Chapter 11: Concepts of Care for Patients With Common Environmental Emergencies

Environmental emergencies represent acute medical crises triggered by exposure to extreme temperatures, toxic substances, electrical currents, high altitudes, or water immersion, requiring rapid assessment and coordinated interprofessional intervention to prevent mortality and long-term disability. Heat-related illnesses exist on a continuum from heat exhaustion, characterized by dehydration and electrolyte depletion in conscious patients, to heat stroke, a true medical emergency marked by core body temperature exceeding 104°F with concurrent altered mental status and multi-system organ failure. Vulnerable populations including older adults, athletes, outdoor workers, and those with chronic conditions face heightened risk, necessitating prevention strategies centered on adequate hydration, gradual acclimatization, appropriate clothing, and avoidance of peak environmental heat exposure. Management prioritizes rapid core temperature reduction through immersion or evaporative cooling, airway protection, intravenous fluid resuscitation, and seizure prophylaxis. Envenomation injuries from snakes and arthropods require systematic assessment of bite or sting location, toxin type, and progression of local and systemic effects, with nursing interventions including limb immobilization, removal of constrictive items, poison control consultation, and potential antivenom administration based on clinical presentation. Lightning injuries represent unique electrical traumas with distinctive complications including cardiac dysrhythmias, neurological dysfunction, tympanic membrane rupture, and characteristic dermal patterns called Lichtenberg figures, demanding spinal precautions and advanced life support protocols. Cold-related emergencies such as hypothermia and frostbite require careful passive and active rewarming techniques, dysrhythmia monitoring, and prevention of complications including refreezing and compartment syndrome. High-altitude emergencies including acute mountain sickness, high-altitude cerebral edema, and high-altitude pulmonary edema stem from hypoxia and require interventions such as gradual ascent, descent protocols, supplemental oxygen, and pharmacological agents like acetazolamide and dexamethasone. Drowning, defined as respiratory compromise from water immersion, involves pathophysiological mechanisms including surfactant disruption and pulmonary edema, with recovery dependent on submersion duration, water temperature, and speed of rescue intervention. Throughout all environmental emergencies, nurses provide essential assessment, intervention, patient education, and advocacy for at-risk populations while collaborating across disciplines to optimize clinical outcomes.