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ENVIRONMENTAL EMERGENCIES

LESSON 15. ENVIRONMENTAL EMERGENCIES. Introduction. Body temperature problems occur when body becomes too cold or too hot Cold- and heat-related injuries can begin gradually but become an emergency Cold or heat emergencies can lead to serious injury or death

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ENVIRONMENTAL EMERGENCIES

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  1. LESSON 15 ENVIRONMENTAL EMERGENCIES

  2. Introduction • Body temperature problems occur when body becomes too cold or too hot • Cold- and heat-related injuries can begin gradually but become an emergency • Cold or heat emergencies can lead to serious injury or death • Submersion in water can cause a third type of environmental emergency

  3. Body Temperature • Constant core body temperature necessary • Body has several mechanisms to create or lose heat • Mechanisms cannot maintain constant temperature when exposed to temperature extremes for extended period • Infants and elderly are more susceptible

  4. Mechanisms For Staying Warm • Metabolic processes – most body heat produced this way • Contraction of muscle tissue – including shivering • Vasoconstriction – less radiation of heat away from skin

  5. Mechanisms For Staying Cool • Vasodilation • More warm blood to surface of skin to be radiated away • Primary heat loss method • Sweating – evaporation from skin surface cools body

  6. Prolonged Exposure to Cold • Especially when wet: • The body cannot conserve heat • Shivering cannot produce enough heat • Hypothermia develops • Organ systems gradually begin to fail, leading eventually to death

  7. Prolonged Exposure to Heat • Body cannot maintain normal temperature • Profuse sweating leads to dehydration • Blood volume and blood pressure decrease • Without fluid, body cannot cool itself • With activity or exercise, body loses fluid quickly • Heatstroke occurs when body temperature rises • Without treatment, organ damage or death occurs

  8. Heat and Cold Injuries Risk Factors • Young children • Elderly • Injuries • Chronic health problems • Mental impairment • Dehydration • Too little body fat • Too much body fat • Activity in extreme environments • Medications and drugs (including alcohol) • Environmental variables (water immersion, wind chill, humidity)

  9. Hypothermia • Occurs when body cannot make heat as fast as it loses it • Body temperature <95°F • Can occur whenever and wherever person feels cold • Progressive • May occur gradually or quickly • About 600 people die each year in United States

  10. Hypothermia with Obvious or Subtle Exposure to Cold • Obvious cases involve exposure in cold environment • Duration of exposure and exposed skin or thin clothing increases risk • More subtle cases may occur with underlying illness, overdose, poisoning or an elderly patient in a cool home

  11. Signs and Symptomsof Hypothermia • Pale, cool skin  even under clothing • Slow breathing • Uncontrollable shivering (may stop in severe hypothermia) • Decreasing mental status or motor function • Patient seems apathetic, confused or irrational • Lethargy, clumsy movements, drowsiness, dizziness

  12. Signs and Symptomsof Hypothermia (continued) • Memory disturbances or confusion • Reduced or loss of touch or sensation • Speech difficulty • Poor judgment • Stiff or rigid posture, muscular rigidity, joint or muscle stiffness

  13. Early Signs and Symptomsof Hypothermia • Shivering • Numbness • Lethargy • Poor coordination • Slurred speech • Infants may have bright red skin and little energy Take early action to prevent progression!

  14. Late Signs and Symptomsof Hypothermia • Shivering typically stops • Patient may not feel cold • Breathing becomes shallow, pulse slows • Mental status deteriorates • Patient may become unresponsive and stop breathing

  15. Emergency Care for Hypothermia • Perform standard patient care • Remove patient from cold environment immediately • Protect from further heat loss • Remove wet clothing, cover with warm blankets • Have patient lie down, handle gently • Follow local protocol for oxygen • Don’t allow patient to walk or exert self • Don’t give patient any food or drink

  16. Emergency Care forHypothermia (continued) • Don’t allow patient to use stimulants such as caffeineor nicotine • Don’t massage skin or extremities • Don’t immerse patient in hot water • Don’t use direct heat • Assess unresponsive patient for pulse for 30-45 seconds before CPR • Follow local protocol to use AED as usual

  17. Remote LocationEmergency Care • Only if patient is far from medical care, use active rewarming • Put patient near heat source or put warm water in containers against skin

  18. Frostbite • Freezing of skin or deeper tissues • Usually clear demarcation of area of injury • More common in exposed skin areas (head, hands, feet) • Wind chill increases risk • Severe frostbite kills tissue and can result in gangrene and need for amputation

  19. Signs and Symptomsof Frostbite Early or superficial frostbite: • Skin color doesn’t return after palpation • Skin remains soft • Area is numb, tingles or aches when rewarmed

  20. Severe Frostbite • Skin looks waxy, white, gray, yellow or bluish • Area feels firm or frozen hard on palpation • Swelling or blisters

  21. Severe Frostbite (continued) • Affected area may become painless • After warming, area becomes: • Swollen • Blistered and flushed • Mottled and cyanotic

  22. Emergency Care for Frostbite • Perform standard patient care • Remove patient from environment • Remove wet or constrictive clothing • Protect patient from further heat loss • Handle patient very gently • Have patient rest and avoid movement or exertion • Check for hypothermia • Protect cold-injured area from further injury

