Hypothermia Flashcards
1
Q
- superficial, not destructive injury
- itching, pain, numbness
- on exam: red, white, yellow patches
- tx: passive rewarming
A
Frostnip
2
Q
- repeated wet, non-freezing exposure creating acral lesions
- burning numbness, itching presenting 12-24 hours after exposure
- on exam: edema, red/purple macules, may form vesicles and ulcerate
- tx: supportive; topical steroids last 1-3 weeks
A
Pernio (chillblains)
3
Q
- Prolonged immersion in cold water
- numbness, pain, itching, swelling
- exam: pale, mottled, insensate feet, edema, blisters (can lead to gangrene)
- tx: supportive, duration highly variable
- prevention: dry socks
A
Trench foot
4
Q
erythema, edema, waxy appearance, hard white plaques, sensory deficit
A
1st degree
5
Q
erythema, edema, formation of blisters (within 24 hrs)
A
2nd degree
6
Q
blood filled blisters which progress to black eschar (weeks)
A
3rd degree
7
Q
full thickness damage, affecting muscles, tendons and bone with resultant tissue loss
A
4th degree
8
Q
managment of frostbite
A
- rapid rewarming with a circulating bath of water heated to 40-42 degrees C. for 10-30 minutes until skin is pliable and erythematous
- rewarming is PAINFUL; requries analgesia
- clear, large blisters should be debrided leave hemorrhagic blisters intact
- involvement of surgical service (or IR) early for IA tPA and/or wound management
- Early amputation not indicated
9
Q
fibrinolytics for frostbite
A
- intra-aerterial administration of thrombolytics- need to administer within 24 hrs of injury
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10
Q
what EKG changes would you see in hypothermia?
A
- slowed impulse through K channels
- prolongation of all EKG intervals
- J point elevation “osborn wave” (best in V2-V5)
- height of wave proportional to severity
- masked hyperkalemia changes
11
Q
- symptoms: awake, occasionally drowsy, ataxia, dysarthria, uncomfortable, shivering
- signs: tachycardia, tachypnea, increased cardiac output
- tx: passive external rewarming
- requires physiologic reserve sufficient to generate heat (shivering/increased metabolic rate), ambient warmth, remove wet clothes, blankets, oral hydration, food
A
Mild Hypothermia (90-95F)
12
Q
- Symptoms: confused, lethargic, slurred speech, no shivering, paradoxical undressing
- signs: loss of pupillary reflexes, bradycardia, decreased BP, hypoventilation, arrhythmias, cold diuresis
- tx: active external rewarming
- heat actively applied to body (directly to skin) via electric blankets, forced-air blankets, space heaters
- rewarming rates of 1-2C per hour
- warm trunk first… rewarming of extremities may result in core temperature afterdrop
A
Moderate hypothermia
13
Q
- obtundation/altered
- signs: bradycardia, pulmonary edema, oliguria, areflexia, coma, hypotension, ventricular arrhythmias (Vfib, asystole)
A
severe hypothermia < 82F
14
Q
Vitals managment in hypothermia
A
- take care when moving patient; rough handling may precipitate arrhythmias
- measuring temp: use rectal prove or esophageal probe
15
Q
resuscitation management in hypothermia
A
- ABCDs (march)
- active internal rewarming: humidified O2, warmed IV fluids, irrigation of body cavities (pleural irrigation/peritoneal irrigation)
- extracorporeal blood rewarming
- inflow: 2nd/3rd miclavicular, intercostal; outflow: 4th/5th axillary line, intercostal
