Class 21 (Environmental Emergencies & Drowning) Ch18Factors Affecting ExposureLoss of Body Heat (1 of 2)Loss of Body Heat (2 of 2)HypothermiaSigns and Symptoms of Mild HypothermiaSigns and Symptoms of More Severe HypothermiaCore Temperature Less Than 80°FLocal Cold InjuriesEmergency Care for Local Cold InjuryWarm-Water BathCold Exposure and YouOn The Scene: Cold ExposureScene Size-upInitial AssessmentFocused History and Physical ExamBaseline Vital SignsInterventionsDetailed Physical ExamOngoing AssessmentHeat ExposureHeat CrampsSigns and Symptoms of Heat Exhaustion (1 of 2)Signs and Symptoms of Heat Exhaustion (2 of 2)Emergency Medical CareSigns and Symptoms of HeatstrokeCare for Heat Stroke (1 of 2)Care for Heat Stroke (2 of 2)On The Scene: Heat ExposureYou are the ProviderYou are the Provider (continued)Slide 32Slide 33Slide 34You are the Provider (continued) (1 of 2)You are the Provider (continued) (2 of 2)Slide 37Slide 38Slide 39Slide 40Slide 41Slide 42Drowning and Near DrowningDrowning ProcessSpinal Injuries in Submersion IncidentsSpinal Stabilization in WaterResuscitation EffortsDiving ProblemsSigns and Symptoms of Air Embolism (1 of 2)Signs and Symptoms of Air Embolism (2 of 2)Decompression Sickness (The Bends)Other Water HazardsPreventionOn The Scene: DrowningSlide 55Slide 56Transport DecisionSlide 58Baseline Vital Signs/ SAMPLE HistoryDrowning InterventionsDiving InterventionsSlide 62Slide 63LightningSlide 65Spider BitesBlack Widow SpiderBrown Recluse SpiderSnake BitesFour Types of Poisonous Snakes in the USPit VipersSigns and Symptoms of a Pit Viper BiteCare for Pit Viper Bites (1 of 2)Care for Pit Viper Bites (2 of 2)Coral SnakesCare for Coral Snake Bites (1 of 2)Care for Coral Snake Bites (2 of 2)Scorpion StingsTick Bites (1 of 3)Tick Bites (2 of 3)Tick Bites (3 of 3)Caring for a Tick BiteInjuries from Marine AnimalsCare for Marine StingsClass 21 (Environmental Emergencies & Drowning)Ch18Factors Affecting Exposure•Physical condition•Age•Nutrition and hydration•Environmental conditionsLoss of Body Heat (1 of 2)•Conduction–Transfer of heat from body to colder object•Convection–Transfer of heat through circulating air•Evaporation–Cooling of body through sweating•Radiation–Loss of body heat directly into a colder environment•Respirations–Loss of body heat during breathing•Rate and amount of heat gain or loss can be modified in three ways:–Increase or decrease heat production.–Move to sheltered area where heat loss is increased or decreased.–Wear insulated clothing.Loss of Body Heat (2 of 2)Hypothermia•Lowering of the body temperature below 95°F (35°C)•Weather does not have to be below freezing for hypothermia to occur.•Older persons and infants are at higher risk.•People with other illnesses and injuries are susceptible to hypothermia.Signs and Symptomsof Mild Hypothermia•Shivering•Rapid pulse and respirations•Red, pale, cyanotic skinSigns and Symptoms of More Severe Hypothermia•Shivering stops.•Muscular activity decreases.•Fine muscle activity ceases.•Eventually, all muscle activity stops.Core TemperatureLess Than 80°F•Patient may appear dead (or in a coma).•Never assume that a cold, pulseless patient is dead.Local Cold Injuries•Frostnip–Freezing of the skin but not the deeper surface•Immersion (trench) foot–Prolonged exposure to cold water• Frostbite–Freezing of a body part, usually an extremityEmergency Carefor Local Cold Injury•Remove the patient from further exposure to the cold.•Handle the injured part gently.•Administer oxygen.•Remove any wet or restrictive clothing.•Never rub the area.•Do not break blisters.•Transport.Warm-Water Bath•Water temperature should be between 100-112oF.•Recheck water temperature and stir to circulate.•Keep body part in water until warm and sensation returns.•Dress with dry, sterile dressings.Cold Exposure and You•EMT-Bs are at risk for hypothermia when working in a cold environment.•Stay aware of local weather conditions.•Dress appropriately and be prepared.•Vehicle must be properly equipped and maintained.•Never allow yourself to become a casualty!On The Scene: Cold ExposureThe following slides walk the student though a cold exposure call.Scene Size-up•Note weather conditions.•Identify safety hazards such as icy roads, mud, or wet grass.Initial Assessment•Check temperature on patient’s abdomen.•Mental status can be affected.•Ensure adequate airway.•Warmed, humidified oxygen helps warm from inside out.•Palpate for carotid pulse; wait 30–45 seconds.•Transport immediately or move to warmer location.Focused History and Physical Exam•If unconscious, do a rapid physical exam.•If conscious, attempt to obtain SAMPLE history.–Determine how long the patient was exposed to the cold.–Medications can affect the patient’s metabolism.•Focused physical exam–Concentrate on areas of body directly affected by exposure.Baseline Vital Signs•Can be altered by hypothermia•Monitor for changes in mental status.•Check for core body temperature.Interventions•Move from cold environment.•Do not allow patient to walk, eat, use any stimulants, or smoke or chew tobacco.•Remove wet clothing.•Place dry blankets under and over patient.•Handle gently.•Do not massage extremities.•Give warm, humidified oxygen.Detailed Physical Exam•Aimed at determining degree and extent of cold injury•Evaluate skin temperature, texture, and turgor.Ongoing Assessment•Rewarming can be harmful; monitor carefully.•Communicate conditions at scene, clothing, changes in mental status.Heat Exposure•Normal body temperature is 98.6°F.•Body attempts to maintain normal temperature despite ambient temperature.•Body cools itself by sweating (evaporation) and dilation of blood vessels.•High temperature and humidity decrease effectiveness of cooling mechanisms.Heat Cramps•Painful muscle spasms•Remove the patient from hot environment.•Rest the cramping muscle.•Replace fluids by mouth. •If cramps persist, transport the patient to hospital.Signs and Symptomsof Heat Exhaustion (1 of 2)•Dizziness, weakness, or fainting•Onset while working hard or exercising in hot environment•In older people and young, onset may occur while at rest in hot, humid, and poorly ventilated areas.•Cold, clammy skinSigns and Symptomsof Heat Exhaustion (2 of 2)•Dry tongue and thirst•Patients usually have normal vital signs, but pulse