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Environmental Med for Dummies > COLD INJURIES > Flashcards

COLD INJURIES Flashcards

1
Q

Another name for Chilblains?

A

Trench Foot

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2
Q

Signs and Symptoms:

1) Patients may complain of pruritus and burning paresthesia.
2) Localized edema,
3) Erythema,
4) Cyanosis,
5) Plaques,
6) Nodules,
7) In rare cases, ulcerations, vesicles, and bullae.

Initial examination:

1)The skin is pale, mottled, anesthetic, pulseless, and immobile, which initially does not change after rewarming.

A

Chilblains / Trenchfoot

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3
Q

What are the signs and symptoms of Chilblains / Trench Foot?

A

Signs and Symptoms:

1) Patients may complain of pruritus and burning paresthesia.
2) Localized edema,
3) Erythema,
4) Cyanosis,
5) Plaques,
6) Nodules,
7) In rare cases, ulcerations, vesicles, and bullae.

Initial examination:

1)The skin is pale, mottled, anesthetic, pulseless, and immobile, which initially does not change after rewarming.

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4
Q

What is the treatment for Trench Foot?

A

1) Supportive
2) Rewarm, bandage and elevate affected skin
3) Fluocinolone cream (Topical Corticosteroids)

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5
Q

What are the preventative measure for Trench Foot / Chilblains?

A

1) Keeping warm.
2) Ensuring good boot fit.
3) Changing out of wet socks
4) Never sleeping in wet socks and boots.

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6
Q

What degree of frostbite?

1) Transient stinging and burning, followed by throbbing.
2) Partial skin freezing, erythema, mild edema, lack of blisters, and occasional skin desquamation several day slater.

A

First Degree Frostbite

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7
Q

What is the prognosis for first degree frostbite?

A

Excellent

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8
Q

What degree of frostbite?

1) The patient complains of numbness, followed later by aching and throbbing.
2) Full-thickness skin freezing, formation of substantial edema over 3 to 4 h, erythema, and formation of clear blisters.

A

Second Degree Frostbite

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9
Q

What is the prognosis of Second Degree Frostbite?

A

Good

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10
Q

What degree of frostbite?

1) The patient may complain that the involved extremity feels like a “block of wood,” followed later by burning,throbbing, and shooting pains.
2) Hemorrhagic blisters form and are associated with skin necrosis and a blue- gray discoloration of the skin.

A

Third Degree Frostbite

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11
Q

Frostbite:

Hemorrhagic blister are associated with what?

A

Skin Necrosis

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12
Q

What is the prognosis of Third Degree Frostbite?

A

Often Poor

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13
Q

What degree of frostbite?

1) The patient may complain of a deep, aching joint pain.
2) The skin is mottled, with little edema and non- blanching cyanosis, and eventually forms a deep, dry, black, mummified eschar.
3) Vesicles often present late, if at all, and may be small, bloody blebs that do not extend to the digit tips

A

Fourth Degree Frostbite

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14
Q

What is the prognosis of Fourth Degree Frostbite?

A

Extremely Poor

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15
Q

What are important questions to ask in the history of a patient with frostbite?

A

1) What was the temperature and wind velocity?
2) How long was the extremity frozen, and if it was thawed,did any refreezing occur?
3) Was there any self- treatment, such as rubbing with snow or use of aloe vera cream or ibuprofen?
4) Were recreational drugs, alcohol, or tobacco involved?
5) Are there any predisposing medical conditions?

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16
Q

What is the “Field Management” for frostbite?

A

1) Remove wet constrictive clothing
2) Elevate and wrap involved extremities
3) Separate toes and fingers with dry sterile gauze
4) Avoid further cold injuries

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17
Q

What is the is the core of frostbite therapy and should be initiated as soon as possible?

A

Rapid rewarming

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18
Q

What is the “Clinical Management” for frostbite?

A

1) Rapid Rewarming
2) Warm in water 104° - 107.6°F for 10 - 30 minutes
3) Debride or aspirate CLEAR blisters
4) Aloe Vera on blisters
5) Separate digits
6) Elevate

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19
Q

What temperature should the water be for rapid rewarming of frostbite be?

A

104° - 107.6°F for 10 - 30 minutes

20
Q

Hypothermia is defined as a core temperature below _____.

A

95ºF

21
Q

What are the TEMPERATURE stages for hypothermia?

