Heat And Cold Illness Flashcards
What is the difference between heat exhaustion and heat stroke
Heat stroke: hyperthermia and multi organ dysfunction including CNS dysfunction (altered mental status)
Core temp usuallyover 40.5
Symptoms of heat exhaustion
Dizziness, weakness, irritability Sweating Nausea vomiting Core temp usually normal but can be elevated 38-40 Preserved mental status
Clinical presentation of heat stroke
Hx heat exposure and consider risk factors
Hyperthermia with temp usually >40.5
Altered mental status
Jaundiced 24-72h post exposure
Anhidrosis
Can have cv collapse with hypotension, pulmonary edema
6 Management steps of heat stroke
remove from heat source
Cooling: passive (ice packs to groin and axilla, fan, cool ivf and active as needed ie pleural, bladder, gastric), cooling blanket
Benzodiazepines for shivering
Dantrolene if suspect MH
Ivf target urine output of 0.5 ml/kg/hr but consider possibility of pulm edema
Dopamine if persistent hypotension despite fluids, avoid norepi
No antipyretics (can be harmful)
Complications of heat stroke
Renal failure Rhabodmylosis DIC ARDS Hepatic injury Cerebral edema and multi organ failure if not treated
7 poor prognostic factors in heat stroke
Coma Delayed cooling Renal failure < 48 hours DIC AST>1000 Hypotension Lactic acidosis
7 risk factors for cold injury
Homelessness, extremes of age, peripheral vascular disease, substance abuse , diabetes, altered mental status, atherosclerosis
Presentation of trench foot (immersion injury) and treatment
From repeated exposure to wet environment in freezing temp
Initially pale, mottled
Then hyperaemic stage with erythema, swelling, pain
Management : remove from source, wash and dry feet, wrap in warm clothing
Elevate to decrease swelling
Non weight bearing
Symptomatic (analgesia for pain)
Pruritic erythematous lesions on Dorsum of hands and feet resulting from repeated exposure to non freezing temperatures
Can progress to plaques, blue nodules and ulcerations
Chilblains
The release of which protein causes thrombosis and ischemia in frostbite
Arachidonic acid
Difference between superficial and deep frostbite
Deep involves tissue loss, underlying tissues feel hard
Management of frostbite
Treat associated hypothermia first
Rewarm if no chance of refreezing with immersion in warm 40-42 degrees until skin feels pliable
Opioids for pain
Tetanus
Only aspirate clear blisters, but can leave.
No friction, no refreezing, no dry heat
Consider Intra arterial thrombolytics if present within 24 hours
Prevent further tissue loss : NSAIDs, smoking cessation, splint and elevate, topical aloe Vera
Early debridement only if gangrene or sepsis
Temperature ranges for mild, moderate and severe hypothermia
Mild 32-35 (shivering, vasoconstriction)
Mod 30-32 (a dynamic, metabolism slows, shivering stops)
Severe < 30 (looks dead)
Classic ECG finding in hypothermia
Osborn J wave
Can also see any dysrhythmias including prolonged QRS And QT
Mechanism of dehydration in hypothermia
Peripheral vasoconstriction leading to increased renal perfusion and cold diuresis
