ENVIRONMENTAL INJURY

OLEH :
Dr. ROCHMAT JASIN
M
 ENVIRONMENTAL
INJURY

I. COLD -RELATED INJURIES

II. HEAT – RELATED
INJURIES III. ELECTRICAL
IV. SUBMERSION/DROWNING
INJURIES
V. CO POISONING
VI. BITES AND STINGS
 COLD – RELATED CONDITIONS
TISSUE INJURY

 FROSTBITE
• Tissue is cold and lacks sensation
• Skin appears pale or mottled blue
• Feels waxy and firm
• Blisters,macerationand secondary bacterial
infection can occur
cold related conditions…………….
 TRENCH FOOT/IMMERSION FOOT
Tissue in wet, cold environment
 Patient complains of numbness, pain
and paresthesias
 Initially pale, sensitive and
edematous
 laters findings are erythema,
mottling or cyanosis
 TREATMENTS

 Frostbite  Trench/Immersion
Warm in water foot
Tetanus prophylaxis  Rewarm
Analgesia Remove wet clothing
Remove clear blister Elevate
but not hemorrhagic Local skin care
blister - Topical antibiotics
- Cleansing of
denuded areas
 HYPOTHERMIA

 Core body temperature < 35 C

 Clinical signs
Mild : shivering, confusion,lethargy, incr.
HR,RR
Moderate: disoriented, stupor, decr.
HR,BP,RR
and Reflexes
Severe (<28 C): coma,dilated unreactive
pupils, absent reflexes, muscle rigidity,
asystole, ventricular fibrillation
 Hypothermia…..

 Cardiac Issues
Mild : tachycardia
Moderate: AF, T-wave changes
Severe: bradicardia, asystole, VF
 ABC’s, IV, O2
 Continuous cardiac and temp monitoring
 Remove all wet clothes
 Rewarming stage
Warm blankets (bair hugger)
Warm (45 C) IV fluids and humidified O2 (45
C)
 Heat-Related Conditions

 Neuroleptic malignant  Heat syncope

 syndro  Heat
me
exhaustio
 n
Internal
SerotoninHeat External Heat

Emergencies Heat emergencies
syndrome
 Malignantstroke  Heat cramps
hiperthermia  Heat edema
 HEAT CRAMPS
 Brief, intermittent, muscle cramping
 Abdominal rectus or calf muscles
 Euthermic, mild dehydration
 IV fluid rarely required
 HEAT EDEMA
 Swollen feet/ankles after prolonged
sitting/standing
 Vasodilation,hidrostatic pressure
 No underlying cardiac, lymphatic, hepatic or
venous disease
 Elevated
 diuretics
 Heat
Syncope
 Diagnosis of exclusion in young, healthy
patients without cardiac problems
 Syncopal event in warm/humid weather
following strenuous activity
 Pooling of b;ood in periphery from
vasodilation due to heat
 Euthermic, normal exam
 hydrate
 HEAT
EXHAUSTION
 Fatique and weakness
 Nausea and vomiting
 Headache and myalgias
 Dizziness
 Muscle cramps
 Irritability, tachycardia
 Normal mental status
 Heat Exhaustion Treatment

 Check electrolytes
 Check CPK and dip urine
 Aggressive rehydration with iv normal saline
 Endpoint: normothermic and good urine output
 HEAT STROKE

 Exposure to heat stress

 Signs of severe CNS dysfunction (coma,
seizures,delirium)
 Core temperature usually above 40,5 C
 Dry, hot skin common, but sweating may
persist
 Marked elevation of hepatic transaminases
 Heat Stroke
End Organ Damage
 Central nervous system
(coma,seizures,hallucinations)
 Cardiovascular (tachycardia, hypodinamic)
 Coagulopathy (GI bleeding,hematuria, melena)
 Respiratory (tachypnea, ARDS)
 Renal and metabolic (glomerular damage)
 Liver (transaminase rise > 10,000)
 Management
of Heat Stroke
 Cooling should be initiated immediately
Prehospital if possible
Pririty over diagnostic studies
Delays increase mortality
 Remove clothing
 Monitor temperature continuously
 ELECTRICAL INJURIES

 Sudden death
 Cardiac dysrhythmias
 Tissue injuries (external and internal)
 Neurologic dysfunction
 Trauma
 internal : vascular thrombosis, muscle damage
External ; tetanic muscular contraction, long
bone fracture
 Management of Electrical Injury

 Evaluate as if multiple trauma patient

• ABCs
• Immobilize cervical spine
• IV fluids, O2 monitor
 12-lead ECG
 Extensive resuscitative measure for
cardiopulmonary arrest
 Tetanus
Submersion/Drowning Injuries

 Management
 IV, O2, Monitor, remove wet
clothing
 CPR
 Airway : ( clear debris, intubate,
suctioning, bronchoscopy)
 Gastric decompression
 Not proven to be helpful ; ( steroid,
antibiotics, induced hypothermia0
 CO POISONING
Evaluation and Management
 CO POISONING
Evaluation and Management

 Multiple patients have similar complaints of

headache and dizziness
 Oxigen saturation by pulse oximetri will be falsely
normal
 Give 100% oxigen
 CO poisoning causes a metabolic acidosis
 Check an ECG
 Consider hyperbaric oxygen therapy