Chapter 33: Environmental Emergencies

Overview

• Focus on environmental injuries in emergency care.
• Includes hypothermia, frostbite, heat stroke, drowning, diving emergencies, high altitude sickness, lightning strikes, and bites from animals.

Factors Affecting Exposure

1. Physical Condition: Poor physical condition increases risk.
2. Age: Infants, children, and older adults are at greater risk.
3. Nutrition and Hydration: Lack of food/water and alcohol affect temperature regulation.
4. Environmental Conditions: Air temperature, humidity, and wind influence risk.

Cold Exposure

• Heat Loss Mechanisms: Conduction, convection, evaporation, radiation, respiration.
• Heat Production and Loss Control: Shivering increases heat; limiting movement decreases heat.

Hypothermia

• Occurs when core body temp < 95°F.
• Signs and Symptoms: Blue lips, shivering, slowed body functions, potential death.
• Stages:
  • Mild: Core temp > 93.2°F
  • Moderate: Core temp 86°F - 93.2°F
  • Severe: Core temp < 86°F
• Management: Stabilize ABCs, prevent heat loss, transport.

Local Cold Injuries

• Frostnip: Skin freezes, deeper tissues unaffected.
• Immersion Foot: Prolonged cold water exposure.
• Frostbite: Tissues freeze, potential gangrene.
• Management: Remove from cold, handle gently, rewarm if possible.

Heat Exposure

• Heat Emergencies: Heat cramps, heat exhaustion, heat stroke.
• Risk Factors: High temperature, humidity, lack of acclimation, vigorous exercise.
• Management:
  • Move to a cooler environment.
  • Provide high flow O2, cool with water spray and fan.

Drowning and Diving Emergencies

• Drowning: Respiratory impairment due to submersion.
• Diving Emergencies: Air embolism, decompression sickness.
• Management: Resuscitate, transport, treat hypothermia.

High Altitude Sickness

• Types:
  • Acute Mountain Sickness
  • High-Altitude Pulmonary Edema (HAPE)
  • High-Altitude Cerebral Edema (HACE)
• Signs and Symptoms: Shortness of breath, headache, possible severe complications.
• Management: Descend to lower altitude, provide oxygen, transport.

Lightning Strikes

• Cardiovascular and nervous systems are most affected.
• Management: Reverse triage, stabilize spine, provide CPR.

Bites and Envenomations

• Spider Bites: Black widow and brown recluse.
• Insect Stings: Remove stinger, apply ice.
• Snake Bites: Pit vipers (rattlesnakes, copperheads) and coral snakes.
  • Management: Calm patient, immobilize extremity, transport.
• Marine Animal Injuries: Treat with hot water immersion, transport.

Summary

• Key focus on understanding and managing various environmental emergencies.
• Importance of knowing signs, symptoms, and appropriate emergency responses.