EnvironmentEnvironmental al EmergenciesEmergencies

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Thermoregulatory Thermoregulatory EmergenciesEmergenciesThermoregulatory Thermoregulatory EmergenciesEmergencies

Thermoregulatory emergency:Thermoregulatory emergency:

An increase or decrease in the An increase or decrease in the temperature of the body or temperature of the body or body part that results in an body part that results in an injury.injury.

Temperature Temperature Regulation Regulation in the Bodyin the Body

Temperature Temperature Regulation Regulation in the Bodyin the Body

The body performs a

delicate balancing act

between the heat

generated in the body

and the heat lost from it.

Types of Types of

Heat LossHeat LossConvection

Evaporation

Respiration

Conduction

Radiation

Heat loss occurs

during respiration -

when the body warms

and humidifies the air.

Maintenance of Body TempMaintenance of Body Temp Falling body temperatureFalling body temperature

Peripheral blood vessels constrictPeripheral blood vessels constrict Muscles produce heat through shiveringMuscles produce heat through shivering

Rising body temperatureRising body temperature Blood vessels dilateBlood vessels dilate Sweat glands produce moistureSweat glands produce moisture

The body The body

also also

produces produces

heat by heat by

shivering.shivering.

Ambient temperature Ambient temperature

affects how the body affects how the body

maintains its temperature.maintains its temperature.

This results from the combined effects of wind and humidity.

Exposure to Exposure to the Coldthe Cold

Exposure to Exposure to the Coldthe Cold

Extreme weather conditions can Extreme weather conditions can produce a variety of cold produce a variety of cold emergencies.emergencies.

Hypothermia:Hypothermia:

A condition in which the core body A condition in which the core body

temperature falls below 35temperature falls below 35oo C C (95(95oo F) F) and the body’s normal functions are and the body’s normal functions are impaired.impaired.

Caused by prolonged exposure to cold.

The most common cause of

generalized hypothermia is

exposure to a cold

environment.

Factors that Contribute to HypothermiaFactors that Contribute to Hypothermia

Cold environmentsCold environments

Immersion or submersion in waterImmersion or submersion in water

Age Age (the very young and the elderly)(the very young and the elderly)

AlcoholAlcohol

Shock (hypoperfusion)Shock (hypoperfusion)

Some medications and poisonsSome medications and poisons

Factors that Contribute to Hypothermia continued

Factors that Contribute to Hypothermia continued

Medical conditionsMedical conditions Diabetes and hypoglycemiaDiabetes and hypoglycemia Metabolic and infectious processesMetabolic and infectious processes

TraumaTrauma Hypovolemia or shockHypovolemia or shock Head injuriesHead injuries Spinal cord injuriesSpinal cord injuries BurnsBurns

Alcohol use is a complicating factor in many hypothermic patients.

Mental & Motor Function Changes caused by Hypothermia

Mental & Motor Function Changes caused by Hypothermia

Dizziness and poor coordinationDizziness and poor coordination

Altered mental statusAltered mental status Memory disturbancesMemory disturbances

Poor judgementPoor judgement

Mood changesMood changes

Communication and speech difficultiesCommunication and speech difficulties

Mental & Motor Function Changes caused by Hypothermia continued

Mental & Motor Function Changes caused by Hypothermia continued

Stiffness/rigid postureStiffness/rigid posture

Reduced or absent sense of touchReduced or absent sense of touch

Changes in vital signsChanges in vital signs

Joint or muscle painJoint or muscle pain

Vital Signs in HypothermiaVital Signs in Hypothermia

SIGN EARLY LATE

Pulse Rapid Slow & barelypalpable

BloodPressure

Normal Low or absent

Breathing Rapid Shallow, slowor absent

Skin Red Pale, cyanoticStiff & hard

Pupils Reactive Sluggish

Focused Assessment Focused Assessment What was the source of the cold?What was the source of the cold?

If water, what was the temperature?If water, what was the temperature?

What were the general environmental conditions like?What were the general environmental conditions like?

Did the patient experience a loss of consciousness?Did the patient experience a loss of consciousness?

Are the effects Are the effects generalgeneral or or local?local?

