MilMed-Cold Injury

Question 1

What ways do we lose heat?

Answer 1

Radiation, evaporation, conduction and convection

Question 2

What ways do we make heat?

Answer 2

Activity, shivering, vasoconstriction and insulation

Question 3

What puts you at risk for hypothermia?

Answer 3

Immersion, exhaustion, inadequate nutrition, alcohol and poor judgement

Question 4

A patient comes to see you with shivering, numb hands, confusion and frustration. Their temperature is 34C. What category of hypothermia is he?

Answer 4

Mild

Question 5

A patient comes to see you with violent shivering and is irrational. Temperature is 28-34C (83-93F). What category of hypothermia is he?

Answer 5

Moderate

Question 6

A patient comes to see you with slowed heart rate, is unconscious and a temperature below 28C (83). What category of hypothermia is he?

Answer 6

Severe

Question 7

How much brain function do you lose for every 1C drop in temperature below 35C?

Answer 7

10.00%

Question 8

What are the most common cardiac symptoms when someone has a temperature below 32C?

Answer 8

Atrial and ventricular arrhythmias

Question 9

Why do respirations fall in people with hypothermia?

Answer 9

CO2 production falls and they don’t need as much oxygen.

Question 10

Why do people recovering from hypothermia often become hypovolemic?

Answer 10

Movement of fluid centrally from peripheral vasoconstriction causes diuresis. When they recover they need fluids to keep their blood pressure up as they vasodilate.

Question 11

Why don’t you test coagulation factors in someone who is hypothermic?

Answer 11

The machine heats them up, so it’s worthless.

Question 12

What is your 1st choice for hypothermia above 30C?

Answer 12

Passive rewarming if they are stable vitals and have stable cardiac rhythm

Question 13

What is the most dangerous thing you can do for someone with hypothermia?

Answer 13

Climb in a sleeping bag. This can cause after drop (hypovolemia) as they vasodilate)

Question 14

What are some of the good hospital solutions for mild to moderate hypothermia?

Answer 14

Active INTERNAL rewarming via humidified air (40-45C), heated IV, extracorporeal bypass etc

Question 15

How long should you wait before going into BLS on a patient with hypothermia?

Answer 15

1 minute

Question 16

Why are you at higher risk for frostbite at higher altitude?

Answer 16

You have less oxygen getting to the tissue so it will become ischemic faster.

Question 17

What are the different degrees of frostbite?

Answer 17

1= hyperemia and edema 2 = large clear bullae 3= hemorrhagic bullae 4 = necrosis with gangrene

Question 18

How does frostbite actually occur?

Answer 18

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

Question 19

When would you consider amputation of a frostbit finger?

Answer 19

60-90 days to allow healing to occur.

Question 20

What drugs have been shown to decrease amputation?

Answer 20

TPA and Heparin. They increase blood flow and decrease thrombus formation.

Question 21

What are the different phases of this condition?

Answer 21

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)

Question 22

What is the biggest risk for trench foot?

Answer 22

Having your feet wet all the time

Question 23

What is the medical term for Hailey and Maggie’s noses getting red and rosy when they go out in the cold?

Answer 23

Chilblains (pernio). It is caused by hypervasoconstriction from cold.

Question 24

What drug makes frostbite, chilblains and trench foot worse?

Answer 24

Tobacco. It is a vasoconstrictor.