Environmental Emergencies

K.S. Chew
Lecturer/Emergency Physician
School of Medical Sciences
Universiti Sains Malaysia
Introduction
HUMAN BODY ENVIRONMENT
Hemostasis Interaction
MAINTAIN A STABLE ENVIRONMENT FOR THE BODY
METABOLISMS
Sources of Heat Loss
Conduction
Heat lost to a cooler object with direct contact with the body
Convection
Heat lost to surrounding air which then carried away by
convection currents
Radiation
Heat lost in form of infra-red. For an unclothed person, this way
accounts for ~ 60% of total heat loss
Evaporation
Heat is lost as water evaporates (changing from liquid to vapor)
from skin and lungs at rate of ~ 600 ml/day
Respiration
Combination of evaporation, convection and radiation
Temperature Regulation
Thermoregulation is coordinated by
anterior hypothalamus
This centre receives information about
environmental temperature from
thermoreceptors in skin and core
temperature from thermoreceptors in
anterior hypothalamus itself.
Thermoregulation
Cutaneous blood vessels
Vasodilation
Vasoconstriction
Sweating
Shivering
Increasing/Decreasing Activity will cause
corresponding increases in heat production and
decreases in heat production.
Behavioral Responses
DROWNING AND
HYPOTHERMIA
Drowning Sequence
Panic, hyperventilation, automatic
swimming movements
Uncontrolled breaths; increased amounts
of swallowed water
Vomiting & gasping with aspiration
Violent struggle before become
unconscious
Lost airway reflexes and passive entry of
fluid into airway
Drowning
First Aid
ALWAYS be aware of your own personal
SAFETY FIRST
Whenever possible, attempt to save the
drowning victim without getting into the
water.
HOW?
Reaching with a rescue aid throwing rope,
buoyant rescue aid, stick etc
First Aid
Alternatively, use rescue boat or other
water vehicle to assist with the rescue
If entry into water is a must, take a
buoyant rescue aid / life jacket / floatation
device with you.
The key principle is TO REMOVE the
patient from the water by the FASTEST
and SAFEST means available.
Drowning Threats In Children
A child can drown in as little as two inches
of water
A child can drown in less time than it takes
to answer the telephone
In California, 67% of all drowning deaths
occur in their own backyard pool, spa or hot
tub.
And 25% of all children who have drowned
or nearly drowned have had swimming
lessons.
Remember
Drowning is a silent killer!
The victims don't cry for help.
Because, if they are not getting enough
air to breathe, they do not have the extra
air needed to call for help.
First Aid
Put patient in horizontal position. Do not
raise the legs as this would cause cold
blood to flow from legs to body core and
adversely affect the heart
Do not let patient walk.
Do not massage the body.
When the patient in cardiac
arrest
Proceed with ABC as for other cardiac
arrest victims
DO NOT withhold resuscitation unless
there is obvious lethal injuries or the body
is completely frozen making CPR difficult
The brain has a 10 times higher chance to
tolerate cardiac arrest in hypothermic
condition than in normal condition
Hypothermia
When body temperature less than 35C
Can occur even in people with normal
thermoregulation that
exposed to cold environments, especially in wet or
windy conditions
following immersion in cold water
Arbitrarily classification:
Mild 32-35C
Moderate 30-32C
Severe less than 30C
The HELP Position
A life jacket helps in
two ways:
it reduces the need to
move
it helps insulate
against heat loss.
With the life jacket,
draw knees up into a
H.E.L.P (Heat Escape
Lessening Position)
position
Heat Related Emergencies
Girl Locked In Van Died
KUALA KUBU BARU: A six-year-old girl who was locked inside a
van for almost three hours died of heat exhaustion five days after
she was found slumped inside the van.
Apparently the girl dozed off in the van while on her way to her
kindergarten in Bukit Sentosa near Bukit Beruntung at 7.05am
last Wednesday.
The heat caused the organs in Syarifah Fatin Syahirah Syed
Ahmad Najmi's body to fail..
(The Star Online, Tuesday April 11, 2006)
(www.thestar.com.my)
Hyperthermia
Occurs when bodys thermoregulation fails
Hyperthermia maybe exogenous or
endogenous
Exogenous
Heat Stress including heat cramps, heat
syncope, heat cramps
Heat exhaustion
Heat stroke
Heat Cramps
HOT ENVIRONMENTAL TEMPERATURE
VASODILATATION ON SKIN SURFACE
WATER AND ELECTROLYTES LOSS THROUGH SWEAT
PAINFUL MUSCLE CRAMPS DUE TO
ELECTROLYTE LOSSES
First Aid
Remove victim from the environment
Drink water, preferably with oral
rehydration salt or sport drinks
Salt tablet not advised as it is not readily
absorbed and can cause stomach irritation
Gentle elevation / stretching of cramped
muscle
Heat Exhaustion
Severe dehydration (water and sodium
loss)
Loss of about 1 2 L of water per hour when
working under hot environment
Signs and symptoms include
Severe thirst with fatigue
Nausea and vomiting, sometimes diarrhea
Headache, anxiety
If untreated can progress to heat stroke
LOSS OF THERMOREGULATORY CONTROL BY
HYPOTHALAMUS
UNCOMPENSATED HYPERTHERMIA
CELLULAR DEATH AND ORGANS DAMAGE
HIGH CORE BODY TEMPERATURE (E.G. >
40.6C)
Signs and Symptoms of
Heat Stroke
ORGAN SYSTEM DAMAGED SIGNS AND SYMPTOMS
Central Nervous system Confusion, disorientation, seizure
Sweat Glands Cessation of sweating, dry hot skin
Respiratory system Deep breathing initially, then
shallow and rapid
Cardiovascular system Tachycardia, later bradycardia
Hypotension with low or absent
diastolic reading
Thermoregulatory center of
anterior hypothalamus
High core body temperature (e.g.
> 40.6C)
First Aid
Move victim to cool place
Initiate rapid cooling
Remove victims clothing
Cover victim with sheets soaked in tepid
water
Spray with water
Fanning
Ice bags at large vein areas groins, armpits
Seek medical help
Preventing Heat Illnesses
Avoid dehydration
Drink one cup (about 8 ounces) every 20 minutes
while working
Thirst not always a good indicator of adequacy of
fluid intake
If you drink water only when you feel thirsty, you may
not be able to adequately replace the water loss
An average person, would only be able to drink up to
one pint (16 ounces) of water
It takes time for the water to be absorbed so theres
no point drinking too much water at any one time.
Preventing Heat Illnesses
Cool water is easier to be absorbed from the GI
tract than warm water
Most people require only water but commercial
sport drinks (that can be absorbed faster and
resemble more closely to sweat) are useful in
vigorous sport activities.
Drinking too much water with profuse sweating
for a long periods can result in water intoxication
(hyponatremia).
Preventing Heat Illnesses
Fruit juices range from 11% - 18% of sugar and
have a longer time for absorption.
Avoid coffee or tea as they contain caffeine, a
diuretic that increases water loss through
urination
Dress in loose, light-colored clothing to reflect
heat
Rest frequently, preferably under shade
Apply cool water on exposed areas