Spring and Summer Emergencies

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Spring and Summer Emergencies

• Silver Cross EMS System
• May 2014 EMD CE

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Heat Emergencies

• When a person is exposed to excess heat, the
  bodys mechanisms for regulating temp-erature can
  be overwhelmed, resulting in
• Heat cramps
• Heat exhaustion
• Heatstroke

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Heat Cramps

• Involuntary spasms of the muscles
• Often occur after exercise, especially in hot
  weather
• Most commonly occur in the leg or calf muscles
• When abdominal cramps occur, it may appear that
  the patient is having an acute abdominal problem.

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Heat Cramps

• Treatment
• Move the patient to a cool place.
• Have the patient lie down in a comfortable
  position.
• Give the patient water to drink.
• If the cramps do not disappear, arrange to have
  the patient transported.

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Heat Exhaustion

• Occurs when a person is exposed to temperatures
  greater than 80F (27C), usually in combination
  with high humidity
• Can also occur as the result of vigorous exercise
  at lower temperatures

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Heat Exhaustion

• Signs and symptoms
• Profuse sweating
• Lightheadedness
• Dizziness
• Nausea
• Weak pulse
• Low blood pressure

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Heat Exhaustion

• Predisposing factors may make some people more
  susceptible.
• Very young or old age
• Preexisting medical conditions
• Certain medications
• High ambient temperatures
• High humidity

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Heat Exhaustion

• Treatment
• Move the patient to a cooler place and treat him
  or her for shock.
• Unless the patient is unconscious, nauseated, or
  vomiting, give fluids by mouth.
• Monitor the ABCs.
• Arrange transport to a medical facility.

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Heatstroke

• Occurs when the body is subjected to more heat
  than it can handle and the normal mechanisms for
  getting rid of the excess heat are overwhelmed
• The patients body temperature rises until it
  reaches a level at which brain damage occurs.
• Signs and symptoms
• Flushed, dry skin that feels hot to the touch
• Semiconsciousness or unconsciousness
• Internal temperatures as high as 106F (41.1C)

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Heatstroke

• Treatment
• Maintain the patients ABCs.
• Remove the patient from the hot environment.
• Remove the patients clothes, down to the
  underwear.
• Soak the patient with water.
• If the patient is conscious and not nauseated,
  administer small amounts of cool water.
• Ice packs to the core (torso).
• Arrange for rapid transport.

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Heat Emergencies Comparison

• Normal Body Temp
• Cool, clammy skin
• Sweating
• Dizziness
• Nausea

• High Body Temp
• Sweating stops
• Flushed, hot skin
• Altered Mental Status or unconscious
• TRUE EMERGENCY!

• Heat Exhaustion

• Heat Stroke

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EMD Protocol for Heat Emergencies

• How long was the patient exposed?
• Was the onset of symptoms sudden?
• Is the patient exhibiting any unusual behavior?
• Is the patient complaining of cramps, nausea or
  vomiting?
• Is the patients skin hot, dry and flushed?
• Yes? See HEAT STROKE pre-arrival

• HEAT EXHAUSTION
• Move patient to a cool, well ventilated area
• Remove the patients outermost clothing
• Sponge patient with cool water to lower body
  temp. or fan to cool them
• Keep them calm and dont allow them to move
  around
• If patient is able to swallow and not nauseated,
  give them sips of water
• Call back if patients condition worsens prior to
  arrival of medical personnel
• HEAT STROKE
• Cool rapidly by placing ice packs behind neck,
  under armpits and in the groin area. If patient
  begins to shiver, remove ice.

• Key Questions

• Pre-Arrival Instructions

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Lightning Injury

• Definition Injuries from transmission of
  electricity between sky ground
• Strikes injure 500-1000 per year and kill 100
• Most common in spring and early summer, between
  300PM and 600PM

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Make yourself small and stay away from high
profile targets
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Lightning Injury

• Physical findings
• Minor injury
• Tympanic membrane rupture
• Confusion
• Amnesia may deny event occurred
• Brief loss of consciousness
• Temporary deafness
• Blindness
• Numbness or tingling in extremities

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Lightning Injury

• Physical findings
• Moderate injury
• Disorientation
• Combativeness (hypoxia)
• Coma
• Motor paralysis
• Absent pulses due to arterial spasm

• Sympathetic instability (cardiac irritability)
• Hypotension
• Vascular trauma
• Spinal shock
• Seizures
• Burns

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Lightning Injury

• Physical findings
• Severe injury
• Cardiac arrhythmia
• Cardiac arrest
• Pulmonary edema
• Pulmonary contusion
• Ortho injuries

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Lightning Injuries

• The electrical injury resulting from a lightning
  strike can cause cardiac irregularities or
  cardiac arrest.
• Treat patients by supporting their ABCs.
• CPR may be needed for some patients.
• Patients must be transported to a medical
  facility.
• Lightning injuries can cause electrical burns.
• This type of burn is mainly internal.
• The extent of burn damage will not be visible
  immediately after the injury occurs.

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Electrical Shock/ElectrocutionEMD Protocol

• Is patient still in contact with the electricity?
• Yes?
• Whats the source?
• Can you safely disable it? If Yes, do so.
• If No, proceed to next step
• Once source is disabled, re-assess the patient.
• Is the patient now conscious and breathing?
• Yes proceed to next step
• No Go to CPR per age
• Are there any obvious injuries?
• Yes go to proper protocol

1. Do not touch or approach patient until it is safe
   to do so!
2. Monitor the patients breathing and pulse.
3. Call back if the patients condition worsens
   prior to arrival of medical personnel.

