Chapter 31

water chill

chilling caused by conduction of heat from the body when the body or clothing is wet

muscular activity in the form of shivering and the rate at which fuel (food) is burned within in

the body both increase to produce more heat

conduction

the transfer of heat from one material to another through direct contact

heat will flow from a warmer

material to a cooler one

convection

carrying away from the heat by currents of air, water, or other gas or liquids

most heat is lost from which body part

the head

wind chill

chilling caused by convection of the heat from the body in the presence of air

radiation

sending out energy, such as heat, in waves into space

evaporation

the change from liquid to gas

respiration

breathing. during respiration, body heat is lost as warm air is exhaled from the body

hypothermia

generalized cooling to reduces body temperature below normal, which is a life-threatening condition in its extreme

pt’s becomes irrational, lose contact with the environment, and drifts into a stuporous state. Muscular righty continues. pulse and respirations are

slow, and cardiac dysrhythmias may develop

since infants and young children are small with large skin surface areas in relation to their total body mass and have little body fat,

they are especially prone to hypothermia

because of pediatric being so small, infants and children do not

shiver very much or at all--another reason why very young

a crucial part of the care for newborn infants is to

dry them to prevent heat loss from evaporation and cover their heads to prevent heat loss by radiation and convection

decreased ambient temperature

is your pt living in home or apartment that’s too cold?

the following list contains common signs and symptoms of hypothermia (1)

shivering in early stages when the core body temperature is above 90F. in severe cases, shivering decreases or is absent (1)

the following list contains common signs and symptoms of hypothermia (2)

cool abdominal skin temperature (place your hand inside the clothing with the back of your hand against the pt’s abdomen (2)

passive rewarming

covering a hypothermic patient and taking other steps to prevent further heat loss and help the body warm itself

active rewarming

application of an external heat source to rewarm the body of a hypothermic patient

hypothermic patient who is alert and responding appropriately

remove all the patient’s wet clothing. keep the patient dry, and dress the patient in dry clothing or wrap in dry, warm blankets. keep the pt still, and handle him very gently. do not allow the patient to walk or exert himself. do not massage his extremities, exercise or unnecessary movement could quickly circulate the cold blood and lower the core body temperature

for extreme hypothermia

assess the carotid pulse for 30 to 45 seconds. if there is no pulse, start CPR immediately and prepare to apply the AED

ice crystals can form in the skin and, in the most severe cases

gangrene (localized tissue death can set in, which may ultimately lead to the loss of the body part

early or superficial local cold injury

localized with clear demarcation of its limits. patients are often unaware of the onset of an early local cold injury until someone indicates that there is something unusual about the person’s skin color

signs and symptoms of early or superficial local cold injuries

affected area in patients with light skin redness; in patients with dark skin, lightened. both then blanched (whiten). once blanching begins, the color change can take place very quickly. the affected area feels numb to the patient

active rapid rewarming of frozen parts

head the water between 100F and 105F. fill the container with heated water, and prepare the injured part by removing clothing, jewelry, bands, or straps. thawed areas often swell so you need to remove potentially constricting items beforehand. fully immerse the injured part. do not allow the injured area to touch the sides or bottom of the container. do not place any pressure on the affected part. continuously stir the water. remove the affected part and add more warm water if the water cools below 100F

hyperthermia

an increase in body temperature above the normal, which is a life threatening condition in its extreme

prolonged exposure to excessive heat can create an emergency in which the patient presents with

pale skin that may feel normal or cool to the touch, a condition generally known as head exhaustion

healthy individuals who have been exposed to excessive heat while working or exercising may experience a form of

shock brought about by fluid and salt loss

heat emergency patient with most, pale, and normal or cool skin

heavy perspiration

emergency care of a heat emergency pt with moist, pale and normal or cool skin includes the following steps

remove the pt from the hot environment, and place him in a cool environment (such as in shade or an air conditioned ambulance)

when a person’s temperature-regulating mechanisms fail and the body cannot rid itself of excessive heat, you will see

a pt with hot and dry or possibly moist skin.

