Presentation on theme: "Caring for Environmental Emergencies"— Presentation transcript:
1 Caring for Environmental Emergencies 16Caring for Environmental Emergencies
2 Define the following terms: ObjectivesDefine the following terms:AnaphylaxisConductionConvectionCore temperatureDrowningEvaporation(continued)
3 Define the following terms: ObjectivesDefine the following terms:FrostbiteHeat crampsHeat exhaustionHeat strokeHyperthermiaHypothermiaRadiation(continued)
4 Explain the four ways the body loses excess heat. ObjectivesExplain the four ways the body loses excess heat.Describe the signs and symptoms of a patient experiencing a heat-related emergency.Explain the appropriate assessment and care for a patient experiencing a heat-related emergency.Differentiate the signs and symptoms of heat stroke and heat exhaustion.Describe the signs and symptoms of a cold-related emergency.(continued)
5 Describe common factors leading to submersion injuries. ObjectivesExplain the appropriate assessment and care for a patient experiencing a cold-related emergency.Describe the signs and symptoms of emergencies related to bites and stings.Explain the appropriate assessment and care for a patient experiencing an emergency related to a bite or sting.Describe common factors leading to submersion injuries.(continued)
6 Describe common methods used for water-related rescue. ObjectivesDescribe common methods used for water-related rescue.Explain the hazards related to a water rescue.Describe the signs and symptoms of a submersion injury.Explain the appropriate care for a victim of a submersion injury.Demonstrate the ability to appropriately assess and care for a patient experiencing a heat-related emergency.(continued)
7 ObjectivesDemonstrate the ability to appropriately assess and care for a patient experiencing a cold-related emergency.Demonstrate the ability to appropriately assess and care for a patient experiencing a bite or sting emergency.Value the importance of proper training when attempting to conduct a water rescue.
8 Topics Temperature and the Body Heat Emergencies Cold Emergencies Bites and StingsWater-Related IncidentsIce-Related Incidents
10 Temperature and the Body Temperature regulationProcess of maintaining proper body temperature.HypothermiaWhen body loses heat faster than it can produce heat.HyperthermiaWhen heat gain occurs faster than body can shed heat.Teaching Tip: Stress the prefix “hypo” as meaning “low” and “hyper” as meaning “high” to help students remember the meaning and difference in these terms.
11 Temperature and the Body RadiationBody heat is emitted into environment.ConductionLoss of body heat through direct contact with object or ground.ConvectionLoss of body heat when air close to skin moves away, taking body heat with it.Teaching Tip: Ask students to provide an example of how someone might counter the effects of each of these heat loss mechanisms.Sample Answers: Radiation: wearing a jacket or hat; Conduction: sitting on a cushion at a football game rather than directly on a cold bench; Convection: removing oneself from a breeze or putting on a windbreaker.
12 Temperature and the Body EvaporationLoss of body heat through evaporation of moisture in form of sweat on skin.RespirationHeat leaves body with each breath.Teaching Tip: Ask students to provide an example of how someone might counter the effects of each of these heat loss mechanisms.Sample Answers: Evaporation: removing wet clothing, toweling off sweaty skin; Respiration: wearing scarf or face shield.
14 Think About ItIt is late fall and you respond to a call for a teen who has fallen into the river after standing in his canoe. A rescue team has been dispatched. While waiting for help, how might he be losing heat?
16 Heat EmergenciesCore temperature: temperature in core of body 98.6°F (37°C).Heat generated through digestion, metabolism, movement.Heat lost through breathing and sweating.Hypothalamus: body's thermostat.
17 Algorithm for the assessment of patients with a heat emergency. Teaching Tip: Review algorithm; discuss with students how it might be challenging to distinguish between each heat emergency.Algorithm for the assessment of patients with a heat emergency.
18 Heat EmergenciesEffects of heat loss through evaporation greatly reduced when humidity is high.Perform history and physical exam.Very young, very old, those with chronic illnesses susceptible to effects of heat and cold.Critical Thinking: Why are the very young, very old, and those with chronic illnesses especially susceptible to the effects of heat and cold?
