Environmental Objectives

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Environmental Objectives

• Upon completion of this lecture, you will be
  better able to
• List the critical components in documenting a
  bite or sting
• Describe appropriate interventions for the 3
  categories of burns
• Describe primary interventions for the 3 types of
  heat related illness
• Identify early signs of hypothermia
• State assessment findings and appropriate
  interventions for a near-drowning episode
• Describe the role of the poison specialist in
  evaluating and managing student poisonings
• List signs and symptoms associated with specific
  toxic syndromes

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ENVIRONMENTAL EMERGENCIES
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ENVIRONMENTAL EMERGENCIES

• Bites and Stings
• Burns
• Hyper- and Hypothermia
• Toxicological Emergencies
• Water Emergencies
• Drowning/Near Drowning
• Diving Accidents

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BITESAnimal or Human

• Soft tissue damage - Crushing/Lacerations
• Infection - especially if human bite
• Functional and Cosmetic Damage
• Intervention
• Monitor ABCs including shock
• Control bleeding
• Transport to ED/MD
• Report incident if required

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POISONOUS SNAKES, SPIDERS, SCORPIONS

• Important factors to consider
• Age and size of child
• Type of venom/toxin or
  identification of source
• Amount of venom injected
• Location of bite/sting
• Not all are poisonous

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Snake Bite with Envenomation
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BURNS

• CATEGORIES
• SUPERFICIAL PARTIAL THICKNESS (1ST DEGREE)
• PARTIAL THICKNESS (2ND DEGREE)
• FULL THICKNESS (3RD DEGREE)

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EXTENT OF BURN INJURY

• BSA - Body Surface Area
• Estimate of size/area involved
• Palm (of affected student) including fingers
  equals 1
• Rule of Nines chart
• Modified chart for children

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SEVERITY OF BURN

• Depth (full thickness or deep partial)
• Extent - over 10 BSA deep/full thickness
• Location of injury - hands, face, genitalia
• Age and health status - chronic problems
• Associated injury - smoke inhalation or
  electrical trauma

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BURNS
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ASSESSMENT OF BURNS

• ABCDs are first priority
• Expose burn area unless clothing adhered
• Irrigate chemical burns
• Use sterile gloves, if available
• Cool thermal burns with tepid water until burned
  area is no longer warm, then apply dry, sterile
  dressing
• Call EMS for major burns or altered LOC

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SPECIFIC BURN INJURIES

• CHEMICAL BURNS
• ELECTRICAL BURNS
• Electric current
• Lightning
• INHALATION INJURIES
• Heat
• Smoke
• Toxic fumes

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DOCUMENTATION

• Source or causative agent
• Duration of contact
• Time and site of burn
• Assessment and interventions
• Related injury
• Disposition of student

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HYPERTHERMIA

• HEAT STROKE
• HEAT EXHAUSTION
• HEAT CRAMPS

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HEAT STROKE

• ASSESSMENT
• Hot, dry skin
• Headache, confused, or lethargic
• Thirsty
• INTERVENTION
• EMERGENT-CALL EMS!
• Remove from heat
• Cool quickly

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HEAT EXHAUSTION

• ASSESSMENT
• Skin wet, normal temperature
• Fatigue, weakness
• INTERVENTION
• ABCDs
• Cool skin
• Give fluids, unless nauseated or vomiting
• Call EMS if not responding to interventions

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HEAT CRAMPS

• ASSESSMENT
• Physical exertion, perspiring
• Drinking large amounts of water
• INTERVENTIONS
• Remove from heat
• Apply moist towels over cramped muscle
• Massage muscle to stretch (per protocol)
• Replace salt and liquids

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HYPOTHERMIA

• Loss of body heat
• Respiration
• Radiation
• Conduction
• Convection
• Evaporation

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HYPOTHERMIA

• SHIVERING THAT STOPS AFTER CONTINUOUS EXPOSURE
  TO SEVERE COLD, IS AN OMINOUS SIGN!!

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ASSESSMENT OF HYPOTHERMIA

• Call EMS
• Stabilize ABCs
• Handle carefully
• Place in warm area-cover head
• Monitor LOC and mental status
• Vital signs may be significantly slowed
• Do not initiate CPR unless no pulse for 2 min.

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FROSTBITE

• Localized severe cooling of skin
• Typically involves hands, fingers, feet, toes,
  nose, ears or face
• Stages
• Incipient
• Superficial
• Deep

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FROSTBITE
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FROSTBITE
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FROSTBITE

• INTERVENTIONS
• Warm quickly
• Do not rub or cause friction on tissue
• If exposure sufficient for deep tissue damage, do
  not warm, transport immediately
• Refer for diagnosis and treatment

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NEAR DROWNING

• Assessment
• Call EMS
• ABCs/LOC
• History
• time submerged
• water temperature
• diving injury
• Safe removal from water

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TOXICOLOGIC EMERGENCIES
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POISON CONTROL

• Know the Poison Control helpline number
• Give critical information
• Note substance (if known)
• How much was taken ?
• What route ?
• How long ago ?
• NOTE any other substances or daily medications
  that student takes
• Current status/symptoms
• Interventions and effect

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INTERVENTIONS FOR SPECIFIC TOXICOLOGICAL
EMERGENCIES

• Dermal exposure
• Flush with water, except powders/dust
• Ocular exposure
• Inhalation exposure
• Removal from source, protect yourself
• Ingestions
• Dilute with sips of water
• Wait for directions before inducing vomiting

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TOXIC SYNDROMES

• Illicit drug use
• Over-the-counter medication abuse
• Cough and cold preparations
• Diet aids
• Toxidromes
• Opiod
• Sympathomimetic
• Anticholinergic
• Cholinergic

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PREVENTION

• Increase awareness of toxic substances likely to
  be encountered
• Obtain copies of MSDS sheets for every chemical
  on site at school
• Secure poison awareness educational material
  through poison control center
• Assure all school staff are aware of how to
  contact Poison Control Center as appropriate

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SUMMARY

• Students are subject to a variety of
  environmental emergencies, from heat-related
  illness to frostbite, insect stings, scald burns
  and toxic ingestions to name a few.
• Use your clinical knowledge and additional
  resources to provide appropriate interventions
  when confronted with these types of emergencies.

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ANY QUESTIONS??