emergency-nursing-finals

Environmental Emergencies

• Emergencies caused by environmental factors include:

  • Heat-related illnesses (heat stroke, frostbite, hypothermia)

  • Nonfatal drowning

  • Decompression sickness

  • Animal, human, and insect bites

Heat-Induced Illnesses

• Severity ranges from mild to life-threatening.

• Heat Stroke:

  • Acute medical emergency; failure of the body’s heat-regulating mechanisms.

  • Commonly caused by prolonged exposure to temperatures >39.2°C (102.5°F).

  • A heat index >35°C (95°F) is linked with increased mortality (ENA, 2020a).

• Exertional Heat Stroke:

  • Caused by strenuous activity in hot environments.

• At-risk individuals include:

  • Those unaccustomed to heat, older adults, young children, those with chronic illnesses, and those on certain medications (e.g., major tranquilizers).

Prevention of Heat-Induced Illnesses

• Key recommendations for patients treated for heat-related illnesses include:

  • Avoid re-exposure to high temperatures.

  • Stay hydrated, wear loose clothing, and reduce activity on hot days.

  • Monitor fluid loss, and adjust intake accordingly.

  • Gradually increase physical activity to allow acclimatization.

  • Plan activities outside hot hours (10 AM to 2 PM).

  • In urban areas, direct older adults to air-conditioned spaces (e.g., malls, libraries).

Gerontologic Considerations

• Older adults are particularly vulnerable to heat-related deaths due to:

  • Impaired circulatory response to heat stress.

  • Decreased subcutaneous tissue and thirst perception.

  • Reduced ability to concentrate urine.

Assessment and Diagnostic Findings

• Symptoms of heat illness may include:

  • Central nervous system dysfunction (confusion, delirium, coma, seizures).

  • Elevated temperature (≥40.6°C [105°F]), hot dry skin, tachycardia.

  • Cardinal manifestations include muscle cramps and extreme thirst.

Management of Heat Stroke

• Immediate intervention includes:

  • Stabilizing oxygenation (CAB: Circulation, Airway, Breathing).

  • Establishing IV access for fluid administration.

  • Rapid cooling of core temperature to <39°C (102°F), preferably within 1 hour.

  • Methods for cooling include:

    • Cool sheets, towels, sponging with water.

    • Ice to neck, groin, chest, axillae, along with tepid water spraying.

    • Cooling blankets or immersion in cold water.

  • Monitoring temperature through rectal, bladder, or esophageal thermistors, ceasing at 38°C (100.4°F) to prevent hypothermia.

  • Administration of 100% oxygen to meet tissue needs.

Frostbite

• Definition: Trauma from exposure to freezing temperatures causing intracellular fluid freezing.

• Often affects extremities (feet, hands, nose, ears) and can lead to venous stasis and thrombosis.

• Severity ranges from first degree (redness) to fourth degree (tissue destruction).

Assessment and Management of Frostbite

• Affected areas may be hard, cold, insensitive to touch, appearing white or mottled blue-white.

• Management goals include:

  • Restoring normal body temperature.

  • Removing constrictive items and wet clothing.

  • Controlled rewarming in circulating baths (37°C - 40°C [98.6°F - 104°F]).

  • Protecting the re-warmed area and preventing further injury.

  • Avoid massage; analgesics may be required during rewarming.

  • Monitor for complications and provide discharge instructions focusing on avoidance of vasoconstrictors.

Hypothermia

• Definition: Core temperature ≤35°C (95°F) due to cold exposure or inability to maintain temperature.

• Symptoms include apathy, poor judgment, shivering suppression, and possible coma at lower temperatures.

Assessment and Management of Hypothermia

• Management priorities:

  • Remove wet clothing and rewarm the patient continuously.

  • Monitor vital signs and fluid status, assessing for arrhythmias.

Monitoring and Rewarming Techniques

• Rewarming methods include:

  • Active internal (e.g., warmed fluids, heated oxygen).

  • Passive or active external rewarming (e.g., warming blankets, heaters).

  • Close monitoring of vital signs and potential cardiac issues.

Nonfatal Drowning

• Defined as survival for ≥24 hours post-rescue.

• Highest risk groups: children <5 years old and adults >85 years old.

• Key prevention strategies include pool fencing, supervision, and swimming lessons.

Management of Nonfatal Drowning

• Major challenges post-rescue include hypoxia and acidosis; immediate intervention is essential.

• Freshwater drowning leads to surfactant loss; saltwater leads to pulmonary edema.

• Establishing airway and ventilation is critical in management; close monitoring of vitals is necessary.

Decompression Sickness

• Occurs from rapid ascents during diving or flying, leading to nitrogen bubble formation.

• Symptoms include joint pain, numbness, respiratory failure.

Management of Decompression Sickness

• Rapid transfer to a hyperbaric chamber is critical; 100% oxygen supports treatment.

Animal and Human Bites

• Common ED visits: dog bites (80-90%), cat bites (risk of infection).

• Report all bites; human bites are often linked to violence.

Snakebites

• Venomous snakes cause thousands of bites yearly; most victims are children.

• Initial management includes immobilization and avoiding tourniquets or ice.

Antivenin Administration

• Effective if administered within 4-12 hours post-bite; doses depend on severity.

Spider and Tick Bites

• Commonly encountered venomous species can cause systemic symptoms.

• Important to monitor for signs of disease transmission post-tick bite.

Poisoning and Food Poisoning

• Includes ingestion of harmful substances, initial treatment focuses on stabilization, antidotes, and detoxification.

• Food poisoning requires tracing the source; botulism is particularly severe.

Carbon Monoxide Poisoning

• Characterized by hypoxia symptoms; treatment includes removing from exposure and supportive care.

Skin Contamination and Chemical Burns

• Remove chemicals and wash the area immediately to prevent injury.