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Pathophysiology of Heat and Cold Disorders

Heat Disorders Cold Disorders Near-Drowning and Drowning Diving Emergencies High-Altitude Illness Nuclear Radiation




Risk Factors Age Poor General Health Fatigue Predisposing Medical Conditions Medications

Homeostasis Tendency of the body to maintain a steady and normal

internal environment

Risk Factors Age Poor General Health Fatigue Predisposing Medical Conditions Medications

Homeostasis Tendency of the body to maintain a steady and normal

internal environment

Mechanisms of Heat Gain and Loss Thermal Gradient

Wind Relative Humidity

Thermogenesis Work-Induced Thermoregulatory Diet-Induced

Mechanisms of Heat Gain and Loss Thermal Gradient

Wind Relative Humidity

Thermogenesis Work-Induced Thermoregulatory Diet-Induced

Pathophysiology of Pathophysiology of Heat and Cold Heat and Cold

DisordersDisorders

Thermolysis Conduction Convection Radiation Evaporation Respiration

Thermolysis Conduction Convection Radiation Evaporation Respiration


DisordersDisorders

Thermoregulation Body Temperature

Core temperature Peripheral temperature

The Hypothalmus Heat Dissipation

Sweating, vasodilation

Heat Conservation Shivering,

vasoconstriction

Thermoregulation Body Temperature

Core temperature Peripheral temperature

The Hypothalmus Heat Dissipation

Sweating, vasodilation

Heat Conservation Shivering,

vasoconstriction


DisordersDisorders

Thermoreceptors Peripheral thermoreceptors Central thermoreceptors

Metabolic Rate Basic metabolic rate Exertional metabolic rate Core temperature measurement

Thermoreceptors Peripheral thermoreceptors Central thermoreceptors

Metabolic Rate Basic metabolic rate Exertional metabolic rate Core temperature measurement


DisordersDisorders

Heat DisordersHeat Disorders Hyperthermia

Signs of Thermolysis Diaphoresis, increased skin temperature

Signs of Thermolytic Inadequacy Altered mentation or altered level of consciousness

Manifestations Heat cramps Heat exhaustion Heat stroke

Hyperthermia Signs of Thermolysis

Diaphoresis, increased skin temperature Signs of Thermolytic Inadequacy

Altered mentation or altered level of consciousness Manifestations

Heat cramps Heat exhaustion Heat stroke

Heat DisordersHeat Disorders Predisposing Factors

Age of the Patient Health of the Patient Medications

Diuretics, beta-blockers, psychotropics, and antihistamines

Level of Acclimatization Length and Intensity of Exposure Environmental Factors

Predisposing Factors Age of the Patient Health of the Patient Medications

Diuretics, beta-blockers, psychotropics, and antihistamines

Level of Acclimatization Length and Intensity of Exposure Environmental Factors

Heat DisordersHeat Disorders

Preventive Measures Maintain adequate fluid intake. Allow time for gradual acclimatization. Limit exposure to hot environments.

Preventive Measures Maintain adequate fluid intake. Allow time for gradual acclimatization. Limit exposure to hot environments.

Heat DisordersHeat Disorders

Heat CrampsHeat Cramps

Heat ExhaustionHeat Exhaustion

HeatstrokeHeatstroke

Close Relationship to Heat Disorders Dehydration prevents thermolysis.

Signs & Symptoms Nausea, vomiting, and abdominal distress Vision disturbances, decreased urine output Poor skin turgor and signs of hypovolemic shock

Treatment Oral fluids if the patient is alert and oriented IV fluids if the patient has an altered mental status or

is nauseated

Close Relationship to Heat Disorders Dehydration prevents thermolysis.

