1. Submersion Injuries (Drowning and Near-Drowning)
Pathophysiology: Involves hypoxia due to water entering the airway, potentially causing laryngospasm and subsequent respiratory and cardiac arrest.
Management: Prioritize airway management, oxygenation, and ventilation. Consider spinal precautions if trauma is suspected. Initiate CPR if necessary and be prepared for potential complications such as hypothermia and aspiration pneumonia.
2. Temperature-Related Illnesses
Hypothermia:
Definition: Occurs when the body’s core temperature drops below 35°C (95°F). Severity ranges from mild (shivering, lethargy) to severe (loss of consciousness, arrhythmias).
Management: Remove the patient from the cold environment, use passive and active warming techniques (e.g., warm blankets, warm IV fluids), and monitor for rewarming shock.
Hyperthermia:
Definition: Elevated body temperature due to heat exposure, ranging from heat cramps and heat exhaustion to life-threatening heat stroke (core temperature >40°C or 104°F).
Management: Initiate rapid cooling methods such as ice packs, cool water immersion, or evaporative cooling. Provide hydration and monitor for signs of multi-organ dysfunction.
3. Cold Injuries
Frostbite and Frostnip:
Frostnip: A mild form of cold injury that does not involve tissue freezing, causing reversible skin blanching and tingling.
Frostbite: Involves actual freezing of tissues, potentially leading to permanent damage. Signs include white, hard, or waxy skin, and blisters after rewarming.
Management: Gradual rewarming, protection of the affected areas, pain control, and prevention of refreezing. Avoid friction or direct heat, which can cause further damage.
4. Bites and Envenomation
Animal Bites:
Includes domestic or wild animal bites that carry the risk of infection and soft tissue damage.
Management: Clean and debride the wound, control bleeding, and consider tetanus prophylaxis.
Snake and Insect Bites (Envenomation):
Involves venomous snakes or insects leading to local or systemic reactions (e.g., swelling, neurotoxicity, anaphylaxis).
Management: Immobilize the affected limb, avoid suction or incision, and administer antivenom if appropriate. For anaphylaxis, administer epinephrine and supportive measures.
5. High-Altitude Illness
Conditions:
Acute Mountain Sickness (AMS): Characterized by headache, nausea, and fatigue due to rapid ascent.
High-Altitude Pulmonary Edema (HAPE): Causes shortness of breath, cough, and potential cyanosis due to fluid accumulation in the lungs.
High-Altitude Cerebral Edema (HACE): A severe, life-threatening condition marked by confusion, ataxia, and coma due to brain swelling.
Management: Immediate descent to lower altitudes is crucial. Administer oxygen, medications like acetazolamide, and supportive care as needed.
General Considerations for EMS Providers
Assessment and Early Recognition: Rapidly identify symptoms and their severity to initiate appropriate care.
Transport Decisions: Understand when rapid transport is critical to access advanced care and when field stabilization suffices.
Environmental Precautions: Protect yourself and the patient from ongoing environmental exposure during care.
The goal in managing these emergencies is to minimize further harm while stabilizing the patient for transport to definitive care.
Each condition has unique aspects to consider, but the key is to prioritize life threats, airway, breathing, circulation (XABCs), and prevent secondary injury.
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