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EMERGENCY MED > Hypothermia / Hyperthermia > Flashcards

Hypothermia / Hyperthermia Flashcards

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1
Q

Dry hot skin, pupils constricted, very high body temperature

A

Heat stroke

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2
Q

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

A

Heat exhaustion

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3
Q

Core temperature indicative of heat stroke

A

104 F or 40 C

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4
Q

Two types of heat stroke

A

Exertional vs nonexertional (classic)

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5
Q

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

A

Exertional heat stroke

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6
Q

Being unable to leave a hot environment might lead to

A

Nonexertional heat stroke

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7
Q

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

A
  • cardiovascular
  • neurologic / psychiatric
  • obesity
  • anhidrosis
  • physical disability
  • extreme ages
  • certain drugs (anticholinergics, cocaine, alcohol)
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8
Q

Vital sign abnormalities seen in heat stroke

A

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

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9
Q

Physical exam findings of heat stroke

A

Flushing
Pulm crackles (pulm edema)
Excessive bleeding?

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

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10
Q

Risk factors for mortality in heath stroke

A

63% mortality rate overall

Presence of

  • Anuria
  • Coma
  • Cardiovascular failure

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

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11
Q

Heat stroke management (4 steps)

A
  1. Airway, breathing, circulation
  2. Rapid cooling (water, ice, cooling pads)
  3. Endotracheal intubation / ventilation often necessary
  4. IV saline bolus for hypotension
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12
Q

Best tolerated cooling method for classic (nonexertional) heat stroke

A

Evaporative cooling methods (moistened skin, fans across)

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13
Q

How to control shivering during cooling

A

Benzodiazepines

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14
Q

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

A

Immersion in ice water

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15
Q

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

A

Immersion - increased mortality

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16
Q

Core temperature indicative of hypothermia

A

below 95 F, or 35 C

17
Q

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

A

Mild hypothermia

18
Q

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

A

Moderate hypothermia

19
Q

Core temperature below 28ºC (82ºF)

A

Severe hypothermia

20
Q

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?

A

Moderate hypothermia (82-90 F)

21
Q

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

A

Mild hypothermia (90-95 F)

22
Q

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?

A

Severe hypothermia ( < 82 F)

23
Q

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

A

Indefinitely, until core body temp reaches 90-95 F

24
Q

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

A

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

25
Q

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

A

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

26
Q

How is mild hypothermia treated

A

Passive external rewarming: remove wet clothing, cover with blankets

27
Q

How is moderate and refractory mild hypothermia treated?

A

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

WARM TRUNK FIRST

28
Q

How is severe hypothermia treated?

A

Active internal rewarming:

  • IV administration of warmed (40-42 C) saline
  • Extracorporeal blood warming
  • Irrigation of peritoneum w warmed saline
29
Q

Fever is defined as a rectal temp that exceeds

A

100.4 F (38 C)

30
Q

Fever work-up in NON TOXIC child

A
  • Look for visible sources of fever (URI, otitis media, strep throat)
  • Rapid testing for viruses (influenza, RSV, mono)
  • UA / culture (via cath if necessary)
31
Q

Criteria for performing UA/culture via catheterization

A
  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
32
Q

Fever work-up in TOXIC child

A
  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
33
Q

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

A

IV

  1. Ceftriaxone
  2. Cefotaxime
  3. Ampicillin / sulbactam

(50mg/kg dose)

34
Q

General ED approach - RAPID

A

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)

EMERGENCY MED (10 decks)

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