Environmental emergencies: Nursing

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ENVIRONMENTAL EMERGENCIES
	KEY POINTS	NOTES
DEFINITION	Event or condition r/t exposure to weather Emergencies involving heat and/or cold
HEAT-RELATED EMERGENCIES	Heat-related emergencies Occur when body heat regulation becomes less effective Caused by prolonged or intense heat exposure Heat exhaustion Results from heat exposure over hours or days Body temperature may reach 105.8 F (41 C) Symptoms Anxiety Fatigue Nausea Thirst Pale skin Can progress to heat stroke if untreated Heat stroke Medical emergency with failed thermoregulation Temperature > 105.8 F (41 C) Symptoms Weakness Flushed dry skin Fluid and electrolytes lost through perspiration in both conditions Signs include tachycardia weak pulse low blood pressure Sodium loss may cause cerebral edema and confusion Severe cases may lead to coma or brain hemorrhage
NURSING CONSIDERATIONS FOR HEAT-RELATED EMERGENCIES	Place patient in a cool environment immediately For heat exhaustion give fluids and electrolytes Use oral or IV replacement as needed Heat stroke interventions Provide high-flow oxygen Establish IV access Initiate rapid cooling measures Use wet sheets and fans for airflow Place ice packs on groin and axillae Use tepid or cool water immersion Monitor temperature to prevent shivering Additional assessments Obtain 12-lead ECG Check labs Insert urinary catheter Check for myoglobinuria
COLD-RELATED EMERGENCIES	Caused by prolonged exposure to cold air or water Frostbite Tissue freezes forming intracellular ice crystals Damages organelles and breaks cell membranes Common on feet hands nose ears and cheeks Skin may look waxy yellow mottled or blue May feel firm crunchy numb or burning Hypothermia Core temperature < 95 F (35 C) Body responds with vasoconstriction and shivering Blood thickens increasing clotting risk Slowed flow causes hypoxia and acidosis Heart function impaired with possible dysrhythmias Symptoms Lethargy Confusion Bradycardia Hypotension
NURSING CONSIDERATIONS FOR COLD-RELATED EMERGENCIES	Frostbite Focus on rewarming and preventing further injury Gently remove clothing and jewelry Immerse area in temperature-controlled circulating bath Use warm wet cloths for face areas Do not massage affected tissue Debride blisters and apply sterile dressings Elevate extremity if deep tissue is involved Assess pain and give prescribed analgesics Hypothermia care Remove wet clothing and apply warm dry blankets Provide heated humidified oxygen Begin rewarming as ordered Use heating blankets or warm water immersion Use warm IV fluids or extracorporeal warming Monitoring and labs Use continuous ECG and frequent vital signs Measure core temperature with rectal or urinary probe Monitor electrolytes especially potassium Watch for rebound hyperkalemia during rewarming Stop rewarming when temperature reaches 90 - 95 F

An environmental emergency refers to an event or condition related to exposure to weather, which can include emergencies involving heat and cold.

Alright, so heat-related emergencies happen when the body’s normal thermoregulatory mechanisms like sweating, vasodilation, and increased respirations, are less effective in situations where there’s prolonged exposure to heat, or if there’s brief exposure to intense heat.

Heat exhaustion happens when heat exposure occurs over hours or days, like during a hike on a hot day, leading to a body temperature as high as 105.8° F or 41° C.

Other assessment findings can include anxiety, fatigue, nausea, thirst, and pale skin.

If left untreated, heat exhaustion can progress to heat stroke, which is a medical emergency. With heat stroke, the body’s thermoregulatory mechanisms fail, leading to a temperature above 105.8° F or 41° C. Other assessment findings can include weakness and hot, flushed, dry skin.

Now, in both heat exhaustion and heat stroke, fluid and electrolytes are lost through perspiration, which can manifest as tachycardia, weak pulses, and decreased blood pressure. In heat stroke, an excessive loss of sodium can lead to cerebral edema, brain hemorrhage, and mental status changes ranging from confusion to coma.

Alright, when caring for your patient with a heat-related emergency ensure they are in a cool environment. For heat exhaustion, provide fluid and electrolyte replacement orally, or intravenously, if needed. For heat stroke, provide high-flow oxygen and initiate continuous pulse oximetry; establish IV access to replace fluids and electrolytes; and initiate rapid cooling measures.

These could include placing wet sheets over your patient and placing them in front of a fan to increase airflow over their body; placing ice packs on their groin and axillae; or immersing them in a tepid or cool water bath. Be sure to monitor their temperature closely to control shivering, which can lead to heat production.

Then, obtain a 12-lead ECG, and monitor laboratory test results, including CBC, electrolytes, and coagulation studies. Insert an indwelling urinary catheter and check for myoglobinuria, which could result from rhabdomyolysis, or muscle breakdown, which can happen due to heat-related muscle damage.

Fuentes

"Lewis's medical-surgical nursing: Assessment and management of clinical problems. (12th ed.). " Elsevier. (2022)

"Medical-surgical nursing: Concepts for interprofessional and collaborative care. (10th ed.). ISBN: 978-0323654050 " Elsevier. (2021)

"Lewis’s medical-surgical nursing in Canada: Assessment and management of clinical problems. (5th ed.). ISBN 978-0323791588 " Elsevier (2023)

Environmental emergencies: Nursing

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