EMT Chapter 33 Environmental Emergencies

Air embolism

The presence of air in the veins, which can lead to cardiac arrest if it enters the heart.

Ambient temperature

The temperature of the surrounding environment.

Antivenin

A serum that counteracts the effect of venom from an animal or insect.

Bends

Common name for decompression sickness.

breath-holding syncope

Loss of consciousness caused by a decreased breathing stimulus.

Conduction

Transfer of heat from a part of the body to a colder object by direct contact; Heat can also be gained if the substance being touched is warm.

Convection

Transfer of heat to circulating air; When cool air moves across the body

Core temperature

The temperature of the central part of the body (eg, the heart, lungs, and vital organs).

decompression sickness

A painful condition seen in divers who ascend too quickly, in which gas, especially nitrogen, forms bubbles in blood vessels and other tissues; also called "the bends."

Diving reflex

Slowing of the heart rate caused by submersion in cold water.

Drowning

The process of experiencing respiratory impairment from submersion or immersion in liquid.

dysbarism injuries

Any signs and symptoms caused by the difference between the surrounding atmospheric pressure and the total gas pressure in various tissues, fluids, and cavities of the body.

Evaporation

Conversion of any liquid to a gas; Natural mechanism by which sweating cools the body

Frostbite

Damage to tissues as the result of exposure to cold; frozen or partially frozen body parts

Heat cramps

Painful muscle spasms usually associated with vigorous activity in a hot environment.

heat exhaustion

A heat emergency in which a significant amount of fluid and electrolyte loss occurs because of heavy sweating; also called heat prostration or heat collapse.

heat stroke

A life-threatening condition of severe hyperthermia caused by exposure to excessive natural or artificial heat - more than you can handles, marked by warm, dry skin; severely altered mental status; and often irreversible coma

Homestasis

A balance of all systems of the body.

Hymenoptera

A family of insects that includes bees, wasps, ants, and yellow jackets.

Hyperthermia

condition in which the body temperature rises to 101 degrees Fahrenheit

Hypothermia

A condition where the body core temperature falls below 95 degrees Fahrenheit

Radiation

The transfer of heat to colder objects in the environment by radiant energy; for example, heat gain from a fire; Heat loss caused when a person stands in a cold room

Respiration

The inhaling and exhaling of air and exchanges carbon dioxide from fresh air; Loss of body heat during normal breathing/ Warm air in the lungs is exhaled into the atmosphere and cooler air is inhaled; If air temperature is above body temperature, an individual can gain heat

reverse triage

A triage process used in treating multiple victims of a lightning strike, in which efforts are focused on those who are in respiratory and cardiac arrest. Reverse triage is different from conventional triage where such patients would be classified as deceased.

Scuba gear

A system that delivers air to the mouth and lungs at various atmospheric pressures, increasing with the depth of the dive; stands for self-contained underwater breathing apparatus.

Turgor

The ability of the skin to resist deformation; tested by gently pinching skin on the forehead or back of the hand.

Certain populations are at higher risk from environmental factors

Children, Older people, People with chronic illnesses, Young adults who overexert themselves

Conditions that can complicate environmental situations

Air temperature, Humidity level, Wind

The rate and amount of heat loss or gain by the body can be modified in three ways

Increase or decrease in heat production, Move to an area where heat loss can be decreased or increased, Wear the appropriate clothing for the environment

Below 95°F is a critical point

Hypothermia

Hypothermia Signs and symptoms

Body constricts vessels in skin, Shivering, Body functions begin to slow

core temperature is greater than 93.2°F (34°C) but less than 98°F (36.7°C)

Mild hypothermia

core temperature is 86°F to 93.2°F (30°C to 34°C)

Moderate hypothermia

core temperature is less than 86°F (30°C)

Severe hypothermia

If body temperature is 80°F or less

Pulse becomes slower and weaker; Cardiac dysrhythmias may occur; Patient may appear dead (or in a coma)

Main types of cold injuries

frostnip, immersion/trench foot, and frostbite

Frostnip

After prolonged exposure to the cold, skin may freeze while deeper tissues are unaffected

Immersion foot

prolonged exposure to cold water; common in hikers and hunters

Most serious local cold injury because the tissues are actually frozen and Permanently damages cells

Frostbite

With __, contact with a warm object may be all that is needed

frostnip

With __, remove wet shoes, boots, and socks, and rewarm the foot gradually

immersion foot

With __, do NOT apply heat or rewarm the part

a late or deep cold injury

Immerse the frostbitten part in water between

102°F and 104°F

Moderate or severe hypothermia interventions

Do NOT try to actively rewarm the patient

Mild hypothermia interventions

Apply heat packs or hot water bottles to the groin, axillary, and cervical regions; Give warm fluids by mouth

Palpate for a carotid pulse and wait for up to

60 seconds (to decide if the patient is pulseless)

Normal body temperature is

98.6 degrees

Hyperthermia is a core temperature of

101°F (38.3°C) (or higher)

Heat Cramps treatment

Remove patient from hot environment; Rest cramping muscle; Replace fluids by mouth

Treatment of Heat Exhaustion

Remove extra clothing and remove from hot environment

Treatment of Heat Stroke

Move patient out of the hot environment, remove clothing, provide A/C on high; Apply cold packs to the patient’s neck, armpits, and groin, and cover the patient with wet towels or sheets

Exposure to __ occurs on a daily basis

non-ionized radiation

Long-term exposure to ___ is one of the main risk factors of skin cancer

UV light

Laryngospasm

Inhaling water causes the muscles of the larynx and vocal cords to spasm.

