Heat + Cold injury

Question 1

Describe heat exhaustion

Answer 1

Water + salt depletion
Non specific malaise, headache, fatigue
Body temp normal
Dehyration

Question 2

Management of heat exhaustion

Answer 2

Rest in cool place

IV NaCl if orthostatic hypotension, otherwise replace losses slowly PO

Question 3

Describe classical heat stroke

Answer 3

Occurs in high temperatures
Dry, hot skin
Temp >40
Altered mental state

Question 4

Describe exertional heat stroke

Answer 4

Occurs with high heat production
Skin is diaphoretic
DIC, renal failure, rhabdomyolysis, lactic acidosis

Question 5

Management of heat stroke

Answer 5

Cool body with spray mist + standing fans
Ice water emersion
Secure airway
Avoid epinephrine, peripheral vasoconstrictors

Question 6

Classification of mild, moderate + severe hypothermia

Answer 6

Mild = 32-35 - high RR + HR, ataxia, dysarthria 
Mod = 28-32 - loss of shivering, J waves on ECG, muscle rigidity
Severe = <28 - coma, hypotension, acidemia, VF, flaccidity, apnea

Question 7

What is afterdrop phenomenon?

Answer 7

Warming of extremities causes vasodilation + movement of cool pooled blood from extremities to core, cause drop in core temp leading to cardiac arrest

Question 8

Approach to cardiac arrest in hypothermic patient

Answer 8

Do procedures gently
Check pulse for 1 min - may have severe bradycardia 
If there is any pulse, do not do CPR 
If in VF, give max of 3 shocks 
Focus on re-warming

Question 9

Classification of frostbite

Answer 9

1st degree = initial paraesthesia, pruritus, erythema, edema, hyperemia
2nd = numbness, clear blisters
3rd = pain, burning, throbbing, hemorrhagic blisters, skin necrosis, no movement
4th = extension into subcuticular, osseous + muscle tissues, painless

Question 10

What is the rule of 9s?

Answer 10

Arms = 4.5% 
Torso = 18% 
Head = 4.5% 
Legs = 9% 

For total BSA for burns

Question 11

Management of frostbite

Answer 11

Treat for hypothermia
Clean injured area, leave open to air
Tetanus prophylaxis + penicillin G

Question 12

Burn depth classification

Answer 12

1st = epidermis only 
2nd = extends to superficial dermis, blisters. Deep = involves hair follicles, sebaceous glands, exposed skin is white/ yellow, absent sensation 
3rd = full thickness, skin is pale, insensate
4th = involvement of fat, muscle or bone

Question 13

Management of burns

Answer 13

Establish airway (>40% BSA or smoke inhalation)
Fluid resus - Parkland formula
Burn wound care

Question 14

What can you use to estimate 1% burn?

Answer 14

Palm of patients hand

Question 15

What is Parkland’s formula?

Answer 15

Ringer’s lactate 4ml/kg/% BSA burned
Give half in first 8h then half in next 16h
+ maintenance fluids if they can’t manage PO

Question 16

RF for inhalation injury

Answer 16

Closed space fires, periods of unconsciousness, noxious chemicals involved