Hyperthermia/Hypothermia/Fever

Question 1

Left untreated, heat exhaustion will lead to ____ ____, which is often deadly

Answer 1

heat stroke

Question 2

Heat Exhaustion or Heat Stroke?

1. Moist and clammy skin, dilated pupils, normal/subnormal temperature
2. Dry hot skin, constricted pupils, very high body temperature

Answer 2

(Heat Exhaustion) 1. Moist and clammy skin, dilated pupils, normal/subnormal temperature
(Heat Stroke) 2. Dry hot skin, constricted pupils, very high body temperature

Question 3

Heat stroke is defined as a core body temperature usually _____ºF with associated _____ dysfunction in the setting of a large environmental heat load that (can/cannot) be dissipated

Answer 3

> 104 F
CNS
cannot

Question 4

What are the two types of heat stroke?

Answer 4

Exertional and Nonexertional (“Classic” heat stroke)

Question 5

What are 2 examples of nonexertional heat stroke causes?

Answer 5

Underlying chronic medical conditions that impair thermoregulation
Unable to leave a hot environment/correct it

Question 6

What are some examples of underlying chronic medical conditions that impair thermoregulation?

Answer 6

CVD, neuro/psych disorders, obesity, anhidrosis, physical disability, extremes of age, use of drugs/meds (i.e. ETOH, cocaine, anticholinergics, diuretics)

Question 7

Exertional heat stroke generally occurs in (old/young) (unhealthy/healthy) individuals

Answer 7

young healthy (who exercise heavily in hot, humid weather)

Question 8

Sx of heat stroke include…

Answer 8

…weakness, lethargy, N, dizziness

Question 9

Why might you hear crackles on PE of a pt who is experiencing heat stroke?

Answer 9

Due to noncardiogenic pulmonary edema

Question 10

Mortality of heat stroke is up to ~___%

Answer 10

up to ~63%

Question 11

Risk factors that increase mortality related to heat stroke include…

Answer 11

Higher degree of temperature elevation
Increased time to initiation of cooling measures
Higher number of organ systems affected
Presence of anuria, coma, or CV failure

Question 12

In a pt with heat stroke, hypotension or volume depletion is tx w/ ______

Answer 12

IV boluses of isotonic crystalloid (normal saline)

Question 13

T/F Endotracheal intubation and mechanical ventilation are often necessary for pts with heat stroke

Answer 13

True

Question 14

What type of cooling methods are best tolerated for the treatment of classic heat stroke?

Answer 14

Evaporative cooling methods (i.e. moistened skin with fans across patient)

Question 15

What can you Rx to patients w/ heat stroke who are shivering? Why is it important to control shivering in heat stroke pts?

Answer 15

Control shivering prn with benzodiazepines

Shivering can raise the body’s temperature

Question 16

T/F Utilizing malignant hyperthermia pharmacologic therapy (i.e. dantrolene) and alcohol sponge baths in pts with heat stroke are effective methods of tx

Answer 16

False, they should not be used!

Question 17

Immersion in ice water is a rapid and effective in young patients w/ exertional heat stroke, but is associated with increased mortality in what population presenting with what type of heat stroke?

Answer 17

Increased mortality in elderly patients with classic heat stroke

Question 18

Hypothermia is defined as a core temperature below _____ºF

Answer 18

<95ºF

Question 19

Temperature ranges for mild/moderate/severe hypothermia are….

Answer 19

Mild: 90-95 F
Moderate: 82-90 F
Severe: <82 F

Question 20

Mild, moderate, or severe hypothermia?

A. pulmonary edema, oliguria, areflexia, coma, hypotension, bradycardia, ventricular arrhythmias (including ventricular fibrillation), and asystole

B. tachypnea, tachycardia, initial hyperventilation, ataxia, dysarthria, impaired judgment, shivering, and “cold diuresis”

C. reductions in pulse rate and cardiac output, hypoventilation, central nervous system depression, hyporeflexia, decreased renal blood flow, loss of shivering, arrhythmias

Answer 20

A. Severe
B. Mild
C. Moderate

Question 21

How do you rewarm a pt with mild hypothermia?