21 Heat Emergencies Heat Cramps Painful muscle spasms following strenuous activity in hot environment.Usually caused by electrolyte imbalance.Patient fully alert and sweaty with normal to warm skin temperature.Move to cool environment; replenish fluids.Critical Thinking: What is an electrolyte imbalance? How can it be treated?
22 Heat Emergencies Heat Exhaustion Exposure to excessive heat for prolonged period of time.Body barely able to shed as much heat as it is generating.(continued)
23 Heat Emergencies Heat Exhaustion Signs and Symptoms Mild to moderate perspirationWarm or cool skin temperatureSkin color may be normal to paleWeakness, exhaustion, dizzinessNausea and vomitingCritical Thinking: In what situations might you expect to see cases of heat exhaustion? What can the EMR do to help prevent predictable cases?Sample Answer: Outdoor festivals in the summer; providing water misters, ensuring adequate shade areas.(continued)
24 Heat Emergencies Heat Exhaustion Signs and Symptoms Muscle cramps (usually in legs)Rapid, weak pulseRapid, shallow breathingAltered mental status (extreme cases)
25 Heat Emergencies Emergency Care for Heat Exhaustion Take appropriate BSI precautions.Primary assessment; ensure breathing is adequate.Move patient to cool area.Loosen or remove excess clothing.Discussion Question: Why is it important to explain to patients what you are doing for treatment?(continued)
26 Heat Emergencies Emergency Care for Heat Exhaustion Cool patient by fanning.Be careful not to overcool patient.Place patient in recovery position.Provide oxygen per local protocol.Discussion Question: How might the EMR best provide passive cooling?
27 Algorithm for the emergency care of patients with a heat emergency.
28 Heat Emergencies Heat Stroke Temperature-regulating mechanism fails; unable to rid excess heat.Core temperature allowed to rise uncontrolled, causing body to overheat.It is life-threatening emergency.Temperature may increase to 105°F (40.5°C) or higher.Critical Thinking: What are the implications of a body temperature of 105 degrees or higher?(continued)
29 Heat Emergencies Heat Stroke Signs and Symptoms Altered mental status Skin hot to touchSkin slightly moist to dryRapid, shallow breathingRapid pulseCritical Thinking: Why is altered mental status a significant finding?(continued)
30 Heat Emergencies Heat Stroke Signs and Symptoms Weakness, exhaustion, dizzinessNausea and vomitingConvulsionsCritical Thinking: How might the EMR suspect that convulsions are due to heat stroke and not simply seizures due to epilepsy?
31 Heat Emergencies Emergency Care for Heat Stroke Take appropriate Standard Precautions.Primary assessment; ensure breathing is adequate.Move patient to cool area; remove excess clothing.Cool patient by dowsing or immersing in cool water.Critical Thinking: How might the EMR cool the patient if s/he has limited resources?(continued)
32 Heat Emergencies Emergency Care for Heat Stroke Do not overcool patient to the point of him/her shivering.Wrap cold packs or ice bags; place under armpits, on groin, and each side of neck.Critical Thinking: Why is it important not to overcool the patient?(continued)
33 Heat Emergencies Emergency Care for Heat Stroke Place patient in recovery position.Provide oxygen per local protocol.Monitor vital signs.
34 Think About ItIt is a hot summer day and you are dispatched for a “man down.” You arrive to find a 36-year-old male jogger who is seated on the ground. His shirt and shorts are wet from perspiration. He seems confused and has just vomited. What do you suspect? What else should you assess? How will you proceed?Talking Point: Remind students that a person may have stopped sweating even though their clothing appears wet from perspiration.
