COLD INJURIES Flashcards
Another name for Chilblains?
Trench Foot
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.
Chilblains / Trenchfoot
What are the signs and symptoms of Chilblains / Trench Foot?
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.
What is the treatment for Trench Foot?
1) Supportive
2) Rewarm, bandage and elevate affected skin
3) Fluocinolone cream (Topical Corticosteroids)
What are the preventative measure for Trench Foot / Chilblains?
1) Keeping warm.
2) Ensuring good boot fit.
3) Changing out of wet socks
4) Never sleeping in wet socks and boots.
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.
First Degree Frostbite
What is the prognosis for first degree frostbite?
Excellent
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.
Second Degree Frostbite
What is the prognosis of Second Degree Frostbite?
Good
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.
Third Degree Frostbite
Frostbite:
Hemorrhagic blister are associated with what?
Skin Necrosis
What is the prognosis of Third Degree Frostbite?
Often Poor
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
Fourth Degree Frostbite
What is the prognosis of Fourth Degree Frostbite?
Extremely Poor
What are important questions to ask in the history of a patient with frostbite?
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?
What is the “Field Management” for frostbite?
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
What is the is the core of frostbite therapy and should be initiated as soon as possible?
Rapid rewarming
What is the “Clinical Management” for frostbite?
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
What temperature should the water be for rapid rewarming of frostbite be?
104° - 107.6°F for 10 - 30 minutes
Hypothermia is defined as a core temperature below _____.
95ºF
What are the TEMPERATURE stages for hypothermia?
Mild - 90-95ºF
Moderate – 82-90ºF
Severe below 82°F
Mild Hypothermia
90-95ºF
Moderate Hypothermia
82-90ºF
Severe Hypothermia
Below 82°F
What are the CLINICAL stages of hypothermia?
1) Cold stressed (not hypothermic)
2) Mild hypothermia
3) Moderate hypothermia
4) Severe/profound hypothermia
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).
Cold stressed (not hypothermic)
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).
Mild Hypothermia
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).
Moderate Hypothermia
What Clinical Stage of Hypothermia?
1) Unconscious.
2) Not shivering.
3) Estimated core temperature <28°C (<82°F).
Severe/profound hypothermia
Heat is generated by cellular metabolism (most prominently in the _________ and _________.
Heart and Liver
Heat is lost by the skin and lungs via what processes?
Evaporation
Radiation
Conduction
Convection
What are the most common mechanisms of accidental hypothermia?
Convective heat loss to cold air
and
Conductive heat lost to water
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”
Mild Hypothermia
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
Moderate Hypothermia
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
Severe Hypothermia
Pupils will dilate in a hypothermic patient with a core temperature below ______.
29 C
Many standard thermometers only read to minimum of ______
93 F
What are the Important Labs for hypothermia?
1) Fingerstick glucose*
2) Electrocardiogram (ECG)* (Osborne Waves)
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?
1) Hypothyroidism
2) Sepsis
3) Adrenal insufficiency
4) Neuromuscular disease
5) Thiamine deficiency
6) Hypoglycemia
What are the management procedures for hypothermia?
1) ABC
2) Prevent further heat loss
3) Rewarming
4) Treatment of complications
5) Duration of resuscitation:
Resuscitation efforts should be continued in a patient with hypothermia (occasionally for several hours) until the patient’s core temperature reaches ___________.
32 to 35°C (90 to 95°F)
Rewarming:
Mild Hypothermia =
Passive External Rewarming
Blankets
Rewarming:
Moderate and Refractory Mild Hypothermia =
Active External Rewarming
“Bear Huggers” or Warming blankets
Rewarming:
Severe (and some cases of refractory moderate)hypothermia =
active internal rewarming andpossibly extracorporeal rewarming
(Warm IV or Warm Gastric Lavage)
What factors were associated with death within 24 hours of presentation of a hypothermic patient?
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
