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Environmental Emergencies
Thermoregulatory Emergencies

An increase or decrease in the temperature of the body or body part that results in an injury.

Temperature Regulation in the Body

The body performs a delicate balancing act between the heat generated in the body and the heat lost from it

Types of Heat Loss
- Respiration
- Convection
- Conduction
- Radiation
- Evaporation

Heat loss occurs during respiration - when the body warms and humidifies the air.

Maintenance of Body Temp
Falling body temperature
- Peripheral blood vessels constrict
- Muscles produce heat through shivering
Rising body temperature
- Blood vessels dilate
- Sweat glands produce moisture

The body also produces heat by shivering

Exposure to the Cold (at Tembagapura ?)

Extreme weather conditions can produce a variety of cold emergencies

Hypothermia: A condition in which the core body temperature falls below 35o C (95o F) and the body’s normal functions are impaired.

Caused by prolonged exposure to cold.
The most common cause of generalized hypothermia is exposure to a cold environment such as cold water.

Factors that Contribute to Hypothermia
- Cold environments
- Immersion or submersion in water
- Age (the very young and the elderly)
- Alcohol
- Shock (hypoperfusion)
- Some medications and poisons
- Medical conditions
- Diabetes and hypoglycemia
- Metabolic and infectious processes
- Trauma
- Hypovolemia or shock
- Head injuries
- Spinal cord injuries
- Burns

Alcohol use is a complicating factor in many hypothermic patients

Mental & Motor Function Changes caused by Hypothermia
= Dizziness and poor coordination
= Altered mental status
- Memory disturbances
- Poor judgement
- Mood changes
= Communication and speech difficulties
= Stiffness/rigid posture
= Reduced or absent sense of touch
= Changes in vital signs
= Joint or muscle pain
Focused History
What was the source? If water, what was the temperature? What was the general environmental like? How long was the patient exposed? Did the patient experience a loss of consciousness? Are the effects general or local?
Hypothermia Treatment
- Remove the patient from the cold environment and protect from heat loss - Remove any cold or wet clothing, and cover the patient with blankets - Handle the patient with care, and avoid rough handling - Warm the patient compartment of the ambulance as much as possible - Hypothermia Treatment continued - Apply high-flow oxygen; warmed and humidified if possible - Use no stimulants such as caffeine or alcohol - Do not massage the extremities - Check for a pulse for 30 - 45 seconds before starting CPR

Do not attempt to actively warm hypothermic patients who have a decreased level of consciousness...

Care for Hypothermia with No Signs of Life
- Ensure a patent airway - Ventilate the patient with 100% oxygen - Begin CPR if no pulse for 30 - 45 seconds - Use the AED according to local established protocols, or call medical direction

Local cold injuries result from decreased blood flow to, or freezing of, a body part. These injuries are often called frostbite or frostnip.

Early or Superficial Cold Injury
- Pale skin with delayed capillary refill
- Loss of feeling/sensation in injured area
- Skin still soft
- Tingling sensation when rewarmed
Late or Deep Cold Injury
- White or waxy skin appearance
- Firm or frozen skin presentation
- Swelling and blister formation
- Loss of sensation in injured area
- If thawed, skin may be purple and pale
Care for Local Cold Injuries
- Remove patient from cold environment
- Protect the cold extremity from injury
- Administer oxygen
- Remove wet or restrictive clothing and all jewelry
- Splint if extremity involved, and cover with dry, sterile dressing

Place dressings between those fingers affected by local cold injury.
Never

re-expose the area to cold, break blisters, rub or massage the area, apply heat, or allow the patient to use the affected area.

In a cold emergency, if transport time will be long:
- Immerse the affected part in warm water (102o - 104o F)
- Continuosly stir and add warm water to maintain temperature
- Continue immersion until the area is soft andcolor and sensation return
- Pat gently and dress with dry, sterile dressings
- Protect the injured area from refreezing
- Refer to local protocols for other treatment

Exposure to Heat

baru ini di Doha,

Predisposing Factors for Heat Emergencies
- Hot, humid weather
- Vigorous physical activity
- Age (the very young and the elderly)
- Medical conditions
- Diabetes
- Heart disease
- Fever
- Predisposing Factors for Heat Emergencies continued
- Dehydration
- Obesity
- Fatigue
- Drugs and medications
- Previous history of hyperthermia
Signs and Symptoms of Hyperthermia
- Muscle cramps
- Weakness or exhaustion
- Dizziness or fainting
- Rapid, bounding pulse
- Altered mental status
- Moist, pale, cool, hot or normal skin
- Nausea, vomiting and abdominal cramps
Care for Hyperthermia with Moist, Pale, Cool or Normal Skin (Heat Exhaustion)
- Remove patient from hot environment
- Administer oxygen
- Loosen or remove clothing
- Cool the patient by fanning
- Place responsive patient supine with legs elevated; if vomiting, place on side
- If no nausea, provide cool water to drink
Care for Hyperthermia with Hot, Dry Skin (Heat Stroke)
- Remove patient from hot environment
- Remove clothing and administer oxygen
- Apply cold to neck, groin and armpits
- Moisten patient’s skin with wet towels
- Fan the patient aggressively
- Transport patient immediately

Drowning and Near Drowning
Care of the Near Drowning Patient
- Immobilize spine if trauma is suspected
- Ensure adequate airway, provide oxygen and ventilate if necessary
- Provide CPR if pulseless (use AED if allowed by local protocols)
- Suction as needed
- If no trauma, place patient on left side
- Transport immediately

Bites and Stings
Care of Bites and Stings
- Ensure adequate ABC’s
- Inspect the site for stinger or bite marks
- Wash the area gently
- Remove jewelry from injured area
- If extremity, position just below level of heart
- If snakebite, consult medical direction
- Watch for development of allergic reaction

Source MOSBY