Environmental Injury Flashcards
What is a common lab finding in a hypothermic patient?
Hypomagnesemia
Which of the following should be included on the differential diagnosis of a hypothermic patient? a. Renal Failure b. Liver failure c. Cardiac dysfunction d. Myxedema
C but also D?
You are at a beach with no lifeguard and notice someone pulling a person out of the water onto the beach after they had been struggling in the water. The person is not talking. Someone is contacting EMS. Which of the following should you do first? a. Turn patient on their side to drain their lungs. b. give rescue breaths c. Check for pulse d. Keep them warm
B
Hypothermia is defined by a core temp below ___.
95 F
List 3 secondary causes for hypothermia
Sepsis Trauma Hypoglycemia
List 4 mechanisms for heat loss.
Conduction Convection Evaporation Radiation
List 3 causes of decreased heat production
Hypothyroidism Hypoglycemia Malnutrition
List 3 causes of increased heat loss.
Ethanol Burns Neonatal age
List 4 causes of impaired thermoregulation.
CVA ICB Medications (narcotics, sedatives) Sepsis
What 3 bacteria can cause low temps during sepsis?
Haemophilus, strep, and staph
What patient population is especially prone to becoming hypothermic due to infection?
Neonates
List 2 physiologic compensations for hypothermia.
Shivering (2-5x increase in basal metabolic rate) Peripheral vasoconstriction
T/F? An infrared tympanic thermometer measures a temperature of 94. This patient is hypothermic.
False - infrared tympanic thermometers are not accurate enough
What is the standard for measuring core temperature?
Rectal or bladder temperatures
List the core temperature ranges for mild, moderate, and severe hypothermia.
Mild 90-95F (32-35C) Moderate 80-90F (28-32C) Severe 48-80F (9-27C)
List 4 symptoms of mild hypothermia.
Lethargy Confusion Shivering Loss of fine motor skills
T/F? Patients do not shiver in moderate hypothermia.
True - patients stop shivering in moderate hypothermia
Below what temperature are patients susceptible to Vtach?
86F (30C)
What pupillary response do you expect to see in moderate hypothermia?
Dilation of pupils
What occurs around core temp 78F (26C)?
Acid base abnormaility (lose response to pain)
What occurs around core temp 75F (24C)?
Hypotension
The max risk of V fib occurs around what core temperature?
73F (22C)
Asystole occurs around what core temp?
64F (18C)
Treatment for mild (HT1) hypothermia?
Warm environment, warm sweet drinks, active movement
What is the treatment for moderate (HT2) hypothermia?
Active external and minimally invasive rewarming (warm parenteral fluids, heating blanket). Need core temp monitoring
Can patients with severe hypothermia be conscious?
No
If vitals are absent in a hypothermic patient, what swiss hybrid classification are they in?
HT4
Treatment for severe hypothermia (with vitals present)?
Same as moderate, but consider transport to ECMO hospital due to high risk of cardiac arrest.
Treatment for HT4 class hypothermia?
CPR and 3 doses of epi with defib. HT2 treatment and transport to ECMO.
What is the classic EKG finding in hypothermic partients?
J or Osborn waves best seen in lead II or V6
What is an “afterdrop”?
When you’re warming a patient up and then their core temp decreases.
What is the cause of an “afterdrop”?
Pt gets warm enough to resume peripheral circulation and cold blood from peripheral tissues cools down core
What can be done to prevent an afterdrop?
Warm patient for a while with arms and legs outside of blankets
An unconscious hypothermic patient should receive what treatments?
Epi x 3 shock once Warm up 5 degrees and repeat
What is an example of active external rewarms?
Bair hugger
What are some examples of active internal rewarming?
Foley irrigation Warm IVF Nasogastric tube
What electrolyte disturbances should you expect in hypothermic patients?
Hypocalcemia Hypomagnesemia Hypophosphatemia
T/F? Peritoneal lavage is indicated in the treatment of hypothermia.
False - gut doesn’t get much blood flow when you’re freezing so it doesn’t really help
Which patient has a better prognosis, an immersion cardiac arrest or a submersion cardiac arrest?
Immersion
Drowning risk is highest during what ages?
Toddler age and 15-25 yo males
What patient population is at a 15x higher risk for drowning?
Epileptic patients
How should CPR proceed in an unconscious patient who drowned.
ABC not CBA! Give 5 initial rescue breaths and start CPR
When should you consider draining a drowned victim?
If the stomach is so bloated that it interferes with CPR
What is Pernio or Chilblains?
Inflammatory lesions of skin caused by long term intermittent exposure to damp
Chilblain vs Pernio
Chilblain (3-6h)
- Blue discolored subq vesicles
- Tenderness
- NO long term sequelae
Pernia (12hrs-3days)
- All of the above + swelling, pain, ache
- Desquamation
- Skin sloughs off
- Eschars form
- Chronic pain - inability to walk
Chilblain/Pernio Treatment?
- Warm
- Dry
- No massage
- Nicardipine - occasional steroids