36 Cold Emergencies Hypothermia Body loses heat faster than it can be generated (generalized cold emergency).Young children and elderly more susceptible.Critical Thinking: Why are young children and the elderly more susceptible to hypothermia?(continued)
37 Cold Emergencies Hypothermia Signs and Symptoms Cool or cold skin temperatureShivering (may stop later)Altered mental statusAbnormal pulse (rapid, then slow)Lack of coordination(continued)
38 Cold Emergencies Hypothermia Signs and Symptoms Muscle rigidity Impaired judgmentComplaints of joint/muscle stiffnessTalking Point: Victims of extreme hypothermia have been known to become confused and perceive that they are actually feeling overheated; leading them to remove their clothing.
40 Cold Emergencies Emergency Care for Hypothermia Take appropriate BSI precautions.Primary assessment; ensure adequate breathing.Remove patient from cold environment.Do not allow patient to walk or exert himself/herself in any way.Critical Thinking: Why is it important not to let a hypothermic patient walk or exert themselves in any way?Sample Answer: Movement can cause cold blood in the extremities to shunt toward the internal organs, potentially leading to cardiac arrest.(continued)
41 Cold Emergencies Emergency Care for Hypothermia Protect patient from further heat loss.Remove wet clothing and place blanket over and under patient.Handle patient gently.Administer oxygen per local protocols.Discussion Question: Considering the methods of heat loss; why is it important to remove wet clothing?(continued)
42 Cold Emergencies Emergency Care for Hypothermia Monitor vital signs. Do not give patient anything to eat or drink, including hot coffee, tea, alcohol.Critical Thinking: Why should you avoid giving the hypothermic patient anything to eat or drink?
43 Cold Emergencies Severe Hypothermia Patient unresponsive with skin cold to the touch; no vital signs.Do not assume patient is dead.Assess pulse for seconds. If no pulse, begin CPR.Not be pronounced dead until core temperature to within normal range.Teaching Tip: Hypothermia Rule of Thumb: “A patient is not dead until they are warm and dead.”
44 Cold Emergencies Localized Cold Injury Cold injury or frostbite: freezing or near freezing of body part.Caused by significant exposure to cold temperature (below 0°F or 17°C).Occurs in extremities (fingers, toes, ears, face, nose).Critical Thinking: Why are extremities more susceptible to injury from extreme cold?(continued)
45 Cold Emergencies Localized Cold Injury Signs and Symptoms (Early Signs)Numbness, tingling exposed areaSlow or absent capillary refillSkin remains softIf thawed, tingling and pain present(continued)
46 Cold Emergencies Localized Cold Injury Signs and Symptoms (Late Signs) White, waxy skinFirm to frozen feeling upon palpationSwellingBlistersIf thawed, flushed with areas of purple and blanching
47 Discussion Question: What treatment priorities would you have for a patient presenting with this type of cold injury?Severe frostbite.
48 Cold Emergencies Emergency Care for Cold Injury Take appropriate BSI precautions.Primary assessment; ensure adequate breathing.Remove patient from cold environment; protect from cold exposure.Remove wet or constrictive clothing.(continued)
49 Cold Emergencies Emergency Care for Cold Injury Early injury: Manually stabilize extremity, affected part.Cover affected part.Do not rub or massage it.Do not re-expose part to cold.Critical Thinking: Why is it important not to rub or massage the affected part?(continued)
50 Cold Emergencies Emergency Care for Cold Injury Late injury: Remove jewelry from injured part.Cover injured part with dry, sterile dressings. Place dressing between fingers and toes prior to covering.Do not break blisters.Critical Thinking: Why is it important to remove jewelry (e.g., rings, bracelets) from the affected part?(continued)
51 Cold Emergencies Emergency Care for Cold Injury Late injury: Do not rub or massage injured part.Do not apply heat.Do not rewarm.If legs, do not allow patient to walk.Critical Thinking: Why is it important not to rewarm or apply heat to the affected part?
53 Think About ItYou respond to a water-filled quarry on a hot sunny day where a couple has been scuba diving. You find a 47-year-old petite female in a wet suit. She is confused and complaining of joint pain. Her husband reports that the water is “warm” at 72 degrees and they had been in the water for about an hour. What might be going on?Critical Thinking: What ELSE could be affecting this diver?
