Environmental/Burns Flashcards
-Severe cramps
-Dizziness
-Nausea
-Headache
-Perfuse sweating
-Unsteady gait
-Mild to moderate elevation of the CBT (up to 103°F [39.4°C])
HX:
-Exposed to Heat
Heat Exhaustion
TX:
-Move victim to a cool area away from sun/heat
-Remove as much clothing as is practical and loosen any restrictive garments
-If alert and oriented, give small sips of cool liquids
-If altered mental status, check blood glucose level
-IV Access
-Assess for shock
-Fluids
-EKG
-CBT of 104°F (40°C) or higher
-Tachypneic
-Tachycardia
-Irrational behavior, coma
-Convulsions
-Flushed, hot skin
-Pulmonary edema (accompanied by systemic acidosis, tachypnea, hypoxemia, and hypercapnia)
-Myocardial dysfunction
-Cardiac dysrhythmias
-Gastrointestinal bleeding
-A reduction in renal function (secondary to hypovolemia and hypoperfusion)
-Hepatic injury
-Clotting disorders
-Electrolyte abnormalities
Heat Stroke
TX:
-Move the patient to a cool and shaded environment
-Begin cooling by fanning the patient while keeping the skin wet
-If hypovolemia is present, administer cool IV fluids in 20-mL/kg boluses
-If seizures occur, midazolam, lorazepam, or diazepam are indicated.
-Blood glucose should be assessed early. If the patient is hypoglycemic, glucose should be administered.
-Cardiac dysrhythmias are associated with heatstroke; continuous electrocardiographic (ECG) monitoring is indicated
89.6–95.0 °F
Awake & Shivering
Stage 1 MILD hypothermia
(82.4–89.6 °F)
-Disorientation
-Confusion
-Lethargy proceeding to stupor & coma
-Lost shiver ability
-Uncoordinated physical activity
Stage 2 MODERATE hypothermia
TX:
-Minimal Movement
-Adequate airway/ventilatory
-Circulatory support
-Rewarming (Blankets, Heating, Humidified Air, Warm Fluids)
68.0–82.4 °F
(usually unconscious)
Stage 3 SEVERE hypothermia
TX:
-Patient should be gently moved to a warm environment if vital signs are present
-Avoid increasing return of cold blood to the heart, maintain the patient horizontal and avoid moving the extremities
-Rewarming (Blankets, Heating, Humidified Air, Warm Fluids)
68.0 °F
No Vital Signs
Stage 4 hypothermia
Dead
Hypothermia special considerations
-Pulse and respirations may be difficult to detect
-Vital signs (including ECG readings) should be assessed for 60 seconds to confirm the need for CPR
-Advanced airway management is indicated for uresponsive/code patients
-Hypothermic heart may be unresponsive to cardiovascular drugs
-Drug metabolism may be reduced, allowing for toxic accumulation of the drug in the peripheral tissues
-Antidysrhythmic drugs are often withheld when the CBT is less than 86°F (30°C)
-Once the patient is rewarmed to at least 86°F (30°C), it may be reasonable to consider rewarming strategies, at an interval twice as long as in normothermic patients (Class IIc)
-Sinus bradycardia may be protective in severe hypothermia
-Cardiac pacing usually is not indicated or successful
Hypothermia
CBT less than 95°F [35°C])
Progression of clinical signs and symptoms of hypothermia is divided into three classes based on the CBT:
-Mild
-Moderate
-Severe
Burn Center Referral Criteria
-Partial thickness greater than 10%
-Face
-Hands
-Feet
-Genitalia
-Perineum
-Major joints
-Electrical burns
-Inhalation burns
-Preexisting medical disorders
Indicators of decreasing Airway from Burn/hot inhalation
-Burns around nose or mouth
-Soot in mouth or nose (singed nasal hairs)
-Intraoral burns (burned toungue)
-Intraoral swelling (no stridor)
-Visible pharyngeal edema
-Hoarseness of voice
-Inspiratory stridor
Burns
-General Impression
-LOC
-ABC’s (O2, Vent)
-HX & Vitals
-Determined Burn
-Large Bore IV/IO Access
-Fluids (Lactated Ringers)
-Burn Sheet/Dry Sterile Warmth
-Pain management (Ketamine)
-12 Lead EKG
-Calcium & Albuterol (Compartment Syndrome)
-Rapid Transport
