Chapter 32: Environmental Emergencies

What are dysbarism injuries?

Injuries caused by scuba diving and high altitude

What are some factors that may cause a patient to be more likely go into hypo or hyperthermia?

Physical condition: People in bad physical condition or with chronic illnesses may have limited ability to regulate their body temp

Age: Children: Ability to shiver does not develop until they are 12-18 months old

• Older adults: Lose subcutaneous tissue as you age, reducing amount of insulation you have

Nutrition and hydration: Lack of healthy food or water will aggravate both hot and cold stress

Environmental: Cases occur at temps b/n 30 degrees F and 50 degrees F

What are the different types of ways heat loss can occur?

1. Conduction: Transfer of heat from body part to something cold

2. Convection: Heat is transferred to circulating air

3. Evaporation: Liquid to gas

4. Radiation: Invisible light that transfers heat

5. Respiration

When can a patient be diagnosed with hypothermia?

When their core temperature falls below 95 degrees F

What happens in the initial stage of hypothermia?

Constricts blood vessels in the skin

People create additional heat by shivering

Body functions slow down, mental status deteriorates, creating lethargy confusion and apathy

Clotting affects are slowed

What are the signs and symptoms of the three levels of hypothermia?

Mild: 89.8 → 95 degrees

• Patient is alert, shivering

• Pulse rate and respirations are rapid

Moderate: 82.5 → 89.7 degrees

• Shivering stops and muscular activity decreases

• Fine muscle activity is the first to go

Severe: < 82.4 degrees

• Muscles that control vasoconstriction fatigue and stop working

• Blood may rush from the body’s core to the extremities and cause patient to feel hot, which may cause them to remove their clothes

Profound: < 75.2 degrees

• Cardiorespiratory activity ceases, patient appears dead

What is the difference between frost bite and frost nip?

Frost nip can be warmed up, function is usually restored

Frost bite: Tissue is frozen and dies

What is immersion foot

Prolonged exposure to cold water

What should you do for a patient who is experiencing hypothermia?

Maintain patient in a supine position

Handle patient gently as they may go into ventricular fibrillation

Do not massage extremities

Do not allow them to eat or use any stimulants (coffee, tea, soda, or tobacco)

Begin passive rewarming slowly

What temperature should passive rewarming begin?

98.6 → 102 degrees F

What is hyperthermia?

Core temperatures reach 101 degrees or higher

What are heat cramps?

Painful muscle spasms that occur after vigorous exercise

Usually occur in leg or stomach

What is heat exhaustion?

Water and electrolytes lost through heavy sweating are so extensive that the fluids circulating through the vascular system become insufficient to meet the body’s demands

Resembles hypovolemic shock

What are the signs and symptoms of heat exhaustion?

• Dizziness, weakness, or syncope accompanied with nausea, vomiting, or headache

• Muscle cramping

• Onset while working vigorously in hot areas, in older or infant age

• Cold, clammy skin with ashen pallor

• Dry tongue and thirst

• Normal vital signs, pulse rapid and weak, diastolic bp may be low

What is heat stroke?

Body temp rises rapidly to the level at which tissues are destroyed

Absence of perspiration is an important

What saying should you use for trying to save a drowning victim?

Reach, throw, row, and only then go

What is the diving reflex?

Heart rate slowing may cause bradycardia