55 Bites and Stings Assessment and Emergency Care Signs and Symptoms Noticeable puncture marks on skinPain at or around injury siteRedness, itching at injury siteWeakness, dizzinessTeaching Tip: Provide information on dangerous species specific to your geographic location. Discuss appropriate treatment techniques.(continued)
56 Bites and Stings Assessment and Emergency Care Signs and Symptoms Difficulty breathingHeadacheNauseaAltered mental statusCritical Thinking: Why might a victim of a bite or sting have difficulty breathing?
57 Bites and Stings Emergency Care for Localized Reaction Take appropriate BSI precautions.Perform scene size-up.Primary assessment; ensure adequate breathing.Scrape away bee and wasp stingers and venom sacs.(continued)
58 Bites and Stings Emergency Care for Localized Reaction Do not attempt to pinch or pull out stingers. Plastic credit card works as scraper.Place cold pack over injury site.Administer oxygen per local protocols.Critical Thinking: Why is it important to avoid pinching or pulling out stingers?
59 Class Activity: Direct students to work in pairs and use a credit card to mimic the stinger removal procedure.If the insect stinger is still present, remove it by scraping it away with the edge of a credit card or similar object.
60 Bites and Stings Anaphylactic Shock Severe allergic reaction; shock develops.BP decreases.Life-threatening emergency.Causes: bee stings; foods (nuts, spices, shellfish); inhaled substances; dust and pollens; certain chemicals; medications.Teaching Tip: Review local protocols regarding anaphylactic shock and the use of epinephrine auto-injectors by the EMR.(continued)
61 Bites and Stings Anaphylactic Shock Signs and Symptoms Burning, itching, breaking out of skin (hives or rash).Breathing difficult, rapid; possible chest pains, wheezing.Pulse rapid, weak, not detected.Lips turn blue (cyanosis).Discussion Question: How can age, medications, and underlying medical conditions affect treatment?(continued)
62 Bites and Stings Anaphylactic Shock Signs and Symptoms Swelling of face and tongueRestlessnessChanges in mental status (fainting or unresponsiveness)Critical Thinking: Why is swelling of the face and tongue a danger sign?(continued)
63 Bites and Stings Anaphylactic Shock Emergency Care Follow same procedures as used in shock.Follow local protocols regarding epinephrine autoinjector.Always call for medical direction before assisting patient with medications.
64 Bites and Stings Snakebites Signs and Symptoms Noticeable bite to skin Pain, swelling; may be slow to developRapid pulse; labored breathingWeaknessVision problemsNausea and vomitingTeaching Tip: Provide photos of the most common snakes in your area. Compare and contrast venomous from non-venomous.
65 Bites and Stings Emergency Care for Snakebite Take appropriate Standard Precautions.Perform scene size-up.Primary assessment; ensure breathing adequate.Locate fang marks; clean site with soap and water.Remove rings, bracelets, other constricting items.Critical Thinking: Why is it important to remove jewelry?(continued)
66 Bites and Stings Emergency Care for Snakebite Keep extremity immobilized.Provide supplemental oxygen.Provide care for shock.Monitor vital signs.Do not apply cold pack unless directed by a physician.Discussion Question: Why is it important to know that the signs and symptoms of snake poisoning may take several hours to develop?
67 Think About ItYou respond to a golf course for a 62-year-old male complaining of left ankle pain. Upon arrival, you learn the golfer tried to retrieve a ball in the woods and felt a sudden sting. There is an obvious puncture with redness and he is beginning to have trouble breathing. How do you proceed with assessment and care?
69 Water-Related Incidents DrowningRespiratory impairment from submersion in water or other liquid.Airway obstruction from water, foreign matter in airway, swollen airway.Cardiac arrest usually related to respiratory arrest.Injuries to head and neck to be expected.Teaching Tip: Clarify for students that this section is a review of water-related incidents and will not adequately prepare an individual to perform water rescue. EMRs should not attempt water rescue without specialized training.
