Hypothermia / Hyperthermia Flashcards
Dry hot skin, pupils constricted, very high body temperature
Heat stroke
Moist and clammy skin, pupils dilated, normal or subnormal temperature
Heat exhaustion
Core temperature indicative of heat stroke
104 F or 40 C
Two types of heat stroke
Exertional vs nonexertional (classic)
Generally occurs in young, otherwise healthy individuals who exercise heavily in hot, humid weather
Exertional heat stroke
Being unable to leave a hot environment might lead to
Nonexertional heat stroke
Certain underlying chronic medical conditions such as ______ might lead to nonexertional heath stroke
- cardiovascular
- neurologic / psychiatric
- obesity
- anhidrosis
- physical disability
- extreme ages
- certain drugs (anticholinergics, cocaine, alcohol)
Vital sign abnormalities seen in heat stroke
High core body temp
Sinus tachycardia
Tachypnea
Widened pulse pressure / Hypotension
Physical exam findings of heat stroke
Flushing
Pulm crackles (pulm edema)
Excessive bleeding?
Altered mentation (slurred speech, irritable)
Ataxia / poor coordination
Seizures
Coma
Risk factors for mortality in heath stroke
63% mortality rate overall
Presence of
- Anuria
- Coma
- Cardiovascular failure
and of course higher body temp, longer time before cooling measures initiated
Heat stroke management (4 steps)
- Airway, breathing, circulation
- Rapid cooling (water, ice, cooling pads)
- Endotracheal intubation / ventilation often necessary
- IV saline bolus for hypotension
Best tolerated cooling method for classic (nonexertional) heat stroke
Evaporative cooling methods (moistened skin, fans across)
How to control shivering during cooling
Benzodiazepines
Rapid, effective cooling method for young patients with exertional heat stroke
Immersion in ice water
What cooling method to avoid in elderly pts with classic heat stroke
Immersion - increased mortality
Core temperature indicative of hypothermia
below 95 F, or 35 C
Core temperature 32 to 35ºC (90 to 95ºF)
Mild hypothermia
Core temperature 28 to 32ºC (82 to 90ºF)
Moderate hypothermia
Core temperature below 28ºC (82ºF)
Severe hypothermia
A patient presenting with reductions in pulse rate and cardiac output, hypoventilation, central nervous system depression, hyporeflexia, decreased renal blood flow, loss of shivering, arrhythmias - might be at what stage of hypothermia?
Moderate hypothermia (82-90 F)
A patient presenting with tachypnea, tachycardia, initial hyperventilation, ataxia, dysarthria, impaired judgment, shivering, and “cold diuresis” - might be at what stage of hypothermia?
Mild hypothermia (90-95 F)
A patient presenting with pulmonary edema, oliguria, areflexia, coma, hypotension, bradycardia, ventricular arrhythmias (including ventricular fibrillation), and systole - might be at what stage of hypothermia?
Severe hypothermia ( < 82 F)
How long should resuscitative efforts be made for a patient with hypothermia?
Indefinitely, until core body temp reaches 90-95 F
Chest compressions for a patient with hypothermia - do em or not? Why?
No chest compressions if patient has an organized rhythm - their heart is working at an appropriate pace for that reduced body temperature
EVEN IF THEY HAVE NO PULSE / NO SIGNS OF LIFE
Potential complication of rewarming a patient with moderate - severe hypothermia, and how to manage that complication
Can become hypotensive during rewarming from severe dehydration / fluid shifts
2 large (14 or 16 gauge) peripheral IVs should be placed to support BP w WARMED (40-42 F) isotonic infusions
How is mild hypothermia treated
Passive external rewarming: remove wet clothing, cover with blankets
How is moderate and refractory mild hypothermia treated?
Active external rewarming:
- combo of warm blankets, heating pads, radiant heat, warm baths, or force warm air directly to skin
WARM TRUNK FIRST
How is severe hypothermia treated?
Active internal rewarming:
- IV administration of warmed (40-42 C) saline
- Extracorporeal blood warming
- Irrigation of peritoneum w warmed saline
Fever is defined as a rectal temp that exceeds
100.4 F (38 C)
Fever work-up in NON TOXIC child
- Look for visible sources of fever (URI, otitis media, strep throat)
- Rapid testing for viruses (influenza, RSV, mono)
- UA / culture (via cath if necessary)
Criteria for performing UA/culture via catheterization
- All males < 6 months
- All uncircumcised males < 12 months
- All females < 24 months
- Older female peds w UTI symptoms if can’t do “clean catch “ w parents
Fever work-up in TOXIC child
- Rapid testing for viruses to avoid antibiotics
- CBC w manual differential (Bandemia)
- Obtain blood cultures
- CXR
- If diarrhea present, stool WBC and guaiac
- UA / culture according to previous criteria
- LP for CSF analysis
- ADMIT for further tx, IV antibiotics
Parenteral antibiotics to use, pending blood culture results, for tx toxic child w fever
IV
- Ceftriaxone
- Cefotaxime
- Ampicillin / sulbactam
(50mg/kg dose)
General ED approach - RAPID
R Resuscitation (CAB, Vital signs, AMS: check BS)
A Analgesia & Assessment
Symptoms or chief complaint
Allergies
Medications
Past Medical History
Last Meal
Events leading up to the presentation
P Patient needs (non-medical)
I Interventions (diagnostic, therapeutic, consults)
D Disposition (home, observation, admit, or transfer)
