Chapter 33: Environmental Emergencies

Introduction

• Medical emergencies can result from environmental factors.

• Certain populations are at higher risk:

  • Children

  • Older people

  • People with chronic illnesses

  • Young adults who overexert themselves

• Environmental emergencies include:

  • Heat- and cold-related emergencies

  • Water emergencies

  • Pressure-related injuries

  • Injuries caused by lightning

  • Envenomation

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Factors Affecting Exposure

• Physical condition

  • Patients who are —- or in poor —- condition will not tolerate extreme temperatures well.

• Age

  • —, —, and — are more likely to experience temperature-related illness.

• Nutrition and hydration

  • A lack of — or — will aggravate hot or cold stress.

  • — will change the body’s ability to regulate temperature.

• Environmental conditions

  • Conditions that can complicate environmental situations:

    • Air —

    • — level

    • —

  • Extremes in temperature and humidity are not needed to produce injuries.

ill, physical

infants, children, elderly

food water, alcohol

temperature humidity wind

Cold Exposure

• Cold exposure may cause injury to:

  • Feet

  • Hands

  • Ears

  • Nose

  • Whole body (hypothermia)

• There are five ways the body can lose heat.

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Cold Exposure

• There are five ways the body can lose heat.

• Conduction

  • Transfer of heat from a part of the body to a colder object by — —

  • Heat can also be gained if the substance being touched is warm.

• Convection

  • Transfer of heat to — —

  • When cool air moves across the body

• Evaporation

  • Conversion of any — to a —

  • Natural mechanism by which — cools the body

• Radiation

  • Transfer of heat by — —

  • Heat loss caused when a person stands in a cold room or in the hot sun

• Respiration

  • Body heat loss as warm air in the lungs is exhaled into the atmosphere and —— air is inhaled.

direct contact

circulating air

liquid gas , sweating

radiant energy

cooler

Cold Exposure

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

  1. Increase or decrease in heat —-

  2. Move to an — where heat loss can be decreased or increased.

  3. Wear the appropriate —- for the environment.

production, area, clothing

Hypothermia

• Core temperature falls below —-°F (—°C)

• Body loses the ability to — its temperature and —- body heat.

• Eventually, key organs such as the heart begin to — —, and mental status —.

• Can lead to death 

• Air temperature does not have to be below freezing for it to occur.

  • Can develop quickly or gradually

• People at risk:

  • Homeless people and those whose homes lack heating

  • Swimmers

  • Geriatric, pediatric, and ill individuals

• Signs and symptoms become more severe as the core temperature —.

• Progresses through four stages

• Assess general temperature.

  • Pull back your gloves and place the back of your hand on the patient’s —-.

95, 35, regulate generate, slow down, deteriorates , decreases abdomen 

Hypothermia

• Mild hypothermia

  • Occurs when the core temperature is greater than —-°F (34°C) but less than —-°F (36.7°C).

  • Patient is usually alert and —-.

  • Pulse rate and respirations are —-.

  • Skin may appear red, pale, or cyanotic.

• Moderate hypothermia exists when the core temperature is —°F to —-°F (30°C to 34°C).

  • Shivering —-.

  • Muscular activity —-.

• Severe hypothermia occurs when the core temperature is less than —-°F (30°C).

  • The patient becomes —- and stops —-.

• If body temperature is 80°F or less 

  • Pulse becomes — and —.

  • Cardiac — may occur.

  • Patient may appear — (or in a coma).

• Never assume a cold, pulseless patient is dead.

93.2, 98, shivering rapid

86, 93.2, stops, decreases 

86, lethargic, fighting 

slower weaker, dysrhythmias, dead 

Local Cold Injuries

• Most injuries from cold are confined to — parts of the body.

  • Frostnip

  • Immersion foot (trench foot)

  • Frostbite 

• Important factors in determining the severity of a local cold injury

  • — of the exposure

  • — to which the body part was exposed

  • — — during exposure

• Consider underlying factors.

  • Exposure to wet conditions

  • Inadequate insulation from cold or wind

  • Restricted circulation from tight clothing or shoes or circulatory disease

  • Fatigue

  • Poor nutrition

  • Alcohol or drug abuse

  • Hypothermia

  • Diabetes

  • Cardiovascular disease

  • Age

exposed, duration, temperature, wind velocity

Frostnip and Immersion Foot

• Frostnip

  • After prolonged exposure to the cold, skin may —- while deeper tissues are —-.

