Heat and Cold Emerg. Ch. 30

Question 1

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

Answer 1

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

Question 2

Definition of hyperthermia

Answer 2

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

Question 3

Hypothermia pathophysiology (5)

Answer 3

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

Question 4

Heat rash

Answer 4

obstructed sweat glands

Question 5

What are heat cramps? and what causes them?

Answer 5

2* DHN and electrolyte loss caused by exertion

Question 6

Sings of heat exhaustion (5) and temp.

Answer 6

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

Question 7

Signs of heat stroke (2) including temp.

Answer 7

T* > 104, AMS up to coma

Question 8

heat stroke TX

Answer 8

NO NSAIDS, benzos to control shivering,

Question 9

Hypothermia grades

Answer 9

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

Question 10

Osborn waves

Answer 10

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

Question 11

Hypothermia effect on CV system

Answer 11

tachy, then brady , then asystole

Question 12

Hypothermia effect on Heme system

Answer 12

coagulation 2* to enzyme reactions

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

Question 13

Hypothermia effect on Resp system

Answer 13

hypoxia, ^ lactic acid levels

Question 14

Hypothermia effect on renal system

Answer 14

fluid shifts 2* to cold diuresis leads to hypovolemia

rhabdo may occur

Question 15

Rewarming types

Answer 15

passive, active

Question 16

Passive rewarming

Answer 16

dry off and cover up, let body do its work

Question 17

Active rewarming

Answer 17

forced air, heated blankets, heated IV fluids

rewarm TRUNK then LIMBS

Question 18

Physiologic changes with hypothermia (4)

Answer 18

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

Question 19

What is the Order of rewarming body parts?

Answer 19

trunk, then limbs

Question 20

Would you give NSAIDs with heat injuries and rationale?

Answer 20

No, not a dysregulation issue

Question 21

How does hypothermia affect acid -base balance?

Answer 21

causes acidosis elevating lactic acid levels

Question 22

How does hypothermia affect fluid balance?

Answer 22

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).

Question 23

How can you control shivering with heat stroke?

Answer 23

Benzodiazepines