Hypothermia Treatment Hypothermia Treatment

Remove the patient from the cold environment and protect from heat lossRemove the patient from the cold environment and protect from heat loss

Remove any cold or wet clothing, and Remove any cold or wet clothing, and cover the patient with blanketscover the patient with blankets

Handle the patient with care, and avoid rough handlingHandle the patient with care, and avoid rough handling

Warm the patient compartment of the ambulance as much as possibleWarm the patient compartment of the ambulance as much as possible

Apply high-flow oxygen; warmed and humidified if possibleApply high-flow oxygen; warmed and humidified if possible

Use no stimulants such as caffeine or alcoholUse no stimulants such as caffeine or alcohol

Do not massage the extremitiesDo not massage the extremities

Check for a pulse for 30 - 45 seconds before starting CPRCheck for a pulse for 30 - 45 seconds before starting CPR

Hypothermia Treatment continued Hypothermia Treatment continued

Do not attempt to Do not attempt to activelyactively

warm hypothermic patients warm hypothermic patients

who have a decreased level of who have a decreased level of

consciousness... consciousness...

...simply ...simply preventprevent further further heat loss.heat loss.

Care for Hypothermia with No Signs of LifeCare for Hypothermia with No Signs of Life

Ensure a patent airwayEnsure a patent airway

Ventilate the patient with 100% oxygenVentilate the patient with 100% oxygen

Begin CPR if no pulse for 30 - 45 secondsBegin CPR if no pulse for 30 - 45 seconds

Use the AED according to local established protocols, or call medical directionUse the AED according to local established protocols, or call medical direction

Local cold injuries result from Local cold injuries result from

decreased blood flow to, or decreased blood flow to, or

freezing of, a body part.freezing of, a body part.

These injuries are often

called frostbite or frostnip.

Local cold injury after Local cold injury after thawing.thawing.

FrostbitFrostbiteeFrostbitFrostbitee

Early or Superficial Cold Injury Early or Superficial Cold Injury

Pale skin with delayed capillary refillPale skin with delayed capillary refill

Loss of feeling/sensation in Loss of feeling/sensation in injured areainjured area

Skin still softSkin still soft

Tingling sensation when rewarmedTingling sensation when rewarmed

Late or Deep Cold Injury Late or Deep Cold Injury White or waxy skin appearanceWhite or waxy skin appearance

Firm or frozen skin presentationFirm or frozen skin presentation

Swelling and blister formationSwelling and blister formation

Loss of sensation in injured areaLoss of sensation in injured area

If thawed, skin may be purple and paleIf thawed, skin may be purple and pale

Care for Local Cold Injuries Care for Local Cold Injuries Remove patient from cold environmentRemove patient from cold environment

Protect the cold extremity from injuryProtect the cold extremity from injury

Administer oxygenAdminister oxygen

Remove wet or restrictive clothing and all jewelryRemove wet or restrictive clothing and all jewelry

Splint if extremity involved, and cover with dry, sterile dressingSplint if extremity involved, and cover with dry, sterile dressing

Place Place

dressings dressings

between those between those

fingers fingers

affected by affected by

local cold local cold

injury.injury.

NeverNeverre-expose the area to cold,re-expose the area to cold,

break blisters, rub or break blisters, rub or

massage the area, apply massage the area, apply

heat, or allow the patient to heat, or allow the patient to

use the affected area. use the affected area.

In a cold emergency, if transport time will be long:In a cold emergency, if transport time will be long:

Immerse the affected part in warm water Immerse the affected part in warm water (102(102oo - 104- 104oo F) F)

Continuosly stir and add warm water to Continuosly stir and add warm water to maintain temperaturemaintain temperature

Continue immersion until the area is soft andContinue immersion until the area is soft andcolor and sensation returncolor and sensation return

Pat gently and dress with dry, sterile dressingsPat gently and dress with dry, sterile dressings

Protect the injured area from refreezingProtect the injured area from refreezing

Refer to local protocols for other treatmentRefer to local protocols for other treatment

Exposure to HeatExposure to HeatExposure to HeatExposure to Heat

Hyperthermia:Hyperthermia:

A condition in which the core A condition in which the core body temperature exceeds body temperature exceeds normal limits and starts to normal limits and starts to malfunction.malfunction.

Caused by exposure to heat.

Predisposing Factors for Heat EmergenciesPredisposing Factors for Heat Emergencies

Hot, humid weatherHot, humid weather

Vigorous physical activityVigorous physical activity

Age Age (the very young and the elderly)(the very young and the elderly)

Medical conditionsMedical conditions DiabetesDiabetes Heart diseaseHeart disease FeverFever

Predisposing Factors for Heat Emergencies continued

Predisposing Factors for Heat Emergencies continued

DehydrationDehydration

ObesityObesity

FatigueFatigue

Drugs and medicationsDrugs and medications

Previous history of hyperthermiaPrevious history of hyperthermia

Working in a hot Working in a hot environment can result environment can result in a heat emergency.in a heat emergency.

