Cold/Heat emergencies Flashcards
First degree frost bite
Numbness, swelling, erythema
Second degree frost bite
Blisters of the skin
Third degree frostbite
Tissue loss involving entire thickness of the skin
Fourth Degree
Tissue loss involving the entire thickness of the part - including deep structures
1st degree fb tx
Numbness swelling erythema
Remove wet and cold clothing
Prevent further cold injury
Warm them up
2nd degree fb tx
Effects dermal layers, redness and blanching, no necrosis if stopped here
Don’t rub, warming then refreezing will cause further damage
3rd degree fb tx
Loss of tissue involving all layers of skin, don’t warm then re freeze, rewarming will be very painful
4th degree fb tx
Effects dermal, subq and muscular layers
Obvious necrosis, solid white appearance, same tx as 1st-3rd
Overall tx for frostbite
Do not heat area (dry heat may increase injury)
All wet clothing removed
Prevent further cooling
Consider analgesia
Mild hypothermia temp range
32-35
Mild hypothermia presentation
Shivering, pt feels cold, confusion and lethargy, poor judgement, loss of fine motor control, ataxia
Mild hypothermia tx
Remove wet clothes, remove pt from cold environment, prevent heat loss with blankets
Moderate hypothermia temp range
30-34
Moderate hypothermia presentation
Progressive loss of congnitive functions, stupor, delirium, slow reflexes, dysrhthmias
Moderate hypothermia TX
Heating packs or heating blankets, increase ambient heat
Severe hypothermia temp
Less than 30
Severe hypothermia presentation
Unconscious, loss of papillary light reflexes, apnea, pulseless, decreased CO and BP. blood volume can decrease by 1/3. Arrythmias, J wave
Severe hypothermia tx
Warm IV fluids, peritoneal lavage, pleural lavage, cardiopulmonary bypass, extracorporeal circulation
J wave
Positive deflection between QRS and ST, negative in aVR and V1, usually seen below 30 degrees
Overall rewarming EMS strategies
Stop heat loss, keep pt still (supine ideally) and remove wet clothing, provide supportive care prn, consider analgesics, warm blankets and warm IV fluid
Bradycardia in hypothermia
DON’T TCP, leave bradycardic and rewarm first, bradycardia is a normal physiological response to severe hypothermia
Physiologic response to heat
Dilation of blood vessels (primarily in skin), increased sweat production, decreased heat production
Mechanisms of heat loss
22% evaporation
60% radiation (heat waves)
15% air currents (convection)
3% Conduction to objects
Heat cramps
Normal body temp, usually from prolonged strenuous activity.
Brief, intermittent, severe, abdo and ext
Heat cramps manifestations
Prolonged and profuse sweating, no core temp elevation, tachy, normal or slightly up BP
Heat cramp tx
Passive cooling, remove from environment, fluid and lyte replacement
Heat exhaustion
From prolonged high core or environmental temp, develops over hours to days, core temp not over 40C
Heat exhaustion characterized by
Increased lyte imbalances, vasodilatory disturbances causing inadequate peripheral and cerebral perfusion
Heat exhaustion manifestations
Profuse sweating/pallor, cool/clammy skin. Weakness Syncope N/V Dizzy/headache Tachy-cardia and pnea
Heat exhaustion tx
Passive cooling, remove from environment, fluid replacement
Heat stroke temp
Greater than 40C because mechanisms for heat dissipation become exhausted. Can cause hypothalamus and multi-system tissue damage
Heat stroke death %
30-80%. Altered LOC at heat stroke temps
2 classifications of heat stroke
Classic is passive fluid loss by sweating, usually in oldies and develops over a few days
Exertional from fit people working hard in hot and humid environment
Heat stroke manifestations
Confusion, agitation, irritability, delirium, ataxia, seizures Dry/hot/flushed/red skin Tachy - cardia/pnea Hypotension Circulatory shock
Tx heat stroke
True emergency, active external cooling using wet towels and AC, cold packs to axillae, neck and groin, removal from environment, fluid replacement
