Chapter 33 EMT Basic

hypothermia

general cooling of the body -> internal body temperature is concerningly low - prolonged exposure to cool or freezing temperature

frostbite

frozen tissue - exposed parts of the body become frozen

air embolism

vein has been punctured, bubbles of air in blood vessels and heart -> lead to cardiac arrest

four factors affecting exposure

physical condition, age, nutrition and hydration, environmental conditions

infants effects from exposure

do not have thermoregulation until 12-18 months

geriatic effects from exposure

geriatric lose subcutaneous tissues and poorer circulation -> lose insulation

what do you need for metabolism

food and water

when does hypothermia occur

30-50 degrees fahrenheit

when does heastroke occur

>80 degrees and humididty >80%

ambient temperature

temperature of surrounding environment

ways heat loss can happen

conduction, convection, evaporation, radiation, respiration

conduction

transfer of heat from part of body to a colder object or substance by direct contact or immersed in water <98 degrees

convection

heat is transferred to circulation air

exampels of convection

spas and hot tubs

evaporation

conversion of liquid to gas -> requires energy or heat

examples of evaporation

sweating, cold after swimming

radiation

transfer of heat by radiant energy

radiant energy

type of invisible light that transfers heat

example of radiation

standing in cold room

respiration heat loss

body heat loss as warm air in lungs is exhaled into atmosphere and cooler air is inhaled

rate and amount of heat loss can be modified in 3 ways

1. increase or decrease heart production 2. move to area where heat loss is decreasing or increasing 3. wear appropiate clothing

exampels of increasing or decreasing heat production

moving, standing still, shivering

hypothermia core temperature

less than 95 degrees

what can hypothermia not regulate

temperature and generate heat

core temperature

temperature heart, lungs, vital organs

ways body protects from heat loss

- body normally constricts blood vessels in skin -> cynaosis - shivering

dysparism

difference in bariatric pressure

example of dysparism

diving or high altitude

chronic exposure to hypothermia

bodoy functions slows and mental status deterioriates

people who are more susceptible to hypothermia

- injuries or illness, young and old, intoxicated from drugs or alcohol

how to access core body temperature

pull back of your glove and place back of hand on bare skin of abdomen

hypothermia thermometer

registers loewr core temperatures per rectum

more susceptible to hypothermia

injuries or illness, young and old, intoxicated from drugs or alcohol

how to assess core body temperatuer

pull back of your glove and place back og hand on bare skin of abdomen

mild hypothermia temperature

CBT between 90-95 degrees

mild hypothermia

- alert and shivering to gain heat -> muscle movement

pulse and respiratory mild hypothermia

fast and rapid

skin during mild hypothermia

red but eventually cyanotic

moderate hypothermia temperature

CBT 82-90 degrees

if <90 degrees moderate hypothermia

shivering and muscular activity decreases

first type of muscular activity that decreases during moderate hypothermia

fine muscle activity such as finger

severe hypothermia temperature

less than 82 degrees CBT

severe hypothermia signs and symptoms

- lethargy - LOC decreases - poorly coordinated and memory loss - unresponsive to environment and behavior - stiff and rigid position

pulse during severe hypothermia

slow and weak

respirations severe hypothermia

shallow or absent

blood pressure severe hypothermia

low

less than 80 degree severe hypothermia

cardiorespiratory activity may cease, pupil reaction slow, dead

what to do if 80 degrees or less in severe hypothermia

check pulse for the full minute and rewarm

determining severity of local cold injury

- determine duration of exposure - temperature - wind velocity - exposure to wet conditions - fatigue - restricted circulation - inadequate insulation

hypothermia shunting

blood is shunted away from extremities to maintain CBT

high risk of cold injury to where for hypothermia shunting

extermity, ears, face

frostnip

freezing but deeper tissues are unaffected -> painless

what does frostnip affect

ears, nose, fingertip

immersion foot

prolonged exposure to cold water

immersion foot common in

hikers or hunters who stand for a long time in river or lake

signs and symptoms of frostnip and immersion food

- skin is balanced and cold - normal color does not return after palpation - no CSM in injured area - skin of foot is wrinkled and soft

what does frostbite permanently damage

cells but cause is unknown sometimes

necrosis aka

gangrene

what might you need if necrosis

amputation or surgically removed

less severe frostbite

ice crystals, chemical change in water content, ice thaws

how to determine if frostbite

- hard, waxy, feel of affected tissues

if skin deep frostbite

leathery or thick, blisters and swelling

if deeper than skin frostbite

skin may appear red or white, mottled or cyanotic

how long should calculating pulse be for hypothermia

one whole minute

secondary assessment for cold emergencies

- assess affected areas - degree or damage - vital signs

managing cold emergencies

- move patient from cold to prevent heat loss - remove wet clothing - place blankets and covers - heat packs - high temp in ambulance - transport

what not to do for treating cold emergencies

- massage extremities - let patient eat stimulants - heat - break blisters - stand or walk

why should patient not eat stimulants for cold emergencies

impair circulation during hypothermia

moderate-severe hypothermia treatment

warming therapies

warming therapies

IV, warm fluids, extracorpeal rewarming

extracorporeal rewarming

rewarming outside before inside

emergency care of cold injuries

- remove patient from cold - gentle - remove wet or restricting clothing from patient

treating frostnip

exposure to warmth

treating immersion foot

- remove shoes and socks - warm - cover with dressing

treating frostbite

- remove jewelry - dressing

warm-water bath temperature

104-105 degree and stir -> recheck frequently

what should warm water bath not exceed

>105 degrees

warm-water bath

• dressing - keep frostbitten part in water until sensation returned and feels warm in extremity

2 most effecient methods to reduce swelling

sweating and silation of blood vessels

hyperthermia

greater than 101 degrees

risk factors for hyperthermia

- inability to adjust to climate - vigorous exercise

three ways heat emergency can form

- heat cramps - heat exhaustion - heatstroke

people at greatest risk of heat emergency

- COPD - children - geriatric - patients with heart disease - dehydration - diabetes - obese - alcohol and drugs - limited mobility

heat cramps

- painful muscle spasms that occur after vigorous exercise of factory workers and athletes

what causes heat cramps

dehydration and sweating

heat cramps in leg or abdomen

- pain and muscle spasm in abdomen is severe -> acute abdomen - abdominal pain after exercise in hot environment

heat exhaustion aka

heat prostration of heat collapse

most common heat emergency

heat exhaustion

causes of heat exhaustion

heat exposure, stress, fatigue, hypovolemia

what must sweating do to cool off body

evaporate

high risk of heat exhaustion

work or exercise viguorously or heavy clothing in warm environment, older or infant

signs and symptoms of heat exhaustion

- dizziness, weakness, fainting with NV, headache - muscle and abdominal cramping - dry tongue and thirst

heat exhaustion pulse

rapid and weak

heat exhaustion blood pressure

DBP is lwo

heat exhaustion body temperature

elevated

what is the most serious heat emergency

heatstroke

heatstroke

- body is subjected to more heat than it can handle and normal mechanisms for getting rid of excess heat are overwhelmed - DLOC

what happens to body temperature during heatstroke

increases

what happens to tissues during heatstroke

destroyed

when does heatstroke develop

patients during vigorous physical activity of outdoors or inside with poor ventilation, heat waves in buildings with no AC or poor ventilations, children in hot vehicle