The diving reflex may cause immediate

bradycardia

Assume spinal injury if

Submersion resulted from a diving mishap or fall, The patient is unconscious, The patient complains of weakness, paralysis, or numbness

Barotrauma “the squeeze”

the sudden increase in pressure as the person dives deeper into the water

Descent Emergencies

The pain forces the diver to return to the surface to equalize the pressures, and the problem clears up by itself

Ascent Emergencies

Most common and most severe; Air embolism and decompression sickness are serious problems

Air embolism generally occurs _ on return to the surface

immediately

Symptoms of decompression sickness may not occur for

several hours

Recompression in a hyperbaric chamber for

Ascent and Descent Emergencies

_ is the fifth most common cause of death from isolated environmental phenomena

Lightning

The cardiovascular and nervous systems are most commonly injured

Lightning

Mild Lightning

Loss of consciousness, amnesia, confusion, tingling, superficial burns

Moderate Lightning

Seizures, respiratory arrest, dysrhythmias, superficial burns

Severe Lightning

Cardiopulmonary arrest

Only the _ deliver serious or life-threatening bites

female black widow spider and the brown recluse spider

Black Widow Spider

Usually black with a distinctive, bright red-orange marking in the shape of an hourglass on its abdomen

Brown Recluse Spider

Dull brown in color and 1 inch long; Violin-shaped mark on its back

Brown Recluse Spider venom is

cytotoxic

Hymenoptera Stings

Bees, wasps, yellow jackets, ants

Of the approximately 115 different species of snakes in the United States, only

19 are venomous

Pit Vipers

Rattlesnakes, copperheads, and cottonmouths; with triangular-shaped/ flat heads

Rattlesnakes

Most common form of pit viper; Many patterns of color, diamond pattern; Can grow to 6 feet or longer

Copperheads

Usually 2 to 3 feet long - Red-copper color crossed with brown and red bands; Their bites are almost never fatal, but the venom can cause significant damage to extremities

Cottonmouths

Olive or brown with black cross-bands and a yellow undersurface; Water snakes with aggressive behavior; Tissue destruction may be severe

Coral Snakes

Small reptile with a series of bright red, yellow, and black bands completely encircling the body; Injects the venom with its teeth and tiny fangs by a chewing motion, leaving puncture wounds - paralysis of the nervous system

Within a few hours of being bitten, a patient will exhibit bizarre behavior, followed by progressive paralysis of eye movements and respiration

Coral Snakes

If the bite occurred on the trunk

keep the patient supine and quiet, and transport as quickly as possible

Scorpions

eight-legged arachnids with a venom gland and a stinger at the end of their tail

The exception of venomous scorpians are

Centruroides sculpturatus - Circulatory collapse, Severe muscle contractions, Excessive salivation, Hypertension, Convulsions and cardiac failure

Ticks commonly carry

Rocky Mountain spotted fever or Lyme disease

May be confused with rheumatoid arthritis

Lyme disease

Rocky mountain spotted fever

Cardiorespiratory collapse/ Paralysis; Occurs within 7 to 10 days after the bite

When a person is exposed to cold temperatures and strong winds for an extended period of time, he or she will lose heat mostly by

convection

Shivering in the presence of hypothermia indicates that the

body is trying to generate more heat through muscular activity

All of the following are examples of passive rewarming techniques, EXCEPT

administering warm fluids by mouth

A woman has frostbite in both feet after walking several miles in a frozen field. Her feet are white, hard, and cold to the touch. Treatment at the scene should include

removing her wet clothing and covering her feet with dry, sterile dressings

A 30-year-old male, who has been playing softball all day in a hot environment, complains of weakness and nausea shortly after experiencing a syncopal episode. Appropriate treatment for this patient includes all of the following, EXCEPT

giving a salt-containing solution by mouth

You are assessing a 27-year-old woman with a heat-related emergency. Her skin is flushed, hot, and moist, and her level of consciousness is decreased. After moving her to a cool environment, managing her airway, and administering oxygen, you should

cover her with wet sheets and fan her

It is important to remove a drowning victim from the water before laryngospasm relaxes because

less water will have entered the patient’s lungs

A 13-year-old girl is found floating face down in a swimming pool. Witnesses tell you that the girl had been practicing diving. After you and your partner safely enter the water, you should

rotate the entire upper half of her body as a unit, supporting her head and neck

Shortly after ascending rapidly to the surface of the water while holding his breath, a 29-year-old diver begins coughing up pink, frothy sputum and complains of dyspnea and chest pain. You should suspect and treat this patient for

an air embolism

Three ambulances respond to a golf course where a group of six golfers were struck by lighting. Two of the golfers are conscious and alert with superficial skin burns (Group 1). The next two golfers have minor fractures and appear confused (Group 2). The last two golfers are in cardiac arrest (Group 3). According to reverse triage, which group of golfers should be treated FIRST?

Group 3

An air embolism associated with diving occurs when

the diver holds his or her breath during a rapid ascent

Compared to adults, infants and children are higher as risk for hypothermia for all of the following reasons (a decreased ability to shiver/ a smaller overall muscle mass/ a smaller amount of body fat) EXCEPT

a relatively small surface area

The EMT must assume that any unwitnessed water-related incident is accompanied by

possible spinal injury

In contrast to Lyme disease, Rocky Mountain spotter fever

can cause paralysis and cardiorespiratory collapse

Burns associated with lightning strikes are typically

superficial