Answer 21

Passive external rewarming

Remove wet clothing and cover with blankets

Question 22

How do you rewarm a pt with moderate hypothermia?

Answer 22

Active external rewarming (combo of warm blankets, heating pads, radiant heat, warm baths, or forced warm air)

Question 23

Why should rewarming of the trunk be undertaken BEFOREthe extremities?

Answer 23

To minimize the risk of core temperature afterdrop, hypotension, and acidemia

Question 24

How do you rewarm a pt with severe hypothermia?

Answer 24

Active internal rewarming (IV administration of warmed crystalloid (40 to 42ºC), irrigation of the peritoneum or the thorax (via the pleural space) with warmed isotonic crystalloid, extracorporeal blood rewarming)

Question 25

Define Fever of unknown origin (FUO).

Answer 25

(1) a temperature greater than 38.3°C (101°F) on several occasions, (2) more than 3 weeks’ duration of illness, and (3) failure to reach a diagnosis despite 1 week of inpatient investigation.

Question 26

Is FUO worked up in the Emergency Department?

Answer 26

FUO is not worked up in the Emergency Department

Question 27

Is acute fever with no obvious source the same thing as FUO?

Answer 27

Acute fever with no obvious source is NOT the same thing as FUO

Question 28

Is acute fever with no obvious source worked up in the Emergency Department?

Answer 28

Yes, commonly to r/o occult bacterial infxns

Question 29

Fever is defined as a rectal temperature that exceeds___ F

Answer 29

100.4°F

Question 30

____% of childhood fevers have no apparent cause, and are likely (bacterial/viral)

Answer 30

20%; viral

Question 31

Up to 3% of highly febrile children younger than ___ y/o have occult bacteremia

Answer 31

3 y/o

Question 32

Presence of palpable occipital lymph nodes can indicate what type of infection is present in a child with fever?

Answer 32

Viral

Question 33

When should a UA be performed via catheter?

Answer 33

All males <6 months
All uncircumcised males < 12 months
All females < 24 months
Older female children if symptoms of UTI

Question 34

Elevated WBC with left shift can indicate predominately _____ (which indicate a bacterial infxn) but can also indicate _______

Answer 34

neutrophils; bandemia

Question 35

What can bandemia indicate in conjunction with a feverish child?

Answer 35

That the bacterial infection is so bad that the body cannot “keep up” and is pushing out immature RBCs

Question 36

If _____ is present in a child with fever, you should obtain a stool sample to analyze for ___ and ___

Answer 36

diarrhea; WBCs and guaiac

Question 37

For a fever in a toxic child, you should perform a _______ to obtain_____and perform studies and culture.

Answer 37

LP; CSF

Question 38

T/F It is okay to administer abx prior to performing alumbar puncture(LP) if delay to tx is anticipated

Answer 38

True, otherwise want to wait

Question 39

In a toxic child with fever, you should administer parenteral antibiotics such as IV _______, ______, and ________

Answer 39

IV ceftriaxone, cefotaxime, or ampicillin/sulbactam

Question 40

Starting Jan 1, 2018, narcotic Rxs will be limited to ___ days for acute pain and ___ days post-op

Answer 40

5; 7

Question 41

What are some alternatives to analgesic narcotics?

Answer 41

NSAIDs
APAP
Tramadol (Mu receptor blocker, also addictive, but less so than narcotics, avoid in pts w/ Hx of seizures or elderly)
Lidocaine patch
Voltaren cream (NSAID cream, locally delivered)
Capsaicin cream
Muscle relaxers (i.e. skelaxin is good, flexeril has a lot of side effects, for muscle spasms Rx valium and toradol)