70 Water-Related Incidents Look for fractures, soft-tissue injuries, internal bleeding.Water does not have to be very cold and time in water does not have to be very long for hypothermia to occur.
71 Water-Related Incidents Reaching the VictimUnless trained in water rescue, do not go into water to save someone.If patient is close to shore or poolside, attempt to reach and pull from water.Use branch, fishing pole, oar, stick, towel, shirt, article of clothing.Critical Thinking: What other items can be thrown to the victim to help keep them afloat?(continued)
72 Water-Related Incidents Reaching the VictimSecure your position so you will not be pulled into water.Throw objects that will float.Throw lines or flotation devices attached to line.
73 Reach for the victim. Throw an object to him Reach for the victim. Throw an object to him. If necessary, go to the victim if you are trained to do so.
74 Reach for the victim. Throw an object to him Reach for the victim. Throw an object to him. If necessary, go to the victim if you are trained to do so.
75 Reach for the victim. Throw an object to him Reach for the victim. Throw an object to him. If necessary, go to the victim if you are trained to do so.
76 Water-Related Incidents Care for Patient (No Neck/Spine Injuries)Primary assessment.Mouth-to-mask resuscitation.Check for airway obstruction.Provide CPR.Activate EMS system.Discussion Question: Why is it important to provide CPR to victims of water-related incidents even if it appears they were in the water for an extended length of time?(continued)
77 Water-Related Incidents Care for Patient (No Neck/Spine Injuries)Breathing and pulse, check and control bleeding.Breathing and pulse, perform patient assessment.Cover patient to conserve body heat.(continued)
78 Water-Related Incidents Care for Patient (No Neck/Spine Injuries)Hypothermia suspected, remove wet clothing to minimize heat loss.If patient can be moved, take to warm place. Do not allow patient to walk.Handle gently at all times.Care for shock.Discussion Question: Why is it important to handle patient gently when hypothermia is suspected?
79 Water-Related Incidents Patient with Neck or Spine InjuriesTurn patient face up in water.Begin primary assessment.Provide rescue breathing.Float patient to shore; continue to provide back and neck support.(continued)
80 Water-Related Incidents Patient with Neck or Spine InjuriesPatient out of water, attempt resuscitation.Check for and control serious bleeding.Critical Thinking: What should the EMR be prepared to manage while resuscitating the drowning victim?Answer: Vomiting
87 Water-Related Incidents Submersion InjuriesAssociated with scuba diving.Air Embolism Signs or SymptomsPersonality changesDistorted senses; blurred visionChest painNumbness and tingling sensations in arms and/or legs(continued)
88 Water-Related Incidents Submersion InjuriesAir Embolism Signs or SymptomsGeneral weakness; weakness of one or more limbsFrothy blood in mouth or noseConvulsions(continued)
89 Water-Related Incidents Submersion InjuriesDecompression Sickness (Bends) Signs and SymptomsFatiguePain to muscles and joints (bends)Numbness or paralysisChoking, coughing, labored breathing(continued)
90 Water-Related Incidents Submersion InjuriesDecompression Sickness (Bends) Signs and SymptomsChest painsCollapse and unresponsivenessBlotches on the skin (mottling)Talking Point/Critical Thinking: Signs and symptoms of decompression sickness may not appear until one-48 hours after diving. Why is this important for the EMR to know?
91 For scuba accidents, position the patient head down. Critical Thinking: Why might it be important for the EMR to ensure that the responding EMS crew knows that the patient appears to be suffering from decompression sickness?For scuba accidents, position the patient head down.
92 Think About ItYou respond to the city pool for a 16-year-old male drowning victim. He is unresponsive, breathing, has a pulse, and his skin is cold. What other injuries or conditions are you concerned about at this point? How will you proceed with assessment and treatment?
