EMT Lecture - Environmental & Behavioral Emergencies

Medical Emergencies in EMS

Snake Bites

• Introduction to medical emergencies, focusing on environmental and behavioral emergencies commonly encountered in EMS.

• Symptoms of snake bites can be similar to other conditions; understanding the signs is crucial but should not cause panic.

• Proper technique for removing a stinger: avoid using tweezers or faucets as they may inject poison; instead, use a hard object like a credit card.

• Positioning the injection site below heart level is recommended when dealing with bee stings; cold packs should not be applied to snake bites.

• Explanation of VC B (venous constricting band), which occludes venous return without stopping arterial blood flow, differentiating it from a tourniquet.

Understanding Hypothermia

• Definition of hypothermia: lowering of body temperature, particularly affecting the very old and very young populations.

• Wet patients lose heat 20 times faster than those on dry land; immersion in water significantly increases risk for hypothermia.

• Importance of recognizing that wetness accelerates heat loss, making such patients more critical than those who are merely cold and dry.

Understanding Hypothermia and Its Treatment

Body's Response to Cold Exposure

• When body temperature drops below 95°F, shivering begins as a primary response, indicating the onset of shock.

• Additional compensatory mechanisms include foot stamping and increased breathing rate, alongside tachycardia, to maintain core temperature.

• As temperature decreases further (below 90°F), shivering ceases, leading to cognitive slowdown and lethargy (AMS).

Progression of Symptoms

• Between 85°F and 88°F, lethargy increases significantly; bradycardia (slowed heart rate) becomes evident.

• Below 80°F indicates severe hypothermia; this stage is critical and often fatal if not treated promptly.

Treatment Protocol for Environmental Emergencies

• The first step in treating any environmental emergency is to remove the patient from the hazardous environment.

• EMS personnel should ensure patients are moved inside where they can be properly treated with blankets and warmth.

Special Considerations for CPR in Hypothermic Patients

• For hypothermic patients, the carotid pulse check duration changes from the standard 5–10 seconds to 30–45 seconds due to potential false readings caused by low body temperatures.

Active Rewarming Techniques

• Remove wet clothing immediately as it exacerbates heat loss; cover patients with blankets for insulation.

Hypothermic Emergencies and Rewarming Techniques

Understanding Passive and Active Rewarming

• Passive rewarming involves using heated blankets and the heating system in an ambulance to gradually warm a hypothermic patient.

• Caution is advised as patients may not feel excessive heat, potentially leading to burns; responsiveness is key for assessing comfort levels.

Key Points in Hypothermia Management

• Remove the patient from cold environments and wet clothing; check for signs of life for 30 to 45 seconds if unresponsive.

• Recognize that at temperatures between 80°F to 83°F, patients may be non-responsive but can still show signs of life like bradycardia.

Types of Cold Injuries

• Generalized injuries affect the entire body, while localized injuries typically occur on extremities such as ears, nose, fingers, and toes.

• Localized cold injuries can be categorized into early (superficial) or late (deep), similar to burn classifications.

Symptoms and Treatment of Cold Injuries

• Early symptoms include skin blanching, loss of sensation, and pliable skin. Patients may experience tingling sensations as they begin to warm up.

• Late symptoms involve frozen extremities with blistering; treatment should avoid rubbing or massaging affected areas.

Protocol for Severe Cold Injuries

• Do not rub or massage affected areas; keep them immobile and protected from further cold exposure.

• In cases where transport is delayed due to severe weather conditions, immersion in water at 105°F is permitted under specific protocols.

Heat Emergencies: Understanding Different Types

Classifying Heat Emergencies

• Patients are generally classified based on skin condition: moist normal skin versus dry hot red skin.

• The body's compensatory mechanisms differ: shivering occurs in cold emergencies while sweating helps cool down during heat emergencies.

Understanding Heat Emergencies and Behavioral Issues

Types of Heat Emergencies

• The first time a patient can be given something to drink is when they are diabetic; fruit juice is acceptable due to its sugar content.

• Patients with moist skin can be encouraged to drink water, while those with dry skin may require wet towels for cooling.

• There are three types of heat emergencies: heat cramps, heat exhaustion, and heat stroke. Understanding the differences is crucial.

