Risa Herlianita

Learning Objectives

1. Mendeskripsikan tanda dan gejalan serta

intervensi pd kasus sengatan ataupun gigitan
2. Mendeskripsikan intervensi yang tepat pada luka
bakar
3. Mendeskripsikan intervensi primer pada 3 jenis
heat related illness
4. Mengidentifikasi tanda awal hipotermia
5. Mengetahui pengkajian dan intervensi yang tepat
untuk korban yang tenggelam

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 Sengatan Gigitan

Environmental Emergencies Luka

Hipertermi
Bakar

Tenggelam Hipotermi

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 Gigitan Hewan/Manusia

Soft tissue damage - Crushing/Lacerations

Infection - especially if human bite
Functional and Cosmetic Damage
Intervention:
Monitor ABCs including shock
Control bleeding
Transport to ED/MD
Report incident if required

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 Gigitan Ular, Spider, Scorpion

Important factors to consider:

Age and size of child
Type of venom/toxin or identification of source
Amount of venom injected
Location of bite/sting
Not all are poisonous

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 Cont.

Coral snakes have a neurotoxin that does not cause

significant local injury
Signs and symptoms include tremors, dysarthria
(Slurred, slow speech), diplopia (Single object
appears as two), miosis (Pupil Constriction), ptosis
(Downward displacement), dyspnea and seizures
These signs and symptoms may be delayed up to 12
hours after the bite
 Management of Snake Bite

Retreat beyond the striking range

All victims of a snake bite should have the
extremity immobilize
AVOID ice packs, tourniquets, incisions,
steroids or prophylactic antibiotics
Local wound care and tetanus prophylaxis
should be given initially
 Cont.
Pit viper bites should be monitored for evidence of
progressive erythema or swelling, systemic effects, or
significant coagulopathies
Antivenin should be administered if they develop
progressive Signs and symptoms
All patients should be observed for at least 8 hours. Those
with dry bites who remain symptom free may be discharged.
All others should be admitted for observation
Mild reactions can be treated supportively with analgesics,
tetanus prophylaxis, local wound care and patient
reassurance
Snake Bite with Envenomation

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 BURNS
Categories:

Superficial partial thickness (1st degree)

Partial thickness (2nd degree)

Full thickness (3rd degree)

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 EXTENT OF BURN INJURY

BSA - Body Surface Area

Estimate of size/area involved
Palm (of affected student) including
fingers equals 1%
Rule of Nines chart
Modified chart for children

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 SEVERITY OF BURN

Depth (full thickness or deep partial)

Extent - over 10% BSA deep/full thickness

Location of injury - hands, face, genitalia

Age and health status - chronic problems

Associated injury - smoke inhalation or electrical trauma

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BURNS

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 ASSESSMENT OF BURNS

ABCDs are first priority

Expose burn area unless clothing adhered
Irrigate chemical burns
Use sterile gloves, if available
Cool thermal burns with tepid water until burned
area is no longer warm, then apply dry, sterile
dressing
Call EMS for major burns or altered LOC

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 SPECIFIC BURN INJURIES

Chemical burns
Electrical burns
Electric current
Lightning
Inhalation injuries
Heat
Smoke
Toxic fumes

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HYPERTHERMIA

Heatstroke

Heat Exhaustion

Heat Cramping

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 HEAT STROKE
A dangerous condition occurs when the body is unable to cool
itself by sweating, due to illness or prolonged exposure to heat.
Signs & symptoms:
a. Restlessness.
b. Headache and dizziness.
c. Flushed, hot skin.
d. Rapid loss of consciousness.
e. Rapid, strong pulse.
f. Body temperature may reach 40 C or higher.

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 Emergency Care of Heat Stroke

1. Lay the victim down in a cool place and remove his

clothes.
2. If available, wrap the victim in a cold, wet sheet and
keep it wet, or sponge his body down with cold or
tepid water.
3. Fan the victim until his temperature falls 38 C .
4. When the victims temperature has fallen to a safe
level, replace the wet sheet with a dry one.
5. Regularly monitor the victims vital signs and level
of consciousness until help arrives.