  • Usually affects the —, —, and —

  • Usually —- painful, so the patient often is unaware that a cold injury has occurred.

• Immersion foot

  • Occurs after prolonged exposure to —- —-

  • Common in hikers and hunters

• Signs and symptoms 

  • —, —- skin

  • Normal color does not — after palpation of the skin.

  • The skin of the foot may be —-.

  • Loss of —- and — in the injured area

freeze, unaffected, ear nose fingers, not 

cold water

pale cool , return, wrinkled, feeling sensation 

Frostbite

• Most — local cold injury because the tissues are actually frozen.

• Gangrene requires —- removal of dead tissue.

• Signs and symptoms

  • Hard, waxy feel of the affected tissues

  • The injured part feels —-.

  • — and — may be present.

• The depth of skin damage will vary.

  • With superficial frostbite, only the —- is frozen.

  • With deep frostbite, —- —- are frozen.

  • You may not be able to tell superficial from deep frostbite in the field.

serious, surgical

firm, blisters swelling

skin, deeper tissues

COLD EXPOSURE ASSESSMENT

Scene Size-up

• Scene safety

  • Note the environmental conditions.

  • Ensure that the scene is safe for you and other responders.

  • Identify safety hazards such as icy roads, mud, or wet grass.

  • Use appropriate standard precautions.

  • Consider the number of patients.

  • Summon additional help as quickly as possible.

• Mechanism of injury/nature of illness

  • Look for indicators of the MOI.

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Primary Assessment

• Form a general impression.

  • Perform a rapid scan.

  • If a life threat exists, treat it.

  • Check core temperature.

  • Evaluate mental status using the AVPU scale.

  • An altered mental status can be affected by the intensity of the cold injury.

• If the patient is in cardiac arrest, begin compressions.

• Airway and breathing

  • Ensure that the patient has an adequate airway and is breathing.

  • —, — oxygen helps warm the patient from the inside out.

• Circulation 

  • Palpate for a —- pulse and wait for up to —- — to decide if the patient is pulseless.

  • The AHA recommends that CPR be started on a patient who has no detectable pulse or breathing.

  • — will be compromised.

  • Bleeding may be difficult to find.

• Transport decision

  • Complications can include cardiac dysrhythmias and blood clotting abnormalities.

  • All patients with hypothermia require immediate transport.

  • Rough handling of a hypothermic patient may cause a cold, slow, weak heart to ——.

warmed humidified, carotid, 60 seconds, perfusion, fibrillate

Secondary Assessment

• Physical examinations

  • Focus on the —- of hypothermia.

  • Assess the areas of the body directly affected by cold exposure.

  • Assess the degree and extent of damage.

• Vital signs

  • May be altered by the effects of hypothermia and can be an indicator of its severity

  • Respirations may be — and —.

  • — blood pressure and a — pulse indicate moderate to severe hypothermia.

  • Evaluate for changes in mental status.

• Monitoring devices

  • Determine a core body temperature using a hypothermia thermometer.

  • Pulse oximetry will often be —-.

severity, slow shallow , low slow , inaccurate

Reassessment

• Repeat the primary assessment.

• Reassess vital signs and the chief complaint.

• Monitor the patient’s level of consciousness and vital signs.

• Rewarming can lead to cardiac ——.

• Communicate all of the information you have gathered to the receiving facility.

  • Patient’s physical status

  • Conditions at the scene

  • Any changes in the patient’s mental status during treatment and transport

dysrhythmias

General Management of Cold Emergencies

• Move the patient from the cold environment.

• Remove any —- clothing.

• Place dry — over and under the patient.

• If available, give the patient —, humidified oxygen.

• Handle the patient —-.

• Do NOT massage the extremities.

• Do NOT allow the patient to —- or use any stimulants.

• Mild hypothermia

  • Patient is alert, shivering, and responds appropriately.

  • Place the patient in a warm environment, and remove wet clothing.

  • Apply heat packs or hot water bottles to the groin, axillary, and cervical regions.

  • Give warm fluids by mouth.

• Moderate or severe hypothermia

  • Do not try to —— rewarm the patient.

  • The goal is to prevent — heat loss.

  • Remove the patient from the cold environment.

