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Flashcards in Environmental Emergecies Deck (59):
1

Convection

Loss of body heat to the atmosphere when air passes over the body

2

Conduction

Transfer of heat through direct physical touch with nearby objects

3

Respiration

Heat is lost through exhalation of warm air and inhalation of cold air

4

Evaporation

Conversion of a liquid or solid into a gas; evaporation of sweat is a means by which the body is cooled

5

Radiation

Transfer of heat from the surface of one object to the surface of another without physical contact between the objects

6

Stages of hypothermia

1. Shivering, does NOT occur when body temp is below 90 F
2. Apathy and depressed motor function
3. Decreased level of consciousness
4. Decreased vital signs
5. Death :(

7

Mydexerma coma

Life-threatening late complication of hypothyroidism that may be precipitated by exposure to cold temperatures as well as to illness, infection, trauma, or certain drugs.

8

S&S of hypothermia

1. Decreasing mental status:
- Amnesia, memory lapses, and incoherence
- Mood changes
- Impaired judgement
- Reduced ability to communicating
- Dizziness
- Vague, slow, slurred, thick speech
- Drowsiness progressing to unresponsiveness
2. Decreasing motor and sensory function
3. Changing vital signs (start of high HR, drops to low HR)

9

Active rewarming

Technique of aggressively applying external sources of heat to
patients to re-warm their body.

10

Hypothermia

An overall reduction in body temperature that affects the entire
body; also called hypothermia or generalized cold emergency.

11

Hyperthermia

Abnormally high core body temperature resulting from failed
thermoregulation; core body temperature above the normal
37 °C (98.6 °F).

12

Local cold injury

Damage to body tissues in a specific part of the body resulting
from exposure to cold; frostbite

13

Passive rewarming

The use of patients’ own heat production and conservation
mechanisms to rewarm them (for example, placing patients in
a warm environment and covering them with blankets).

14

Thermoreceptor

A sensory receptor that is stimulated by temperature.

15

Urban hypothermia

Hypothermia precipitated by cold environments; affects people
who live on the streets in cold weather or whose indoor
environment is too cold.

16

Water chill

The increase in rate of cooling in the presence of water or wet
clothing.

17

Wind chill

The combined cooling effect of wind speed and environmental
temperature.

18

"Thermostat of the body"; part of brain that controls body temp

Hypothalamus

19

How body warms & cools itself

Warming body:
- chemical reactions (metabolism), which results, for the most part, when the body converts food into energy.
- Hormones released by the adrenal glands will also increase metabolism, producing heat as a by-product.
- shivering (involuntary contractions of the muscles)
- heat is conserved by vasoconstriction of the blood vessels in the extremities and nonessential parts, which shunt blood to the core
- Other methods of conserving heat include moving to a warmer environment, putting on a coat or thicker clothes, folding your arms, and assuming a fetal position.

Cooling body:
- blood vessels in the periphery vasodilate and send the warm blood to the surface of the skin, which helps get rid of heat through radiation and convection. This will only work if the environment is cooler than the skin temperature.
- The cardiovascular system increases cardiac output (tachycardia and contractile force), which increases the amount of blood reaching the skin to be cooled.
- The respiratory system eliminates heat through evaporation during exhalation.

20

Heat cramps

Painful muscle spasms (cramps) that are usually a result of profuse sweating combined with the loss of electrolytes and water.
- This causes the larger muscles (such as abdominal muscles, gluteus muscles, and hamstrings) to cramp.
- Generally, patients with heat cramps only need to be removed from the hot environment, rest, and slowly replace fluids by drinking water and/or sports drinks.

21

Heat exhaustion

Occurs when patients overexert themselves in a hot, humid environment, causing profuse sweating and loss of electrolytes, which may cause the body to go into a mild form of shock.

