DEFINITION

Environmental emergency are defined as

sudden- onset disasters or accidents
resulting from natural,technological or
human-induced factors ,or combination of
these ,that causes or threatens to cause
severe environmental damage as well as
loss of human lives and property.
The term include secondary consequences
from natural hazards such as
earthquakes,storms,floods,tsunamis,wildland
fires ,landslides and/or man-made disaster
such as industrial accidents,transport
accidents,chemical spills ,oil spills and
multitude of other types of emergencies.
HYPOTHERMIA
Lowering of the body temperature below
95.F(35.C) or less as a result of exposure to
cold or an inability to maintain body
temperature in the absence of low ambient
temperature.
Weather does not have to be below freezing
for hypothermia to occur.
Older persons and infants are at high risk.

SIGNS AND SYMPTOMS
MILD HYPOTHERMIA
Shivering
Rapid pulse and respirations
Red, pale ,cyanotic skin
MORE SEVERE HYPOTHERMIA
Shivering stops
Muscular activity decreases
Fine muscle activity ceases
Eventually ,all muscle activity stops.



OTHER
Progressive deterioration ,with apathy.
Ataxia ,dysarthria ,drowsiness, pulmonary
edema ,acid-base abnormalities and coma.
MANAGEMENT
MONITORING
The ABCs of basic life support are a priority.
The patients vital signs ,CVP, urine output
,arterial blood gas levels, blood chemistry
determinations(blood urea nitrogen,
creatinine ,glucose ,electrolytes), and chest
x-rays are evaluated frequently.
Body temperature is monitored with an
esophageal, bladder or rectal thermistor.
REWARMING
Rewarming methods include Active internal
rewarming - Active external rewarming
ACTIVE EXTERNAL REWARMING: used for
moderate to severe hypothermia(less than 28 .C to
32.2.C).
Warm fluid administration ,warm humidified oxygen
by ventilator and warm peritoneal lavage.
ACTIVE EXTERNAL REWARMING:used for mild
hypothermia.
Uses over the bed heaters to the extremities .
Care must be taken to prevent extremity burn from
these devices because the patient may not have
effective sensation to feel warm.
HEAT STROKE
Heat stroke is an acute medical emergency
caused by failure of the heat regulating
mechanisms of the body.
Causes-prolonged exposure to an
environmental temperature of greater than
39.2.C(102.5.F).
-During extended heat waves ,especially
when they are accompanied by high
humidity.
ASSESSMENT AND DIAGNOSTIC
FINDINGS
Heat strokes causes thermal injury at the
cellular level ,resulting in coagulopathies
and widespread damage to the heart
,kidneys and liver.
Profound central nervous system (CNS)
dysfunction :confusion ,delirium ,bizarre
behavior,coma.
Elevated body temperature ;hot ,dry skin
Anhidrosis (absence of
sweating),tachypnea ,hypotension,and
tachycardia.

MANAGEMENT
GOAL- to reduce the high body
temperature as quickly as possible.
Simultaneously treatment focuses on
stabilizing oxygenation using the ABCs of
basic life support.
Cool sheets and towels or continuous
sponging with cool water.
Ice applied to the neck ,groin ,chest ,and
axilla while spraying with tepid water.
Cooling blankets.
Immersion of patient in a cold water bath.

PREVENTING HEAT STROKE

Emphasize the importance of maintaining
adequate fluid intake ,wearing loose
clothing and reducing activity in hot weather.
Advice athletes to monitor fluid losses and
weight loss during workout activities or
exercise and to replace fluids and
electrolytes.
Advise the patient to plan outdoor activities
to avoid the hottest part of the day(between
10 A.M and 2 P.M)
FROST BITE
Frost bite is a trauma from exposure to
freezing temperatures and freezing of the
intracellular spaces.
It results in cellular and vascular damage.
Frost bite can result in venous stasis and
thrombosis.
Body part most frequently affected by frost
bite include the feet , nose ,hands and ears.
Frost bite range from 1
st
degree(redness and
erythema )to fourth degree (full-depth tissue
distruction.
ASSESSMENT AND DIAGNOSTIC
FINDINGS
A frozen extremity may be hard ,cold and
intensive to touch and may appear white or
mottled blue-white.
The extent of injury from exposure to cold is
not always initially known.
Patient history include: environmental
temperature ,duration of exposure ,humidity
and the presence of wet conditions.
MANAGEMENT
GOAL To restore normal body temperature.
Conservative clothing and jewellery that could
impair circulation are removed.
Wet clothing is removed as rapidly as possible.
If the lower extremity involved , the patient
should not be allowed to ambulate.
Frozen extremity are usually placed in a 37.C
to 40.C (98.6.F to 104.F) circulating bath for 30
to 40 minute spans. This treatment is repeated
until circulation is effectively restored.