  • Remove wet clothing, cover with a blanket, and transport.

wet, blankets, warm, gently, eat

actively, further

Emergency Care of Local Cold Injuries

• Remove the patient from further exposure to the cold.

• Handle the injured part gently and protect it from further injury.

• Remove any wet or restricting clothing over the injured part.

• If transport will be delayed, consider active rewarming.

  • With frostnip, —- with a warm object may be all that is needed.

  • With immersion foot, —- wet shoes, boots, and socks, and rewarm the foot —-.

  • With a late or deep cold injury, do —- apply heat or rewarm the part.

  • Never —- or — injured tissues.

• Rewarming in the field

  • Immerse the frostbitten part in water between —-°F and —-°F.

  • Dress the area with dry, sterile dressings.

  • If blisters have formed, do not break them.

  • Never attempt rewarming if there is any chance that the part may — again. 

contact, remove, gradually, not, rub massage

102-104, freeze

Cold Exposure and You

• You are at risk for hypothermia if you work in a cold environment.

• If cold weather search-and-rescue is possible in your area, you need:

  • Survival training

  • Precautionary tips

• Wear appropriate clothing

  • DRESS IN ——

layers

Heat Exposure

• In a hot environment, the body tries to rid itself of excess heat.

  • — and — of skin blood vessels

  • Removal of clothing and relocation to a cooler environment

• Hyperthermia is a core temperature of —-°F (38.3°C) or higher.

• Risk factors of heat illness:

  • High air —- (reduces —-)

  • High humidity (reduces evaporation)

  • Lack of acclimation to the heat

  • Vigorous —- (loss of — and —)

• Persons at greatest risk for heat illnesses are:

  • Children (especially newborns and infants)

  • Geriatric patients

  • Patients with heart disease, COPD, diabetes, dehydration, and obesity

  • Patients with limited mobility

sweating, dilation, 101

temperature radiation, humidity evaporation, exercise fluid electrolytes 

Heat Cramps

• Painful — — that occur after vigorous —

• Do not occur only when it is hot outdoors

• Exact cause is not well understood.

• Usually occur in the leg or abdominal muscles

muscle spasms, exercise,

Heat Exhaustion

• Most —- illness caused by heat

• Causes:

  • — as the result of the loss of water and electrolytes

  • High —-

  • Exertion in poorly —- areas

• Signs and symptoms

  • Dizziness, weakness, or —

  • Nausea, vomiting, or headache

  • —, — skin with — pallor

  • Dry tongue and —

  • — vital signs

  • — or slightly elevated body temperature

common, hypovolemia, humidity, ventilated

syncope, cold clammy, ashen, thirst normal normal

Heatstroke

• Least common but most — illness caused by heat exposure

• Occurs when the body is subjected to —- heat than it can —-, and normal mechanisms are —-.

• Untreated heatstroke always results in —-.

  • Will stop —-

• Typical onset situations

  • During vigorous —- activity 

  • Outdoors or in a closed, poorly —-, —- space

  • During heat —- without sufficient air conditioning or poor ventilation

  • Children left unattended in a locked —- on a hot day

• Signs and symptoms

  • —, —-, —- skin

  • Quickly — body temperature

  • Change in behavior

  • — and —

  • —, — pulse

  • — respiratory rate

  • — of perspiring

serious, more handle, overwhelmed , death , sweating

physical , ventilated humid, waves, car

hot dry flushed, rising, unresponsiveness seizures rapid weak, increased, cessation 

HEAT EXPOSURE ASSESSMENT

Scene Size-up

• Scene safety

  • Perform an environmental assessment.

  • The heat emergency may be secondary to a medical or trauma emergency.

  • Consider calling ALS.

  • Look for indicators of MOI.

  • Stay hydrated.

  • Use appropriate standard precautions, including gloves and eye protection.

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Primary Assessment

• Form a general impression.

  • Observe how the patient interacts with you and the environment.

  • Introduce yourself and ask about the chief complaint.

  • Perform a rapid scan, and avoid tunnel vision.

  • Assess mental status using AVPU.

• Airway and breathing

  • Unless the patient is unresponsive, the airway should be patent.

  • Nausea and vomiting may occur.

  • Position the patient to protect the airway.

  • Consider spinal immobilization.

  • If unresponsive, insert an airway and provide bag-mask ventilations.

• Circulation

  • If adequate, assess for perfusion and bleeding.