Signs & Symptoms Nausea, vomiting, and abdominal distress Vision disturbances, decreased urine output Poor skin turgor and signs of hypovolemic shock

Treatment Oral fluids if the patient is alert and oriented IV fluids if the patient has an altered mental status or

is nauseated

Role of Dehydration Role of Dehydration in Heat Disordersin Heat Disorders

Fever (Pyrexia)Fever (Pyrexia)

Pyrogens Differentiating Fever from

Heatstroke Cooling the Fever Patient

Consider antipyretic medication. Acetaminophen or ibuprofen

Avoid sponge baths.

Pyrogens Differentiating Fever from

Heatstroke Cooling the Fever Patient

Consider antipyretic medication. Acetaminophen or ibuprofen

Avoid sponge baths.

Cold DisordersCold Disorders Hypothermia Mechanisms of Heat Conservation

and Loss Predisposing Factors

Age of the Patient Health of the Patient Medications Prolonged or Intense Exposure Coexisting Weather Conditions

Hypothermia Mechanisms of Heat Conservation

and Loss Predisposing Factors

Age of the Patient Health of the Patient Medications Prolonged or Intense Exposure Coexisting Weather Conditions

Cold DisordersCold Disorders Preventative Measures

Dress warmly and ensure plenty of rest. Eat appropriately or at regular intervals. Limit exposure to cold environments.

Degrees of Hypothermia Mild Severe Compensated Hypothermia Acute, Subacute, and Chronic Exposure

Preventative Measures Dress warmly and ensure plenty of rest. Eat appropriately or at regular intervals. Limit exposure to cold environments.

Degrees of Hypothermia Mild Severe Compensated Hypothermia Acute, Subacute, and Chronic Exposure

Cold Cold DisordersDisorders

HypothermiaHypothermia

Signs & Symptoms Mild Severe

Signs & Symptoms Mild Severe

HypothermiaHypothermia ECG

Pathognomonic J waves (Osborn waves). Eventual onset of bradycardia. Ventricular fibrillation probable below 86º F.

ECG Pathognomonic J waves (Osborn waves). Eventual onset of bradycardia. Ventricular fibrillation probable below 86º F.

HypothermHypothermiaia

HypothermiaHypothermia

Treatment Active Rewarming

Active external rewarming Active internal rewarming

Rewarming Shock Cold Diuresis

Treatment Active Rewarming

Active external rewarming Active internal rewarming

Rewarming Shock Cold Diuresis

HypothermiaHypothermia Resuscitation

BCLS Perform pulse and respiration checks for longer periods. Administer up to 3 shocks with the AED. Follow with CPR, rewarming, and rapid transport.

ACLS Intubate and administer up to 3 shocks and initial

medications. Establish IV access, begin rewarming, and transport

rapidly.

Avoid further resuscitation until the core temperature is above 86º F.

Resuscitation BCLS

Perform pulse and respiration checks for longer periods. Administer up to 3 shocks with the AED. Follow with CPR, rewarming, and rapid transport.

ACLS Intubate and administer up to 3 shocks and initial

medications. Establish IV access, begin rewarming, and transport

rapidly.

Avoid further resuscitation until the core temperature is above 86º F.

FrostbiteFrostbite Superficial

Frostbite Freezing of

epidermal tissue Redness followed

by blanching and diminshed sensation

Deep Frostbite Freezing of

epidermal and subcutaneous layers

White, frozen appearance

Superficial Frostbite Freezing of

epidermal tissue Redness followed

by blanching and diminshed sensation

Deep Frostbite Freezing of

epidermal and subcutaneous layers

White, frozen appearance

FrostbiteFrostbite Treatment

Do not thaw the affected area if there is the possibility of refreezing.

Do not massage the affected area. Administer analgesia prior to thawing. Transport; rewarm by immersion only if transport is

lengthy or delayed. Cover the thawed part with a loose, sterile dressing. Elevate and immobilize the thawed part.

Do not puncture or drain blisters. Do not rewarm feet if walking will be required.

