MilMed-Cold Injury Flashcards
What ways do we lose heat?
Radiation, evaporation, conduction and convection
What ways do we make heat?
Activity, shivering, vasoconstriction and insulation
What puts you at risk for hypothermia?
Immersion, exhaustion, inadequate nutrition, alcohol and poor judgement
A patient comes to see you with shivering, numb hands, confusion and frustration. Their temperature is 34C. What category of hypothermia is he?
Mild
A patient comes to see you with violent shivering and is irrational. Temperature is 28-34C (83-93F). What category of hypothermia is he?
Moderate
A patient comes to see you with slowed heart rate, is unconscious and a temperature below 28C (83). What category of hypothermia is he?
Severe
How much brain function do you lose for every 1C drop in temperature below 35C?
10.00%
What are the most common cardiac symptoms when someone has a temperature below 32C?
Atrial and ventricular arrhythmias
Why do respirations fall in people with hypothermia?
CO2 production falls and they don’t need as much oxygen.
Why do people recovering from hypothermia often become hypovolemic?
Movement of fluid centrally from peripheral vasoconstriction causes diuresis. When they recover they need fluids to keep their blood pressure up as they vasodilate.
Why don’t you test coagulation factors in someone who is hypothermic?
The machine heats them up, so it’s worthless.
What is your 1st choice for hypothermia above 30C?
Passive rewarming if they are stable vitals and have stable cardiac rhythm
What is the most dangerous thing you can do for someone with hypothermia?
Climb in a sleeping bag. This can cause after drop (hypovolemia) as they vasodilate)
What are some of the good hospital solutions for mild to moderate hypothermia?
Active INTERNAL rewarming via humidified air (40-45C), heated IV, extracorporeal bypass etc
How long should you wait before going into BLS on a patient with hypothermia?
1 minute
Why are you at higher risk for frostbite at higher altitude?
You have less oxygen getting to the tissue so it will become ischemic faster.
What are the different degrees of frostbite?
1= hyperemia and edema 2 = large clear bullae 3= hemorrhagic bullae 4 = necrosis with gangrene
How does frostbite actually occur?
ECF freezes, water is drawn out of the cells,intracellular hyper-osmolarity, intracellular ice crystals form and cell membranes don’t rupture. The indirect effects come from ischemia, thrombus formation and ischemai
When would you consider amputation of a frostbit finger?
60-90 days to allow healing to occur.
What drugs have been shown to decrease amputation?
TPA and Heparin. They increase blood flow and decrease thrombus formation.
What are the different phases of this condition?
This is trench foot. There is a hours to days pre-hyperemic phase (cold, swollen, numb, weak pulses), a 2-6 week hyperemic phase (warm, red, swollen with bounding pulses), and post-hyperemic phase (most, smelly, gangrenous necrosis)
What is the biggest risk for trench foot?
Having your feet wet all the time
What is the medical term for Hailey and Maggie’s noses getting red and rosy when they go out in the cold?
Chilblains (pernio). It is caused by hypervasoconstriction from cold.
What drug makes frostbite, chilblains and trench foot worse?
Tobacco. It is a vasoconstrictor.
