EMS chapter 17 - caring for environmental emergencies

5 ways body loses excess heat

• radiation

• conduction

• convection

• evaporation

• respiration

signs + symptoms of hyperthermia

• dizzy/lightheaded

• flushed skin

• skin hot to touch

• nausea/vomiting

• muscle cramps

• headache

• sweating

• altered mental status

• feeling hot

(SCHHADNF)

hypo vs hyper (thermia)

hypo: low body temp, under 95 F

hyper: temp over 104F (40.5 C). Organs compensate by generating waste - builds up acid - then organ gets damaged or dies

Heat cramp signs + symptoms

• Mild to severe muscle cramps in legs, arms, abdomen, or back

• Exhaustion, dizziness, and light-headedness

• Weak pulse and rapid, shallow breathing

• Heavy perspiration

• Normal to pale skin color

heat cramp + heat exhaustion care

1.Stop activity and rest in cool place
2. Remove excess or tight clothing
3. Provide water or commercial sports drink
4. Have victim lie down w/ legs elevated (recovery position if unresponsive)
5. Apply cool packs or wet towels
6. if no history of circulatory problems, massage cramped muscle

heat stroke signs + symptoms

• Altered mental status

• Skin that is hot to the touch

• Rapid, shallow breathing

• Strong, rapid pulse

• Weakness, dizziness

• Little to no sweating

• Seizures or muscular twitching

• nausea and vomiting

heat stroke care

1. BSI

2. primary assessment (adequate breathing + open airway??)

3. provide oxygen at 15 LPM nonrebreather mask (if local protocols say yes - the B part of primary assessment)

4. Rapidly cool patient with cool, wet, towels, fanning, and cold packs. move to cool place

5. wrap cold packs and place at neck, armpits, wrists, groin, and fan patient

6. immerse patient in cool water, if possible

7. monitor patients vital signs continuously (don’t stop checking, use electronic devices)
   
   If unresponsive and not breathing start CPR

heat cramp

Painful muscle spasms that occur with exercise.

heat exhaustion

This is when there is heavy perspiration (sweating) with a normal or slightly above normal body temperature.

heat exhaustion signs + symptoms

- Heavy sweating
- Severe thirst
- Weakness
- Headache
- Nausea and vomiting

heat exhaustion care

• BSI 

• primary assessment, ensure open airway and adequate breathing.

• Move the patient to a cool area and have them lie down.

• Loosen or remove excess clothing.

• Cool the patient with a cool water spray and by fanning. Don’t over cool

• Consider giving the patient small sips of water, juice, or a sports drink if allowed by local protocol.

Hypothermia signs + symptoms

• dizzy

• slurred speech

• exhaustion

• shivering at first, little to no shivering later

• can’t feel things (no sensation)

• decreasing mental status

• rigidity/stiffness

hypothermia vital signs

• breathing rapid at first, then slow or absent later

• pulse rapid, then slows to stop

• low to absent BP

• slow responding pupils

• skin red, then pale, cyanotic, to gray and waxy and hard

stages of hypothermia

mild: below 95 F (35 C), alert but shivering maybe confused

moderate: 86-93.2 F (30-34 C) drowsy, not shivering, decreased responsiveness

severe: below 86 F (30 C) unresponsive, no detectable vital signs

Hypothermia care

1. BSI .

2. primary assessment ( Open airway and adequate breathing). If unresponsive, assess pulse for 30-45 seconds.

   1. if no pulse, start CPR

3. Remove the patient from the cold environment, but do not allow the patient to walk or exert themselves in any way.

4. Protect the patient from further heat loss.

5. Remove any wet clothing and place a blanket over and under the patient. Remember to handle the patient gently.

6. Administer oxygen per local protocols (if you didn’t do this for step 2)

7. Monitor vital signs.

8. Do not give the patient anything to eat or drink.

frostbite

freezing of the skin and underlying tissues

Early/superficial: soft skin, soft tissue under skin, pale

Late/deep: hard skin, soft but becoming hard tissue, pale and waxy then blotchy then yellow-gray then blue-gray

frostbite care

1. BSI .

2. primary assessment ( Open airway and adequate breathing).

