Environmental Injury

Question 1

What is a common lab finding in a hypothermic patient?

Answer 1

Hypomagnesemia

Question 2

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

Answer 2

C but also D?

Question 3

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

Answer 3

B

Question 4

Hypothermia is defined by a core temp below ___.

Answer 4

95 F

Question 5

List 3 secondary causes for hypothermia

Answer 5

Sepsis Trauma Hypoglycemia

Question 6

List 4 mechanisms for heat loss.

Answer 6

Conduction Convection Evaporation Radiation

Question 7

List 3 causes of decreased heat production

Answer 7

Hypothyroidism Hypoglycemia Malnutrition

Question 8

List 3 causes of increased heat loss.

Answer 8

Ethanol Burns Neonatal age

Question 9

List 4 causes of impaired thermoregulation.

Answer 9

CVA ICB Medications (narcotics, sedatives) Sepsis

Question 10

What 3 bacteria can cause low temps during sepsis?

Answer 10

Haemophilus, strep, and staph

Question 11

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

Answer 11

Neonates

Question 12

List 2 physiologic compensations for hypothermia.

Answer 12

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

Question 13

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

Answer 13

False - infrared tympanic thermometers are not accurate enough

Question 14

What is the standard for measuring core temperature?

Answer 14

Rectal or bladder temperatures

Question 15

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

Answer 15

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

Question 16

List 4 symptoms of mild hypothermia.

Answer 16

Lethargy Confusion Shivering Loss of fine motor skills

Question 17

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

Answer 17

True - patients stop shivering in moderate hypothermia

Question 18

Below what temperature are patients susceptible to Vtach?

Answer 18

86F (30C)

Question 19

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

Answer 19

Dilation of pupils

Question 20

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

Answer 20

Acid base abnormaility (lose response to pain)

Question 21

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

Answer 21

Hypotension

Question 22

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

Answer 22

73F (22C)

Question 23

Asystole occurs around what core temp?

Answer 23

64F (18C)

Question 24

Treatment for mild (HT1) hypothermia?

Answer 24

Warm environment, warm sweet drinks, active movement

Question 25

What is the treatment for moderate (HT2) hypothermia?

Answer 25

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

Question 26

Can patients with severe hypothermia be conscious?

Answer 26

No

Question 27

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

Answer 27

HT4

Question 28

Treatment for severe hypothermia (with vitals present)?

Answer 28

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

Question 29

Treatment for HT4 class hypothermia?

Answer 29

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

Question 30

What is the classic EKG finding in hypothermic partients?

Answer 30

J or Osborn waves best seen in lead II or V6

Question 31

What is an "afterdrop"?

Answer 31

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

Question 32

What is the cause of an "afterdrop"?

Answer 32

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

Question 33

What can be done to prevent an afterdrop?

Answer 33

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

Question 34

An unconscious hypothermic patient should receive what treatments?

Answer 34

Epi x 3 shock once Warm up 5 degrees and repeat

Question 35

What is an example of active external rewarms?

Answer 35

Bair hugger

Question 36

What are some examples of active internal rewarming?

Answer 36

Foley irrigation Warm IVF Nasogastric tube

Question 37

What electrolyte disturbances should you expect in hypothermic patients?

Answer 37

Hypocalcemia Hypomagnesemia Hypophosphatemia

Question 38

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

Answer 38

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

Question 39

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

Answer 39

Immersion

Question 40

Drowning risk is highest during what ages?

Answer 40

Toddler age and 15-25 yo males

Question 41

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

Answer 41

Epileptic patients

Question 42

How should CPR proceed in an unconscious patient who drowned.

Answer 42

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

Question 43

When should you consider draining a drowned victim?

Answer 43

If the stomach is so bloated that it interferes with CPR

Question 44

What is Pernio or Chilblains?

Answer 44

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

Question 45

Chilblain vs Pernio

Answer 45

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

Question 46

Chilblain/Pernio Treatment?

Answer 46

* Warm * Dry * No massage * Nicardipine - occasional steroids