94 Ice-Related Incidents Unless trained to work on ice, do not attempt rescue.Major problem is reaching victim.Never attempt ice rescue by yourself.Never go onto ice that is rapidly breaking up.Throw line to victim or reach out with stick or pole.Discussion Question: Why is “scene safety” especially important in ice-related incidents?
95 Ice-Related Incidents Throw anything that will float.Ice rescues require special training, protective clothing, rescue equipment.Broken legs and hypothermia are often problems.Do not attempt to actively rewarm a severely hypothermic patient.Activate EMS system.Critical Thinking: Why are broken legs and hypothermia often a problem with ice-related incidents?
96 A safe ice rescue requires teamwork from specially trained responders.
97 Think About ItWhat injuries or illnesses might not show up immediately in accidents involving cold water and ice?How can an EMR anticipate this and provide proper care?
99 Summary Body loses heat through: Radiation Conduction Convection EvaporationRespiration
100 SummaryHyperthermia: hot, humid environment may cause body to generate too much heat creating abnormally high body temperature.Signs and symptoms:CrampsExcessive sweatingRapid weak pulseWeakness
101 SummaryHeat cramps: sudden and sometimes severe muscle cramps (often occurring in legs).Heat exhaustion: prolonged exposure to heat; creates moist, pale skin that may feel normal or cool to the touch.
102 SummaryHeat stroke: prolonged exposure to heat; hot, dry or moist skin; altered mental status; rapid breathing.It is a life-threatening emergency.Emergency care for heat emergencies: remove patients from hot environment, cooling with water, fanning.
103 SummaryHypothermia: rapid heat loss creating state of low body temperature.Cool skin temperatureShiveringDecreased mental statusStiff or rigid posturePoor judgmentTemperature does not have to be below freezing to occur.
104 Summary Frostbite Emergency care Freezing or near freezing of a body part; feeling of cold followed by pain, numbness, or tingling.Emergency careRemove patient from cold environment; remove wet clothes; keep patient calm and warm; stabilize any cold extremity.
105 Summary Care for injected poisons (other than snakebite): Care for shockScrape away stingers and venom sacsPlace ice bag or cold pack over area
106 Summary For snakebite: Keep patient calm and lying down Clean site Keep bitten extremities immobilizedAlert dispatcherCare for shock
107 Summary Anaphylactic shock (allergy shock): Life-threatening emergency When people come into contact with substance to which they are allergic (bee stings, insect bites, chemicals, foods, dusts, pollens, drugs)
108 Summary Signs of anaphylactic shock: Burning or itching skin Hives Difficulty breathingRapid, weak pulseSwelling of face and tongueCyanosisAltered mental status
109 Summary Care same as for other cases of shock. Transport patient to hospital and care for according to local protocol.Ask patient about allergies during interview.Look for medical identification device.
110 SummaryMany submersion injuries related to scuba diving and result when a person ascends too quickly.The “bends” result when tiny gas bubbles form in tissues, causing pain.In severe cases, these bubbles can form air embolism that obstructs blood flow, resulting in death.
112 What are the four ways the body loses excess heat? Review QuestionsWhat are the four ways the body loses excess heat?What are the signs and symptoms of a patient experiencing a heat-related emergency?You have a patient experiencing a heat-related emergency. What is the appropriate assessment and care?(continued)
113 What are the signs and symptoms of a cold-related emergency? Review QuestionsWhat is the difference in the signs and symptoms of heat stroke versus heat exhaustion?What are the signs and symptoms of a cold-related emergency?You have a patient experiencing a cold-related emergency. What is the appropriate assessment and care?
114 What are the signs and symptoms of a bite and sting emergency? Review QuestionsWhat are the signs and symptoms of a bite and sting emergency?You have a patient with a bite or sting emergency. What is the appropriate assessment and care?What are common methods for water-related rescue and their hazards?
115 What are some common factors that can lead to a submersion injury? Review QuestionsWhat are some common factors that can lead to a submersion injury?What are the signs and symptoms of a submersion injury?How will you provide the appropriate care for a victim of a submersion injury?
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