Environmental emergencies Flashcards
Heat-Induced Illnesses
- Range from Mild and self limiting to life threatening emergencies.
- Heat Stroke is most serious
- Inability to maintain cardiac output
- Most common cause is non-exertional, prolonged exposure to an environmental temp. greater than 39.2°C (102.5°F),
- Clinical manifestations resemble flu
— HA, Weakness, N/V - Treatment – Reduce Temp, Stop physical activity, transfer to a cool place
Heat-Related Illness: Heat Stroke
- True medical emergency
- Body temp may exceed 104 º F (40º C)
- High mortality rate without treatment
- Exertional – Sudden onset; from strenuous physical activity in hot, humid conditions
- Non-exertional (Classic) – Occurs over period of time from chronic exposure to hot, humid environment
Heat Stroke Complications
- Multiple organ dysfunction syndrome
- CNS dysfunction
- Cerebral edema
- Pulmonary edema
- Renal impairment
- Electrolyte and acid-base disturbances
- Coagulopathy
- See Chart 72-6 Preventing Heat Induced Illnesses
Heat Stroke Treatment
- Stabilize CAB’s
- IV Access
- Remove Clothing
- Rapid Reduction of temp
- Cool Sheets
- Ice
- Cooling Blankets
- Immersion in cold water
- Fan
- Monitor
An older client with heat exhaustion is being cooled with cool water spray and fanning. What assessment indicates to the nurse that the client needs hospitalization?
- A. The client is alert and oriented.
- B. The client’s mucous membranes are dry and sticky.
- C. The client reports weakness and nausea.
- D. The client continues to sweat while being cooled.
D?
Which client is at greatest risk for heat exhaustion?
- a. A 34 year old police officer
- b. A 78 year old gardener
- c. A 42 year old swimming instructor
- d. A 24 year old construction worker
B?
Cold-Related Injury: Hypothermia
- Occurs at core body temp <95º F (35º C)
- Categories by severity: Treatment depends on severity
- Mild: 90-97º F (32-36º C) - shivering, dysarthria (slurred speech), muscular incoordination, impaired cognitive abilities, and cold diuresis.
- Moderate: 82-90º F (28-32º C) - obvious motor impairment and weakness
- Severe: Below 82º F (<28º C) coagulopathy (abnormal clotting) or cardiac failure can occur.
Cold-Related Injury: Hypothermia
- Cold water immersion
- Acute illness (e.g., sepsis)
- Shock states
- Immobilization
- Cold weather (especially for the homeless and people working outdoors)
- Advanced age
- Selected medications (e.g., phenothiazines, barbiturates)
- Alcohol intoxication and substance abuse
- Malnutrition
- Hypothyroidism
- Inadequate clothing or shelter (e.g., the homeless population)
- Traumatic injury
Cold-Related Injury: Hypothermia
Teach:
- Proper clothing/layers
- -Prepare for cold weather
- Wear synthetic not cotton
- Wear a hat to decrease heat loss
- Face Protection including sunscreen
- Protect eyes
Hypothermia: Pre Hospital and Hospital Treatment
Pre Hospital for Mild
- Sheltered from cold
- remove wet clothing
- Warm clothing or blankets (Passive)
- Drink warm fluids no caffeine or alcohol
Hospital Care for Moderate and Severe hypothermia
- Prevent ventricular fibrillation – avoid external heating devices which can cause vasodilation.
- Horizontal position (supine to reduce orthostatic changes
- Maintenance of ABCs
- After-drop – cont. decrease in core body temp-return of cold blood
- Extracorporeal rewarming methods
Cold-Related Injury: Frostbite
- Accompanied by initial pain, numbness, pallor of affected area
- Deep frostbite requires aggressive management in a medical facility
- First degree – least severe type hyperemia of involved area and edema formation
- Second-degree - development of large fluid-filled blisters with partial-thickness skin necrosis.
- Third-degree - small blisters containing dark fluid and affected body part cool, numb, blue, or red and does not blanch.
- Fourth-degree most severe no blisters or edema. body part numb, cold, and bloodless. gangrene develops, which may necessitate amputation of the affected part.
Do not apply dry heat or massage the frostbitten areas as part of the warming process. These actions can produce further tissue injury.
Rewarming Methods
- Active internal (Core) rewarming
- Passive or Active external rewarming
An occupational health nurse is teaching a safety class to city employees who work outdoors year round. What does the nurse teach are risk factors for developing frostbite? Select all that apply.
- A. Excessive fatigue
- B. Prior episodes of frostbite
- C. Diabetes or other peripheral vascular disease
- D. Dehydration
- E. Smoking
- F. Wearing polyester socks
B, C, D, E?
Non Fatal Drowning
- Prevention is key
- Safe rescue of victim
- Airway and cardiopulmonary support interventions
- CPR greatest influence on survivial.
- Gastric decompression
- Support of body systems
- Don’t swim alone, watch others who are not good swimmers, test depth of water before diving, avoid alcohol, use water rescue equipment.
Non-Fatal Drowning
- Aspiration causes surfactant to wash out of lungs
- Pulmonary Edema
- Water Quality – contaminants
- Duration and severity of hypoxia determine outcomes
- Hypothermia might be better
- Immediate emergency care focuses on a safe rescue of the victim
- Do not attempt to get the water out of the victim’s lungs; deliver abdominal or chest thrusts only if airway obstruction is suspected.
Therapeutic Goals
- Maintain perfusion
- Maintain Breathing
- Maintain Temperature
A 2-year-old child falls into the community swimming pool and does not resurface. A lifeguard dives in to save the child. What does the lifeguard do first after the rescue?
- a. Rapidly rewarms the child
- b. Stabilizes the child’s spine
- c. Removes water from the child’s lungs
- d. Initiates rescue breathing on the child
D?
Decompression sickness
- AKA The BENDS
- Occurs in diving, high altitude flying or flying commercial within 24 hours after diving.
- Results from formation of nitrogen bubbles that occur with rapid changes in atmospheric pressure.
- S/S – Joint or extremity pain, numbness, hypesthesia, decrease ROM
The nurse is providing reminders to a Red Cross class about safety procedures to prevent drowning or submersion. In which situation does this present the greatest risk?
- a. College students going to a frat party at a boat hours
- b. Families going to the quarry to swim
- c. Children swimming at the community pool
- d. A Couple going swimming together at a local lake
A?
Animal Bites
- Common reason for ED Visit
- Dogs most common
- Cats are high risk for infection
- Must be reported to public health