A

Mild - 90-95ºF

Moderate – 82-90ºF

Severe below 82°F

22
Q

Mild Hypothermia

A

90-95ºF

23
Q

Moderate Hypothermia

A

82-90ºF

24
Q

Severe Hypothermia

A

Below 82°F

25
Q

What are the CLINICAL stages of hypothermia?

A

1) Cold stressed (not hypothermic)
2) Mild hypothermia
3) Moderate hypothermia
4) Severe/profound hypothermia

26
Q

What Clinical Stage of hypothermia?

1) Normal mental status with shivering.
2) Functioning normally.
3) Able to care for self.
4) Estimated core temperature 35 to 37°C (95 to 98.6°F).

A

Cold stressed (not hypothermic)

27
Q

What Clinical Stage of Hypothermia?

1) Alert, but mental status may be altered.
2) Shivering present.
3) Not functioning normally.
4) Not able to care for self.
5) Estimated core temperature 32 to 35°C (90 to 95°F).

A

Mild Hypothermia

28
Q

What Clinical Stage of Hypothermia?

1) Decreased level of consciousness.
2) Conscious or unconscious, with or without shivering.
3) Estimated core temperature 28 to 32°C (82 to 90°F).

A

Moderate Hypothermia

29
Q

What Clinical Stage of Hypothermia?

1) Unconscious.
2) Not shivering.
3) Estimated core temperature <28°C (<82°F).

A

Severe/profound hypothermia

30
Q

Heat is generated by cellular metabolism (most prominently in the _________ and _________.

A

Heart and Liver

31
Q

Heat is lost by the skin and lungs via what processes?

A

Evaporation

Radiation

Conduction

Convection

32
Q

What are the most common mechanisms of accidental hypothermia?

A

Convective heat loss to cold air
and
Conductive heat lost to water

33
Q

What clinical stage of hypothermia shows:

1) Tachypnea
2) Tachycardia
3) initial hyperventilation
4) Ataxia
5) Dysarthria
6) Impaired judgment
7) Shivering
8) “cold diuresis”

A

Mild Hypothermia

34
Q

What clinical stage of hypothermia shows:

1) CNS depression
2) drop in heart rate and cardiac output
3) hypoventilation
4) hyporeflexia.
5) No Shivering
6) ATRIAL Fib
7) Dilated Pupils

A

Moderate Hypothermia

35
Q

What clinical stage of hypothermia shows:

1) Pulmonary edema
2) Oliguria
3) Hypotension
4) Bradycardia
5) VENTRICULAR dysrhythmias. (V fib/tach/asystole)
6) Loss of oculocephalic reflexes

A

Severe Hypothermia

36
Q

Pupils will dilate in a hypothermic patient with a core temperature below ______.

A

29 C

37
Q

Many standard thermometers only read to minimum of ______

A

93 F

38
Q

What are the Important Labs for hypothermia?

A

1) Fingerstick glucose*

2) Electrocardiogram (ECG)* (Osborne Waves)

39
Q

What are the differential that can cause hypothermia and should be suspected if the vitals due not align to the vitals in the clinical stages of hypothermia?

A

1) Hypothyroidism
2) Sepsis
3) Adrenal insufficiency
4) Neuromuscular disease
5) Thiamine deficiency
6) Hypoglycemia

40
Q

What are the management procedures for hypothermia?

A

1) ABC
2) Prevent further heat loss
3) Rewarming
4) Treatment of complications
5) Duration of resuscitation:

41
Q

Resuscitation efforts should be continued in a patient with hypothermia (occasionally for several hours) until the patient’s core temperature reaches ___________.

A

32 to 35°C (90 to 95°F)

42
Q

Rewarming:

Mild Hypothermia =

A

Passive External Rewarming

Blankets

43
Q

Rewarming:

Moderate and Refractory Mild Hypothermia =

A

Active External Rewarming

“Bear Huggers” or Warming blankets

44
Q

Rewarming:

Severe (and some cases of refractory moderate)hypothermia =

A

active internal rewarming andpossibly extracorporeal rewarming

(Warm IV or Warm Gastric Lavage)

45
Q

What factors were associated with death within 24 hours of presentation of a hypothermic patient?

A

1) Prehospital cardiac arrest,
2) Low or absent blood pressure on presentation
3) Elevated BUN
4) The need for endotracheal intubation

CORE TEMP IS NOT A FACTOR

Environmental Med for Dummies (12 decks)

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