Hyper and Hypo Thermia

Question 1

past what age does thirst sensation decline?

Answer 1

50

Question 2

a core temp over what is hyperthermia?

Answer 2

105 F

Question 3

list some complications of heat stroke

Answer 3

Myocardial damage
renal failure
seizures
hepatocelullar necrosis

Question 4

with early hyperthermia will you sweat?

Answer 4

Yes but not with late

Question 5

Why do elderly have difficulty with temp regulation?

Answer 5

Loss of diurnal variation (rise)
Diminished sweating
Abnormal vasoconstrictor response

Question 6

What is hypothermia?

Answer 6

Core temp < 35C or < 95F

increased heat loss with decreased heat production

Question 7

Early signs of hypothermia

Answer 7

Fatigue, weakness, slowed gait, cool skin, shivering

Question 8

Moderate signs of hypothermia

Answer 8

Cold skin, cyanotic, bradycardia, arrhythmia, hypotensive, hypo-reflexive, slowed pupillary rxn

Question 9

Severe signs of hypothermia

Answer 9

Areflexia, fixed pupils, apneic, non-responsive, v. fib

Question 10

What is a key finding of hypothermia?

Answer 10

J wave (Osborne wave) follows the QRS complex

Question 11

Other labs that treat hypothermia

Answer 11

CMP, BUN, creatinine, clotting factors, CBC, urine/serum toxicity screens, thyroid, cardiac enzymes

Question 12

Treatment of hypothermia

Answer 12

Warm IV fluids, warm core before limbs, anticipatory monitoring

Question 13

What are anticipatory monitoring in hypothermia?

Answer 13

Metabolic acidosis
Cardiac decompensation/arrhythmias
Hyperkalemia, hypoglycemia
Renal failure

Question 14

What is numb, swollen, erythematous area?

Answer 14

Frostnip (non-freezing)

Question 15

Distal extremities & exposed skin

Cold, hard, white & numb; dry vs. wet gangrene

Answer 15

Frostbite

Question 16

pale, edematous, clammy, cold, numb foot/feet

Answer 16

Immersion foot (non-freezing)

Question 17

How do you treat frostnip, immersion foot, frostbite?

Answer 17

Rewarm

Wound care in frostbite

Question 18

What is passive treatment for hypothermia and what temp should it be done at?

Answer 18

> 32 C or 89.6 F, evidence shivering

Remove wet clothes and from cold env’t
Warm fluids, heated blankets

Question 19

What is active treatment for hypothermia and what temp should it be done at?

Answer 19

< 89.6F (also cardiac instability,toxin, trauma, or co-morbidity)

Heated and humidified O2
Warmed IV infusion (Lavage or ECR)

Question 20

How to prevent hypothermia?

Answer 20

Warm layered clothing
Wind protection & moisture wicking
Foot wear allows for circulation
Head covering
Community outreach

Question 21

What is hyperthermia?

Answer 21

Core temp > 40.6C or >105F

increased heat input with decreased heat output

Question 22

Dizzy s/p exercise/exertion in hot weather

Pale & sweaty, moist & cool skin, HR increased, core temp normal

Answer 22

Heat syncope

Question 23

Treatment for heat syncope and heat fatigue

Answer 23

rest, oral rehydration, cooler & less humid environment

Question 24

Weakness, dizzy, HA, malaise, NAUSEA, syncope with prolonged standing in heat
PE: appear tired, sweaty, tachycardia, MS INTACT, NORMAL TEMP or < 40C or < 104F

Answer 24

Heat exhaustion

Question 25

d/t exposure to elevated ambient temp or overexertion | Pale & sweaty, moist & cool skin, HR increased, core temp normal

Answer 25

Heat fatigue

Question 26

Muscle cramps in legs due to exertion in hot weather, core temp normal

Answer 26

Heat cramps

Question 27

How do you treat heat cramps?

Answer 27

Rx: cool environment, oral rehydration, IV NS, rest

Question 28

How do you treat heat exhaustion?

Answer 28

Rx: Remove to cool environment, rest, supine, IV fluids/electrolyte replacement

Question 29

hypoglycemia, coronary syndrome/MI, sepsis should be ruled out for what problem?

Answer 29

Heat exhaustion

Question 30

Weakness, HA, malaise, CONFUSED, delirious | PE: skin hot & dry, supine tachycardia, tachypnea, ALTERED MENTAL STATUS, T > 40 C or > 104 F

Answer 30

Heat stroke

Question 31

What are some causes of heat stroke?

Answer 31

Thermoregulatory dysfunction, heat wave exposure (2-3 days exposure)

Question 32

CBC, clotting factors, electrolytes, BUN, creatinine, LFT, monitor urine output, core temp via rectal or esophageal probe What are these labs for?

Answer 32

Heat stroke

Question 33

What is treatment for heat stroke?

Answer 33

Admit & ID underlying cause Ddx: sepsis, meningitis, CVA, meds/drugs, thyroid storm, malignant hyperthermia, neuroleptic malignant syndrome (from antipsychotics), serotonin syndrome (SSRIs) Manage shivering/prevent seizures Anticipatory monitoring

Question 34

What is prescription for heat stroke?

Answer 34

Rapid cooling (continually wet & fan the skin; Add ice packs (groin & axilla)) IV hydration NS PRN sedation to prevent agitation, seizures Prevent aspiration if vomiting DIC: platelets & fresh frozen plasma

Question 35

Prevention of hyperthermia

Answer 35

``` Access to air conditioning in excessively hot weather Avoid exertion Maintain hydration Loose fitting/ventilating clothing Community outreach ```