Signs and Symptoms of Hyperthermia Signs and Symptoms of Hyperthermia

Muscle crampsMuscle cramps

Weakness or exhaustionWeakness or exhaustion

Dizziness or faintingDizziness or fainting

Rapid, bounding pulseRapid, bounding pulse

Altered mental statusAltered mental status

Moist, pale, cool, hot or normal skinMoist, pale, cool, hot or normal skin

Nause, vomiting and abdominal crampsNause, vomiting and abdominal cramps

Care for Hyperthermia with Moist, Pale, Cool or Normal Skin (Heat Exhaustion)

Care for Hyperthermia with Moist, Pale, Cool or Normal Skin (Heat Exhaustion)

Remove patient from hot environmentRemove patient from hot environment

Administer oxygenAdminister oxygen

Loosen or remove clothingLoosen or remove clothing

Cool the patient by fanningCool the patient by fanning

Place responsive patient supine with legs elevated; if vomiting, place on sidePlace responsive patient supine with legs elevated; if vomiting, place on side

If no nausea, provide cool water to drinkIf no nausea, provide cool water to drink

Remove patients from the hot environment and allow them to cool off.

Care for Hyperthermia with Hot, Dry Skin (Heat Stroke)

Care for Hyperthermia with Hot, Dry Skin (Heat Stroke)

Remove patient from hot environmentRemove patient from hot environment

Remove clothing and administer oxygenRemove clothing and administer oxygen

Apply cold to neck, groin and armpitsApply cold to neck, groin and armpits

Moisten patient’s skin with wet towelsMoisten patient’s skin with wet towels

Fan the patient aggressivelyFan the patient aggressively

Transport patient immediatelyTransport patient immediately

Severe hyperthermia can Severe hyperthermia can lead to cardiac arrest.lead to cardiac arrest.

Drowning and Near Drowning and Near DrowningDrowningDrowning and Near Drowning and Near DrowningDrowning

Water-related Emergencies:Water-related Emergencies:

DrowningDrowning is death following is death following submersion in water.submersion in water.

Near-DrowningNear-Drowning is survival is survival (either short or long term) (either short or long term) following submersion in water.following submersion in water.

Water rescue requires

specialized training - NEVER

ENDANGER yourself or

others by attempting

something you are not

trained to do.

Water Rescue with Spinal Water Rescue with Spinal ImmobilizationImmobilization

Care of the Near Drowning Patient Care of the Near Drowning Patient

Immobilize spine if trauma is suspectedImmobilize spine if trauma is suspected

Ensure adequate airway, provide oxygen and ventilate if necessaryEnsure adequate airway, provide oxygen and ventilate if necessary

Provide CPR if pulseless Provide CPR if pulseless (use AED if allowed by local protocols)(use AED if allowed by local protocols)

Suction as neededSuction as needed

If no trauma, place patient on left sideIf no trauma, place patient on left side

Transport immediatelyTransport immediately

DO NOTDO NOT attempt to relieve attempt to relieve

gastric distention unless it gastric distention unless it

interferes with ventilation. interferes with ventilation.

There is significant risk of There is significant risk of

aspiration. aspiration.

Bites and StingsBites and StingsBites and StingsBites and Stings

Creatures that Bite and Sting

Signs & Symptoms of Bites and Stings Local pain,Local pain,

swellingswelling

Headache, Headache, dizzinessdizziness

Rash,Rash,rednessredness

Nausea,Nausea,vomitingvomiting

BiteBitemarksmarks

Fever and chills Fever and chills may also follow may also follow the bite or sting.the bite or sting.

Care of Bites and Stings Care of Bites and Stings Ensure adequate ABC’sEnsure adequate ABC’s

Inspect the site for stinger or bite marksInspect the site for stinger or bite marks

Wash the area gentlyWash the area gently

Remove jewelry from injured areaRemove jewelry from injured area

If extremity, position just below level of heartIf extremity, position just below level of heart

If snakebite, consult medical directionIf snakebite, consult medical direction

Watch for development of allergic reactionWatch for development of allergic reaction

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Drowning and Near-DrowningDrowning and Near-Drowning

Bites and StingsBites and Stings