Lesson 6 – Environmental and Toxicological Respiratory Emergencies

Lesson 6 overview

Environmental and toxicological emergencies threaten respiratory function and require rapid, specialized interventions. Includes smoke inhalation, near-drowning, chemical exposures, anaphylaxis. Focus on removing patient from harm, ensuring oxygenation, preparing for rapid transport. Final lesson in this course.

Smoke inhalation signs

Look for carbonaceous sputum, singed nasal hairs, hoarseness. Causes airway burns, chemical irritation, asphyxiation, which can severely compromise the airway.

Carbon monoxide poisoning signs

Symptoms are nonspecific: headache, nausea, confusion. Cherry-red skin is a late, unreliable sign. Pulse oximetry may be inaccurate in CO poisoning. Treat based on history and presentation.

Smoke/CO treatment

Remove patient from source, administer high-flow oxygen, assess for associated injuries. Transport promptly. Consider hyperbaric oxygen therapy for severe CO poisoning. Notify fire/hazmat teams as needed. Many EMS carry CO detectors.

Near-drowning management

Begin with ABCs, maintain spinal precautions if diving injury suspected. Watch for aspiration pneumonia, hypothermia, severe hypoxia. Use BVM or CPAP if trained and available. Initiate rewarming: heat packs, blankets, warm ambulance environment.

Near-drowning complications

Patients can worsen due to secondary drowning (fluid accumulation in lungs). Even if improved, hospital evaluation is required. Be prepared for sudden respiratory decline.

High-altitude emergencies

Includes Acute Mountain Sickness (AMS), High Altitude Pulmonary Edema (HAPE), High Altitude Cerebral Edema (HACE). AMS causes headache, nausea; HAPE causes severe shortness of breath; HACE causes confusion, ataxia.

High-altitude treatment

Primary treatment is descent to lower altitude. Give oxygen, position patient semi-Fowler’s to ease breathing. Educate on acclimatization. Assess ascent rate, altitude, pre-existing conditions. Conditions can progress rapidly and be life-threatening.

Chemical inhalation injuries

Caused by exposure to chlorine, ammonia, solvents. Symptoms: coughing, wheezing, chest pain, eye irritation. Ensure scene safety and PPE. Call hazmat/fire teams. Remove patient from area; decontaminate if needed.

Chemical exposure treatment

Administer high-flow oxygen. Consider bronchodilators for bronchospasm. Watch for delayed respiratory distress. Obtain chemical info to guide hospital care. Chemicals can off-gas from clothes, risking provider exposure—decontaminate patient/clothing.

Anaphylaxis respiratory signs

Look for urticaria (hives), angioedema, wheezing, stridor. Life-threatening signs: hypotension, altered mental status, airway compromise.

Anaphylaxis treatment

Administer IM epinephrine if authorized and indicated. Provide high-flow oxygen, manage airway as needed. Bronchodilators help wheezing. Rapid recognition and treatment critical. Assist patient with epinephrine auto-injector if present.

Aspiration emergencies

Foreign material enters airway, common in altered mental status or impaired gag reflex. Signs: sudden coughing, wheezing, wet/hoarse lung sounds. Complications: chemical pneumonitis, bacterial pneumonia.

Aspiration management

Suction airway as needed. Give oxygen therapy. If aspiration is unilateral, position affected side down to protect unaffected lung. Monitor closely for worsening respiratory distress, low O2 saturation. Symptoms may worsen over time; hospital evaluation required.

Lesson conclusion

This concludes Lesson 6 on environmental and toxicological respiratory emergencies, the last lesson of this course. Next, review the Chapter Summary and overall course content. Good studying!