Treatment Do not thaw the affected area if there is the possibility

of refreezing. Do not massage the affected area. Administer analgesia prior to thawing. Transport; rewarm by immersion only if transport is

lengthy or delayed. Cover the thawed part with a loose, sterile dressing. Elevate and immobilize the thawed part.

Do not puncture or drain blisters. Do not rewarm feet if walking will be required.

Trench FootTrench Foot Trench Foot

Occurs above freezing. Typically occurs from standing in cold water.

Symptoms are similar to frostbite. Pain may be present, and blisters may form with

spontaneous rewarming. Treatment:

Warm, dry, and aerate the feet. Prevention is the best treatment.

Trench Foot Occurs above freezing.

Typically occurs from standing in cold water. Symptoms are similar to frostbite.

Pain may be present, and blisters may form with spontaneous rewarming.

Treatment: Warm, dry, and aerate the feet. Prevention is the best treatment.

Near-Drowning vs. Drowning Pathophysiology of Drowning and

Near-Drowning Dry vs. Wet Drowning Fresh-Water vs. Saltwater Drowning

Fresh water causes the alveoli to collapse from a lack of surfactant.

Salt water causes pulmonary edema and eventual hypoxemia due to its hypertonic nature.

Near-Drowning vs. Drowning Pathophysiology of Drowning and

Near-Drowning Dry vs. Wet Drowning Fresh-Water vs. Saltwater Drowning

Fresh water causes the alveoli to collapse from a lack of surfactant.

Salt water causes pulmonary edema and eventual hypoxemia due to its hypertonic nature.

Near-Drowning Near-Drowning and Drowningand Drowning


Factors Affecting Survival Cleanliness of Water Length of Time Submerged Victim’s Age and General Health Water Temperature

Cold-water drowning. Mammalian diving reflex. The cold-water drowning patient is not dead until

he is warm and dead.

Factors Affecting Survival Cleanliness of Water Length of Time Submerged Victim’s Age and General Health Water Temperature

Cold-water drowning. Mammalian diving reflex. The cold-water drowning patient is not dead until

he is warm and dead.


Treatment for Near-Drowning Remove the patient from the water.

Attempt rescue only if properly trained and equipped. Initiate ventilation while the patient is still in the water. Suspect head and neck injury if the patient

experienced a fall or was diving. Place the victim on a long spine board and use c-spine precautions throughout care.

Protect the patient from heat loss. Evaluate ABCs. Begin CPR and defibrillation if

indicated.

Treatment for Near-Drowning Remove the patient from the water.

Attempt rescue only if properly trained and equipped. Initiate ventilation while the patient is still in the water. Suspect head and neck injury if the patient

experienced a fall or was diving. Place the victim on a long spine board and use c-spine precautions throughout care.

Protect the patient from heat loss. Evaluate ABCs. Begin CPR and defibrillation if

indicated.


Manage the airway using proper suctioning and airway adjuncts.

Administer oxygen at 100% concentration. Use respiratory rewarming, if available. Establish IV of lactated Ringer’s or normal saline at

75 mL/hr. Follow ACLS protocols if the patient is normothermic.

Treat hypothermic patients according to hypothermia guidelines.

Adult Respiratory Distress Syndrome

Manage the airway using proper suctioning and airway adjuncts.

Administer oxygen at 100% concentration. Use respiratory rewarming, if available. Establish IV of lactated Ringer’s or normal saline at

75 mL/hr. Follow ACLS protocols if the patient is normothermic.

Treat hypothermic patients according to hypothermia guidelines.

Adult Respiratory Distress Syndrome


Diving Diving EmergenciesEmergencies Scuba

The Effects of Air Pressure on Gases Boyle’s Law

The volume of a gas is inversely proportional to its pressure if the temperature is kept constant.

Dalton’s Law The total pressure of a mixture of gases is equal to the

sum of the partial pressures of the individual gases. Henry’s Law

The amount of gas dissolved in a given volume of liquid is proportional to the pressure of the gas above it.