  23. Emergency Care for Frostbite(continued) • For early or superficial injury: • Manually stabilize and cover extremity • Do not rub or massage area • Prevent another exposure to cold • For late or deep cold injury: • Remove jewelry and tight-fitting clothing • Put dry gauze between frostbitten fingers or toes • Protect and elevate area

  24. Emergency Care for Frostbite (continued) • Do not: • Break blisters • Rub or massage area • Apply heat • Rewarm area • Allow patient to walk on affected extremity • Give food or drink • Allow tobacco use

  25. Rewarming Frostbite • If help is delayed, rewarm severe frostbite by immersing area in lukewarm (not hot) water for 20-30 minutes • Do this only if there is norisk of refreezing • Never apply a direct heat source

  26. Heat Emergencies • Heat exhaustion • Develops when body becomes dehydrated • Can progress to heatstroke • Heatstroke • Medical emergency • If untreated, can cause death

  27. Heat Emergencies (continued) • Most occur during hot weather but can also occur in hot settings (furnace room, factory, vehicle) • Average 400 deaths/year in United States • Heatstroke is progressive  starts with milder symptoms • Recognize signs and symptoms early and treat

  28. Signs and Symptoms of Heat Exhaustion • Early signs and symptoms: • Sweating, pale/ashen moist skin • Thirst • Fatigue, weakness, exhaustion • Muscle cramps • Later signs and symptoms • Headache, dizziness, fainting • Nausea, vomiting • Fast, shallow breathing • Rapid heart rate

  29. Emergency Care for Heat Exhaustion • Move patient from heat to rest in cool place • Loosen or remove clothing • Give sports drink or water • Raise legs 6-12 inches • Cool patient

  30. Emergency Care for Heat Exhaustion(continued) • Cool patient with one of these methods: • Put wet cloths on forehead and body • Sponge skin with cool water • Spray skin with water from spray bottle and then fan area (ineffective in high humidity) • Do not give salt tablets • If patient is lethargic, nauseous or vomiting, do not give liquids • Seek medical care if condition worsens or does not improve in 30 minutes • Seek urgent medical attention if patient has heart condition or high blood pressure

  31. Heatstroke vs. Heat Exhaustion Heatstroke • Patient’s skin is flushed and feels hot to touch • Patient becomes confused and irrational and may become unresponsive or have convulsions Heat Exhaustion • Skin may be pale, or ashen, and clammy • Patient dizzy or tired or may be irritable and have a headache

  32. Signs and Symptomsof Heatstroke • Skin is flushed, dry, hot • Sweating usually has stopped • Fast breathing • Headache, dizziness, extreme confusion, other signs of altered mental status • Irrational or belligerent behavior • Possible convulsions or unresponsiveness

  33. Emergency Care for Heatstroke • Perform standard patient care • Move to cool place • Remove outer clothing • Cool quickly with any means at hand • Follow local protocol for oxygen • Cool until temperature drops to 101°F (38.3°C) • Do not apply rubbing alcohol to skin

  34. Emergency Care for Heatstroke(continued) Cool quickly using one or more of these techniques: • Immerse patient up to neck in cold water • Spray skin with water and then fan (ineffective in high humidity) • Wrap patient in wet sheet and keep it wet • Sponge patient with cold water • Put ice bags or cold packs beside neck, armpits and femoral pressure point area near groin

  35. Emergency Care for Heatstroke(continued) • No pain relievers or salt tablets • No caffeine or alcohol • No liquids if nauseous, vomiting, diminished mental status • Monitor patient and provide needed care • Put unresponsive patient in recovery position if breathing normally • Assist patient with ventilation if breathing is inadequate

  36. Submersion Injury • Drowning occurs when airway is surrounded by water or another liquid that prevents breathing • About 3,700 people die each year from drowning in United States • For every child who dies from drowning, 4 more receive emergency care for submersion injury • Often results in permanent disabilities and brain damage

  37. Drowning Patients • Begin rescue breaths as soon as possible • If possible, begin rescue breaths still in shallow water • Must remove patient from water to give CPR • If cause of incident is unknown, assume patient may have spinal injury • Keep head in line with body when moving or positioning patient • Use jaw thrust to open airway

  38. Assessing Submersion Injury • Perform standard assessment • Severity of patient’s condition depends on duration of submersion and other factors

  39. Signsand Symptoms ofSubmersion Injury • Patient may still be responsive or may have become unresponsive • Coughing • Vomiting • Difficulty breathing • Respiratory arrest • Cardiac arrest

  40. Emergency Care for Submersion Injury • Perform standard patient care • If patient is still in water, maintain your personal safety • If spinal injury suspected, manually stabilize patient’s neck and spine • If patient is breathing normally, place in recovery position • Follow local protocol for oxygen • If patient is not breathing normally, first open airway and give 2 rescue breaths, then quickly check for pulse

  41. Emergency Care for Submersion Injury(continued) • If patient has pulse but is still not breathing normally, continue rescue breathing • If patient does not have pulse, give CPR immediately – begin with chest compressions • Because of high risk for vomiting, be prepared to roll patient on side and to suction mouth

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