environmental emergencies

Chapter 11: 

Chapter 11 Care of Patients with Common Environmental Emergencies

Heat-Related Illnesses: Heat Exhaustion: 

Heat-Related Illnesses: Heat Exhaustion Heat exhaustion is a syndrome caused primarily by dehydration, stemming from heavy perspiration and inadequate fluid and electrolyte consumption during heat exposure over a period of hours to days. Patients feel ill, and their clinical manifestations resemble the flu. Treatment involves immediate termination of physical activity and transfer to a cool place.

Heat-Related Illnesses: Heat Stroke: 

Heat-Related Illnesses: Heat Stroke Heat stroke is a true medical emergency in which body temperature may exceed 104 ° F (40 ° C). High mortality rate if not treated in a timely manner. Exertional heat stroke — sudden onset, typically caused by strenuous physical activity in hot, humid conditions. Classic heat stroke — occurs over a period of time as a result of chronic exposure to a hot, humid environment.

Heat Stroke Assessment: 

Heat Stroke Assessment Profoundly elevated body temperature (>104 ° F or 40 ° C) Mental status changes as a result of thermal injury to the brain Hypotension, tachycardia, tachypnea Hot and dry skin; however, persons may continue to perspire

Heat Stroke Complications: 

Heat Stroke Complications Multiple organ dysfunction syndrome Renal impairment Electrolyte and acid-base disturbances Coagulopathy Pulmonary edema Cerebral edema

Heat Stroke Treatment: 

Heat Stroke Treatment In the prehospital setting, rapid cooling is the first priority of care after ensuring that the patient has a patent airway, effective breathing, and circulation Hospital care—oxygen therapy, IV 0.9% saline solution, Foley, aggressive cooling methods, continuous core temperature monitoring Thorazine 25 to 50 mg IM or IV for shivering Valium for seizure activity

Snakebites: 

Snakebites

Envenomation: 

Envenomation

Pathophysiologic Effects of Pit Viper Envenomation: 

Pathophysiologic Effects of Pit Viper Envenomation Local tissue necrosis Massive tissue swelling Intravascular fluid shifts and hypovolemic shock Pulmonary edema Renal failure Hemorrhagic complications from DIC

First Aid—Snakebite: 

First Aid — Snakebite First priority is to move the person to a safe area away from the snake and encourage rest to decrease venom circulation. Remove jewelry and constricting clothing. Immobilize affected extremity in a position of function. Maintain the extremity below the level of the heart. Keep individual warm and calm. Do not offer any stimulants such as caffeine.

First Aid—Snakebite (Cont’d): 

First Aid — Snakebite (Cont ’ d) If transportation is delayed, apply a 2 to 4 cm constricting band that is not used as a tourniquet. Assess distal circulation frequently. Do not incise and suck or apply ice to the wound.

Hospital Care—Snakebite: 

Hospital Care — Snakebite Supplemental oxygen Two large-bore IV lines for NSS or RL Continuous cardiac and BP monitoring Opioids Tetanus prophylaxis Wound care Broad-spectrum antibiotics Baseline labs and coagulation profile

Arthropod Bites and Stings: 

Arthropod Bites and Stings Bites from brown recluse spiders result in ulcerative lesions: Necrotic wound (necrotic arachnidism) Systemic effects (loxoscelism)

First Aid—Brown Recluse Spider Bite: 

First Aid — Brown Recluse Spider Bite Use ice intermittently during the first 4 days after the bite. Do not use heat. Elevate the affected extremity. Provide local wound care. Rest the extremity.

Hospital Care—Brown Recluse Spider Bite: 

Hospital Care — Brown Recluse Spider Bite Topical antiseptic and sterile dressing Possible antibiotics Dapsone (Avlosulfon) Possible reconstructive surgery Supportive care for loxoscelism including management of renal failure, leukopenia, seizures, hemolytic anemia, and coma

Black Widow Spider: 

Black Widow Spider Envenomation produces latrodectism, severe abdominal pain, muscle rigidity and spasm, hypertension, and nausea and vomiting. Other symptoms include facial edema, ptosis, diaphoresis, weakness, increased salivation, priapism, respiratory difficulty, increased respiratory secretions, fasciculations, and paresthesias.

First Aid—Black Widow Spider Bite: 

First Aid — Black Widow Spider Bite Apply an ice pack. Monitor the individual for systemic toxicity. Support the patient ’ s airway, breathing, and circulation. Transport the patient to a medical facility.

Hospital Care—Black Widow Spider Bite: 

Hospital Care — Black Widow Spider Bite Monitor vital signs Opioid pain medication Muscle relaxants such as Valium, calcium gluconate Tetanus prophylaxis Antihypertensive agents as needed Treatment of pulmonary edema, uncontrollable hypertension, and shock

Tarantula: 

Tarantula Largest spiders of the arachnid class. Most bites to humans result in only local effects. Treatment — supportive management, analgesics, immobilize and elevate involved extremity, tetanus prophylaxis. Remove tarantula hairs as soon as possible through repeated use of sticky tape or duct tape, and then thoroughly irrigate the skin.

Scorpion Sting: 

Scorpion Sting Effects of a sting that injects venom from a scorpion are typically self-limiting and best treated by analgesics, supportive management, and basic wound care. One species of scorpion can inflict a sting associated with a severe, potentially fatal systemic response.

Interventions for Scorpion Sting: 

Interventions for Scorpion Sting Vital sign assessment Continuous monitoring for symptom progression Ice pack to sting site to control pain Analgesic and sedative agents Treat fever Tetanus prophylaxis Basic wound care

Bees and Wasps: 

Bees and Wasps Potential for anaphylactic reaction Emergency care to remove stinger and apply an ice pack Advanced emergency care in a hospital to ensure that the airway, breathing, and circulation are maintained “ EpiPen ” administration of epinephrine with the click of a button, which is especially valuable for allergic patients

Lightning Injuries: 

Lightning Injuries Both the cardiopulmonary and the central nervous systems are profoundly affected by lightning injuries. Most lethal initial effect on the cardiopulmonary system is asystole. Treatment includes immediate CPR. Rescuer is in no danger of electrical charge from contact with the victim.

Hypothermia: 

Hypothermia Hypothermia occurs at core body temperature of <95 ° F (35 ° C) Mild hypothermia (32 ° C to 35 ° C) Moderate hypothermia (28 ° C to 32 ° C) Severe hypothermia (<28 ° C)

Hospital Treatment—Hypothermia: 

Hospital Treatment — Hypothermia Moderate and severe hypothermia Prevent ventricular fibrillation Horizontal position Maintenance of ABCs After-drop Extracorporeal rewarming methods

Frostbite: 

Frostbite Frostbite is accompanied by initial pain, numbness, and pallor of the affected area. Deep frostbite requires aggressive management in a medical facility.

Altitude-Related Illness: 

Altitude-Related Illness Elevations >5000 ft can produce physiologic responses in the body that can be fatal Acclimatization Acute mountain sickness (AMS) High altitude cerebral edema (HACE) High altitude pulmonary edema (HAPE)

Near-Drowning Event: 

Near-Drowning Event Prevention is key Safe rescue of the victim After removal from the water, airway and cardiopulmonary support interventions CPR if necessary Gastric decompression Support of body systems