Signs and symptoms:
- headache
- weakness
- dizziness
- tachycardia
- nausea, vomiting
- syncope.
- slightly warm to normal to cool skin (patient is still sweating)

22

Heat stroke

Body is no longer able to use its normal mechanisms (sweating, vasodilation) to get rid of heat.
- The temperature can become so high that tissue/cells are destroyed

S&S:
- Hot, dry, flushed skin (sweating has ceased or is at a bare minimum),
- Decreased level of consciousness or are unconsciousness
- Signs of profound shock
- Body temperature may increase rapidly to temperatures as high as 106 °F

23

S&S of pit viper bite (rattlesnakes, copperheads, and water moccasins)

- obvious fang mark
- pain at site bitten
- weakness
- dizziness
- sweating
- chills
- thirst
- nausea and vomiting
- signs of shock
- respiratory distress
- bloody urine
- these bites may affect the body’s ability to clot.

24

S&S of coral snake bite

Venom contains neurotoxin
“red on yellow, kill a fellow; red on black, venom lack”

- Symptoms may be delayed from 1 to 8 hrs
- Respiratory & skeletal muscle paralysis
- localized numbness
- drowsiness
- weakness
- slurred speech
- salivation
- abdominal pain
- ataxia (lack of voluntary coordination of muscle movements)
- paralysis
- nausea and vomiting
- seizure
- respiratory failure
- signs of shock

25

Factors affecting severity of snake/animal bite

- location of the bite (
fatty tissue absorbs the venom slower than muscle tissue)
- the patient’s size and weight
- the overall health of the patient prior to the bite (medical conditions such as cardiac disease and respiratory diseases may exasperate the patient’s survivability)
- how active the patient is after being bitten
(the greater the level of activity, the quicker the venom is spread).

26

Black widow spider bite (S&S)

- Small fang marks approximately 1 mm apart surrounded by a small papule
- Bite feels like pinprick followed by a dull, localized ache within 30 minutes, with redness and swelling appearing at the site of the bite.
- Progressive muscle spasm and cramping may occur, especially in the abdomen and shoulders.
- altered level of consciousness
- nausea, vomiting
- diaphoresis
- dizziness
- seizure

27

Brown recluse spider bite (S&S)

- severe necrosis of the skin (which must be surgically repaired) and infection
- The bite is initially painless.
- After several hours the bite site becomes bluish and is surrounded by a white ring followed by a halo or “bulls-eye pattern.”
- An ulcer and necrotic tissue usually develop after 7 to 10 days.
- chills
- fever
- nausea and vomiting
- joint pain
- bleeding disorders.

28

Scorpion stings (S&S)

- burning and tingling sensation that progresses to numbness (affects nervous system)
- slurred speech
- muscle twitching
- seizure
- restlessness
- salivation
- lacrimation (excessive secretion of tears)
- incontinence
- vomiting
- other signs of GI problems.

29

Fire ants (S&S)

- Southeastern animals
- Circular bite pattern
- Painful bite produces small blister like sores that can become infected later.
- swelling, redness, and pain at the site
- Some patients may have a severe anaphylactic reaction to the bite of a fire ant.

30

Tick bites (S&S, Lyme disease)

- Can transmit microorganisms that are capable of causing diseases in humans.
- The female wood tick secretes a neurotoxin that can cause “tick paralysis.” This paralysis usually begins about six days after the tick has attached itself to the patient.The paralysis and signs of weakness usually go away several days after the tick is removed
- Signs and symptom usually develop at five to seven days after the tick bite

S&S:
- paresthesia to the feet and hands
- headache
- fever
- loss of appetite
- small spots that are “pinkish” in appearance on the wrist and ankles and that eventually spread to the entire body.

Lyme disease is transmitted by the bite of a tick known to infect deer and dogs (called a “deer tick” and “dog tick,” respectively).
S&S:
- red circle on the body around the bite with a rash developing (initially)
- fever
- muscle pain
- lethargy
- arthritic symptoms
- long-term neurological problems.

31

Treatment for tick bites

- Remove the tick by using tweezers
- Get as close as possible to the area where the tick has attached itself to ensure that no parts of the tick are left embedded in the patient
- Do NOT “squeeze” the tick if it is engorged in blood, as doing so will allow infected blood to enter the patient
- Clean the area with soap and then apply an antiseptic.

