A Brief Guide to Snake Envenomations in Malaysia and Antivenom Therapy (Edited)
Environmental Emergencies. Cold and heat exposures Drowning and near-drowning Diving emergencies...
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Transcript of Environmental Emergencies. Cold and heat exposures Drowning and near-drowning Diving emergencies...
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EnvironmentalEnvironmentalEmergenciesEmergencies
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Environmental EmergenciesEnvironmental Emergencies
Cold and heat exposuresDrowning and near-drowningDiving emergenciesLightning strikesBites and envenomations
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Cold & Heat EmergenciesCold & Heat Emergencies
Factors that affect body temperature:– Physical Condition– Age– Nutrition/hydration– Environmental conditions
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Body Heat LossBody Heat Loss
Conduction– Heat transfer form body to another object
Convection– Heat transfer through circulating air
Evaporation– Body cooling through sweating
Radiation– Heat loss directly into the environment
Respirations
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Body Heat LossBody Heat Loss
Rate and amount of heat loss modified:– Increasing heat production– Move to a sheltered area where heat loss
is decreased– Wearing insulated clothing
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Exposure Exposure
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HypothermiaHypothermia
Body temperature below 95 degrees FWeather does not have to be below freezing
for hypothermia to occurHigher risks for geriatric and pediatric
patientsPeople with other illnesses or injuries are at
increased risk
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Mild HypothermiaMild Hypothermia
Core temperature between 90 – 95 FSigns and symptoms include:
– Shivering– Rapid pulse and respirations– Red, pale, cyanotic skin
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Moderate to Severe Moderate to Severe HypothermiaHypothermia
Core temperature less than 90 FSigns and symptoms include:
– Shivering stops– Muscular activity decreases– Mood changes, lethargy, impaired judgement– Stiff muscles, joints– Trouble speaking– Eventually, all muscle activity stops
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Severe HypothermiaSevere Hypothermia
Core temperatures below 80 FSigns and symptoms include:
– Decreased vital signs– Shallow, absent respirations– Cardiac arrhythmias– Slow pupillary reaction– Cessation of all cardiorespiratory activity
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ALS IndicatorsALS Indicators
Decreased level of consciousnessTemperatures less than 95 FCessation of shiveringSignificant co-morbidities (age, illness)Cardiac arrestHypotension
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Patient CarePatient Care
Remove patient from the cold environment and protect from further heat loss
O2 and/or ventilatory assistRemove wet clothingPosition of comfortWarm the patientMonitor vital signs and temperature
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Frostnip & Immersion FootFrostnip & Immersion Foot
Frostnip– Freezing of the skin but not the deeper surface– Usually not painful, but patient is aware
Immersion foot– Also known as trench foot– Caused by prolonged exposure of foot to cold
water
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FrostbiteFrostbite
Serious local cold injury
Cellular damage which can lead to permanent inflammation, tenderness, cold intolerance, or even gangrene
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Local Cold Injury CareLocal Cold Injury Care
Remove patient from cold environmentProtect cold-injured part from further injuryRemove any constricting or wet clothing,
replace with dry bulky dressingSplint the injury, do not let patient walk or
use affected extremityDo not massage injury to re-warm!
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Heat ExposureHeat Exposure
Normal body temperature is 98.6 F Body attempts to maintain core temperature
despite ambient temperature Cooling by seating and dilation of blood vessels High temperatures and humidity decease the
effectiveness of cooling mechanism Severity increase when core rises above 101 F
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Risk FactorsRisk Factors
Newborns, infants, children, and the elderly
Patients with heart disease, COPD, diabetes, dehydration, obesity
Patients with limited mobilityAlcohol and drug use
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Heat CrampsHeat Cramps
Painful muscle spasmsRemove patient from heatRest the cramping muscleRe-hydrateTransport if cramps persist
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Heat ExhaustionHeat Exhaustion
Dizziness, weakness, faintingDry tongue, mouth, increased thirstCold, clammy skinUsually normal vital signs, but pulse can
increaseNormal or slightly elevated body
temperature
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Heat StrokeHeat Stroke
Hot, flushed skin (not sweating)Change in behavior, decreased LOC leading
to unresponsivenessRapid pulse then it slowsDrop in blood pressureDeath will occur if treatment not initiated
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Heat Stroke vs. ExhaustionHeat Stroke vs. Exhaustion
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ALS IndicatorsALS Indicators
Decreased or altered LOCHot, dry skin in the presence of elevated
temperaturesSustained tachycardiaHypotensionPositive postural changes
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Patient CarePatient Care
Medics?Remove patient from the hot environment,
place in cool place, position of comfortCool patient with cold packs or wet
sheets/towels, fan aggressivelyO2, rehydrateLoosen or remove clothingMonitor vitals and temperature
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Drowning and Near-drowningDrowning and Near-drowning
Most are preventableDrowning
– Death as a result of suffocation after submersion in water
Near-drowning– Survival, at least temporarily after
suffocation in water
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Drowning ProcessDrowning Process
Panic, loss of controlDecreased buoyancyExhaustionLaryngospasms (diver’s reflex)Inefficient breathing
– CO2 retention, O2 deprivation
Cardiac or respiratory arrest
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Drowning TypesDrowning Types
Dry Lung15% of casesSmall amount of
H20 aspirated
Laryngospasm occurs, closes airway
Patient asphyxiates
Wet Lung85% of casesLarge amounts of
water enter lungsFluid, electrolyte
imbalances occur
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Wet Lung: Fresh WaterWet Lung: Fresh Water
Water moves from alveoli to bloodstream to red blood cells
Hemodilution occurs causing cell rupture– Potassium release causes arrhythmias– Hemoglobin release causes renal failure
Loss of surfactant causes alveolar collapse greatly diminishes O2 carrying ability
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Wet Lung: Salt WaterWet Lung: Salt Water
Water moves from bloodstream to alveoliHemoconcentration occurs resulting in
shockPulmonary edema occurs
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ALS IndicatorsALS Indicators
Any underwater rescueAltered or decreased LOCRespiratory distress, labored breathingHypotensionHypothermiaSignificant co-morbidityCardiac or respiratory arrest
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Patient CarePatient Care
Medics? C-spine precautions (suspect spinal injury) Remove patient form water Left, lateral recumbent position O2, BVM, suctioning Monitor vital signs, temperature Follow resuscitation protocols if in arrest All immersion incidents get transport to ED!
