Environmental Emergencies Sharon Brown RN Heat Related Emergencies

Environmental Emergencies Sharon Brown, RN

Heat Related Emergencies v. Heat related physiology v Information about body temperature is collected by thermoreceptors and sent to hypothalamus v Sweating is primary response to heat ~ loss of NA, K, fluids can lead to dehydration

Heat Edema v. Occurs during long periods of standing or sitting v“Theme Park Rash” v. Tx is rest, elevation

Heat Cramps Leg, shoulder, thigh, and abdominal cramps Form of hyponatremia r/t loss of sodium and excess water intake TX includes rest, cooling measures. D/C teaching includes encourage adding electrolye drinks while outdoors

Heat Exhaustion v. Prolonged heat exposure without adequate fluid replacement v. Temp can be greater than 104 v. S/S ~ pale, ashen, profuse sweating, weakness, hypotensive, tachycardic, severe thirst v. Tx – cooling measures, IVF replacement

Heat Stroke Emergent and life threatening. Mortality rate is 50% S/S – skin is hot and dry. Temp is greater than 106, ALOC Cooling measures – wet cloths, fans, ice packs at arm pits, neck and groin. Prevent shivering with Demerol or ativan Monitor for Rhabdomyolysis (dark urine, muscle cramps) Aggressive cooling is continued until around 102 degrees

Cold Related Emergencies Body attempts to conserve heat by vasoconstriction and produce heat by shivering DM patients cannot feel extreme changes and may not be aware of potential harm

Chilblains is caused by intermittent, prolonged exposure to damp, nonfreezing environments that are above freezing resulting in painful inflamed lesions over the exposed sites (usually hands, ears, lower legs and feet), with no permanent impairment. Frostnip is a very mild form of frostbite

Frostbite True tissue freezing with formation of ice crystals in tissue Most common areas include fingers, toes, ears, nose Most severe injury results from tissues that freeze, thaw, and then refreeze again

Frostbite degrees of severity 1 st degree Pale skin, may be cyanotic, edema, decreased sensation Superficial 2 nd degree Cyanotic, edema, blisters, decreased sensation Deep 2 nd degree Pale & cyanotic, edema, anesthesia at site, nonpliable skin 3 rd degree Pale, cyanotic, necrotic, gangrene

Frostbite TX includes Rapidly re-warm affected area in 100 -108 temp water for 15 -30 minutes Endpoint of rewarming is softening of skin and return of sensation Elevate affected part

Hypothermia Physiologic changes with hypothermia 79 degrees – obtunded, no DTR’s, no pain response 77 degrees – apnea, pulmonary edema 68 degrees – asystole Treatment for ALL patients Remove all wet garments Provide warm blankets Limit movement

Mild Hypothermia 93. 2 -96. 8 Slurred speech, shivering, pale skin (vasoconstriction) Passive rewarming (0. 5 -2 F/hour)

Moderate Hypothermia 86 -93. 2 ALOC, decreased RR, shivering stops at 89 Need to re-warm core as well as extremities because of re-warming shock! (cold blood from periphery reaches core and causes hypotension and dysrythmias)

Severe Hypothermia Less than 86 degrees Pupils are fixed and dilated Bradycardia, coma If VF occurs, attempt defib x 1. If no response, need to focus on rewarming patient first. Requires passive external, active external, and active internal rewarming

Submersion Incidents 4, 000 deaths/year 40% are less than 4 years old Die from hypoxia…not from too much fluid in lungs Cold water has better prognosis than warm water, but cold water has higher risk for dysrhythmias TX – ABC’s, must consider secondary trauma, monitor for pulmonary complications

Submersion v Death generally occurs from hypoxia followed by respiratory failure and ischemic neurologic injury • Most drowning are considered wet drowning in which the alveoli develop impaired gas exchange after the lungs are flooded; aspiration of as little as 5 cc/kg can result in wet drowning • About 10 -20% of victims suffer dry drowning, in which glottic closure and laryngospasm occur before aspiration of liquid, followed by asphyxia

Snakebites Only 10 -15 deaths/year, but several thousand bites Most are pit vipers

Snake bites, cont. S/S ~ metallic taste, muscle quivering, tingling around mouth, burning at wound site, diaphoresis, seizures Need to know time, location and description of snake Pit viper ~ puncture from fangs, semi circle teeth marks Coral snake ~ scratch marks, teeth marks Treatment Decrease movement, immobilze extremity, don’t elevate Need anti venin. (administer within 4 hours of bite)

Dog Bites Most common animal bite seen in ED Copious wound irrigation Most wounds are left open to heal from inside out d/t high risk of infection Patient is usually prescribed antibiotics

Spider bites Black Widow Lives in dark areas Found in all states except Alaska Only female is poisonous with red hourglass on belly Initial bite is felt as pinprick 20 minutes~dull ache, abd. pain, cramping, parasthesias 1 hour ~ severe pain, increases within 12 -48 hours Can progress with hypotension, shock, and resp. failure TX – ice to bite site, Ca gluconate, antivenin

Black Widow

Spider Bites Brown Recluse Small brown or tan spider with a band (violin shaped) Bite is initially painless or mild, localized 2 -4 hours – pain, redness and blistering 2 -4 days – painful purpura 7 -14 days – necrotizing, ulcerated wound s/s – fever, chills, N/V, joint pain TX- cool compress, debridement, HBO, Dapsone (used for leprosy)

Brown Recluse

Lyme Disease Bulls’ Eye lesion following Tick Bite (can be delay of 3 -30 days) Tick must be attached for 24 hours to transmit disease Non-specific flu s/s and can develop into systemic illness with neuro changes (memory loss, meningitis, poor motor coordination) Tx – amoxicillin, doxycycline

Lyme Disease