32

Treatment of bites & stings

- Manage the patient’s ABCs,
- Treat for anaphylactic shock by using epinephrine autoinjector
- Follow your local protocol and call for advanced life support and/or initiate early transport if possible.
- If stingers are present from bees, gently remove them by scraping them away, and then wash the area with mild soap or antiseptic
- Keep the area that has been bitten below level of the heart if possible
- apply cold packs to reduce swelling except when dealing with venomous bites (for which you would apply heat/hot packs)
- Keep the patient calm and limit his/her activity.
- When encountering a patient with snakebite, some experts advise placing a tourniquet and above and below the snakebite
- Pour vinegar on site of jellyfish/sea anemone sting

33

S&S Jellyfish sting

-localized skin irritation (in some cases, “tentacle prints” are clearly seen)
- redness, burning, and itching at the site.
- Some patients may go into anaphylactic shock from a jellyfish bite

34

S&S sea anemone stings

-burning, stinging pain
- nausea; vomiting
- fever; chills
- sometimes, infection at site of injury.

35

S&S stingray stings

- Often, stingray moves in an upward and forward motion that drives the barbs into the patient’s foot or leg
- The barbs not only inject venom, but they can also cause a large laceration
- Sometimes the barbs break off and become embedded in the skin.

S&S:
- bleeding at the site
- swelling
- severe pain that may radiate throughout the extremity affected
- muscle cramps
- nausea and vomiting
- abdominal pain
- weakness
- seizure
- signs of shock.

36

Barotrauma

Injury to tissue resulting from a change in pressure; typically occurs in areas of the body with air spaces, such as the lung and sinuses, and when a person moves to and from environments at different pressures (such as a scuba diver, lightning strike).

37

Lighting strike mechanisms

1. Direct strike (the lightning makes direct contact)
2. Contact strike (lightning strikes an object the patient is touching)
3. Splash (side flash) strike (lightning strikes an object and jumps to a person nearby)
4. Ground current (step voltage) strike (the lightning energizes the ground)

38

Care for Patients w/ Lightning strike

1. Ensure the safety of you, your partner, and anyone else on the scene.
2. If the patient’s clothes are on fire, extinguish the fire.
3. Establish inline immobilization.
4. Ensure a patent airway.
5. If the patient is in cardiac arrest, start cardiopulmonary resuscitation (CPR) and attach an automated external defibrillator (AED) per American Heart Association guidelines.
6. Immobilize the patient on a long backboard.
7. Transport the patient to an appropriate facility.

39

Acute mountain sickness

- AMS is a common high-altitude sickness that occurs by going above an altitude of 5,000 feet
- The signs and symptoms usually occur within four to six hours, peak around one to two days, and then gradually subside unless the sickness is severe, causing life-threatening conditions such as HAPE and HACE.
- Activities associated with AMS include climbing mountains, riding in hot-air balloons, and flying in unpressurized cabins.
- The more rapid the ascent (without allowing the body to acclimate), the quicker and more severe the signs and symptoms associated with high altitudes.
- Patients who are most affected are those who are not acclimated to the changes resulting from the ascent

S&S:
- headache
- fatigue
- malaise
- anorexia
- tachycardia
- bradycardia
- ataxia
- respiratory distress upon exertion.
Severe symptoms include:
- altered level of consciousness
- impaired judgment (appears intoxicated)
- coma

40

High-Altitude Pulmonary Edema

- HAPE causes fluid accumulation in the lungs after ascent to altitude
- This condition can occur at 8,000 feet, but is more common at heights greater than 14,000 feet. - - Pressure within the pulmonary vessels forces fluid out of the capillaries into the alveoli

S&S:
-altered level of consciousness
- dyspnea
- rales
- weakness
- cough
- pink and frothy sputum
- signs of AMS.

41

High-Altitude Cerebral Edema

HACE is the most severe form of AMS and occurs when an excessive amount of fluid collects in the brain, increasing intracranial pressure

S&S:
- signs associated with AMS and HAPE
- may be difficult to distinguish one from the other.

42

Dysbarism

A medical condition that results from pressure changes that
occur when a person descends in water or ascends in altitude.

43

Drowning

An incident in which someone is submerged or immersed in a liquid that prevents the person from breathing air and that results in a primary respiratory impairment.

-Patients who were submerged in colder water have a significantly higher chance of successful resuscitation & less brain damage

44

Gastric distention

Inflammation of the stomach.

