Hypothermia and pressure sores

Question 1

definition of hypothermia

Answer 1

core body temp <35

Question 2

diagnosis of hypothermia

Answer 2

use of low reading rectal thermometer <35

Question 3

Causes of hypothermia

Answer 3

• exposure (<15 degrees)
• impairment of thermoregulation
• decreased heat production
• increased heat loss

Question 4

cardiovascular features of hypothermia

Answer 4

initial tachycardia followed by bradycardia and asystole

Question 5

respiratory features of hypothermia

Answer 5

initially increased RR then depressed and shallow breaths eventually become apnoeic

Question 6

GI features of hypothermia

Answer 6

gastric dilatation + vomiting
acute pancreatitis
decreased peristalsis
ileus

Question 7

Renal features of hypothermia

Answer 7

decreased renal blood flow- oliguria and acute tubular necrosis

Question 8

At what temperatures is the CNS affected and what are the sx

Answer 8

at <33 degrees electrical activity is abnormal at 19-20 degrees brain death

• slurred speech
• ataxia
• extensor plantars
• slow reflexes

Question 9

what metabolic changes take place in hypothermia

Answer 9

respiratory alkalosis
hyperglycaemia (as insulin is inactivated)
raised CK

Question 10

management of mild, moderate and severe hypothermia

Answer 10

mild (32-35): slow re-warming
moderate (28-32) slow re-warming and ITU
severe (<28) rapid core rewarming + ITU

Question 11

Methods of rapid core rewarming

Answer 11

for pts <31

• warmed inhaled gases
• warmed IV fluid (SALINE NOT HARTMANS)
• Haemodialysis

Question 12

what else might you monitor

Answer 12

food intake- NG tube
glucose
thyroxine
thiamine

Question 13

risk factors for pressure sores

Answer 13

• immobility
• sedation
• dehydration
• old age (poor skin integrity)
• urinary and faecal incontinence
• diabetes

Question 14

what is the risk scoring method for pressure sores

Answer 14

Waterlow score

Question 15

how can we prevent pressure sores

Answer 15

identify high risk patients
2hrly turning of unwell patients
pressure relieving devices (alt. pressure air
mattress)
moisture reduction and nutritional support

Question 16

Grades of pressure sores

Answer 16

1. erythema only
2. shallow ulceration and blistering
3. ulceration into subcut tissues
4. lesion extends into deep fascia

Question 17

Management of pressure sores

Answer 17

• surgical debridement
• medical debridement (streptokinase)
• maintain a moist environment with –hydrocolloid gel dressings

Question 18

What are the 3 steps in a MUST assessment

Answer 18

step 1: BMI 
>20 (0) 18.5-20 (1) <18.5 (2)
step 2: unplanned weight loss in past 3-6 months
<5% (0) 5-10% (1) >10% (2)
step 3: acute disease >5 days (2)
step 4 overall risk
step 5 treat

Question 19

Management of undernutrition

Answer 19

1. increase access to food
2. check mouth- teeth, dentures, candida
3. review drug chart
4. consider GI causes (IBD, coeliac)
5. supplement the diet