chapter 33: environmental hazards

why are infants more sensitive to temp related illness

poor thermoregulation + heat goes up/down faster (higher surface area to mass ratio)

why are older pts more sensitive to temp related illness

loss of subcutaneous tissue → reduce amnt of insulation + poor circulation

conduction

DIRECT CONTACT

convection

transfer of heat from CIRCULATING AIR

hypothermia

core temp <95F

hypothermia causes

key organs slow down + AMS

hypothermia RF

homeless ppl, homes w/o heating, swimmers, geriatrics /pediatrics/ill

hypothermia S/S

worsens as core temp falls

how to check general temp

back of hand on patient’s abdomen

mild hypothermia S/S

alert + shivering, red pale cyanotic, tachycardia/tachypnea

moderate hypothermia S/S

shivering stops, muscular activity dec

severe hypothermia S/S

lethargic + stops fighting

pt temp <80F S/S

slow/weak pulse, dysrhythmia, coma/dead

frostnip/immersion foot

skin freezes after exposure to cold/prolonged exposure to cold water

frostnip/immersion foot S/S

painless (can be numb), pale/blanched + cold, color doesn’t return w/ palpation

frostnip/immersion foot RF

hikers/hunters who stand in rivers/lakes

frostbite

most serious; tissues are frozen → freezing permanently damages cells from chemical damage

frostbite S/S

hard waxy feeling of affected tissues, blisters/swelling, red/white or purple/blue

frostbite treatment

surgical removal (amputation)

local cold injuries

frostnip, immersion foot, frostbite

local cold injury treatment

don’t allow walking, remove wet clothing, blankets under/on patient, DON’T MASSAGE EXTREMITIES, NO STIMULANTS (coffee, tea, soda, tobacco); risk of ventricular fibrillation

hyperthermia

high core temp 101F+

heat cramps

painful muscle spasms that occur after vigorous exercise (change in electrolyte balance + dehydration)

where do heat cramps usually occur

leg/abdominal muscles → can seem like acute abdominal condition

heat cramp S/S

sudden onset of abdominal cramps in hot env

heat cramps treatment

loosen tight clothing, high flow O2 if needed, rest cramping muscles (sit/lie down), fluids by mouth, cool patient w/ mist + fan

heat exhaustion (heat prostration/heat collapse)

result of loss of water + electrolytes from heavy sweating → hypovolemia; sweating w/o evaporation → no cooling + traps heat

heat exhaustion RF

heat exposure, stress, fatigue, standing in sun, several layers of clothing, high humidity, poorly ventilated areas (HOT + NO COOLING)

heat exhaustion S/S

dizziness/weakness/syncope, ALOC, n/v, muscle cramps, COLD CLAMMY SKIN, dry tongue/thirst, NORMAL VITALS, worsens during physical exertion + hot humid poor ventilated areas

heat exhaustion treatment

high flow O2 if needed, check blood glucose if AMS, mist/ice packs lie down, fluids by mouth, transport on left if nauseous

heatstroke

body is subjected to more heat than it can handle + normal mechanisms for heat removal is overwhelmed → tissue damage

heatstroke RF/onset

vigorous physical activity, poor ventilation, humid areas

heatstroke S/S

hot dry flushed skin, ALOC/CHANGE IN BEHAVIOR, tachycardic/bounding → weakens

heatstroke treatment

lower body temp (max AC in ambulance), remove clothing, high flow O2 if needed, ice bath/cold water immersion, fan patient, check glucose

diving reflex

slowing of heart rate caused by submersion in cold water

diving reflex S/S + what it leads to

immediate bradycardia → ALOC + drowning

descent emergencies

sudden inc in pressure as someone dives deeper

descent emergencies S/S

ear pain after returning to surface → rapid transport

descent emergency RF

ruptured eardrum (perforated tympanic membrane)

breath holding syncope

loss of consciousness caused by dec stimulus for breathing

breathing holding syncope RF

swimmers who breathe in/out rapidly + deeply before entering water

air embolism

bubbles of air in blood vessels when diver holds breath during rapid ascent; air pressure in lungs remains high when external pressure dec → air inside lungs expands → rupture alveoli

air embolism can lead to

air entering pneumothorax/mediastinum, air emboli

air embolism S/S

blotching (mottling of skin), froth at nose/mouth, muscle/joint/abd pain, dyspnea, dizziness, n/v, dysphasia, cough, cyanosis, vision issue, paralysis, dysrhythmia

decompression sickness (bends)

bubbles of gas (esp nitrogen) obstruct blood vessels

decompression sickness S/S

abd/joint pain → DOUBLES OVERS/BENDS, symptoms may be unseen for hoursd

ascent emergency treatment

supplemental O2 → hyperbaric chamber

dysbarism injuries

S/S caused by diff btwn surrounding atm pressure + total gas pressure in various tissues, fluids, cavities

altitutde illness

unacclimated person exposed to low O2 pressure in air at high altitudes (CNS/pulmonary system issues)

acute mountain sickness

diminished O2 air at 5000+ altitudes; ascending too high too fast/not acclimatized

acute mountain sickness S/S

headache, lightheadedness, fatigue, loss of appetite, nausea, difficulty sleeping, shortness of breath, physical exertion

high altitutde pulmonary edema (HAPE)

fluid collects in lungs → hypoxia

HADE S/S

shortness of breath, pink frothy sputum, cyanosis, rapid pulse

high altitude cerebral edema (HACE)

in climbers, accompanies HAPE

HACE S/S

severe constant throbbing headache, vomiting, ataxia, extreme fatigue, loss of consciousness

HAPE/HACE treatment

O2, descend from height, rapid transport, pos pressure ventilation w/ BVM

lightning

cardiovascular + nervous system most commonly injured → resp/cardiac arrest

mild lightning injury S/S

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

moderate lightning injury S/S

seizures, resp arrest, dysrhythmia, superficial

severe lightning injury S/S

cardiopulmonary arrest → death

lightning treatment

sheltered area, REVERSE TRIAGE (resp/cardiac arrest pts FIRST), stabilize spine + open airway, assist ventilations/AED, bleeding control + rapid transport