  • Assess the patient’s skin condition.

  • Treat for shock.

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History Taking

• Investigate the chief complaint.

  • Be alert for injury-specific signs and symptoms. 

    • Absence of —-

    • — level of consciousness

    • Confusion

    • Muscle —

    • Nausea

    • Vomiting

• SAMPLE History

  • Note any activities, conditions, or medications.

    • Inadequate oral intake

    • Diuretics

    • Medications

  • Determine exposure to heat and humidity and activities prior to onset.

perspiration, decreased, cramping

Secondary Assessment

• Physical examinations

  • Assess the patient for muscle cramps or confusion.

  • Examine the patient’s mental status and vital signs.

  • Pay special attention to skin —, —, and level of —. 

  • Perform a careful — examination.

• Vital signs

  • Patients who are hyperthermic will be —- and —-.

  • Falling blood pressure indicates that the patient is going into —-.

  • In heat exhaustion, the skin temperature may be — or —- and —-.

  • In heatstroke, the skin is —-.

temperature, turgor, moisture , neurologic, tachycardic tachypneic, shock, normal, cool clammy, hot

Reassessment

• Watch for deterioration.

• Patients with symptoms of heatstroke should be transported immediately.

• Monitor vital signs at least every 5 minutes.

• Evaluate the effectiveness of interventions. 

• Be careful not to —- a patient. 

• Communication and documentation

  • Inform the staff at the receiving facility early on that your patient is experiencing heatstroke.

  • Additional resources may be required.

  • Document environmental conditions and the activities the patient was performing prior to onset.

overcool

Management of Heat Emergencies

• Heat cramps

  • Remove the patient from the hot environment and loosen clothing.

  • Administer high-flow oxygen if indicated.

  • — the cramping muscles. 

  • Replace — by mouth.

  • — the patient with water spray or mist.

• Heatstroke

  • Move the patient out of the hot environment and into the ambulance.

  • Set air conditioning to maximum cooling.

  • Remove the patient’s clothing.

  • Administer high-flow oxygen if indicated.

  • Assist ventilations as needed.

  • Cover the patient with —- towels or sheets.

  • Aggressively fan the patient.

  • Exclude —- —- of altered mental status.

  • Check blood —- level if possible.

  • Transport immediately to the hospital.

  • Notify the hospital.

  • Call for ALS if the patient begins to —-. 

rest, fluids, cool 

wet, other causes, glucose, shiver 

Drowning

• Process of experiencing respiratory —- from submersion or immersion in —-

• Some agencies may still use the term “— —-” to refer to a patient who survives at least 24 hours after suffocation in water.

• Risk factors

  • — consumption

  • Preexisting — disorders

  • Geriatric patients with cardiovascular disease

  • Unsupervised access to water

• Laryngospasm

  • — water causes the muscles of the larynx and vocal cords to —-.

impairment, liquid, near drowning, alcohol, seizure

inhaling, spasm

Spinal Injuries in Submersion Incidents

• Submersion incidents may be complicated by spinal —- and spinal —- injuries.

• Assume spinal injury if:

  • Submersion resulted from a —- mishap or —-

  • The patient is —-.

  • The patient complains of weakness, paralysis, or numbness.

• Most spinal injuries in diving incidents affect the —- spine.

• Stabilize the suspected injury while the patient is still in the —-.

• Safety

• Water rescues are usually handled by specialized rescue personnel.

• “Reach, throw, and row, and only then go.”

fractures, cord, diving , fall, unconscious, cervical, water

Recovery Techniques

• If the patient is not floating or visible in the water, an organized rescue effort is necessary.

• Specialized personnel are required, with snorkel, mask, and scuba gear.

 

Resuscitation Efforts

• Never give up on resuscitating a —- water drowning victim.

  • — can protect vital organs from the lack of oxygen.

• The diving reflex may cause immediate ——.