3. Remove the patient from the cold environment, protect from further cold

4. remove constrictive or wet clothes

5. EARLY injury

   • manually stabalize,

   • remove jewelry then cover with loose fitted gauze

   • don’t rub or re-expose area to cold

6. LATE injury

   • attempt removing jeweltry

   • cover w/ dry, sterile dressing. Dressing between fingers and toes too

   • don’t rub or break blisters

   • consider rewarming

   • don’t walk if affected legs

rewarming frostbite

DON’T do if there is a chance it could freeze again.

Early: warm with body heat (put hand in armpits)

Late: warm with external stuff (hand in warm water)

General reactions to bites or stings

• puncture marks

• Pain at/around the injury

• Redness and itching

• Weakness, dizziness

• Difficulty breathing

• Headache

• Nausea

• Altered mental status

Care for localized stings/bites (example: bee sting)

1. BSI and PPE

2. scene size up - scene safety

3. primary assessment (ABC’s) - ensure open airway + adequate breathing

4. scrape stingers/venom sacs in skin

5. Flush area w/ water

6. Place clean dressing over area

7. Monitor for signs of allergic reactions/anaphylaxis

recognizing anaphylaxis

• Breathing difficulty
• Skin reaction
• Swelling of tongue, mouth, or throat
• Sneezing, coughing
• Tightness in chest
• Blueness around lips and mouth
• Dizziness
• Nausea and vomiting
* altered mental status

Anaphylaxis care

1. BSI, PPE

2. Primary assessment (ABC’s. mental status) 

   • ensure open airway (most likely use epinephrine here - check w/ med direction)

   • check breathing (put on oxygen or BVM, if needed)

   • check circulation

3. secondary assessment (SAMPLE, OPQRST)

4. Reassess + monitor

snake bite signs

• puncture marks

• pain or swelling

• rapid pulse and labored breaths

• weakness

• vision problems

• nausea and vomiting

snake bite care

1. BSI and PPE

2. scene size-up, safety

3. primary assessment (ABC’s)

4. clean site w/ soap + water

5. remove and jewelry or items from affected extremity

6. it bite is on arm or leg, apply pressure bandage around entire length of limb

7. provide supplemental oxygen

8. care for shock

9. monitor vital signs

Jellyfish sting care

- pick off tentacles
- apply vinegar (4-6 percent acetic acid solution)
- immerse in hot water

water incedent care: no spin/neck injuries

1. mindful for neck/spine injuries (even if none)

2. Primary assessment

3. If needed, provide ventillations

4. provide CPR if no pulse + not breathing

5. if breathing + pulse, do secondary assessment

   • cover patient w/ blanket to keep warm first

6. take to warm place (if they can be moved)

7. care for shock

water incident care: with spin/neck injuries

• turn patient face up (if still in water)

• Primary assessment

  • jaw thrust maneuver to open airway

• If needed, provide ventillations.

• have another person support midline

• c-collar + backboard before removing patient from water

• once on land, provide CPR if no pulse + not breathing

• if breathing + pulse, do secondary assessment

  • cover patient w/ blanket to keep warm first

• take to warm place (if they can be moved)

• care for shock

Decompression sickness

small bubbles of nitrogen gas form in the blood and tissues when a diver ascends from a depth too quickly. These bubbles can form an air embolism that will obstruct blood flow wherever they form and cause severe pain and even death. Increased risk if you take airplane within 12 hours of diving

• joint aches

• seems drunk

• numb or paralyzed

• choking, coughs, labored breathing

• chest pain

• unresponsive

• blotches on skin

• fatigue

embolism signs

• convulsion

• chest pain

• personality changes

• frothy blood in mouth/nose

• numbness, tingling, or weakness in arms/legs

• blurred vision

scuba incident care

• put in recovery position (at a slight head down position)

• care for shock

• monitor patient constantly

ice incident care

• get to warm place

• remove wet clothing

• cover with blankets