Scuba The Effects of Air Pressure on Gases

Boyle’s Law The volume of a gas is inversely proportional to its

pressure if the temperature is kept constant. Dalton’s Law

The total pressure of a mixture of gases is equal to the sum of the partial pressures of the individual gases.

Henry’s Law The amount of gas dissolved in a given volume of liquid

is proportional to the pressure of the gas above it.

Diving Diving EmergenciesEmergencies Pathophysiology of Diving

Emergencies Increased dissolution of gases during descent due to

Henry’s law. Boyle’s law dictates that these gases have a smaller

volume. In a controlled ascent, the process is reversed and the

gases escape through respiration. A rapid ascent causes gases to come out of solution

quickly, forming gas bubbles in the blood, brain, spinal cord, skin, inner ear, muscles, and joints.

Pathophysiology of Diving Emergencies Increased dissolution of gases during descent due to

Henry’s law. Boyle’s law dictates that these gases have a smaller

volume. In a controlled ascent, the process is reversed and the

gases escape through respiration. A rapid ascent causes gases to come out of solution

quickly, forming gas bubbles in the blood, brain, spinal cord, skin, inner ear, muscles, and joints.

Diving Diving EmergenciesEmergencies Classification of Diving Emergencies

Injuries on the Surface Injuries During Descent

Barotrauma

Injuries on the Bottom Nitrogen narcosis

Injuries During Ascent Decompression illness Pulmonary overpressure and subsequent arterial gas

embolism, pneumomediastinum, or pneumothorax

Classification of Diving Emergencies Injuries on the Surface Injuries During Descent

Barotrauma

Injuries on the Bottom Nitrogen narcosis

Injuries During Ascent Decompression illness Pulmonary overpressure and subsequent arterial gas

embolism, pneumomediastinum, or pneumothorax

Diving Diving EmergenciesEmergencies General Assessment of Diving

Emergencies Time at Which Signs and Symptoms

Appeared Type of Breathing Apparatus Used Type of Hypothermia-Protective Garment

Worn Parameters of the Dive

Number of dives, depth, and duration

Aircraft Travel following a Dive

General Assessment of Diving Emergencies Time at Which Signs and Symptoms

Appeared Type of Breathing Apparatus Used Type of Hypothermia-Protective Garment

Worn Parameters of the Dive

Number of dives, depth, and duration

Aircraft Travel following a Dive

Diving Diving EmergenciesEmergencies Factors to Assess

Rate of Ascent Associated with panic forcing a rapid ascent

Inexperience of the Diver Improper Functioning of Depth Gauge Previous Medical Diseases Old Injuries Previous Episodes of Decompression Illness Use of Alcohol or Medications

Factors to Assess Rate of Ascent

Associated with panic forcing a rapid ascent

Inexperience of the Diver Improper Functioning of Depth Gauge Previous Medical Diseases Old Injuries Previous Episodes of Decompression Illness Use of Alcohol or Medications

Pressure DisordersPressure Disorders Decompression Illness

May occur with dives of 33’ or more.

Signs & Symptoms Occur within

36 hours. Joint/abdominal

pain. Fatigue,

paresthesias, and CNS disturbances.

Treatment Recompression.

Decompression Illness May occur with dives of 33’ or

more. Signs & Symptoms

Occur within 36 hours.

Joint/abdominal pain.

Fatigue, paresthesias, and CNS disturbances.

Treatment Recompression.

Pressure DisordersPressure Disorders Treatment

Assess ABCs and begin CPR if required. Administer high-flow oxygen and intubate if indicated. Maintain supine position. Protect the patient from heat, cold, wetness, or noxious

fumes. Transport and establish IV access. Consult with medical direction regarding administration

of dexamethasone, heparin, or diazepam if CNS is involved.

If aeromedical evacuation is used, maintain cabin pressure at sea level or fly at the lowest possible altitude.

Send diving equipment with the patient for analysis if possible.

