1. Frostbite- is an injury that is caused by exposure of parts of the body to the cold.
The cold causes freezing of your skin and underlying tissues. Your fingers, toes
and feet are most commonly affected.
Cause of frostbite
body is exposed to extreme cold
vasoconstriction of blood vessels
blood and oxygen are diverted away from the extremities
to the vital organs to keep the body alive
lack of blood supply and oxygen to the skin can start to
cause damage to the cells.
In areas of the body affected by frostbite, ice crystals form
and cells and blood vessels become damaged. Blood clots
can also form in small blood vessels which further reduces
the chance of blood and oxygen getting to the affected
tissues.
Signs and symptoms
At first, cold skin and a prickling feeling
Numbness
Red, white, bluish-white or grayish-yellow skin
Hard or waxy-looking skin
Clumsiness due to joint and muscle stiffness
Blistering after rewarming, in severe cases
Complications of frostbite include:
Increased sensitivity to cold
Increased risk of developing frostbite again
Long-term numbness in the affected area
Changes in the cartilage between the joints (frostbite arthritis)
Growth defects in children, if frostbite damages a bone's growth plate
Infection
Tetanus
Gangrene decay and death of tissue resulting from an interruption of blood
flow to the affected area which can result in amputation
Nursing responsibilities:
Check for hypothermia.
Protect skin from further exposure. If outside, warm frostbitten hands by tucking
them into pocket. Protect face, nose and ears by covering them with dry, gloved
hands. Don't rub the affected area and never rub snow on frostbitten skin.
Get out of the cold. Once you're indoors, remove wet clothes.
Gently rewarm frostbitten areas. Soak hands or feet in warm water 99 to 108
F (37 to 42 C) for 15 to 30 minutes. If a thermometer isn't available, test the
water by placing an uninjured hand or elbow in it it should feel very warm, not
hot.
Don't rewarm frostbitten skin with direct heat, such as a stove, heat lamp,
fireplace or heating pad. These can cause burns.
Take pain medicine. If in pain, take over-the-counter ibuprofen (Advil, Motrin IB,
others) to reduce pain and inflammation.
Don't walk on frostbitten feet or toes if possible. This further damages the tissue.
Know what to expect as skin thaws. If the skin turns red and you feel tingling and
burning as it warms, normal blood flow is returning. But seek emergency medical
attention if the numbness or pain remains during warming or if blisters develop.
Medical treatment
Oral pain medicine. Because the rewarming process can be painful, your doctor
will likely give you a drug to ease the pain.
Removal of damaged tissue (debridement). To heal properly, frostbitten skin
needs to be free of damaged, dead or infected tissue. To better distinguish
between healthy and dead tissue, your doctor may wait one to three months
before removing damaged tissue.
Whirlpool therapy. Soaking in a whirlpool bath (hydrotherapy) can aid healing by
keeping skin clean and naturally removing dead tissue. You'll be encouraged to
gently move the affected area while it is under water.
If your skin or blisters appear infected, your doctor may prescribe oral antibiotics.
Wound therapy. If you have a complex wound, your doctor might suggest a
technique called vacuum-assisted closure therapy to promote healing.
Surgery. In severe cases, surgery or amputation may be necessary to remove
the dead or decaying tissue.
2. Heat stroke develops when the bodys thermoregulatory mechanisms fail or are
overwhelmed; the body temperature then increases to levels that produce
widespread cellular damage
Cause
Exposure to a hot environment. being in a hot environment leads to a rise
in body temperature.
Strenuous activity. Exertional heatstroke is caused by an increase in body
temperature brought on by intense physical activity in hot weather. Anyone
exercising or working in hot weather can get exertional heatstroke, but it's
most likely to occur if you're not used to high temperatures.
In either type of heatstroke, condition can be brought on by:
Wearing excess clothing that prevents sweat from evaporating easily and
cooling the body
Drinking alcohol, which can affect your body's ability to regulate your
temperature
Becoming dehydrated by not drinking enough water to replenish fluids lost
through sweating
Signs and symptoms
Increased temperature (higher than 40 C)
Flushed skin/ ashen gray and dry
Sweating profusely
Increased heart rate
Dilated pupils
Hypotension
Tremors
Dystonia
Muscle rigidity
Diagnostic tests
Abg
BUN
ECG
Muscle function tests
Management:
Ice water immersion
Constant monitoring of rectal temperature
Maintain adequate airway/ ventilation
Monitor urine output
Use evaporation cooling techniques
Benzodiazepine
Cool off with damp sheets and a fan.
