Environmental Emergencies and Bites

Environmental Emergencies

• Heat Stroke vs. Heat Exhaustion: Heat stroke is worse; individuals are unable to sweat.
• Heat Stroke Treatment: Lower core temperature with cold water immersion (if possible), ice packs, and fluids. Monitor temperature and for dysrhythmias. Ensure adequate oxygenation.
• Hypothermia Treatment: Remove cold clothes, use warm blankets and fluids. Actively warm the body (bear huggers). Passive warming with warm blankets in a warm room. Aim for a body temperature of 86-90°F. Monitor ABCs (airway, breathing, and circulation) and urine output.
• Cold Water Drowning: Cold water slows drownings, increasing survival possibility. Evaluate for possible drowning injuries (pulmonary edema, ARDS). Critical treatment includes managing the airway and breathing, and warming the body.

Bites

• Cat bites can cause deep puncture wounds, increasing infection risk. Prophylactic antibiotics are typically given.
• Dog bites can be more extensive, involving larger areas. Antibiotics are often necessary.
• Wounds near joints or on extremities require antibiotics due to higher infection risk.
• Rabies: Evaluate the animal and its vaccination history to prevent rabies.

Stings

• Remove the stinger with a blade or flat object.
• Assess for allergies (and administer the appropriate medications).
• Administer epinephrine, antihistamines, and steroids (as indicated)
• Remove restrictive items like rings to prevent swelling.

Poisoning

• Decontaminate with a shower or water before performing ABCs(airway, breathing, and circulation)
• Call poison control centers to gather and provide relevant information about the ingested substance(s).
• Carbon activated charcoal can be used to bind to toxins. Rectal, oral, or NG administration is possible. If there are any concerns about the patient's GI system or issues like obstruction, administer charcoal with caution.

Opioid Overdoses

• Signs include pinpoint pupils, loss of consciousness, respiratory depression, seizures, and hypoxia.
• Administer Narcan (naloxone) and monitor ABCs (airway, breathing, and circulation) closely.

Spinal Cord Injuries

• Increased risk in males with vehicle-related accidents.
• Immediate care focuses on primary injuries (e.g., head lacerations) followed by secondary injuries.
• Spinal shock can cause the loss of deep tendon reflexes and sphincter reflexes below the injury site. Loss of sensation and paralysis can occur quickly and can persist for days/weeks.
• Monitor for potential neurological deterioration and monitor for increased blood pressure and potentially a headache.
• Stabilize, assess airway, breathing and circulation- the goal is to determine if a breathing tube or other interventions are required while keeping patients stable.

Neurogenic Shock

• Patients with injuries above T6 are at risk.
• Venous pooling, hypotension (systolic <90mm Hg) and temperature dysregulation(flushed and warm skin in extremities, followed by cold extremities) may occur
• Monitor for complications due to autonomic dysfunction in the upper body.

Respiratory Issues

• Issues concerning C3, C4 and C5, and above T6 require respiratory support.

Traumatic Injuries

• Tension pneumothorax (shifting of the mediastinum) is a life-threatening presentation.
• Pneumothorax is an injury in the chest that also requires immediate medical attention.
• Flail chest is a life-threatening injury presenting as paradoxical chest wall movement, and multiple broken ribs.
• Do not pull out an impaled object from the abdomen.

TBI (Traumatic Brain Injury)

• Treatment for TBI often involves a long-term course, involving lifestyle changes, including sleep, diet, and stress management, and support groups for sustained recovery. Recognize triggers.
• Symptoms are typically evaluated along with other factors.

Trauma Nursing

• ESI (Emergency Severity Index): Classifies patients based on their severity and acuity level. Use a 5-tiered system
• Primary survey: Includes assessing airway, breathing, circulation, disability and exposure. Treatment focuses on airway, breathing and circulation first.
• Secondary survey: Comprehensive physical exam to identify all injuries.

Burns

• The Parkland formula guides fluid resuscitation.
• Intubation is crucial for any burn involving the mouth, throat or esophagus to avoid airway complications.

Sepsis

• SIRs (System Inflammatory Response Syndrome): is a clinical syndrome that is characterized by a prolonged inflammatory response.
• Sepsis: Defined by SIRs and a possible infection, severe sepsis is characterized by SIRs, infection, and organ dysfunction, sepsis shock is the most severe sepsis, characterized by SIRs, infection, organ dysfunction, and decreased blood pressure.
• MODS (Multiple Organ Dysfunction Syndrome): Indicates widespread organ failure. A significant concern with high lactate levels (above 4 mEq/L).

Oncology Emergencies

• Neutropenia: Low white blood cell count.
• Infections: Increased risk of infections.
• Thrombocytopenia: Low platelet count; increased bleeding risk.
• Hypercalcemia: High calcium level, potentially due to cancer.
• Decreased kidney function: Monitor kidney function closely, and ensure adequate hydration and blood flow.

Tumor Lysis Syndrome

• Chemo is killing cells leading to hyperkalemia, hyperphosphatemia and hypocalcemia 24-48 hours after receiving the treatment, that can go into metabolic acidosis, leading to kidney damage.
• Prevent kidney damage by monitoring the hydration status. (hydration is KEY)

SIADH (Syndrome of Inappropriate Antidiuretic Hormone)

• Excessive water retention (can lead to hyponatremia) Requires correction of the sodium level, but avoid correcting too quickly. Requires accurate monitoring and timely adjustments of the sodium level.

Superior Vena Cava Syndrome (SVC syndrome)

• Blood flow obstruction in the superior vena cava.
• Higher blood pressure in the upper versus lower extremities, and potential dyspnea may occur.

Spinal Cord Compression

• Pain is potentially worse when the person is supine, and relieved with upright positioning.
• Establish pain management to reduce acute pain.
• Neuroimaging (MRI) is the most effective tool to identify and diagnose spinal cord compression and to determine any other complications.
• Treatments should be determined due to the possible cause of injury.

Burns (Continued)

• Rule of Nines: Estimate burn size.
• Parkland formula: Guides fluid resuscitation.