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Diving EmergenciesDiving Emergencies
Descent problems– Usually due to the sudden increase in pressure
on the diving body, perforated eardrum
Bottom problems– Not commonly seen (equipment problems)
Ascent problems– Air embolism and decompression sickness
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Air EmbolismAir Embolism
Most common diving emergency and the most dangerous
Breath holding during rapid ascentAir pressure in lungs remains high while
external pressure decreases causing alveaoli to rupture
Pneumothorax, pneumomediastinum, air emboli
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Air EmbolismAir Embolism
Blotching Froth at mouth and nose, dysphasia Severe muscle, joint, abdominal pain Dyspnea, chest pain Dizziness, nausea, vomiting Vision problems Paralysis, coma Irregular pulse or cardiac arrest
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Decompression SicknessDecompression Sickness
Occurs when gas bubbles obstruct blood vessels
Rapid ascent, “the bends”Most commonly presents as abdominal or
joint painSymptoms may develop hours laterTreatment is hyperbaric chamber
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Patient CarePatient Care
Consider c-spine precautionsRequest medics!Maintain airway, O2 by NRM or BVMPosition of comfort either supine or on side
to avoid cerebral edemaMonitor vital signs and temperatureTransport to hyperbariatric facility
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Lightning StrikesLightning Strikes
Estimated 25 million cloud-to-ground strikes in the U.S. each year
Third most common cause of death from isolated environmental phenomena
Most common strikes hit boaters, golfers, swimmers, anyone in large, open areas
Cardiac arrest and tissue damage
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Lightning StrikesLightning Strikes
Mild:– Loss of consciousness, amnesia, tingling,
superficial burnsModerate:
– Seizures, respiratory arrest, asystole (spontaneously resolves), superficial burns
Severe:– Cardiopulmonary arrest
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Patient CarePatient Care
Protect yourselfMedics?Move patient to sheltered area or stay close
to groundUse reverse triageTreat for electrical injuriesTransport
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Bites and EnvenomationsBites and Envenomations
Spider bitesSnakebitesScorpion stingsTick bitesInjuries from marine animals
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SnakebitesSnakebites
In the U.S. approximately 40,000 to 50,000 snakebites are reported
7,000 bites from poisonous speciesFatalities are very rare, about 15 per year19 species of venomous snakes in North
America, none found in Western WA
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Venomous SnakesVenomous Snakes
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Snakebite Risk FactorsSnakebite Risk Factors
TequilaTestosteroneTattooTeeth (more missing = greater chance)Trailer parkT-shirt (heavy metal band)
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Signs and SymptomsSigns and Symptoms
Severe burning at the bite siteSwelling and bluish discolorationBleeding at various distant sitesWatch for:
– Weakness– Fainting– Sweating– Shock
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Pit Viper BitesPit Viper Bites
Pain, swellingProgressive edemaBruisingBlood-filled vesicles
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Patient CarePatient Care
Calm and reassure the patientCleanse the bite areaDo not apply ice or constricting bandsSplint to minimize movementNothing by mouthMonitor vital signsSnake to hospital for ID if it has been killed
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Spiders, Scorpions, and TicksSpiders, Scorpions, and Ticks
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Spiders, Scorpions, and TicksSpiders, Scorpions, and Ticks
10 year period only 63 deaths reported from spider bites, only 2 from the brown recluse.
Scorpion sting deaths even rarer as there is only one deadly scorpion species.
Tick bites can transmit Rocky Mountain Spotted Fever or Lyme disease
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Brown RecluseBrown RecluseLocal signs/symptoms
– No pain or only mild stinging– Within 2 hours: Local pain,
blue-gray halo– 12 to 18 hours: Bleb
formation, growing ischemic zone
– 5 to 7 days: Aseptic necrosis, necrotic ulcer
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Patient CarePatient Care
Transport!
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Marine AnimalsMarine Animals
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Marine AnimalsMarine Animals
Coelenterates are responsible for most marine animal envenomations
Nemocysts (stinging cells) contact can result in painful, reddish lesions
Symptoms include headache, dizziness, muscle cramps, and fainting
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Patient CarePatient Care
Limit further discharge by minimizing patient movement
Inactivate nemocysts with alcoholRemove the remaining tentacles by
scrapping them offTransport