Environmental Flashcards
What part of the brain regulates body temperature
Hypothalamus
What is considered hypothermic
Core temp <35 C or <95F
EKG changes seen in hypothermia
Osborn Wave
Notched wave just after the S wave
Usually happens in patients less then 86 degrees (30C)
Things to look out for in the mildly hypothermic patient
Osborn wave or V-fib
Pupils can be minimally responsive and mimic brain death at 82-88 degrees
Should warm to 94 before pronouncing them dead
Gingerly handle the patient to avoid arrhythmias
Monitor acid-base because they will become acidotic
Do not attempt to resuscitate the patient with a frozen chest where compressions are not possible
Treat with warm blankets, warm fluids (PO or IV)
Treatment of patients with extreme hypothermia
Handle the patient gently to avoid V-fib
IVF should be warmed to 105 degrees
Continual temp monitoring through core temp
Watch for acidosis - IVF will help prevent this
Examine pt for frostbite
In very severe cases:
-Place chest tubes and instill with warm saline
-Peritoneal lavage with warmed saline
-ECMO
Clinical management of frostbite
Rewarm the frostbitten area
-Place area in tub of warm water (98.6-102 F)
—If tub not available can use warm wet towels
Do not massage the area because this will cause tissue damage
Thawing usually takes 20-40 minutes and is complete when the distal tip of the affected area flushes and tissue is soft and pliable and takes on a reddish-purple color
Once thawed, keep body part in sterile sheets, elevated and splinted when possible
Administer analgesics
No role for antibiotics in frostbite
Tetanus prophylaxis in those that are due
Consult burn specialist and consider tPA administration within 24 hours if tissue damage is very deep
Takes 1-3 months to determine need for amputation
Treatment for trench foot
Washing and keeping feet dry - no lotions
Elevation for several weeks
Symptoms of heat stroke
Occurs when body temperature is increasing above 104 degrees
Presents with:
-Fatigue
-Vomiting
-Dehydration
-Profuse sweating that sometimes progresses to anhidrosis
-AMS
Treatment of heat stroke
Generous IVF
Spray patient down with tepid water and put a fan on them
Stop this when core temp reaches 101
Care of a marathon runner
Marathon runners who seize with heat stroke often have exertional hyponatremia
—Overly enthusiastic about drinking water and have lost a lot of sodium due to sweating
—Because this happened very rapidly, you want to fix this very rapidly - give hypertonic saline
Cool the patient down with evaporation
Treatment:
-3% saline 100cc IV plus D5NS 1-2L over 1 hour
Thermal burns - rule of 9’s
Anterior trunk - 18%
Posterior trunk - 18%
Each arm 9%
Each leg - 18%
Anterior head - 4.5%
Posterior head - 4.5%
Genitals - 1%
Worrisome exam features in burns
Circumferential burns can cause compartment syndrome
If singed nose hairs, intubate early because there is often delayed laryngospasm and airway edema
–Also intubate if soot in mouth, nose or posterior pharynx
Treatment of burns
Expose the patient completely to exam for burns
Brush off any soot to assess burn
If burned with oil or grease - remove with dish soap and cool water
If burned with tar, use petrolium based product
Stop the burn by applying cool water
–For large open areas, apply soaked, cold sterile towel or ice on top of a sterile towel (never direct ice)
Administer analgesics and update tetanus
Parkland formula for IV hydration
Used to treat thermal burns of greater than 25%
4 X %BSA burned x weight (kg) = total volume of LR to be given in the first 24 hours
Give half of the volume in the first 8 hours and the other half over 16 hours
Management of acidic chemical burns
Remove the patient’s clothes
Brush off any dry chemicals from the patient using any suitable instrument
Irrigation of the burn, starting at the face and head with water - almost all chemicals can be irrigated with water
—-Do not try to neutralize an acid with a base or vice versa as it will make a thermal burn
Chemicals that cannot be irrigated with water
Dry lime: Brush off
Elemental metals: Use mineral oil to remove
Phenol (used in disinfectants and plastic manufacturing): Use polyethylene glycol solution
Tar and asphalt: wipe off any that is loose and use bacitracin or vaseline to remove it completely
Injury and management of patients from radiation
Injury to the skin and mucous membranes
Injury to deep structures
Radiation sickness
Delayed effects include neoplastic disease and birth defects
Anyone exposed to radioactive fallout should have their clothes removed and showered and scrubbed to remove any radioactive material
Should obtain CBC to assess for lymphocytic death
Can give potassium iodine to overwhelm the thyroid
Blood and platelet transfusions to treat any cytopenias
Anaphylaxis treatment for bee stings
If the symptoms are skin and respiratory:
-Benadryl 50mg IV
-Pepcid 40mg IV
-Consider steroids - methyprednisolone 125mg IV
If the symptoms include cardiovascular:
-Give all of the above plus epinephrine
Treatment of mammal bites
Concern is infection (Pasturella most common in dogs and cats) or rabies
-Treatment of Pasturella is with Augmentin 850mg PO BID x7 days
-Treatment for rabies is Rabies vaccine given on days 0, 3, 7 and 14 and Rabies immune globulin given IM on day 0
Cleanse wound carefully with copious amounts of water
Debride any devitalized tissue
If feline or other sharp toothed animal bit the pt:
—Use a #11 blade and cut along tooth marks and irrigate along with a blunt tip needle
Close only wounds that absolutely need it.
—Others can be closed loosely with sutures or steri strips
Electrolytes to be concerned about in burns
Metabolic acidosis expected during early resuscitation phase
Monitor for hyperkalemia during the first 24-48 hours and then hypokalemia as you give them more fluids over the course of the next few days