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

cold, hypothermia

bradycardia, heart rate

Descent Emergencies

• Caused by the sudden increase in —- as the person dives deeper into the water

• Typical areas affected

  • —

  • Sinus cavities

  • — —

  • Teeth

  • Face

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

• Perforated tympanic membrane

  • Increased pressure during descent can rupture the tympanic membrane of the ear 

  • Cold water may enter the — — through a ruptured eardrum (ruptures inwards from the outside pressure)

  • The diver may lose his or her —-, shoot to the surface, and run into —- problems.

pressure, lungs, middle ear, middle ear, balance, ascent 

Emergencies at the Bottom

• Rarely occur

• Caused by faulty connections in the diving —-

  • Inadequate mixing of oxygen and carbon dioxide in the air the diver breathes

  • Accidental feeding of poisonous carbon monoxide into the breathing apparatus

• Can cause —- or rapid —-

gear, drowning ascent

Ascent Emergencies

• Usually requires aggressive —-

• The Bends = Decompression Sickness = causes air embolism

• Air embolism (The Bends/Decompression Sickness)

  • Most —- and most — scuba diving emergency

  • Bubbles of —- in the —- —-

  • Air pressure in the lungs remains at a high level while pressure on the chest ——.

resuscitation, dangerous common, air, blood vessels, decreases

Ascent Emergencies

Decompression sickness/The Bends 

• Bubbles of gas, especially —-, obstruct the — —- (air embolism!)

• Conditions that can cause the bends:

  • Too —- an ascent from a dive

  • Too —- of a dive at too —- of a depth

  • — dives within a —- period

• Complications

  • — of tiny blood vessels

  • Depriving parts of the body of their normal — supply

  • Severe —- in certain tissues or spaces

• Signs and symptoms

  • — and —- pain so severe that the patient doubles up

nitrogen, blood vessels, rapid, long deep, repeated short

blockage, blood, pain

abdominal joint

Ascent Emergencies

• You may find it difficult to distinguish between air embolism and decompression sickness/The Bends, but both fall under Decompression Illness 

  • Air embolism generally occurs —— on return to the surface and is defined by “air bubble entering arterial circulation”

  • Symptoms of decompression sickness may not occur for several —— and are defined by “bubbles forming from dissolved gases in tissues”

• Treatment is the same for both.

  • Basic life support (BLS)

  • Recompression in a —- chamber

immediately, hours, hyperbaric

WATER-BASED INJURY ASSESSMENT

Scene Size-up

• Scene safety

  • Gloves and eye protection

  • Never drive through moving water; be cautious driving through still water.

  • Never attempt a water rescue without proper training and equipment.

  • Consider trauma and spinal immobilization.

  • Check for additional patients. 

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Primary Assessment

• Form a general impression.

  • Pay attention to chest pain, dyspnea, and complaints of sensory changes.

  • Determine level of consciousness using the AVPU scale.

  • Be suspicious of drug or alcohol use.

• Airway and breathing

  • Open the airway and assess breathing in unresponsive patients.

  • Consider spinal trauma and take appropriate actions.

  • Suction if the patient has vomited.

  • Provide ventilations with a bag-mask for inadequate breathing. 

  • If the patient is responsive, provide high-flow oxygen with a nonrebreathing mask.

  • Auscultate and monitor breath sounds.

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Primary Assessment

• Circulation

  • It may be difficult to find a pulse.

  • Begin CPR, and apply your AED.

  • Evaluate for shock and perfusion.

  • If the MOI suggests trauma, assess for bleeding and treat appropriately.

• Transport decision

  • Always transport near-drowning patients to the hospital.

  • Inhalation of any amount of fluid can lead to delayed complications.

  • Decompression sickness and air embolism must be treated in a —— chamber.

recompression

History Taking

• Investigate the chief complaint.

  • Obtain a medical history.

  • Be alert for injury-specific signs and symptoms.

• SAMPLE history

  • Determine the —- of the dive

  • —- of time the patient was underwater

  • Time of —— of symptoms

  • Previous —- activity.

depth, length, onset, diving

Secondary Assessment

• Physical examinations

  • Examine lungs and breath sounds.

  • Look for hidden life threats and trauma, indications of — —- or —- —, and signs of —-. 

  • Complete a detailed full-body scan en route to the hospital.

• Assess for:

  • Peripheral pulses

  • Skin color and discoloration

  • Itching

  • Pain

  • Paresthesia (numbness and tingling)

• Vital signs

  • Check pulse rate, quality, and rhythm.

  • Check respiratory rate, quality, and rhythm, and listen for lung sounds.

  • Assess pupil size and reactivity.

• Monitoring devices

  • Oxygen saturation readings may be inaccurate.

the bends, air embolism, hypothermia 

Reassessment

• Repeat the primary assessment.