45

Mammalian diving reflex

The body's natural response to submersion in cold water in which breathing is inhibited, heart rate decreases, and blood vessels constrict to maintain cerebral and cardiac blood flow.

46

Surfactant

A substance responsible for maintaining surface tension in the alveoli.

- Saltwater drowning causes washout of this, which results in alveolar collapse

47

Atelectasis

Collapse of the alveoli

48

Care for drowning

- Remove the patient from the water and ensure that the patient has a patent airway
- Suction water and liquids out of the oropharynx; do not perform abdominal thrusts unless a foreign body is suspected
- Make sure patient has adequate breathing and circulation.
- If the possibility of a spinal injury is unknown, the cervical spine should be immobilized
- Perform a secondary assessment to ensure that no medical or underlying trauma caused the drowning
- Continuous positive airway pressure (or CPAP) should be considered in patients with rales in the lungs.
- Patients who are immersed in water may also be hypothermic, so begin appropriate treatment for this condition.

49

What happens from 0 to below 66 ft underwater?

- In 0 to 32 feet of water, the pressure exerted on the body is the same pressure as the atmosphere (1 ata). When descending underwater, the volume of air decreases proportionately as pressure increases.
- At 33 feet (2 ata) the pressure is doubled and air volume is halved.
- At 66 feet (3 ata), your air spaces have one-third the volume. In other words 1 liter of air at the surface (sea level) is compressed to 500 milliliters at 33 feet. At 66 feet, the liter of air is compressed to 250 milliliters.

50

Dalton's Law

Total pressure of a mixture of gases is equal to the sum of the partial pressure of the individual gases.

51

Boyle's Law

Volume of a gas is inversely proportional to its pressure, if the temperature is kept constant

52

Henry's Law

The amount of gas dissolved in a given volume of fluid is proportional to the pressure of gas above it

53

Charles's Law

All gases expand equally when heated (volume of gas is directly proportional to temperature)

54

Physical characateristics, environmental and technical factors that increase chance of decompression sickness

Technical:
- Strenuous diving conditions
- overstaying time at any given depth, heavy exercise before or after the dive
- flying after diving (a 24-hour wait is usually recommended)
- driving to a high altitude after diving.

Physical characteristics:
- old age
- obesity
- alcohol consumption before the dive
- dehydration
- fatigue
- medical conditions such as heart disease.

Environmental factors:
- Cold water (vasoconstriction decreases the ability of nitrogen to offload)
- swift undertow or rough seas (which increases the level of exertion; heated diving suits can lead to dehydration)
- heavy work while underwater (which can cause gas pockets to create in tendons).

55

Arterial Gas Embolism

- Condition caused by a gas embolus lodged inside the bloodstream, which interferes with blood flow and perfusion to surrounding tissues
- A gas embolus can be caused by divers holding their breath as they surface rapidly

56

Care for AGE, decompression sickness, barotrauma

1. Take spinal precautions if needed.
2. Check the patient’s airway, breathing, and circulation (ABCs).
3. Apply high-flow oxygen 15 liters per minute (lpm) via nonrebreather (NRB) even if the patient’s saturated oxygen level is greater than 95%.
4. If the patient has altered mental status, place the patient in the lateral recumbent position.
5. Transport the patient to a hospital that has a recompression chamber (chamber or compartment in which atmospheric pressure can be gradually raised or lowered).

57

S&S Type 1 Decompression sickness

- Decompression sickness typically presents within 72 hours of the event
Symptoms:
- pain in the large joints, typically sharp in nature
- redness of the skin with itching and/or burning sensations

58

S&S: Type 2 Decompression sickness

- Symptoms are typically immediate or are seen within the first 36 hours after the event
- altered mental status
- nausea and vomiting
- pain in joints and back
- burning sensation with respirations.

59

Decompression sickness

- If the diver ascends faster than the body can eliminate the nitrogen through exhalation, bubbles of nitrogen are formed in the bloodstream and tissue. The bubbles are now small emboli that can cause obstructions in the circulation. The bubbles also compress and stretch the blood vessels and nerves, and cause an inflammatory response similar to an allergic reaction.
- This reaction is decompression sickness
- Decompression sickness usually occurs when a diver ascends rapidly from a depth of 33 feet or more.