• Key Questions

• Pre-Arrival Instructions

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Mosquitoes
West Nile virus (WNV) is most commonly
transmitted to humans by mosquitoes. You can
reduce your risk of being infected with WNV by
using insect repellent and wearing protective
clothing to prevent mosquito bites. There are no
medications to treat or vaccines to prevent WNV
infection. Fortunately, most people infected with
WNV will have no symptoms. About 1 in 5 people
who are infected will develop a fever with other
symptoms. Less than 1 of infected people develop
a serious, sometimes fatal, neurologic illness.
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Spiders

• High Blood Pressure
• Fever, hyperthermia
• Muscle spasms
• Abdominal pain

• Black widow spider signs/symptoms
• Severe pain at bite site
• Swelling at bite site
• Sweating
• Tachycardia

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Spiders

• Brown recluse spider signs/symptoms
• Local itchiness at site bite
• redness, edema
• Papule formation
• Necrotic lesion
• Bulls-eye rash
• Systemic fever, chills
• Malaise, weakness

• Nausea, vomiting
• Rash
• Seizures
• Hypotension

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Ticks

• Tick diseases
• Rocky Mountain spotted fever
• Fever, headache, abdominal pain, vomiting, muscle
  pain, rash.
• Lyme disease
• Fever, headache, fatigue, characteristic skin
  rash.
• Can spread to joints, heart, nervous system.

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Ticks

• Treatment
• Remove tick with tweezers (get close to skin and
  be patient)
• Clean wound with soap water, dress
• Treat symptoms
• Watch for rash

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Bites and Stings

• Signs and symptoms
• Obvious injury site (bite or sting marks)
• Tenderness
• Swelling
• Red streaks radiating from the injection site
• Weakness
• Dizziness
• Localized pain
• Itching

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Treatment for Insect Stings and Bites

• Keep the patient quiet and still.
• Apply ice packs to reduce swelling and pain.
• Some people may experience an extreme allergic
  reaction and go into anaphylactic shock.
• Signs and symptoms of anaphylactic shock
• Itching
• Hives
• Swelling
• Wheezing and severe respiratory distress
• Generalized weakness
• Loss of consciousness

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Treatment for Insect Stings and Bites

• Signs and symptoms of anaphylactic shock (contd)
• Rapid, weak pulse
• Rapid, shallow breathing
• Treatment for anaphylactic shock
• Maintain the patients ABCs.
• Administer oxygen if available.
• Elevating the patients legs may help.

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Treatment for Insect Stings and Bites

• Treatment for anaphylactic shock (contd)
• Remove the allergen if possible.
• Stingers should be scraped off skin and area
  cleaned with soap and water.
• Monitor the patients vital signs.
• If the patients condition progresses to the
  point of respiratory or cardiac arrest, begin
  mouth-to-mask breathing or CPR.
• Immediately arrange for rapid transport.

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Treatment for Insect Stings and Bites

• Treatment for anaphylactic shock (contd)
• If the patient has a prescribed auto-injector,
  tell them to follow their doctors orders for
  use.
• Place the tip of the auto-injector against the
  outer thigh.
• Push the auto-injector firmly against the thigh
  and hold it for at least 10 seconds.

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Allergic Reactions/Stings/Hives EMD Protocol

• Is the patient responding normally?
• Is the patient having DIB or problems swallowing?
• Does the patient have a history of allergic
  reactions?
• Does the patient have or take allergy meds?
• Yes Oral, when was it last taken?
• Does the patient have an Epi-pen?
• Yes follow their doctors instructions for use
  and notify responders if used
• Has patient had any allergic reactions in the
  past?
• Recently eaten?
• Any bites or stings?
• Recent medications?
• Any swelling noted to face, throat or airway?

1. Do not give anything by mouth
2. Call back if patients condition worsens prior to
   the arrival of medical personnel
3. On insect stings, if stinger is still present,
   gently scrape off of skin and clean area with
   soap and water. Do not use tweezers.

• Key Questions

• Pre-Arrival Instructions

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Snake Bites
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Snake Bites

• Four kinds of poisonous snakes in the United
  States
• Rattlesnake
• Cottonmouth (water moccasin)
• Copperhead
• Coral snake (Red on yellow bands)
• A snake injects its poison into a persons skin
  and muscles with its fangs. Coral snakes chew
  with a row of teeth.

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Snake Bites

• Signs and symptoms
• Immediate pain at the bite site
• Swelling and tenderness around the bite site
• Fainting (from the emotional shock)
• Sweating
• Nausea and vomiting
• Shock

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Snake Bites

• The bite of the coral snake delivers a slightly
  different poison that may cause these additional
  problems
• Respiratory difficulties
• Slurred speech
• Paralysis
• Coma
• Seizures

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Treatment for Snake Bites

• Keep the patient calm and quiet.
• Have the patient lie down and try to relax.
• Wash the bite area with soap and water.
• If the bite occurred on the arm or leg, splint
  the affected extremity.
• Treat the patient carefully.
• Arrange for prompt transport to a hospital for
  possible antivenin.

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Animal Bites EMD Protocol

• Where is the animal now?
• Any serious bleeding?
• Yes, go to bleeding protocol
• What body part was bitten?
• What type of animal was involved?

1. Isolate patient from the animal, if safe to do so
2. Call back if the condition worsens prior to the
   arrival of medical personnel
3. Advise responders if risk from animals still exist

• Key Questions

• Pre-Arrival Instructions

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Resources

• Silver Cross EMS March 2012 CME
• AAOS Emergency Medical Responder, Your First
  Response in Emergency Care, 5th Edition
• Google Images
• CDC.GOV
• Mosby Wilderness Medicine, 5th Edition
• Will County 9-1-1 EMD Protocols