  • Drowning patients may deteriorate rapidly due to:

    • — injury

    • — shifts in the body

    • Cerebral —

    • —

  • —, — —, or — — patients may decompensate quickly. 

• Document

  • Circumstances of drowning and extrication

  • Time submerged

  • Temperature and clarity of the water

  • Possible spinal injury

  • Bring all dive equipment to the hospital, including dive log or dive computer 

pulmonary, fluids, hypoxia, hypothermia

pneumothorax, air embolism, decompression sickness

Emergency Care for Drowning or Diving Emergencies

• Immobilize and protect the patient’s —- if a fall or diving injury is possible.

• If the patient is not breathing:

  • Assist ventilations with a bag-mask device or pocket mask.

  • Provide chest compressions and use the AED if indicated.

  • Treat for —-. 

• For air embolism or decompression sickness in a conscious patient:

  • Remove the patient from the water.

  • Try to keep the patient calm.

  • Administer —-

    • Done to change the pp of —- in lungs so that it will diffuse out faster

  • Consider the possibility of —-, and monitor breath sounds.

  • Provide prompt transport to a place with —- chamber

    • Can be flown in a helicopter, CANNOT be flown in an ——

spine, hypothermia, oxygen, nitrogen, pneumothorax, hyperbaric, airplane

Other Water Hazards

• Pay close attention to the body —- of a person who is rescued from cold water.

• Breath-holding syncope

  • A person swimming in shallow water may experience a loss of consciousness caused by a — —- for breathing.

  • Treatment is the same as a drowning patient.

temperature, decreased stimulus

Prevention of Immersion Incidents

• Appropriate precautions can prevent most immersion incidents.

  • All pools should be surrounded by a fence.

  • The most common problem in child drownings is lack of adult supervision.

  • Half of all teenage and adult drownings are associated with the use of alcohol.

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High Altitude

• Dysbarism injuries

  • Caused by the difference between the surrounding —- pressure and the —- —- pressure in the body

• Altitude illness

  • Caused by diminished —- in the air at high altitudes

  • Affects the —- and —- system

atmospheric, total gas 

oxygen, CNS, pulmonary 

High Altitude

• Acute mountain sickness

  • Diminished —- in the air at higher altitudes

  • Caused by ascending too —-, too —- or not being acclimatized to high altitudes

  • Signs and symptoms

    • Headache

    • —

    • Fatigue

    • Loss of appetite

    • Nausea

    • Difficulty sleeping

    • — of breath during physical exertion

    • — face

oxygen, high, fast, light-headedness, shortness, swollen

High Altitude

• High-altitude pulmonary edema (HAPE)

  • — collects in the —, hindering the passage of — into the bloodstream.

  • Signs and symptoms

    • — of breath

    • Cough with — —

    • —

    • — pulse

• High-altitude cerebral edema (HACE)

  • May accompany —- and can quickly become life threatening

  • Signs and symptoms

    • Severe, constant, throbbing —

    • —

    • Extreme —

    • Vomiting

    • Loss of —

fluid, lungs, oxygen, shortness, pink sputum, cyanosis rapid

HAPE, headache, ataxia, fatigue, consciousness

High Altitude

• Treatment of HAPE and/or HACE

  • Provide —-.

  • — from the height. 

  • Transport promptly.

  • Provide — — ventilation with a —- for inadequate respirations. 

  • Consider —- for pulmonary edema

oxygen, descend, positive pressure, BVM, CPAP

Lightning

• Lightning is the fifth most common cause of death from isolated environmental phenomena.

• Targets of direct lightning strikes:

  • People engaged in outdoor activities

  • Anyone in a large, open area

• Many individuals are indirectly struck when standing —- an object that has been struck by lightning, such as a tree.

• The —- and —- systems are most commonly injured.

  • — or — — is the most common cause of lightning-related deaths.

• Categories of lightning injuries

  • Mild

    • Loss of —, amnesia, confusion, tingling, — burns

  • Moderate

    • Seizures, — —, —, — burns

  • Severe

    • — —

near, cardiovascular nervous, respiratory cardiac arrest

consciousness, superficial

respiratory arrest, dysrhythmias, superficial 

cardiopulmonary arrest 

Lightning

• Emergency medical care

  • Protect —.

  • Move the patient to a — area.