when the skin is hot- whether dry or moist - this condition, generally known as heat stroke, is

a true emergency

the problem is compounded when, in response to loss of fluid and salt, the pt

stops sweating, which prevents heat loss through evaporation

heat emergency pt with hot skin, whether dry or moist

loss of consciousness or altered mental status, rapid/shallow breathing, full and rapid pulse, generalized weakness, little or no perspiration dilated pupils, potential seizures/ no muscle cramps

heat emergency patient with hot skin, whether dry or moist

remove the pt from the hot environment and place him in a cool environment, remove the pt’s clothing, apply cool packs to his neck, groin, and armpits. keep the skin wet by applying water by sponge or wet towels and aggressively fan the pt

drowning

the process of experiencing respiratory impairment from submersion/immersion in liquid, which may result in death, morbidity or no morbidity

in water related accidents, assume that the

unconscious pt has heck and spinal injuries

about ___ of the people who die from downing die just from lack of air

10%

the person typically attempts a final respiratory effort and draws water into the lungs, or the spasms subside with the onset of

unconsciousness and water freely enters the lungs

some pt’s who drown in cold water can be resuscitated after

30 minutes or more in cardiac arrest

once the water temperature fall below 70F

biological death may be delayed

for water related incidents

look for and control profuse bleeding. since the pt’s heart rate may have slowed down, take a pulse for 60 seconds in all cold-water rescue situations before concluding that the patient is in cardiac arrest

air embolism

gas bubble in the bloodstream

arterial gas embolism (AGE)

result of gas leaving a damaged lung and entering the bloodstream. severe damage may lead to a collapsed lung

air emboli (gas bubbles in the blood) are most often associated with

divers who hold their breath because of inadequate training, equipment failure, under water emergency or attempts to conserve air during a dive

divers can also develop an air embolism in

very shallow water

decompression sickness

a condition resulting from nitrogen trapped in the body’s tissues, caused by coming up too quickly from a deep, prolonged dive

decompression sickness in sub divers takes from

1 to 48 hours to appear, with about 90% of cases occurring within 3 hours of the dive

divers increase the risk of decompression sickness if they fly within

12 hours of a dive

sir embolism (rapid onset) signs and symptoms

blurred vision, chest pains, numbness and tingling sensations in the extremities, generalized or specific weakness and possible paralysis, frothy blood in the mouth or nose, convulsions, rapid lapse into unconsciousness, respiratory arrest and cardiac arrest

decompression sickness signs and symptoms

personality change, fatigue, deep pain to the muscles and joints, itchy blotches or mottling of the skin, numbness or paralysis, chocking, coughing, labored breathing, behavior or similar to intoxication, chest pain, collapse leading to unconsciousness

DAN stands for

diver alert network

a hyperbaric trauma center is one that has special pressure chamber for treatment of

air embolisms and decompression shock

reach

when the pt is responsive and close to shore or poolside, try to reach him by holding out an object for him to grab

throw and tow

if the person is conscious and alert but too far away from you to reach and pull from the water, throw an object that will float

row

when the pt is too far from shore to allow from trowing and towing or is unresponsive, you may be able to row a boat to the pt

go

as a last resort, when all other means have failed, you can go into the water and swim to the pt

you can use a small, flat bottomed aluminum boat for

ice rescues

toxins

substances produced by an animal or plants that are poisonous to humans

venom

a toxin produced by a certain animal such as snakes, spiders, and some marine life forms

although all spiders are venomous, most species

cannot get their fangs through human skin

what two spiders can can bite and produce medial emergencies

black widow and brown recluse spiders (fiddleback)

how you remove the stinger or venom sac is

far less important than doing so quickly

remove jewelry from the pt’s affected limb incase

the limb swells, which could make removal more difficult later

some EMS systems recommend placing a cold compress on the wound. however most EMS systems do not use cold for any

injected toxin. follow local protocol

in the United States there are two types of native venomous snakes

pit vipers (including rattlesnakes, copperheads, and water moccasins) and coral snakes

up to 25% of pit viper bites and 50% of coral bites are

“dry bites” without venom injection

native snakes are not the only kind of venomous animas you may encounter. a number of people have decided to keep venomous

reptiles even though it is illegal to do so in most areas

poisoning from marine life

rinsing the affected area with vinegar will reduce the pain of the sting

once the site has been rinsed with vinegar to inactivate the venom, immersion of the site in

hot but non scalding water may further reduce the pain (113F)