Hypothermia / Hyperthermia

Question 1

Dry hot skin, pupils constricted, very high body temperature

Answer 1

Heat stroke

Question 2

Moist and clammy skin, pupils dilated, normal or subnormal temperature

Answer 2

Heat exhaustion

Question 3

Core temperature indicative of heat stroke

Answer 3

104 F or 40 C

Question 4

Two types of heat stroke

Answer 4

Exertional vs nonexertional (classic)

Question 5

Generally occurs in young, otherwise healthy individuals who exercise heavily in hot, humid weather

Answer 5

Exertional heat stroke

Question 6

Being unable to leave a hot environment might lead to

Answer 6

Nonexertional heat stroke

Question 7

Certain underlying chronic medical conditions such as ______ might lead to nonexertional heath stroke

Answer 7

• cardiovascular
• neurologic / psychiatric
• obesity
• anhidrosis
• physical disability
• extreme ages
• certain drugs (anticholinergics, cocaine, alcohol)

Question 8

Vital sign abnormalities seen in heat stroke

Answer 8

High core body temp
Sinus tachycardia
Tachypnea
Widened pulse pressure / Hypotension

Question 9

Physical exam findings of heat stroke

Answer 9

Flushing
Pulm crackles (pulm edema)
Excessive bleeding?

Altered mentation (slurred speech, irritable)
Ataxia / poor coordination
Seizures
Coma

Question 10

Risk factors for mortality in heath stroke

Answer 10

63% mortality rate overall

Presence of

• Anuria
• Coma
• Cardiovascular failure

and of course higher body temp, longer time before cooling measures initiated

Question 11

Heat stroke management (4 steps)

Answer 11

1. Airway, breathing, circulation
2. Rapid cooling (water, ice, cooling pads)
3. Endotracheal intubation / ventilation often necessary
4. IV saline bolus for hypotension

Question 12

Best tolerated cooling method for classic (nonexertional) heat stroke

Answer 12

Evaporative cooling methods (moistened skin, fans across)

Question 13

How to control shivering during cooling

Answer 13

Benzodiazepines

Question 14

Rapid, effective cooling method for young patients with exertional heat stroke

Answer 14

Immersion in ice water

Question 15

What cooling method to avoid in elderly pts with classic heat stroke

Answer 15

Immersion - increased mortality

Question 16

Core temperature indicative of hypothermia

Answer 16

below 95 F, or 35 C

Question 17

Core temperature 32 to 35ºC (90 to 95ºF)

Answer 17

Mild hypothermia

Question 18

Core temperature 28 to 32ºC (82 to 90ºF)

Answer 18

Moderate hypothermia

Question 19

Core temperature below 28ºC (82ºF)

Answer 19

Severe hypothermia

Question 20

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?

Answer 20

Moderate hypothermia (82-90 F)

Question 21

A patient presenting with tachypnea, tachycardia, initial hyperventilation, ataxia, dysarthria, impaired judgment, shivering, and “cold diuresis” - might be at what stage of hypothermia?

Answer 21

Mild hypothermia (90-95 F)

Question 22

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?

Answer 22

Severe hypothermia ( < 82 F)

Question 23

How long should resuscitative efforts be made for a patient with hypothermia?

Answer 23

Indefinitely, until core body temp reaches 90-95 F

Question 24

Chest compressions for a patient with hypothermia - do em or not? Why?

Answer 24

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

Question 25

Potential complication of rewarming a patient with moderate - severe hypothermia, and how to manage that complication

Answer 25

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

Question 26

How is mild hypothermia treated

Answer 26

Passive external rewarming: remove wet clothing, cover with blankets

Question 27

How is moderate and refractory mild hypothermia treated?

Answer 27

Active external rewarming: - combo of warm blankets, heating pads, radiant heat, warm baths, or force warm air directly to skin *WARM TRUNK FIRST*

Question 28

How is severe hypothermia treated?

Answer 28

Active internal rewarming: - IV administration of warmed (40-42 C) saline - Extracorporeal blood warming - Irrigation of peritoneum w warmed saline

Question 29

Fever is defined as a rectal temp that exceeds

Answer 29

100.4 F (38 C)

Question 30

Fever work-up in NON TOXIC child

Answer 30

- Look for visible sources of fever (URI, otitis media, strep throat) - Rapid testing for viruses (influenza, RSV, mono) - UA / culture (via cath if necessary)

Question 31

Criteria for performing UA/culture via catheterization

Answer 31

1. All males < 6 months 2. All uncircumcised males < 12 months 3. All females < 24 months 4. Older female peds w UTI symptoms if can't do "clean catch " w parents

Question 32

Fever work-up in TOXIC child

Answer 32

1. Rapid testing for viruses to avoid antibiotics 2. CBC w manual differential (**Bandemia**) 3. Obtain blood cultures 4. CXR 5. If diarrhea present, stool WBC and guaiac 6. UA / culture according to previous criteria 7. LP for CSF analysis 8. ADMIT for further tx, IV antibiotics

Question 33

Parenteral antibiotics to use, pending blood culture results, for tx toxic child w fever

Answer 33

IV 1. Ceftriaxone 2. Cefotaxime 3. Ampicillin / sulbactam (50mg/kg dose)

Question 34

General ED approach - RAPID

Answer 34

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)