Chemical, Electrical, Hypo, Hyper Flashcards
What is occurring to the tissue in an Acid chemical burn?
- Coagulation
- Formation of touch eschar (dark scab, or flailing of dead skin), this may limit further damage
What is occurring to the tissue in an Alkalis burn?
- Liquefactive necrosis; the transformation of tissue into a liquid mass
- Will have deeper penetration
What are some factors that may alter signs and symptoms of a chemical burn?
- pH
- Concentration of agent
- Contact time
- TBSA
- Physical form of the agent
- Ingestion/inhalation/absorption
What considerations need to be made for the ingestion/inhalation of a chemical agent?
- Dysphagia, stridor, wheezing, dyspnea, tachypnea
- Abdominal tenderness guarding, subcutaneous air
What forms of chemical burns should not be water irrigated?
- Calcium
- Metallic lithium
- Potassium
- Sodium
- Magnesium
Do chemical burns receive the same fluid therapy as thermal burns?
- Yes
Why does IOP ↑ in eye related chemical injuries?
- Due to collagen hydration and inflammatory mediators
What are alkali chemical burns to the eye more detrimental?
- Because alkali are lipophilic and can penetrate the eye structure.
What is the most dangerous acid known and why?
- Hydrofluoric acid
- It contains fluoride ion that readily penetrates the skin causing destruction of deep tissue layers.
Can burns from Hydrofluoric acid be painless?
- Yes
Why is the fluoride in HF so concerning?
- Because fluoride has a high affinity to calcium, this results in the bones being attacked and causing hypocalcaemia.
What may fluoride poisoning cause?
- Hypocalcaemia
- Hyperkalaemia
- Hypomagnesia
- Death
What will retard diffusion of fluoride ion?
- Ice pack
What are the categories of electrical burns?
- Low voltage <1000v
- High voltage >1000v
- Lightning strike
What are the voltage distances that high voltage electricity will discharge through air?
- 1000v – will clear a few millimetres
- 5000v – will bridge 10mm
- 40,000v – will clear 130mm
What is the largest risk group for electrical burns?
- Toddlers
- Teenagers
- Those who work with electricity
What may help determine the severity of electrical burns?
- Current type – AC/DC
- Volts
- Intensity
- Resistance
- Area
- Duration of contact
- Environmental factors
What are the symptoms of electrical burns?
- Contact burns
- Thermal heating
- Flash arc and flame burns
- Blunt trauma
- Prolonged muscle tetany
What typed of voltage will cause what rhythms?
- Low V = VF
- High V = AF
What potential damage can domestic AC voltage cause?
- Significant contact wounds
- Cardiac arrest
- But will not cause deep tissue contact
What injuries can occur from high tension cables?
- Flash burns – the significant electrical charge will cause combustible substances to ignite → burns.
- Deep muscle damage may occur under apparently normal skin and may be life threatening.
How does the pathway of damage appear in lightning strikes?
- Over the skin, rather than through.
- Pt will have significant exit burns on their feet.
What are treatment management of electrical burns?
- 12 lead – assess for arrhythmia
- IV fluids to maintain renal perfusion
- Manage entry and exit burns as per thermal burns
- Pain relief
- Manage arrhythmias accordingly
What are causes of cryogenic burns?
- Coolants such as, liquid nitrogen, methane and propane
What is the treatment for cryogenic burns?
- Rewarm with water between 40-42 degrees for 15-30 min
- Analgesia
- Active movement/motion
- Avoid massaging the affected area
What are the levels of hypothermia severity?
- Mild – 32 to 35 c
- Moderate - 28 to 32 c
- Severe - <28 c
- Death - <24 c
How will a patient present with mild hypothermia?
- Conscious
- Increase HR and BP
- Shivering
- Lethargy
- Hunger
How will a Pt present with moderate hypothermia?
- ACS/confusion
- No shivering
- Uncoordinated movement
- Myocardial irritability /potential for arrhythmias
How will a Pt present with Sever hypothermia?
- Unconscious
- Present vital signs
- Hypercapnic
- Mya be cyanosed
- Arrhythmias
Explain the pathophysiology of hypothermia.
- Exposure of cold stimulus = peripheral vasoconstriction and an increase in catecholamine release.
- ↑ results in an over increase in basal metabolic rate
- Shivering results in try increase Temp
- Once <32c occurs shivering will stop
- Dehydration
- <30 c no glucose transfer = energy depletion
- Decrease HR, BP and RR
- Drop in Ph = Acidosis
- Fluid shift from intravascular space to interstitial space
- <24c cardiac and resp failure
Hypothermia risk factors
- Elderly
- Dementia
- Neonates
- Children
- Trauma – Can be fatal in this pT
- Alcohol
- Immersion
What are the progression of cardiac rhythms in hypothermia?
- ST > SB > AF > VF
- Osborne /J-waves will be seen
- Lower the body temp the Higher the J-wave
What is the worst part of frostbite?
- Secondary thawing
What is the classification of Hyperthermia?
- Marked warming of the core body temp >38c
What is the classification of sever hyperthermia?
- CBT >39.5c
What controls the bodies core temperature?
- Hypothalamus
What are the body mechanism for heat loss?
- Radiation
- Conduction
- Convection
- Evaporation
- Vasodilation
In hyperthermia what are the causes of loss of fluid?
- External heat source
- Exercise
- Infection
- Seizures
List some risk factors of hyperthermia.
- Long periods of warm weather
- High humidity
- Athletes
- Military
- Labourers
- Elderly
- Infants and small children
Explain the pathophysiology of hyperthermia.
- The excessive heat denatures proteins and de-stabilizes lipids
- Redistribution of blood flow + loss of fluids and electrolytes
- Apoptosis in cells occurs
- Organ system failure
At what temp do convulsion occur?
- 41 c
At what temp does death occur in hyperthermia?
- 43c
What are the causes of cramps?
- Water and sodium loss an water replacement.
How will Pt present with Heat stress /cramps?
- Alert
- Pale sweaty
- Tachycardia
- Weakness
- Nausea
- Painful cramps lasting minutes
Treatment of Pt with heat stress/cramps
- Gentle stretching
- Move to cooler place
- Oral fluids
- Avoid salt tablets.
At what temp is heat exhaustion categorised as?
- CBT <40c
At what temp is heat stoke categorised as?
- CBT >40c
What is occurring to the body during heat stroke?
- The body is unable to regulate temperature through hypothalamic thermostat.
What is the ideal temp for cool fluids?
- <10c but as close to 4 c as possible.