  • Use —- triage

    • Tend to patients with severe lightning injuries as the cardiopulmonary arrest induced is usually reversible 

  • Treatment

    • Stabilize the spine, and open the airway.

    • Assist ventilations or use an AED.

    • Control bleeding and transport.

yourself, sheltered, reverse 

Spider Bites

• Spiders are numerous and widespread in the United States.

  • Many species of spiders bite.

  • Only the female —- —- spider and the —- —- spider deliver serious or life-threatening bites

black widow, brown recluse

Black Widow Spider

• The female is fairly large, measuring approximately 2 inches across.

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

• Found in every state except Alaska

• Prefer dry, dim places

• The bite is sometimes overlooked.

  • Most bites cause localized pain and symptoms, including agonizing —- —-.

  • The main danger is the —-, which is poisonous to — tissues.

hourglass, muscle spasms , venom, nerve

Black Widow Spider

• Other systemic symptoms include:

  • Dizziness

  • Sweating

  • Nausea

  • Vomiting

  • Rashes

  • Tightness in the chest

  • Severe cramps

• Generally, these symptoms subside over —- —-.

• Emergency treatment consists of BLS for the patient in —- —-.

• Transport as soon as possible.

48 hours, respiratory distress

Brown Recluse Spider

• Dull brown in color and 1 inch long

• —-shaped mark on its back

• Lives mostly in the southern and central parts of the country

• Tends to live in dark areas

• The venom is —-.

  • Toxin that breaks down —-

  • It causes severe —- —- damage.

  • Typically, the bite is not painful at first but becomes so within hours.

  • The area becomes —- and tender, developing a pale, —-, —- center.

violin, cytotoxic, cells local tissue, swollen, mottled cyanotic 

Hymenoptera Stings

• Bees, wasps, yellow jackets, ants = Hymenoptera

• Stings are painful but are not a medical emergency.

  • Remove the stinger and venom sac using a firm-edged item such as a credit card to —- the stinger and sac off the skin.

  • — may occur if the patient is allergic to the venom.

scrape, anaphylaxis

Snakebites

• Of the approximately 115 different species of snakes in the United States, only 19 are venomous.

  • Rattlesnake, copperhead, cottonmouth or water moccasin, and coral snakes

• Snakes usually do not bite unless provoked, angered, or accidentally injured.

• Protect —— from getting bitten.

  • Use extreme caution and wear proper PPE.

• The classic appearance of the poisonous snakebite is two small puncture wounds, with discoloration, swelling, and pain.

yourself

Pit Vipers

• Rattlesnakes, copperheads, and cottonmouths are all pit vipers, with —--shaped, —- heads.

  • Named for small pits located just behind each nostril and in front of each eye

• Rattlesnakes

  • Most —- form of pit viper

  • Many patterns of color, — pattern

  • Can grow to 6 feet or longer

• Copperheads

  • Usually 2 to 3 feet long

  • — — color crossed with — and — bands

  • Their bites are almost never fatal, but the venom can cause significant damage to —-.

• Cottonmouths

  • — or — with — cross-bands and a — undersurface

  • — snakes with —- behavior

  • Tissue destruction may be —-.

triangular, flat

common, diamond

red copper, brown red , extremities

olive brown, black, yellow , water, aggressive, severe

Pit Vipers

• Signs of envenomation

  • Severe burning pain at the site of injury

  • — and blue —

  • Weakness

  • Nausea and vomiting

  • Sweating

  • Seizures

  • Fainting

  • Vision problems

  • Changes in level of consciousness

  • Shock

• If swelling has occurred, —- its edges on the skin.

swelling, discoloration, mark

Pit Vipers

• Treatment

  • Calm the patient, and place in a —- position.

  • Locate the bite area and —- it gently with soap and water.

  • Be alert for an —- reaction and treat with an epinephrine auto-injector as appropriate.

  • Do not give anything by —- and be alert for —-.

• If the bite occurred on the trunk, keep the patient supine and quiet, and transport as quickly as possible.

• If there are any signs of shock, treat for it.

• If the snake has been killed, —- it with you.

• Notify the hospital that you are bringing in a patient with a snakebite.

• Transport promptly.

supine, clean, anaphylactic, mouth, vomiting 

bring

Coral Snakes

• Small reptile with a series of bright —, —, and — bands completely encircling the body

  • Red - black - yellow = not poisonous

  • Red - yellow = poisonous

• Lives in most southern states

• Injects the venom with its teeth and tiny fangs by a chewing motion, leaving puncture wounds

• Coral snake venom is a powerful toxin that causes —- of the —- system.

