extremes of temperature, drowning, poisoning and overdose Flashcards
How does the body create and lose heat?
created by metabolic and muscle movement.
Lost through conduction, convection, radiation and evaporation.
What happens in the body as hypothermia sets in?
Pulse and respirations becomes slower, and the person becomes unresponsive. Reflex vasoconstriction and increased blood viscosity leads to ischemia and reduced metabolism.
When the core temperature drops, the capillaries and cells membranes become damaged, leading to abnormal fluid movement. This results in hypovolemic shock and cell necrosis.
What are the signs and symptoms of mild hypothermia?
-Temperature of 32-35,
-shivering
-tachycardia
-tachypnoea
-vasoconstriction
-clearly conscious
What are the signs and symptoms of moderate hypothermia?
-Temperature 32-28,
-shivering stops as the body runs out of energy
-cold reduces depolarisation of pacemaker cells; bradycardia
-bradypnoea
-heart arrhythmias
-altered mental state
What are the signs and symptoms of severe hypothermia?
-Temperature <28
-unconcious
-absent breathing
-death
What are the clinical signs of the 5 stages of hypothermia?
I- clearly conscious and shivering
II- Impaired consciousness without shivering
III- unconscious
IV- no breathing
V- death due to irreversible hypothermia
What is the treatment/management for hypothermia?
-CABCDE
-Record temperature
-Re-warm patient: remove wet clothes, heating, foil blanket (Not directly next to skin), blankets
What are the risk factors for hypothermia?
-medical conditions such as hypothyroidism
-intoxicated patients; alcohol causes vasodilation, drugs impact thermoregulation
-exposure to cold, wet, windy environments
-very old or very young
-patients suffering from exhaustion
-injury and immobility
What happens in the body as it becomes hyperthermic?
-the body is producing more heat than it is able to dissipate
-as core body temperature increases, cells start to swell and become more permeable, causing fluid loss and electrolyte imbalances
-enzymes denature, cells break down, organs fail, reduced ability to metabolise
-heat stress-> heat exhaustion -> heat stroke -> multi organ dysfunction
What are the signs and symptoms of heat stress?
-heat oedema- swelling in feet/ankles
-vasodilation and dehydration cause hypotension and syncope
-sodium depletion causes cramps
What are the signs and symptoms of heat exhaustion?
-Headache as brain shrinks away from skull
-dizziness, nausea,
-vomiting due to reduced blood flow to GI tract
-hypotension, sweating, muscle pain, weakness, cramps
- haemoconcentration
hyponatraemia (low sodium levels due to sweating) or hypernatraemia (increased salt concentration due to loss of fluid)
What are the signs and symptoms of heat stroke?
-systemic inflammatory response causes changes in mental function
-hot, dry skin, extreme fatigue, headache, feinting, facial flushing
-cardiovascular dysfunction including arrhythmia and hypotension due to electrolyte imbalances
-respiratory dysfunction as red blood cells change shape and don’t carry as much oxygen
-central nervous system dysfunction including seizures and coma due to reduced blood flow and hypoxia
-liver and renal failure
-coagulopathy as red blood cells change shape
-rhabdomyolysis due to clotting issues
How do you treat/manage hyperthermia?
-move to a cooler environment
-remove clothing layers
-try to cool patient
-be aware cold fluids may send them into shock
-emergency transfer and pre-alert
What is immersion and what can it cause?
-covering the body in liquid.
-causes hypothermia and cardiovascular collapse
-The initial response is gasping, hyperventilation, increased cardiac output, peripheral vasoconstriction.
-hypothermia causes reduced metabolism and muscle fatigue. can also cause loss of consciousness leading to submersion.
What is submersion and what can it cause?
-The entire body and airway being under liquid. Results in asphyxia and hypoxia.
-hydrostatic pressure of water increases blood pressure. When they are removed from the water this can drop. should be kept horizontal.
-initial reaction: holding breath + possible laryngospasm. Leads to hypoxia
-can aspirate water, worsening hypoxia, leading to cardiac arrest
How do you manage a drowning patient?
-risk assessment
-remove patient from water in a supine (flat on back) position if possible
-consider c spine management
-remove wet clothing to prevent hypothermia/keep patient warm
-for breathing patients: High-flow oxygen via non-rebreather mask, recovery position, ensure suction is available
-non-breathing patients: assess for signs of life for up to a minute. 5 rescue breaths with high flow oxygen
What are the life support considerations in hypothermic patients?
-if core body temperature <30, shockable rhythms are shocked a maximum of 3 times
-if core body temperature between 30-35, defibrillate as normal
-once body temperature is above 35, they can be resuscitated as normal
What are the definitions of poisoning and of overdose?
poisoning is when a person is exposed to a substance that can damage their health or endanger their life.
overdose is when someone exceeds the recommended or therapeutic dose
What is the definition of pharmacokinetics?
how the body interacts with administered substances for the duration of the exposure.
absorption -> distribution -> metabolism -> excretion
What is the definition of pharmacodynamics?
the study of a drug’s molecular, biochemical and physiological effects and actions
What is the definition of toxicity?
the level of poison contained within a drug, the the ability of a drug to poison the body
What are the signs, symptoms and treatment of alcohol intoxication?
-vomiting, ataxia, confusion, slurred speech, unconscious, hypoglycaemia
-treat symptoms, airway management
What are the signs, symptoms and treatment of opiate intoxification?
-drowsy, vomiting, reduced gcs, respiratory depression
- naloxone and airway managment
What are the signs, symptoms and treatment of paracetamol overdose/poisoning?
-nausea, vomiting, liver damage
-activated charcoal
What are the signs, symptoms and treatment of carbon monoxide poisoning?
-disorientated, headache, arrhythmias,
-remove patient from area, administer oxygen
What are the signs, symptom and treatment of cocaine intoxification?
-high temperature, dizziness, seizures, arrhythmias, chest pain
-ECG, GTN, diazepam
What are the signs, symptoms and treatment of anti-depressant overdose?
SSRIs: confusion, agitation, convulsions, arrhythmias, unconsciousness
Tricyclics: slurred speech, confusion, dry mouth, hypotension, arrhythmias
-ECG, monitor closely
What are the aspects of a mental health assessment in overdose patients?
Observe:
-dressed appropriately?
-Non-verbal cues
-Weapons risk
De-escalate, remain calm and non-judgemental, empathy, non-confrontation, compromise and distraction
Assess:
-behaviour
-appearance
-speech and rapport
-mood
-cognition/thoughts
-hallucinations/delusions
-risk to self/others
