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RRPA Clinical Decision Making I > Environmental Injury > Flashcards

Environmental Injury Flashcards

1
Q

What is a common lab finding in a hypothermic patient?

A

Hypomagnesemia

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2
Q

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

A

C but also D?

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3
Q

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

A

B

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4
Q

Hypothermia is defined by a core temp below ___.

A

95 F

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5
Q

List 3 secondary causes for hypothermia

A

Sepsis Trauma Hypoglycemia

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6
Q

List 4 mechanisms for heat loss.

A

Conduction Convection Evaporation Radiation

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7
Q

List 3 causes of decreased heat production

A

Hypothyroidism Hypoglycemia Malnutrition

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8
Q

List 3 causes of increased heat loss.

A

Ethanol Burns Neonatal age

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9
Q

List 4 causes of impaired thermoregulation.

A

CVA ICB Medications (narcotics, sedatives) Sepsis

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10
Q

What 3 bacteria can cause low temps during sepsis?

A

Haemophilus, strep, and staph

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11
Q

What patient population is especially prone to becoming hypothermic due to infection?

A

Neonates

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12
Q

List 2 physiologic compensations for hypothermia.

A

Shivering (2-5x increase in basal metabolic rate) Peripheral vasoconstriction

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13
Q

T/F? An infrared tympanic thermometer measures a temperature of 94. This patient is hypothermic.

A

False - infrared tympanic thermometers are not accurate enough

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14
Q

What is the standard for measuring core temperature?

A

Rectal or bladder temperatures

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15
Q

List the core temperature ranges for mild, moderate, and severe hypothermia.

A

Mild 90-95F (32-35C) Moderate 80-90F (28-32C) Severe 48-80F (9-27C)

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16
Q

List 4 symptoms of mild hypothermia.

A

Lethargy Confusion Shivering Loss of fine motor skills

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17
Q

T/F? Patients do not shiver in moderate hypothermia.

A

True - patients stop shivering in moderate hypothermia

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18
Q

Below what temperature are patients susceptible to Vtach?

A

86F (30C)

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19
Q

What pupillary response do you expect to see in moderate hypothermia?

A

Dilation of pupils

20
Q

What occurs around core temp 78F (26C)?

A

Acid base abnormaility (lose response to pain)

21
Q

What occurs around core temp 75F (24C)?

A

Hypotension

22
Q

The max risk of V fib occurs around what core temperature?

A

73F (22C)

23
Q

Asystole occurs around what core temp?

A

64F (18C)

24
Q

Treatment for mild (HT1) hypothermia?

A

Warm environment, warm sweet drinks, active movement

25
Q

What is the treatment for moderate (HT2) hypothermia?

A

Active external and minimally invasive rewarming (warm parenteral fluids, heating blanket). Need core temp monitoring

26
Q

Can patients with severe hypothermia be conscious?

A

No

27
Q

If vitals are absent in a hypothermic patient, what swiss hybrid classification are they in?

A

HT4

28
Q

Treatment for severe hypothermia (with vitals present)?

A

Same as moderate, but consider transport to ECMO hospital due to high risk of cardiac arrest.

29
Q

Treatment for HT4 class hypothermia?

A

CPR and 3 doses of epi with defib. HT2 treatment and transport to ECMO.

30
Q

What is the classic EKG finding in hypothermic partients?

A

J or Osborn waves best seen in lead II or V6

31
Q

What is an “afterdrop”?

A

When you’re warming a patient up and then their core temp decreases.

32
Q

What is the cause of an “afterdrop”?

A

Pt gets warm enough to resume peripheral circulation and cold blood from peripheral tissues cools down core

33
Q

What can be done to prevent an afterdrop?

A

Warm patient for a while with arms and legs outside of blankets

34
Q

An unconscious hypothermic patient should receive what treatments?

A

Epi x 3 shock once Warm up 5 degrees and repeat

35
Q

What is an example of active external rewarms?

A

Bair hugger

36
Q

What are some examples of active internal rewarming?

A

Foley irrigation Warm IVF Nasogastric tube

37
Q

What electrolyte disturbances should you expect in hypothermic patients?

A

Hypocalcemia Hypomagnesemia Hypophosphatemia

38
Q

T/F? Peritoneal lavage is indicated in the treatment of hypothermia.

A

False - gut doesn’t get much blood flow when you’re freezing so it doesn’t really help

39
Q

Which patient has a better prognosis, an immersion cardiac arrest or a submersion cardiac arrest?

A

Immersion

40
Q

Drowning risk is highest during what ages?

A

Toddler age and 15-25 yo males

41
Q

What patient population is at a 15x higher risk for drowning?

A

Epileptic patients

42
Q

How should CPR proceed in an unconscious patient who drowned.

A

ABC not CBA! Give 5 initial rescue breaths and start CPR

43
Q

When should you consider draining a drowned victim?

A

If the stomach is so bloated that it interferes with CPR

44
Q

What is Pernio or Chilblains?

A

Inflammatory lesions of skin caused by long term intermittent exposure to damp

45
Q

Chilblain vs Pernio

A

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
46
Q

Chilblain/Pernio Treatment?

A
  • Warm
  • Dry
  • No massage
  • Nicardipine - occasional steroids

RRPA Clinical Decision Making I (17 decks)

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