  • Within a few hours of being bitten, a patient will exhibit —- behavior, followed by progressive —- of — movements and —-.

  • Antivenin is available, but most hospitals do not stock it.

• Emergency care is the same as for a pit viper bite. 

red yellow black

paralysis, nervous, bizarre, paralysis , eye, respiration

Scorpion Stings

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

  • They are rare and live primarily in the southwestern United States and in deserts.

  • With one exception, a scorpion’s sting is usually very painful, but not dangerous.

• The exception is the Centruroides sculpturatus.

  • The venom may cause:

    • Circulatory —

    • Severe muscle —

    • Excessive —

    • —

    • — and — failure

collapse, contractions salivation, hypertension, convulsions cardiac

Tick Bites

• Tiny insects that usually attach themselves directly to the skin

  • Found most often in brush, shrubs, trees, sand dunes, or other animals

  • Only a fraction of an inch long

  • — — can be spread through the tick’s saliva

• Rocky mountain spotted fever

  • Occurs within 7 to 10 days after the bite

  • Symptoms

    • Nausea

    • Vomiting

    • Headache

    • Weakness

    • Paralysis

    • Cardiorespiratory —-

infectious diseases, collapse 

Tick Bites

• Lyme disease

  • Reported in all states except Hawaii

  • The first symptoms are generally — and — symptoms, sometimes associated with a —— rash that may spread to several parts of the body.

  • Painful swelling of the —- occurs.

  • May be confused with —- —-

• Tick bites occur most commonly during the — months.

  • If transport will be delayed, remove the tick by using fine tweezers to grasp the head and pull it straight out of the skin.

  • Once the tick is removed, cleanse the area with antiseptic and save the tick for identification

fever, flu-like , bullseye, joints, rheumatoid arthritis

summer,

Injuries From Marine Animals

• — are responsible for more envenomations than any other marine animals.

  • Include jellyfish, coral, and sea anemones 

  • Fire coral, Portuguese man-of-war, sea wasp, sea nettles, true jellyfish, sea anemones, true coral, and soft coral

• Signs and symptoms

  • Very painful, red lesions in light-skinned individuals

  • Headache

  • Dizziness

  • Muscle cramps

  • Fainting

• Emergency treatment

  • Limit further discharge of —- by avoiding — —, wet —, —-, or careless manipulation of the —-.

  • Keep the patient calm. 

  • Reduce —- of the affected extremity.

  • Remove the remaining tentacles by —— them off with the edge of a sharp, stiff object.

  • Provide transport to the emergency department.

 

Coelenterates, nematocysts, fresh water, sand, showers, tentacles, motion, scraping,

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:

radiation.

convection.

conduction.

evaporation.

convection

Shivering in the presence of hypothermia indicates that the:

musculoskeletal system is damaged.

nerve endings are damaged, causing loss of muscle control.

body is trying to generate more heat through muscular activity.

thermoregulatory system has failed and body temperature is falling.

body is trying to generate more heat through muscular activity.

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

removing cold, wet clothing.

administering warm fluids by mouth.

turning up the heat inside the ambulance.

covering the patient with warm blankets.

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:

rubbing her feet gently with your own warm hands. 

trying to restore circulation by helping her to walk around. 

removing her wet clothing and rubbing her feet briskly with a warm, wet cloth. 

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

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.

moving him to a cooler environment at once. 

administering oxygen via nonrebreathing mask.

placing him in a supine position and elevating his legs. 

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: 

give her ice water to drink.

place her in the recovery position. 

cover her with wet sheets and fan her. 

take her temperature with an axillary probe.

cover her with wet sheets and fan her. 

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

the patient will suffer less airway trauma.

the risk of severe hypothermia is lessened.

less water will have entered the patient’s lungs.

you can ventilate the patient with laryngospasm.

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:

turn her head to the side and give five back slaps.

turn her head to the side and begin rescue breathing.

rotate her entire body as a unit and carefully remove her from the pool.

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

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.

a pneumothorax.

pneumomediastinum.

decompression sickness.

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 1

Group 2

Group 3

Groups 1 and 2; Group 3 should be tagged as deceased.

Group 3