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 HEAT EXHAUSTION

It is an acute medical condition caused by an abnormal loss of

salt and water from the body through excessive and prolonged
sweating.
Signs & symptoms:
a) Rapid weak pulse.
b) Rapid and shallow breathing.
c) Slightly raised temperature.
d) Pale, moist skin.
e) Cramps in the arms, legs or the abdomen.
f) Anorexia and nausea.
g) Headache, dizziness and confusion.

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 Emergency Care of Heat Exhaustion

1. Help the victim to lie down in a cool place.

2. Raise victim legs to improve blood flow to brain.
3. Give victim plenty of water to drink; if conscious,
make the water slightly salted.
4. Initiate IV fluids; if unconscious.
5. Monitor vital signs and level of consciousness
frequently.
6. Transport to nearest hospital.

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Nabeel Al-Mawajdeh RN.Mcs
 HEAT CRAMPS

ASSESSMENT
Physical exertion, perspiring
Drinking large amounts of water

INTERVENTIONS
Remove from heat
Apply moist towels over cramped muscle
Massage muscle to stretch (per protocol)
Replace salt and liquids

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 HYPOTHERMIA

Is a generalized cooling that reduces body

temperature below normal, life-threatening in its
extreme ( an internal body temperature < 35 C)
Signs & symptoms:
a.Shivering may be present or absent.
b.Numbness, or reduced to lost- sense of touch.
c.Stiff or rigid posture or muscles.
d.Decreased mental and/or motor status.
e.Abnormal breathing
- Early rapid.
- Late slow or absent.
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 Cont.
Loss of body heat
Respiration
Radiation
Conduction
Convection
Evaporation
Causes of hypothermia include:
Sepsis
Adrenal insufficiency
Drugs
CNS disorders
Metabolic disorders

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 Cont.

f. Low to absent blood pressure.

g. Inappropriate judgment.
h. Lethargy or apathy.
i. Decreased level of consciousness, or
unconsciousness.
j. Skin may be red (early), pale, cyanotic, and/or
stiff.

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 Emergency Care of Hypothermia

1. Remove patient from the cold environment and

protect the patient from further heat loss.
2. Remove patients wet clothing and wrap the
patient in blankets.
3. Care for shock and provide oxygen.
4. For unresponsive patients, assess pulse for 30-45
sec or 2 minutes before starting CPR.
a. If no pulse, begin CPR .
b. Place AED.

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 Cont.

c. Continue efforts to rewarm.

Warm blankets.
Turn up heat high in the patient
compartment of the ambulance.
Do not massage extremities.
Do not allow patient to remain in, or return
to, a cold environment.
d. If pulseless and directed by the machine,
defibrillate.

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 Cont.

5. If the patient is alert and responding appropriately,

actively rewarm.
a. Apply warm blankets.
b. Place heat packs to groin, axillary, and cervical
regions.
c. Turn up heat high in the patient compartment of
the ambulance.
d. Do not allow patient to have any stimulants
(caffeine, chocolate, etc.).
e. Do not allow the patient to walk or exert themselves.

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 Cont.

6. Check and Record Pulse and Vitals, including

temperature if possible.
7. Transport to a medical facility without delay.
Notes:
Handle patient gently; ventricular fibrillation may
result from rough handling.
Efforts at defibrillation may be successful after
warming.
Patients should be warmed to normal temperatures
before stopping resuscitation.
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 FROSTBITE
Localized severe cooling of skin
Typically involves hands, fingers, feet,
toes, nose, ears or face
Stages:
Incipient
Superficial
Deep

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Cont.

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Cont.

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 Emergency care of Frosbite

INTERVENTIONS
Warm quickly

Do not rub or cause friction on tissue

If exposure sufficient for deep tissue damage,

do not warm, transport immediately

Refer for diagnosis and treatment

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 NEAR DROWNING

Assessment
Call EMS
ABCs/LOC
History
time submerged
water temperature
diving injury
Safe removal from water

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