Treatment Assess ABCs and begin CPR if required. Administer high-flow oxygen and intubate if indicated. Maintain supine position. Protect the patient from heat, cold, wetness, or noxious

fumes. Transport and establish IV access. Consult with medical direction regarding administration

of dexamethasone, heparin, or diazepam if CNS is involved.

If aeromedical evacuation is used, maintain cabin pressure at sea level or fly at the lowest possible altitude.

Send diving equipment with the patient for analysis if possible.

Pressure DisordersPressure Disorders

Pulmonary Overpressure Accidents Can occur in depths as shallow as 6’. Signs & Symptoms

Substernal chest pain with associated respiratory distress and diminished breath sounds

Treatment Treat as a pneumothorax. Provide rest and supplemental oxygen.

Pulmonary Overpressure Accidents Can occur in depths as shallow as 6’. Signs & Symptoms

Substernal chest pain with associated respiratory distress and diminished breath sounds

Treatment Treat as a pneumothorax. Provide rest and supplemental oxygen.

Pressure DisordersPressure Disorders Arterial Gas Embolism

Signs & Symptoms Onset is within 2–10 minutes of ascent . There is dramatic onset of sharp, tearing pain. Common presentation mimics a stroke; suspect AGE in

any patient with neurological deficits immediately after ascent.

Treatment Assess ABCs, provide high-flow oxygen. Maintain a supine position; monitor vital signs

frequently. Establish IV access and consider administering

corticosteroids. Rapidly transport to a recompression chamber.

Arterial Gas Embolism Signs & Symptoms

Onset is within 2–10 minutes of ascent . There is dramatic onset of sharp, tearing pain. Common presentation mimics a stroke; suspect AGE in

any patient with neurological deficits immediately after ascent.

Treatment Assess ABCs, provide high-flow oxygen. Maintain a supine position; monitor vital signs

frequently. Establish IV access and consider administering

corticosteroids. Rapidly transport to a recompression chamber.

Pressure DisordersPressure Disorders

Pneumomediastinum Signs & Symptoms

Substernal chest pain, irregular pulse, abnormal heart sounds, hypotension with a narrow pulse pressure, and a change in voice

Treatment Provide high-flow oxygen. Establish IV access. Transport for further evaluation.

Pneumomediastinum Signs & Symptoms

Substernal chest pain, irregular pulse, abnormal heart sounds, hypotension with a narrow pulse pressure, and a change in voice

Treatment Provide high-flow oxygen. Establish IV access. Transport for further evaluation.

Pressure DisordersPressure Disorders Nitrogen Narcosis

Occurs during a dive. Can contribute to accidents during the dive.

Signs & Symptoms Altered levels of consciousness and impaired

judgment. Treatment

Return to shallow depth. Use oxygen/helium mix during dive.

Nitrogen Narcosis Occurs during a dive.

Can contribute to accidents during the dive. Signs & Symptoms

Altered levels of consciousness and impaired judgment.

Treatment Return to shallow depth. Use oxygen/helium mix during dive.

Diving Diving EmergenciesEmergencies Other Diving-Related

Emergencies Oxygen Toxicity Hypercapnia

Diver’s Alert Network Consultation and Referrals

(919) 684-8111

Other Diving-Related Emergencies Oxygen Toxicity Hypercapnia

Diver’s Alert Network Consultation and Referrals

(919) 684-8111

High-Altitude High-Altitude IllnessIllness Manifestation

Altitudes above 8,000’

Prevention Ascend gradually. Limit exertion. Descend for sleep. Eat a high-carbohydrate diet. Medications

Acetazolamide and nifedipine

Manifestation Altitudes above 8,000’

Prevention Ascend gradually. Limit exertion. Descend for sleep. Eat a high-carbohydrate diet. Medications

Acetazolamide and nifedipine

High-Altitude High-Altitude IllnessIllness Types of High-Altitude Illness

Acute Mountain Sickness Mild cases include lightheadedness,

breathlessness, weakness, headache, nausea, and vomiting.

