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
SU
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Drowning and Near-DrowningDrowning and Near-Drowning
Bites and StingsBites and Stings
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