1. Environmental Emergencies

2. Heat/Cold Emergencies w Metabolism runs best at 98.6 o F T 0 - Metabolic rates; cell damage

3. Heat Loss Conduction

4. Heat Loss Convection

5. Heat Loss Radiation

6. Heat Loss Evaporation

7. Heat Loss Respiration

8. Heat Production 1. Metabolism 2. Movement of Large Muscles 3. Shivering

9. w Heat Production > Heat Loss = Body Temperature w Heat Loss > Heat Production = Body Temperature

10. Cold Emergencies

11. Hypothermia Risk Groups 1. Young children & elderly 2. Shock patients 3. Diabetics 4. Head/spinal injury 5. Overdose/poisoning 6. Homeless 7. Burn victims 8. Outdoor sports participants

12. Hypothermia w Generalized cooling of the body w Can occur at temperatures above freezing Wet clothes Contact with cold surfaces Prolonged exposure to the cold

13. Stages of Hypothermia Core Body TemperatureSymptoms 99°F-96°F37.0°C-35.5°CShivering. 95°F-91°F35.5°C-32.7°CIntense shivering, difficulty speaking. 90°F-86°F32.0°C-30.0°CShivering decreases and is replaced by strong muscular rigidity. Muscle coordination is affected and erratic or jerky movements are produced. Thinking is less clear, general comprehension is dulled, possible total amnesia. Patient generally is able to maintain the appearance of psychological contact with surroundings. 85°F-81°F29.4°C-27.2°CPatient becomes irrational, loses contact with environment, and drifts into stuporous state. Muscular rigidity continues. Pulse and respirations are slow and cardiac. 80°F-78°F26.6°C-20.5°CPatient loses consciousness and does not respond to spoken words. Most reflexes cease to function. Heartbeat slows further before cardiac arrest occurs.

14. Signs & Symptoms of Hypothermia w Shivering in mild cases (lack of, in more severe cases) w Numbness w Stiff or rigid posture w Drowsiness or mental status changes w Breathing Rapid (early) Shallow, slow, absent (late) w Blood pressure (low or absent)

15. Signs & Symptoms of Hypothermia w Pulse Rapid (early) Slow and barely palpable (late) w Skin Red (early) Pale Cyanotic Stiff/hard (late)

16. Hypothermia Treatment w Remove pt. from environment and prevent further heat loss w Remove wet clothing and cover with blanket w Support airway, breathing w 100% O 2 – warmed/humidified, if possible w Handle patient gently

17. Hypothermia Treatment w Do not allow pt. to walk or exert self w If apneic, check pulse 30-45 seconds before starting CPR w Do not allow patient to eat or drink stimulants or smoke w Do not massage extremities

18. Emergency Care of Hypothermia If patient is responding appropriately, rewarm actively: w Cover with warm blankets w Apply heat to groin, armpits, neck. w Warm trunk/torso first. w Do not warm too quickly. w Increase heat in ambulance. w Warm bath if delayed transport.

19. Emergency Care of Hypothermia If patient unresponsive or responding inappropriately, rewarm passively: w Open airway; provide high- concentration oxygen. w Apply warm blankets. w Increase heat in ambulance.

20. Frostbite w Localized cold injury w Subfreezing temperatures w Vasoconstriction occurs Blood flow to distal circulation – usually occurs to nose, ears, fingers, toes Water in tissues freezes; tissue damage occurs

21. Frostbite Signs/Symptoms w Mild (frost nip): Red, burning areas w Superficial (early): Blanching of the skin, loss of feeling/sensation w Deep (late): white waxy, firm, cyanotic, possibly blisters and swelling

23. Local Cold Injury

25. Emergency Care of Superficial (Early) Local Cold Injury w Remove patient from environment. w Administer oxygen w Remove wet/restrictive clothing w Protect area from further injury. w Splint and cover extremity. w Do not rub or massage. w Do not re-expose to cold.

26. Emergency Care of Deep (Late) Local Cold Injury w Remove patient from environment. w Protect area from further injury – cover with dry clothing or dressing w Remove jewelry w Administer high-concentration oxygen. w Do not: Break blisters Rub or massage area Apply heat or rewarm Allow patient to walk on affected extremity

27. Passive vs. Active Rewarming w Passive Allows the body to rewarm itself Remove wet clothing Cover with blankets w Active Application of external heat sources to patient

28. For an extremely long or delayed transport (>30 min) active rapid rewarming should be done w Seldom recommended w Large potential to permanently injure frozen tissue

29. Active Rapid Rewarming of Frozen Parts w Immerse the affected part in warm (tepid) bath water (not to exceed 105°F) NYS w Ensure the water does not cool from the affected part w Continuously stir water w Continue until the part is soft and color and sensation return w Dress area with dry, sterile dressings. w Protect against refreezing. w Expect complaint of severe pain.

30. Frostbite Treatment w Do NOT rub frostbite w Do NOT allow refreezing w Do NOT allow patient to smoke

31. Hypothermia can cause apparent absence of vital signs Always resuscitate You’re not dead until you’re warm and dead!

32. Heat Illness

33. High Risk Groups Classic Heat Stroke w Elderly w Chronic medical problems Heart Disease Obesity Diabetes

34. High Risk Groups Exertional Heat Stroke w Small children in closed vehicles w Athletes, military recruits, construction workers, on hot humid days

35. Heat Cramps w Due to salt loss from sweating w Spasms in large muscle groups w Patient awake, alert

36. Heat Cramps Treatment w Stop activity w Cool environment

37. Heat Exhaustion Signs, Symptoms w Muscle Cramps w Weakness w Faintness, dizziness w Headache w Nausea, vomiting w Pale, cool, moist skin w Pt. is still sweating therefore body is trying to cool down

38. Heat Exhaustion Treatment w Stop activity w Cool environment w Lie down, elevate legs (trendelenberg) w Transport if LOC or symptoms do not clear rapidly w Administer high concentration oxygen

39. Heat Stroke w Most serious heat-related illness w Body temperature > 106 o F w Damage occurs to temperature regulating center in brainstem w Sweating mechanism fails

40. Heat Stroke Signs/Symptoms w Body temperature w Hot, dry, flushed skin w Absence of sweating w Altered mental status Confusion, irritability LOC Coma w Seizures w Vomiting

41. Heat Stroke Treatment w Remove from hot environment w Remove clothing w High concentration O 2 w Assist ventilations as needed w Apply cool packs to neck, groin, armpits (ancillary regions) w Keep the skin wet by applying water by sponge or wet towels w Transport immediately