Severe cases include weakness, severe vomiting, decreased urine output, shortness of breath, and an altered level of consciousness.

Treatment includes halting of ascent or descent, use of acetazolamide and antinausea drugs and supplemental oxygen.

Types of High-Altitude Illness Acute Mountain Sickness

Mild cases include lightheadedness, breathlessness, weakness, headache, nausea, and vomiting.

Severe cases include weakness, severe vomiting, decreased urine output, shortness of breath, and an altered level of consciousness.

Treatment includes halting of ascent or descent, use of acetazolamide and antinausea drugs and supplemental oxygen.

High-Altitude High-Altitude IllnessIllness High-Altitude Pulmonary Edema

Mild symptoms include dry cough, shortness of breath, and slight crackles in the lungs.

Severe cases develop cyanosis, dyspnea, frothy sputum, weakness, and possibly coma or death.

Treatment includes descent and supplemental oxygen, or portable hyperbaric bag; medications such as acetazolamide, nifedipine, and lasix may be useful also.

High-Altitude Pulmonary Edema Mild symptoms include dry cough, shortness of

breath, and slight crackles in the lungs. Severe cases develop cyanosis, dyspnea, frothy

sputum, weakness, and possibly coma or death. Treatment includes descent and supplemental

oxygen, or portable hyperbaric bag; medications such as acetazolamide, nifedipine, and lasix may be useful also.

High-Altitude High-Altitude IllnessIllness High-Altitude Cerebral Edema

Usually occurs as progression of AMS or HAPE. Symptoms include altered mental status, ataxia,

decreased level of consciousness, and coma. Treatment includes descent and supplemental

oxygen, or portable hyperbaric bag.

High-Altitude Cerebral Edema Usually occurs as progression of AMS or HAPE. Symptoms include altered mental status, ataxia,

decreased level of consciousness, and coma. Treatment includes descent and supplemental

oxygen, or portable hyperbaric bag.

Nuclear RadiationNuclear Radiation

Personal Safety Only appropriately trained and equipped

personnel should handle radiation emergencies.

Basic Nuclear Physics Atoms

Protons, neutrons, and electrons

Isotopes and Half-Life Ionizing radiation

Personal Safety Only appropriately trained and equipped

personnel should handle radiation emergencies.

Basic Nuclear Physics Atoms

Protons, neutrons, and electrons

Isotopes and Half-Life Ionizing radiation

Nuclear RadiationNuclear Radiation Ionizing Radiation

Alpha particles Beta particles Gamma rays Neutrons

Effects of Radiation on the Body Detection of Radiation

RAD and REM Acute and Long-Term Effects

Ionizing Radiation Alpha particles Beta particles Gamma rays Neutrons

Effects of Radiation on the Body Detection of Radiation

RAD and REM Acute and Long-Term Effects

Nuclear RadiationNuclear Radiation

Nuclear RadiationNuclear Radiation Principles of

Safety Time Distance Shielding Clean Accidents

Patient is exposed but not contaminated.

Dirty Accidents Patient is

contaminated by radioactive particles, liquids, gases ,or smoke.

Principles of Safety Time Distance Shielding Clean Accidents

Patient is exposed but not contaminated.

Dirty Accidents Patient is

contaminated by radioactive particles, liquids, gases ,or smoke.

Nuclear RadiationNuclear Radiation Management

Park upwind. Look for signs of

radioactive exposure.

Use portable instruments to detect radioactivity.

Normal emergency care principles should be applied.

Externally radiated and internally contaminated patients pose little danger.

Externally contaminated patients require decontamination.

Management Park upwind. Look for signs of

radioactive exposure.

Use portable instruments to detect radioactivity.

Normal emergency care principles should be applied.

Externally radiated and internally contaminated patients pose little danger.

Externally contaminated patients require decontamination.






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