During rewarming , analgesic for pain is
administered as prescribed ,because the
rewarming process may be very painful.
Sterile gauze or cotton is placed between
affected fingers or toes to prevent maceration ,
and bulky dressing is placed on the extremity.
A foot cradle may be used to prevent contact
with bed clothes if the feet are involved.
Whirlpool bath for the affected body parts to
aid circulation and debridement of necrotic
tissue to help prevent infection.
Escharotomy (incision through the eschar) to
prevent further tissue damage ,to allow for
normal circulation, and to permit joint motion.

DROWNING AND NEAR DROWNING
DROWNING : Death as a result of suffocation
after submersion in water.
Drowning is the second most common cause of
unintentional death in children younger than 14
years .
An estimated 8000 drowning occur yearly in the
united states .
NEAR DROWNING is defined as survival for at
least 24 hours after submersion that caused a
respiratory arrest.
Survival ,at least temporarily after suffocation in
water .

DROWNING PROCESS
SOMETHING GOES WRONG
SWALLOWING OF WATER ,FATIGUE ,UNABLE TO COPE WITH
CURRENTS ,INJURIES ,COLD,LOSS OF ORIENTATION , NITROGEN
NARCOSIS
PANIC
(LOSS OF CONTROL)
INEFFICIENT BREATHING
CO2 RETENTION & O2 DEPRIVATION
DECREASED BUOYANCY
EXHAUSTION
CARDIAC OR RESPIRATORY ARREST
FACTORS ASSOCIATED WITH
DROWNING AND NEAR DROWNING
Alcohol ingestion
Inability to swim
Diving injuries
Hypothermia
Exhaustion
SIGNS OF NEAR DROWNING
Hypoxia
Hypercapnia
Bradycardia
Dysrhythmias
Tachypnea
MANAGEMENT
GOAL- Maintaining cerebral perfusion and
adequate oxygenation to prevent further
damage to vital organs.
Resuscitation to manage hypoxia, acidosis
and hypothermia.
Prevention and management of hypoxia
are accomplished by ensuring an
adequate airway and respiration, thus
improving ventilation (which helps correct
acidosis)and oxygenation.
Arterial blood gases are monitored to evaluate
oxygen, carbondioxide ,bicarbonate levels,and
pH.These parameters determined the type of
ventilatory support needed.
Use of endotracheal intubation with PEEP improves
oxygenation and prevent aspiration.
If the patient is breathing spontaneosly
,supplemental oxygen may be administered by
mask.
A rectal probe is used to determine the degree of
hypothermia.
Prescribed rewarming procedures (eg-
extracorporeal warming, warmed peritoneal dialysis,
inhalation of warm aerosolized oxygen, torso warm)
are started during resucitation.

Intravascular volume expansion and
inotropic agents are used to treat
hypotension and impaired tissue perfusion.
ECG monitor is initiated , because
dysrhythmias frequently occur.
Nasogastric intubation is used to
decompress the stomach and to prevent the
patient from aspirating gastric contents.
DECOMPRESSION SICKNESS
Decompression sickness also called the
bends occurs in patients who have engaged in
diving (lake as well as ocean ,diving) ,high
altitude flying ,or flying in commercial aircraft
within 24 hours after diving.
Decompression sickness results from
formation of nitrogen bubbles that occur with
rapid changes in atmospheric pressure.
They may occur in joint or muscle spaces
,resulting musculoskeletal pain , numbness or
hypesthesia.
ASSESSMENT AND DIAGNOSTIC
FINDINGS
A detailed history is obtained from the
patient.
Evidence of rapid ascent ,loss of air in the
tank ,buddy breathing ,recent alcohol
intake or lack of sleep ,or a flight within 24
hours after diving suggests possible
decompression sickness.
Signs and symptoms include joint or
extremity pain ,numbness, hypoesthesia,
and loss of range of motion.
Cardiopulmonary arrest can also occur in
severe cases.