Rehydrate the patient
3. Electrocution- is a death caused by electric shock, electric current passing
through the body
Caution:
Do not touch the injured person if he is still in contact with the electrical
current
Do not move the person unless he is in immediate danger
Signs and symptoms
Severe burns
Confusion
Difficulty breathing
Arrhythmias
Cardiac arrest
Muscle pain and stiffness
Seizures
Loss of consciousness
Management:
Turn off source of electricity if possible if not move source away from you
or from the victim using a dry, non-conducting object, made of cardboard,
plastic/wood
Begin cpr if person shows no sign of life
Prevent person from being chilled
Apply a bandage
4. Hypothermia -is a medical emergency that occurs when your body loses heat
faster than it can produce heat, causing a dangerously low body temperature
Causes:
Wearing clothes that aren't warm enough for weather conditions
Staying out in the cold too long
Unable to get out of wet clothes or move to a warm, dry location
Accidental falls in water, as in a boating accident
Inadequate heating in the home, especially for older people and infants
Air conditioning that is too cold, especially for older people and infants
Signs and symptoms
Cold and pale
Rigid extremities
Episthotomus
Mental status ranges from confusion to coma
Dehydration
Diagnostic tests:
BUN and Hematocrit
ABG
ECG
CBC
Thyroid function studies
Management:
Move the person out of the cold. Move the person to a warm, dry
location if possible. If you're unable to move the person out of the cold, shield him or
her from the cold and wind as much as possible.
Remove wet clothing. If the person is wearing wet clothing, remove it.
Cut away clothing if necessary to avoid excessive movement.
Cover the person with blankets. Use layers of dry blankets or coats to
warm the person. Cover the person's head, leaving only the face exposed.
Insulate the person's body from the cold ground. If you're outside, lay
the person on his or her back on a blanket or other warm surface.
Monitor breathing. A person with severe hypothermia may appear
unconscious, with no apparent signs of a pulse or breathing. If the person's
breathing has stopped or appears dangerously low or shallow, begin CPR
immediately if you're trained.
Share body heat. To warm the person's body, remove your clothing and
lie next to the person, making skin-to-skin contact. Then cover both of your bodies
with blankets.
Provide warm beverages. If the affected person is alert and able to
swallow, provide a warm, sweet, nonalcoholic, noncaffeinated beverage to help
warm the body.
Use warm, dry compresses. Use a first-aid warm compress (a plastic
fluid-filled bag that warms up when squeezed) or a makeshift compress of warm
water in a plastic bottle or a dryer-warmed towel. Apply a compress only to the neck,
chest wall or groin.
Don't apply a warm compress to the arms or legs. Heat applied to the arms and legs
forces cold blood back toward the heart, lungs and brain, causing the core body
temperature to drop. This can be fatal.
Don't apply direct heat. Don't use hot water, a heating pad or a heating
lamp to warm the person. The extreme heat can damage the skin or, even worse,
cause irregular heartbeats so severe that they can cause the heart to stop.
Medical treatment
Depending on the severity of hypothermia, emergency medical care for hypothermia
may include one of the following interventions to raise the body temperature:
Blood rewarming. Blood may be drawn, warmed and recirculated in the body. A
common method of warming blood is the use of a hemodialysis machine, which is
normally used to filter blood in people with poor kidney function. Heart bypass
machines also may need to be used.
Warm intravenous fluids. A warmed intravenous solution of salt water may be
injected into a vein to help warm the blood.
Airway rewarming. The use of humidified oxygen administered with a mask or
nasal tube can warm the airways and help raise the temperature of the body.
Irrigation. A warm saltwater solution may be used to warm certain areas of the
body, such as the area around the lungs (pleura) or the abdominal cavity (peritoneal
cavity).
5. Anaphylactic reaction is a severe potentially life threatening reaction
- The flood of chemicals released by your immune system during
anaphylaxis can cause you to go into shock
Causes:
Drugs (such as penicillin)
Insect stings
Certain foods (particularly eggs, seafood, and nuts)
Latex
But they can be caused by any allergen. Like other allergic
reactions, an anaphylactic reaction does not usually occur after the
first exposure to an allergen but may occur after a subsequent
exposure.
