Environmental Emergencies - PowerPoint Presentation

Slide1

Environmental Emergencies

Sharon Brown, RNSlide2

Heat Related Emergencies

Heat related physiology

Information about body temperature is collected by thermoreceptors and sent to hypothalamus

Sweating is primary response to heat ~ loss of NA, K, fluids can lead to dehydrationSlide3

Heat Edema

Occurs during long periods of standing or sitting

“Theme Park Rash”

Tx is rest, elevationSlide4

Heat Cramps

Leg, shoulder, thigh, and abdominal cramps

Form of hyponatremia r/t loss of sodium and excess water intake

TX includes rest, cooling measures.

D/C teaching includes encourage adding electrolye drinks while outdoorsSlide5

Heat Exhaustion

Prolonged heat exposure without adequate fluid replacement

Temp can be greater than 104

S/S ~ pale, ashen, profuse sweating, weakness, hypotensive, tachycardic, severe thirst

Tx – cooling measures, IVF replacementSlide6

Heat Stroke

Emergent and life threatening. Mortality rate is 50%

S/S – skin is hot and dry. Temp is greater than 106, ALOC

Cooling measures – wet cloths, fans, ice packs at arm pits, neck and groin. Prevent shivering with Demerol or ativan

Monitor for Rhabdomyolysis (dark urine, muscle cramps)

Aggressive cooling is continued until around 102 degreesSlide7

Cold Related Emergencies

Body attempts to conserve heat by vasoconstriction and produce heat by shivering

DM patients cannot feel extreme changes and may not be aware of potential harmSlide8

Chilblains

Chilblains is caused by intermittent, prolonged exposure

to damp, nonfreezing environments that are above

freezing resulting in painful inflamed lesions over the

exposed sites (usually hands, ears, lower legs and feet),

with no permanent impairment.

Frostnip is a very mild form of frostbiteSlide9

Frostbite

True tissue freezing with formation of ice crystals in tissue

Most common areas include fingers, toes, ears, nose

Most severe injury results from tissues that freeze, thaw, and then refreeze againSlide10

Frostbite degrees of severity

1st degree

Pale skin, may be cyanotic, edema, decreased sensation

Superficial 2

nd

degree

Cyanotic, edema, blisters, decreased sensation

Deep 2

nd

degree

Pale & cyanotic, edema, anesthesia at site, non-pliable skin

3

rd

degree

Pale, cyanotic, necrotic, gangreneSlide11

Frostbite

TX includes

Rapidly re-warm affected area in 100-108 temp water for 15-30 minutes

Endpoint of rewarming is softening of skin and return of sensation

Elevate affected partSlide12

Hypothermia

Physiologic changes with hypothermia

79 degrees – obtunded, no DTR’s, no pain response

77 degrees – apnea, pulmonary edema

68 degrees – asystole

Treatment for ALL patients

Remove all wet garments

Provide warm blankets

Limit movementSlide13

Mild Hypothermia

93.2-96.8

Slurred speech, shivering, pale skin (vasoconstriction)

Passive rewarming (0.5-2F/hour)Slide14

Moderate Hypothermia

86-93.2

ALOC, decreased RR, shivering stops at 89

Need to re-warm core as well as extremities because of re-warming shock! (cold blood from periphery reaches core and causes hypotension and dysrythmias)Slide15

Severe Hypothermia

Less than 86 degrees

Pupils are fixed and dilated

Bradycardia, coma

If VF occurs, attempt defib x 1. If no response, need to focus on rewarming patient first.

Requires passive external, active external, and active internal rewarmingSlide16

Submersion Incidents

4,000 deaths/year

40% are less than 4 years old

Die from hypoxia…not from too much fluid in lungs

Cold water has better prognosis than warm water, but cold water has higher risk for dysrhythmias

TX – ABC’s, must consider secondary trauma, monitor for pulmonary complicationsSlide17

Submersion

Death generally occurs from hypoxia followed by respiratory failure and ischemic neurologic injury

• Most drowning are considered wet drowning in which the alveoli develop impaired gas exchange after the lungs are flooded; aspiration of as little as 5 cc/kg can result in wet drowning

• About 10-20% of victims suffer dry drowning, in which glottic closure and laryngospasm occur before aspiration of liquid, followed by asphyxiaSlide18
Slide19

Snakebites

Only 10-15 deaths/year, but several thousand bites

Most are pit vipersSlide20

Snake bites, cont.

S/S ~ metallic taste, muscle quivering, tingling around mouth, burning at wound site, diaphoresis, seizures

Need to know time, location and description of snake

Pit viper ~ puncture from fangs, semi circle teeth marks

Coral snake ~ scratch marks, teeth marks

Treatment

Decrease movement, immobilze extremity, don’t elevate

Need anti venin. (administer within 4 hours of bite) May need to transfer out.Slide21

Dog Bites

Most common animal bite seen in ED

Copious wound irrigation

Most wounds are left open to heal from inside out d/t high risk of infection

Patient is usually prescribed antibioticsSlide22

Spider bites

Black Widow

Lives in dark areas

Found in all states except Alaska

Only female is poisonous with red hourglass on belly

Initial bite is felt as pinprick

20 minutes~dull ache, abd. pain, cramping, parasthesias

1 hour ~ severe pain, increases within 12-48 hours

Can progress with hypotension, shock, and resp. failure

TX – ice to bite site, Ca gluconate, antiveninSlide23

Black WidowSlide24

Spider Bites

Brown Recluse

Small brown or tan spider with a band (violin shaped)

Bite is initially painless or mild, localized

2-4 hours – pain, redness and blistering

2-4 days – painful purpura

7-14 days – necrotizing, ulcerated wound

s/s – fever, chills, N/V, joint pain

TX- cool compress, debridement, HBO, Dapsone (used for leprosy)Slide25

Brown RecluseSlide26

Lyme Disease

Bulls’ Eye lesion following Tick Bite (can be delay of 3-30 days)

Tick must be attached for 24 hours to transmit disease

Non-specific flu s/s and can develop into systemic illness with neuro changes (memory loss, meningitis, poor motor coordination)

Tx – amoxicillin, doxycyclineSlide27

Lyme Disease