Chapter 26 HeatRelated Emergencies BRADY National Ski Patrol

Objectives 26. 1 Explain the way the body normally adjusts to a hot environment. 26. 2 List the signs and symptoms of a patient with each of the four types of heatrelated illness. 26. 3 Describe and demonstrate the assessment and emergency care of a patient suffering from each of the four types of heat-related illness. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Objectives 26. 4 List the signs and symptoms of a patient who is a victim of a lightning strike. 26. 5 Describe and demonstrate the assessment and emergency care for a patient who has been struck by lightning. 26. 6 Explain what one can do to prevent heat -related illness. BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Topics l Anatomy and Physiology l Common Heat-Related Emergencies l Heat-Related Illness Prevention l Lightning l Assessment l Management l Chapter Summary BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Case Presentation On a beautiful desert summer day, with the temperature at about 105°F, while your group is resting in the shade you encounter a female hiker from another group who is slower than the others, staggering, panting, flushed, and asking for rest and water. BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Anatomy and Physiology l Thermoregulation ◦ Sweating ◦ Dilation of blood vessels in skin l Heat Index l Hydration l Adaptation ◦ Prior exposure ◦ Physical training BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Mechanisms of Heat Loss BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed.

Common Heat-Related Emergencies l Heat ◦ ◦ Illnesses Causes Characteristics Progression Risk groups and factors continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Common Heat-Related Emergencies l Four ◦ ◦ BRADY Levels Heat-induced syncope Heat cramps Heat exhaustion Heat stroke National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Common Heat-Related Emergencies BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©

Heat Syncope and Heat Cramps l Syncope ◦ Cardiovascular ◦ Temporary ◦ Signs and symptoms l Cramps ◦ Muscular ◦ Electrolyte/dehydration issues BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Heat Exhaustion and Heat Stroke BRADY National Ski Patrol, Outdoor Emergency Care, 5 th

Heat Exhaustion and Heat Stroke l Exhaustion ◦ Exposure/dehydration ◦ Signs and symptoms l Stroke ◦ Life threatening ◦ Signs and symptoms ◦ Effects BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Heat-Related Illness Prevention l Heat acclimatization l Hydration: ensure proper hydration; light yellow urine is a good indicator of being well hydrated. l Behavior: prepare for the heat; wear light colored, layered clothing and a wide brimmed hat. BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Sunburn l. A superficial burn of the skin l Repeated exposure may lead to degenerative skin changes and possible cancer l High altitudes, snow, and water increase vulnerability l Clouds may not filter the UV rays BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Sunburn Prevention l Topical creams ◦ Physical sunscreens • Mechanical blocking • Opaque greases i. e. , zinc or titanium dioxide ◦ Chemical sunscreens • SPF factor • Need frequent and sufficient application l Clothing/Shade ◦ May need layers ◦ Thick brimmed hat BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Lightning l Atmospheric discharge of electricity capable of generating 300, 000 amps and 2 billion volts l 1 in 5, 000 chance of being struck l Average of 62 deaths per year l Cannot predict where it will strike BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Lightning BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by

Lightning Injuries l Caused by direct electrical current – high voltage, short duration l Respiratory arrest l Cardiac arrest l Severe tissue damage ◦ Internal may not be obvious, but muscle and internal organs may be affected continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Lightning Injuries l Severe tissue damage ◦ Kidney injury may result from chemicals released into the blood ◦ Entrance and exit wounds will be present ◦ Skin injuries may occur in a fern leaf pattern continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Lightning Injuries l Unpredictable neurologic deficits l Muscular contractions can cause falls resulting in injury l 30% fatality rate BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Reducing Risk of Lightning Strikes l Seek shelter ◦ Outdoor safety ◦ Building safety l 30/30 rule l Clear ski lifts and exposed summit structures BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Case Update You leave the shade of the rock overhang and walk out into the hot sun of a 105°F day to find a young woman who is sweating, asking for water, and complaining of fatigue, nausea, dizziness, and a headache. You offer to help and suggest that the young woman sit under the rock overhang, rest, and have some water and electrolyte drinks. BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Assessment l Standard assessment procedures to start – ABCDs and vitals l Check skin temperature and appearance l Check for muscle spasms / cramping l May determine core body temp l Behavior changes? l Burns? Trauma? BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Management l Move patient to cooler/shaded location l Monitor condition and vitals l Hydration and oxygen as needed ◦ Electrolyte or salt water l Position BRADY for comfort, shock care l Limit re-exposure to heat, sun l Treat other injuries l Transport as appropriate National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Management of Heat Stroke l All of the previous AND ◦ Lower the body temperature by any means possible. • Ice packs for neck, armpits, groin • Remove clothing, apply wet towels, fan • Monitor temp, reduce to about 101º ◦ EMS transport ASAP ◦ If uncertain, treat for this! BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Management of Heat Stroke BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed.

Managing a Lightning-Strike Injury l Treat as unresponsive ◦ Jaw thrust ◦ Protect c-spine l CPR/AED ◦ Survivability is high ◦ Do first in triage situation ◦ Continue high flow oxygen l Transport BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Case Disposition Her respiration is 20; her pulse is 100 BPM. She is responding to questions. She is able to drink a drink containing electrolytes, and once she lies down, she looks more comfortable. You fan her, she continues to rest and sip liquids over the next 30 minutes, her breathing slows, and she becomes more talkative. Her pulse is now 80 BPM. Your findings suggest that she was suffering from heat exhaustion. BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Chapter Summary Allow the body to physiologically adapt to heat gradually, over several days (heat acclimatization). l Exercise in the early-morning or lateevening hours during hot weather. l Evaluate the risk of heat illness using the heat index. l The higher the heat and humidity, the greater the risk for heat illness. continued l BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Chapter Summary Wear loose-fitting, light-colored clothing. l The higher the heat and humidity, the greater the risk for heat illness. l Wear loose-fitting, light-colored clothing. l Drink plenty of water or electrolyte drinks. l Heat exhaustion responds rapidly to treatment. l continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Chapter Summary Heat stroke is characterized by an elevated body temperature and an altered mental status. l Heat stroke is life threatening and does not respond quickly to treatment. l Patients struck by lightning are not electrically charged and (unlike victims of electrical injury) pose no threat to rescuers. l continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Chapter Summary l BRADY In a triage situation, care first for lightningstrike victims who appear dead. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