Signs and Symptoms:
Rapid/weak pulse
Skin rash
Nausea and vomiting
Itching
Lump in throat
Constriction of airways
Dizziness
Diagnosis:
A doctor's evaluation
Sometimes blood or urine tests
The diagnosis of anaphylactic reactions is usually obvious based on symptoms.
Because symptoms can quickly become life threatening, treatment is begun
immediately.
If symptoms are mild, the diagnosis can be confirmed by blood or urine tests,
which measure levels of substances produced during allergic reactions.
However, these tests are usually unnecessary.
Medical management:
Epinephrine
Sometimes a breathing tube
Sometimes fluids given intravenously
Antihistamines and other drugs
Low blood pressure often returns to normal after epinephrine is given. If it does
not, fluids are given intravenously to increase the volume of blood. Sometimes
people are also given drugs that cause blood vessels to narrow
(vasoconstrictors) and thus help increase blood pressure.
Antihistamines (such as diphenhydramine) and histamine-2 (H2) blockers (such
as cimetidinesee Table: Drugs Used to Treat Peptic Ulcer Disease) are given
intravenously until symptoms disappear. If needed, beta-agonists that are inhaled
(such as albuterol) are given to widen the airways and help with breathing.
A corticosteroid is sometimes given to help prevent symptoms from recurring
several hours later
6. Decompression sickness -(DCS; also known as divers' disease, the bends or
caisson disease) describes a condition arising from dissolved gases coming out of
solution into bubbles inside the body on depressurization
Causes:
repetitive exposures repetitive dives within a short period of time
(a few hours) increase the risk of developing DCS. Repetitive
ascents to altitudes above 5,500 metres (18,000 ft) within similar
short periods increase the risk of developing altitude DCS.
the rate of ascent the faster the ascent the greater the risk of
developing DCS. The US Navy Dive Manual indicates that ascent
rates greater than about 20 m/min (66 ft/min) when diving increase
the chance of DCS,
the duration of exposure the longer the duration of the dive, the
greater is the risk of DCS. Longer flights, especially to altitudes of
5,500 m (18,000 ft) and above, carry a greater risk of altitude DCS.
underwater diving before flying . Dive tables make provisions for
post-dive time at surface level before flying to allow any residual
excess nitrogen to outgas. However, the pressure maintained
inside even a pressurized aircraft may be as low as the pressure
equivalent to an altitude of 2,400 m (7,900 ft) above sea level.
diving at altitude diving in water whose surface altitude is above
300 m (980 ft)
. dehydration
Signs and symptoms:
Localized deep pain, ranging from mild to excruciating. Sometimes a dull
ache, but rarely a sharp pain.
itching, usually around the ears, face, neck, arms, and upper torso
Sensation of tiny insects crawling over the skin (formication)
Mottled or marbled skin usually around the shoulders, upper chest and
abdomen, with itching
Swelling of the skin, accompanied by tiny scar-like skin depressions (pitting
edema)
Altered sensation, tingling or numbness (paresthesia), increased sensitivity
(hyperesthesia)
Confusion or memory loss (amnesia)
Visual abnormalities
Unexplained mood or behaviour changes
Seizures, unconsciousness
Treatment:
100 per cent oxygen by mask, at a rate of 10 to 15 litres a minute.
Give the diver plenty of fluid to drink.
Give first aid if the diver is unconscious.
Prevent the diver from exerting himself or getting cold
During treatment for decompression sickness, pressure is increased to
correspond to the pressure found 18m under water. In some cases, the
pressure in the chamber is set at 50 metres.
The diver breathes pure oxygen through a mask, which improves exhalation
of nitrogen. At depths in excess of 18 metres, and also after adequate
intervals, the mask can be removed in the chamber. Pressure in the chamber
is reduced gradually until the diver reaches surface pressure again.
Treatment typically lasts between five and six hours.
After treatment, the diver will be kept for 24 hours for observation in case his
condition deteriorates.
In most instances one course of treatment is adequate, but occasionally
several treatments may be needed.
After treatment for decompression sickness, a diver should take a rest from
diving. The length of this rest should be discussed with a specialist in divers'
medicine.
Written Report for
Clients with
Environmental
Emergencies
Submitted by: Rosalyn Yu
Submitted to: Mrs. Ma. Ashdel Artes RN, MAN