Environmental Injuries - Exam 2 Flashcards
Who are the at risk individuals for a heat illness?
Young/elderly
Obese
Chronic physical/mental illness
Impaired by drugs/ETOH
Anyone denied access to hydration/nutrition
What is heat edema? Why does it happen?
Mild swelling of dependent extremities due to heat exposure
Results from muscular and cutaneous vasodilation combined with venous stasis
What is the treatment for heat edema?
self-limiting with elevation, rest, cooling, oral rehydration
Why does heat syncope happen?
results from vasodilation leading to intravascular volume redistribution
What is the clinical presentation of heat syncope? **What is the core temperature?
Core temp is normal, skin is cool and diaphoretic, weak pulse, transient hypotension
**Core temp is normal
What is the management of heat syncope? What is the disposition?
Rule out other causes of syncope: hypoglycemia, arrhythmias, and fixed myocardial or cerebrovascular lesions
Lie patient supine with legs elevated, remove from heat, (+/-) external cooling, IV/oral rehydration
Disposition home after appropriate tx and patient education
What are heat cramps? What is the underlying cause?
painful spasms of voluntary muscles of the abdomen and extremities resulting from salt depletion
due to salt depletion!
What will the core temperature be in heat cramps? What tests should you order? What will there electrolyte panel be?
core temp normal or slightly elevated
intense work-up is rarely indicated! but should order CMP for electrolytes
low-normal Na, (+/-) low K+ and Mg
What is the management for heat cramps?
Remove from heat and begin external cooling
Oral electrolyte solution (pedialyte or Gatorade) or IV NS
Replace K+ and Mg if needed
What is the disposition for heat cramps? How long should the patient rest?
Discharge home
Rest for 1-3 day - avoid physical exertion and heat exposure
What is heat exhaustion characterized by? If left untreated, what will it evolve into?
Characterized by the inability to maintain adequate cardiac output due to strenuous physical exercise and environmental heat stress
Rapidly evolves to heat stroke if no intervention
What are the two types of heat exhaustion? Which one is seem more often?
Hypernatremic (primary water loss): results from lack of water access
Hyponatremic (primary sodium loss): fluid loss replaced with water only
a combination of the 2!
Temperature often mildly elevated
Diaphoresis, HA, N/V, malaise, weakness,
Muscle cramps, dizziness, (+/-) dark urine
Tachycardia, hypotension
normal CNS exam
What am I?
**What is the highlighted factor?
heat exhaustion
Temperature often mildly elevated - usually will not exceed 40°C (104°F)
How can you differentiate heat exhaustion from heat stroke?
No evidence of CNS dysfunction
aka no AMS, syncope or seizures
What tests should you order for heat exhaustion?
BMP: electrolytes and renal function
UA: myoglobinuria
CK
LFT
ABG
EKG
______ needs to be assessed during heat exhaustion
UA- > looking for myoglobinuria
thinking rhabdo
What is the management for heat exhaustion?
Remove from heat, (+/-) external cooling
Oral electrolyte solution if able to tolerate PO intake
Alt: IV NS or LR²; hypertonic saline used if marked hyponatremia due to water intoxicatio
What are the criteria to admit someone from heat exhaustion?
moderate-to-severe symptoms
comorbid illnesses
patients at extremes of age
lab abnormalities: Elevated CPK, creatinine, LFTs, cardiac abnormalities, hyponatremia, persistent acidosis
social concerns
Define heat stroke. **What is the super underlined finding?
Characterized by a dysfunction of the heat regulating mechanism with hyperthermia and end-organ damage
will have core body temp > 104 AND end-organ damage
**What 4 tissues are the most sensitive to heat stress?
Neural tissue
hepatocytes
nephrons
vascular endothelium
What are the 2 types of heat stroke? How do they differ?
exertional (rapid onset)
non-exertional (slow onset)
HA, dizziness, nausea, diarrhea, visual disturbances
Skin is hot, flushed, usually dry
CV: rapid, bounding pulse, hypotension indicates CV collapse
confusion, seizure, delirium, ataxia, coma
may have DIC
What am I?
What are the signs of DIC?
heat stroke
hematuria, hematemesis, bruising, petechiae, and oozing at sites of venipuncture
aka these pts are usually found sitting under a tree, +/- sweating with increased HR and confusion
How often should you check a CMP in a heat stroke pt? What additional lab needs to be ordered in heat stroke?
need to reassess every hour
Phosphate (hypophosphatemia)
Why does hypophosphatemia occur with heat stroke?
Hypophosphatemia occurs due to renal dysfunction leading to a lack of PO4 reabsorption