MANAGEMENT
A patent airway and adequate ventilation
are established.
100% oxygen is administered throughout
the treatment.
A chest X-ray is obtained to identify
aspiration, and at least one IV line is
started with lactated Ringers or normal
saline solution.
If an air embolus is suspected ,the head of
the bed should be lowered.
The patients wet clothing is removed , and
the patient is kept warm. Transfer to the
closest hyperbaric chamber for treatment
is initated.
ANAPHYLACTIC REACTION
An anaphylactic reaction is an acute
systemic hypersensitivity reaction that
occurs within seconds or minutes after
exposure to certain foreign substances ,
such as medications (ex- penicillin
,iodinated contrast material), and other
agents, such as latex ,insect stings (ex-
bee,wasp, yellow jacket,hornet), or foods
(ex-peanuts,egg).
An anaphylactic reaction is the result of
an antigen-antibody interaction in a
sensitized person ,who as a consequence
of previous exposure ,has developed a
special type of antibody that is specific for
particular allergen.
SIGNS AND SYMPTOMS
RESPIRATORY SIGNS
Nasal congestion
Itching
Sneezing and coughing
Chest tightness
Dyspnea
Cyanosis
SKIN MANIFESTATIONS
Flushing with sense of warmth and diffuse
erythema
Generalized itching over the entire body
Urticaria



CARDIOVASCULAR MANIFESTATIONS
Tachycardia or bradycardia
Peripheral vascular collapse as indicated by
o Pallor
o Imperceptible pulse
o Decreasing blood pressure
o Circulatory failure ,leading to coma
GASTROINTESTINAL PROBLEMS
Nausea
Vomiting
Colicky abdominal pains
Diarrhea
MANAGEMENT
Oxygen is provided in high concentration during
cardiopulmonary resuscitation or if the patient is
dyspneic ,cyanotic or wheezing.
Epinephrine ,in a 1:1000 dilution is administered
subcutaneously in the upper extremity or thigh and
may be followed by a continuous IV infusion.
Antihistamines and corticosteriods may also be
administered to prevent reccurences of the
reaction and to treat urticaria and angioedema.
IV fluids (ex-normal saline),volume expanders and
vasopressor agents are administered to maintain
blood pressure and normal hemodynamic status.


SNAKE BITES
40,000 to 50,000 reported snake bites in the US
annually.
7,000 bites in the US come from poisonous
snakes.
Death from snake bites is rare.
About 15 deaths occur each year in the US.
The most frequent poisonous snake bite occurs
from pit vipers(crotalidae).
The most common site is the upper extremity.Of
these bites only 20% to 25% result in
envenomation (injection of a poisonous material
by sting ,spine ,bite or other means).




CLINICAL MANIFESTATIONS
CLASSIC CLINICAL SIGNS OF
ENVENOMATION
Edema
Ecchymosis
Hemorrhagic bullae ,leading to necrosis of
envenomation.
SYMPTOMS
Lymph node tenderness
Nausea
Vomiting
Numbness
A metallic taste in the mouth.


MANAGEMENT
Initial first aid-person lie down ,removing
constrictive items such as rings , providing
warmth ,cleansing the wound ,covering the
wound ,covering the wound with a light
sterile dressing ,and immobilizing the injured
part below the level of head.
Airway ,breathing and circulation are the
priorities of care.

CARE FOR PIT VIPER BITES
Calm the patient.
Locate the bite and cleanse the area.
Do not apply ice.
Splint area to minimize movement.
Watch out for vomiting caused by anxiety.
Do not give anything by mouth.
If the patient is bitten on the trunk, lay the patient
supine and transport quickly.
Monitor patients vital signs.
Mark the swollen area with a pen.
Care for shock if signs and symptoms develop.
Bring the snake to hospital if it has been killed.


TICK BITES
Ticks attach themselves to the skin.
Bite is not painful ,but potential exposure to
infecting organisms is dangerous.
Ticks commonly carry Rocky Mountain
spotted fever or Lyme diseases.
Rocky Mountain spotted fever develops 7 to
10 days after bite.
SYMPTOMS
Nausea , vomiting
Headache
Weakness
Paralysis
Possible cardio respiratory collapse
Lyme disease has now been reported in
over 35 states.
1995 -2004 ,35 AZ cases are reported
Lyme disease symptoms may begin 3 days
after the bite.
Symptoms may include:
Target bulls-eye pattern
Rash
Painful swelling of the joints

CARING FOR A TICK BITE
Do not attempt to suffocate or burn tick.
Use fine tweezers to grasp tick by the body
and pull it straight out.
Cover the area with disinfectant and save
the tick for identification.
Provide any nec
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