Heat and Cold Emerg. Ch. 30 Flashcards

1
Q

How do peds and adults differ r/t temp regulation (6 ways )

A
  1. peds cant regulate temp well,
  2. have less SC fat
  3. cant shiver to increase temp,
  4. have higher BSA,
  5. higher metabolic rate,
  6. decreased ability to sweat
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2
Q

Definition of hyperthermia

A

temp > 99.5 degrees 2* to dysregulation (not the same a fever)

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3
Q

Hypothermia pathophysiology (5)

A
directly toxic to cells
release of cytokines
injury to vascular endothelium
  leads to ^ permeability
  can cause DIC
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4
Q

Heat rash

A

obstructed sweat glands

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5
Q

What are heat cramps? and what causes them?

A

2* DHN and electrolyte loss caused by exertion

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6
Q

Sings of heat exhaustion (5) and temp.

A

weakness, N/V, cramps, mental status ok, T* ,102.2

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7
Q

Signs of heat stroke (2) including temp.

A

T* > 104, AMS up to coma

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8
Q

heat stroke TX

A

NO NSAIDS, benzos to control shivering,

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9
Q

Hypothermia grades

A

I. mild T* 89.6-95 awake and shivering
II. moderate T* 82.4-89.6 AMS, not shivering
III. severe T* 75.2-82.4 coma, vfib
IV. severe T* <75.2 death, asystole

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10
Q

Osborn waves

A

At T* of 91.4 due to irritiblity knows as J waves

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11
Q

Hypothermia effect on CV system

A

tachy, then brady , then asystole

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12
Q

Hypothermia effect on Heme system

A

coagulation 2* to enzyme reactions

lab test may not be reliable as they rely on T*

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13
Q

Hypothermia effect on Resp system

A

hypoxia, ^ lactic acid levels

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14
Q

Hypothermia effect on renal system

A

fluid shifts 2* to cold diuresis leads to hypovolemia

rhabdo may occur

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15
Q

Rewarming types

A

passive, active

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16
Q

Passive rewarming

A

dry off and cover up, let body do its work

17
Q

Active rewarming

A

forced air, heated blankets, heated IV fluids

rewarm TRUNK then LIMBS

18
Q

Physiologic changes with hypothermia (4)

A
  1. metabolism is lower drugs take longer to work
  2. will need fluids avoid rewarming shock
  3. POX unreliable 2* vasoconstriction
  4. Avoid LR 2* to impaired hepatic metabolism
19
Q

What is the Order of rewarming body parts?

A

trunk, then limbs

20
Q

Would you give NSAIDs with heat injuries and rationale?

A

No, not a dysregulation issue

21
Q

How does hypothermia affect acid -base balance?

A

causes acidosis elevating lactic acid levels

22
Q

How does hypothermia affect fluid balance?

A

Causes hypovolemia

Vasoconstriction causes increased glomerular blood flow, increased UO

Pathophysiology of Hypothermia
Diuresis plus fluid leakage into the interstitial tissues causes hypovolemia. Vasoconstriction, which occurs with hypothermia, may mask hypovolemia, which then manifests as sudden shock or cardiac arrest during rewarming (rewarming collapse) when peripheral vasculature dilates. (Merk Manual).

23
Q

How can you control shivering with heat stroke?

A

Benzodiazepines