Hyperthermia/Hypothermia/Fever Flashcards
Left untreated, heat exhaustion will lead to ____ ____, which is often deadly
heat stroke
Heat Exhaustion or Heat Stroke?
- Moist and clammy skin, dilated pupils, normal/subnormal temperature
- Dry hot skin, constricted pupils, very high body temperature
(Heat Exhaustion) 1. Moist and clammy skin, dilated pupils, normal/subnormal temperature
(Heat Stroke) 2. Dry hot skin, constricted pupils, very high body temperature
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
> 104 F
CNS
cannot
What are the two types of heat stroke?
Exertional and Nonexertional (“Classic” heat stroke)
What are 2 examples of nonexertional heat stroke causes?
Underlying chronic medical conditions that impair thermoregulation
Unable to leave a hot environment/correct it
What are some examples of underlying chronic medical conditions that impair thermoregulation?
CVD, neuro/psych disorders, obesity, anhidrosis, physical disability, extremes of age, use of drugs/meds (i.e. ETOH, cocaine, anticholinergics, diuretics)
Exertional heat stroke generally occurs in (old/young) (unhealthy/healthy) individuals
young healthy (who exercise heavily in hot, humid weather)
Sx of heat stroke include…
…weakness, lethargy, N, dizziness
Why might you hear crackles on PE of a pt who is experiencing heat stroke?
Due to noncardiogenic pulmonary edema
Mortality of heat stroke is up to ~___%
up to ~63%
Risk factors that increase mortality related to heat stroke include…
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
In a pt with heat stroke, hypotension or volume depletion is tx w/ ______
IV boluses of isotonic crystalloid (normal saline)
T/F Endotracheal intubation and mechanical ventilation are often necessary for pts with heat stroke
True
What type of cooling methods are best tolerated for the treatment of classic heat stroke?
Evaporative cooling methods (i.e. moistened skin with fans across patient)
What can you Rx to patients w/ heat stroke who are shivering? Why is it important to control shivering in heat stroke pts?
Control shivering prn with benzodiazepines
Shivering can raise the body’s temperature
T/F Utilizing malignant hyperthermia pharmacologic therapy (i.e. dantrolene) and alcohol sponge baths in pts with heat stroke are effective methods of tx
False, they should not be used!
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?
Increased mortality in elderly patients with classic heat stroke
Hypothermia is defined as a core temperature below _____ºF
<95ºF
Temperature ranges for mild/moderate/severe hypothermia are….
Mild: 90-95 F
Moderate: 82-90 F
Severe: <82 F
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
A. Severe
B. Mild
C. Moderate
How do you rewarm a pt with mild hypothermia?
Passive external rewarming
Remove wet clothing and cover with blankets
How do you rewarm a pt with moderate hypothermia?
Active external rewarming (combo of warm blankets, heating pads, radiant heat, warm baths, or forced warm air)
Why should rewarming of the trunk be undertaken BEFOREthe extremities?
To minimize the risk of core temperature afterdrop, hypotension, and acidemia
How do you rewarm a pt with severe hypothermia?
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)
Define Fever of unknown origin (FUO).
(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.
Is FUO worked up in the Emergency Department?
FUO is not worked up in the Emergency Department
Is acute fever with no obvious source the same thing as FUO?
Acute fever with no obvious source is NOT the same thing as FUO
Is acute fever with no obvious source worked up in the Emergency Department?
Yes, commonly to r/o occult bacterial infxns
Fever is defined as a rectal temperature that exceeds___ F
100.4°F
____% of childhood fevers have no apparent cause, and are likely (bacterial/viral)
20%; viral
Up to 3% of highly febrile children younger than ___ y/o have occult bacteremia
3 y/o
Presence of palpable occipital lymph nodes can indicate what type of infection is present in a child with fever?
Viral
When should a UA be performed via catheter?
All males <6 months
All uncircumcised males < 12 months
All females < 24 months
Older female children if symptoms of UTI
Elevated WBC with left shift can indicate predominately _____ (which indicate a bacterial infxn) but can also indicate _______
neutrophils; bandemia
What can bandemia indicate in conjunction with a feverish child?
That the bacterial infection is so bad that the body cannot “keep up” and is pushing out immature RBCs
If _____ is present in a child with fever, you should obtain a stool sample to analyze for ___ and ___
diarrhea; WBCs and guaiac
For a fever in a toxic child, you should perform a _______ to obtain_____and perform studies and culture.
LP; CSF
T/F It is okay to administer abx prior to performing alumbar puncture(LP) if delay to tx is anticipated
True, otherwise want to wait
In a toxic child with fever, you should administer parenteral antibiotics such as IV _______, ______, and ________
IV ceftriaxone, cefotaxime, or ampicillin/sulbactam
Starting Jan 1, 2018, narcotic Rxs will be limited to ___ days for acute pain and ___ days post-op
5; 7
What are some alternatives to analgesic narcotics?
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)
