, spinal cord, skin, inner ear, muscles, and joints.
Diving Diving EmergenciesEmergencies Classification of Diving Emergencies
Injuries on the Surface Injuries During Descent
Barotrauma
Injuries on the Bottom Nitrogen narcosis
Injuries During Ascent Decompression illness Pulmonary overpressure and subsequent arterial gas
embolism, pneumomediastinum, or pneumothorax
Classification of Diving Emergencies Injuries on the Surface Injuries During Descent
Barotrauma
Injuries on the Bottom Nitrogen narcosis
Injuries During Ascent Decompression illness Pulmonary overpressure and subsequent arterial gas
embolism, pneumomediastinum, or pneumothorax
Diving Diving EmergenciesEmergencies General Assessment of Diving
Emergencies Time at Which Signs and Symptoms
Appeared Type of Breathing Apparatus Used Type of Hypothermia-Protective Garment
Worn Parameters of the Dive
Number of dives, depth, and duration
Aircraft Travel following a Dive
General Assessment of Diving Emergencies Time at Which Signs and Symptoms
Appeared Type of Breathing Apparatus Used Type of Hypothermia-Protective Garment
Worn Parameters of the Dive
Number of dives, depth, and duration
Aircraft Travel following a Dive
Diving Diving EmergenciesEmergencies Factors to Assess
Rate of Ascent Associated with panic forcing a rapid ascent
Inexperience of the Diver Improper Functioning of Depth Gauge Previous Medical Diseases Old Injuries Previous Episodes of Decompression Illness Use of Alcohol or Medications
Factors to Assess Rate of Ascent
Associated with panic forcing a rapid ascent
Inexperience of the Diver Improper Functioning of Depth Gauge Previous Medical Diseases Old Injuries Previous Episodes of Decompression Illness Use of Alcohol or Medications
Pressure DisordersPressure Disorders Decompression Illness
May occur with dives of 33’ or more.
Signs & Symptoms Occur within
36 hours. Joint/abdominal
pain. Fatigue,
paresthesias, and CNS disturbances.
Treatment Recompression.
Decompression Illness May occur with dives of 33’ or
more. Signs & Symptoms
Occur within 36 hours.
Joint/abdominal pain.
Fatigue, paresthesias, and CNS disturbances.
Treatment Recompression.
Pressure DisordersPressure Disorders Treatment
Assess ABCs and begin CPR if required. Administer high-flow oxygen and intubate if indicated. Maintain supine position. Protect the patient from heat, cold, wetness, or noxious
fumes. Transport and establish IV access. Consult with medical direction regarding administration
of dexamethasone, heparin, or diazepam if CNS is involved.
If aeromedical evacuation is used, maintain cabin pressure at sea level or fly at the lowest possible altitude.
Send diving equipment with the patient for analysis if possible.
Treatment Assess ABCs and begin CPR if required. Administer high-flow oxygen and intubate if indicated. Maintain supine position. Protect the patient from heat, cold, wetness, or noxious
fumes. Transport and establish IV access. Consult with medical direction regarding administration
of dexamethasone, heparin, or diazepam if CNS is involved.
If aeromedical evacuation is used, maintain cabin pressure at sea level or fly at the lowest possible altitude.
Send diving equipment with the patient for analysis if possible.
Pressure DisordersPressure Disorders
Pulmonary Overpressure Accidents Can occur in depths as shallow as 6’. Signs & Symptoms
Substernal chest pain with associated respiratory distress and diminished breath sounds
Treatment Treat as a pneumothorax. Provide rest and supplemental oxygen.
Pulmonary Overpressure Accidents Can occur in depths as shallow as 6’. Signs & Symptoms
Substernal chest pain with associated respiratory distress and diminished breath sounds
Treatment Treat as a pneumothorax. Provide rest and supplemental oxygen.
Pressure DisordersPressure Disorders Arterial Gas Embolism
Signs & Symptoms Onset is within 2–10 minutes of ascent . There is dramatic onset of sharp, tearing pain. Common presentation mimics a stroke; suspect AGE in
any patient with neurological deficits immediately after ascent.
Treatment Assess ABCs, provide high-flow oxygen. Maintain a supine position; monitor vital signs
frequently. Establish IV access and consider administering
corticosteroids. Rapidly transport to a recompression chamber.
Arterial Gas Embolism Signs & Symptoms
Onset is within 2–10 minutes of ascent . There is dramatic onset of sharp, tearing pain. Common presentation mimics a stroke; suspect AGE in
any patient with neurological deficits immediately after ascent.
Treatment Assess ABCs, provide high-flow oxygen. Maintain a supine position; monitor vital signs
frequently. Establish IV access and consider administering
corticosteroids. Rapidly transport to a recompression chamber.
Pressure DisordersPressure Disorders
Pneumomediastinum Signs & Symptoms
Substernal chest pain, irregular pulse, abnormal heart sounds, hypotension with a narrow pulse pressure, and a change in voice
Treatment Provide high-flow oxygen. Establish IV access. Transport for further evaluation.
Pneumomediastinum Signs & Symptoms
Substernal chest pain, irregular pulse, abnormal heart sounds, hypotension with a narrow pulse pressure, and a change in voice
Treatment Provide high-flow oxygen. Establish IV access. Transport for further evaluation.
Pressure DisordersPressure Disorders Nitrogen Narcosis
Occurs during a dive. Can contribute to accidents during the dive.
Signs & Symptoms Altered levels of consciousness and impaired
judgment. Treatment
Return to shallow depth. Use oxygen/helium mix during dive.