Heat Cramps

• Heat cramps occur due to a reduction in electrolytes (salt), often experienced during exercise or physical activity.

• Symptoms include leg cramps, abdominal pain, dizziness, and fainting; these are typically not life-threatening but require electrolyte replenishment.

Heat Exhaustion

• Characterized by excessive sweating and moisture on the skin; it indicates that the body is still able to cool itself effectively.

• If not treated promptly by removing the individual from the hot environment, it can escalate into heat stroke.

Heat Stroke

• A severe condition that poses a life-threatening risk; symptoms may include unresponsiveness and various complications if not addressed quickly.

Importance of Electrolyte Replenishment

• Athletes often consume drinks like Gatorade instead of plain water because they need to replenish lost electrolytes during intense activities.

• Hyponatremia (low sodium levels) can occur when individuals only drink water after strenuous exercise without replacing lost salts.

Behavioral Emergencies Overview

• Defined as situations where patients exhibit abnormal behavior that is intolerable or unacceptable within their community or family context.

Understanding Behavioral Emergencies

Identifying Emotional Disturbances

• The speaker discusses the importance of distinguishing between various conditions that may appear similar to emotional disturbances, emphasizing the need for a thorough medical evaluation before labeling someone as an emotionally disturbed patient (EDP).

• The term "emotionally disturbed patient" (EDP) is introduced, highlighting the necessity of confirming this classification through proper assessment and not jumping to conclusions based on initial observations.

Case Study: Misdiagnosis in Emergency Situations

• A personal anecdote illustrates a situation where EMTs prematurely labeled a patient as an EDP without sufficient assessment, leading to potential mismanagement of care.

• Upon arrival at the scene, the speaker challenges the EMT's decision to cancel further assistance based solely on their quick diagnosis, stressing that such decisions should be made with comprehensive information.

• The speaker reveals familiarity with the patient’s medical history, including multiple brain tumors and medication needs, underscoring how prior knowledge can influence emergency responses.

Importance of Thorough Assessment

• Emphasizes that rushing to label someone as an EDP can lead to serious consequences; thorough assessments are crucial in determining appropriate care and intervention strategies.

• Highlights that if a patient expresses suicidal intent, they must be taken seriously and treated accordingly rather than dismissed or trivialized.

Scene Safety Considerations

• Discusses scene safety protocols when dealing with potentially dangerous situations involving EDPs. It stresses awareness of surroundings and maintaining distance from threats while ensuring personal safety.

• Uses imagery to illustrate safe positioning during encounters with potentially aggressive individuals, advising responders on where to stand for optimal safety.

Legal and Ethical Aspects of Consent

• Introduces concepts surrounding consent in emergency situations, particularly regarding patients who may not be mentally competent. It emphasizes understanding implied consent in these contexts.

Understanding Soft Restraints and Emergency Situations

The Use of Soft Restraints

• Soft restraints are utilized in ambulances, but their effectiveness is questioned, likened to "a fifth wheel on a tricycle."

• Preference for PDS (Patient De-escalation Strategies) is expressed due to their superior utility compared to soft restraints.

Recognizing Violent Behavior

• Observing body language can indicate potential violence; uncontrolled temper may be a warning sign.

• Importance of vigilance in assessing patient behavior during emergencies.

Diving Emergencies: Air Embolism and Decompression Sickness

Understanding Air Embolism

• An air embolism occurs when a bubble of air enters the bloodstream, causing blockages.

• This condition can lead to severe complications if not treated promptly; it often results from rapid ascent during diving.

Decompression Sickness (The Bends)

• Known as "the bends," decompression sickness arises from nitrogen gas obstructing blood vessels after ascending too quickly or prolonged exposure underwater.

• Symptoms may manifest immediately upon surfacing or hours later, complicating diagnosis and treatment.

Signs and Symptoms of Abdominal Issues

Identifying Key Symptoms

• Nausea and vomiting are critical symptoms; understanding the difference between them is essential for assessment.

• Point tenderness and rebound tenderness are indicators of possible infections like appendicitis.

Techniques for Assessment

• Proper palpation techniques involve pressing down on the abdomen while observing patient reactions for signs of pain.

• Noting facial expressions during palpation can provide additional insights into the patient's level of discomfort.

Positioning Patients with Abdominal Pain

Optimal Patient Positioning