Nitrogen Narcosis Occurs during a dive.
Can contribute to accidents during the dive. Signs & Symptoms
Altered levels of consciousness and impaired judgment.
Treatment Return to shallow depth. Use oxygen/helium mix during dive.
Diving Diving EmergenciesEmergencies Other Diving-Related
Emergencies Oxygen Toxicity Hypercapnia
Diver’s Alert Network Consultation and Referrals
(919) 684-8111
Other Diving-Related Emergencies Oxygen Toxicity Hypercapnia
Diver’s Alert Network Consultation and Referrals
(919) 684-8111
High-Altitude High-Altitude IllnessIllness Manifestation
Altitudes above 8,000’
Prevention Ascend gradually. Limit exertion. Descend for sleep. Eat a high-carbohydrate diet. Medications
Acetazolamide and nifedipine
Manifestation Altitudes above 8,000’
Prevention Ascend gradually. Limit exertion. Descend for sleep. Eat a high-carbohydrate diet. Medications
Acetazolamide and nifedipine
High-Altitude High-Altitude IllnessIllness Types of High-Altitude Illness
Acute Mountain Sickness Mild cases include lightheadedness,
breathlessness, weakness, headache, nausea, and vomiting.
Severe cases include weakness, severe vomiting, decreased urine output, shortness of breath, and an altered level of consciousness.
Treatment includes halting of ascent or descent, use of acetazolamide and antinausea drugs and supplemental oxygen.
Types of High-Altitude Illness Acute Mountain Sickness
Mild cases include lightheadedness, breathlessness, weakness, headache, nausea, and vomiting.
Severe cases include weakness, severe vomiting, decreased urine output, shortness of breath, and an altered level of consciousness.
Treatment includes halting of ascent or descent, use of acetazolamide and antinausea drugs and supplemental oxygen.
High-Altitude High-Altitude IllnessIllness High-Altitude Pulmonary Edema
Mild symptoms include dry cough, shortness of breath, and slight crackles in the lungs.
Severe cases develop cyanosis, dyspnea, frothy sputum, weakness, and possibly coma or death.
Treatment includes descent and supplemental oxygen, or portable hyperbaric bag; medications such as acetazolamide, nifedipine, and lasix may be useful also.
High-Altitude Pulmonary Edema Mild symptoms include dry cough, shortness of
breath, and slight crackles in the lungs. Severe cases develop cyanosis, dyspnea, frothy
sputum, weakness, and possibly coma or death. Treatment includes descent and supplemental
oxygen, or portable hyperbaric bag; medications such as acetazolamide, nifedipine, and lasix may be useful also.
High-Altitude High-Altitude IllnessIllness High-Altitude Cerebral Edema
Usually occurs as progression of AMS or HAPE. Symptoms include altered mental status, ataxia,
decreased level of consciousness, and coma. Treatment includes descent and supplemental
oxygen, or portable hyperbaric bag.
High-Altitude Cerebral Edema Usually occurs as progression of AMS or HAPE. Symptoms include altered mental status, ataxia,
decreased level of consciousness, and coma. Treatment includes descent and supplemental
oxygen, or portable hyperbaric bag.
Nuclear RadiationNuclear Radiation
Personal Safety Only appropriately trained and equipped
personnel should handle radiation emergencies.
Basic Nuclear Physics Atoms
Protons, neutrons, and electrons
Isotopes and Half-Life Ionizing radiation
Personal Safety Only appropriately trained and equipped
personnel should handle radiation emergencies.
Basic Nuclear Physics Atoms
Protons, neutrons, and electrons
Isotopes and Half-Life Ionizing radiation
Nuclear RadiationNuclear Radiation Ionizing Radiation
Alpha particles Beta particles Gamma rays Neutrons
Effects of Radiation on the Body Detection of Radiation
RAD and REM Acute and Long-Term Effects
Ionizing Radiation Alpha particles Beta particles Gamma rays Neutrons
Effects of Radiation on the Body Detection of Radiation
RAD and REM Acute and Long-Term Effects
Nuclear RadiationNuclear Radiation
Nuclear RadiationNuclear Radiation Principles of
Safety Time Distance Shielding Clean Accidents
Patient is exposed but not contaminated.
Dirty Accidents Patient is
contaminated by radioactive particles, liquids, gases ,or smoke.
Principles of Safety Time Distance Shielding Clean Accidents
Patient is exposed but not contaminated.
Dirty Accidents Patient is
contaminated by radioactive particles, liquids, gases ,or smoke.
Nuclear RadiationNuclear Radiation Management
Park upwind. Look for signs of
radioactive exposure.
Use portable instruments to detect radioactivity.
Normal emergency care principles should be applied.
Externally radiated and internally contaminated patients pose little danger.
Externally contaminated patients require decontamination.
Management Park upwind. Look for signs of
radioactive exposure.
Use portable instruments to detect radioactivity.
Normal emergency care principles should be applied.
Externally radiated and internally contaminated patients pose little danger.
Externally contaminated patients require decontamination.
Environmental Environmental EmergenciesEmergencies
Pathophysiology of Heat and Cold Disorders
Heat Disorders Cold Disorders Near-Drowning and Drowning Diving Emergencies High-Altitude Illness Nuclear Radiation
Pathophysiology of Heat and Cold Disorders
Heat Disorders Cold Disorders Near-Drowning and Drowning Diving Emergencies High-Altitude Illness Nuclear Radiation