temp-related EM

Question 1

heat edema

Answer 1

seen early, mostly in elderly, inc. aldosterone, self-limited

Question 2

heat tetany

Answer 2

2/2 hyperventilation. paresthesias, carpopedal spasm, tetany. self-limited, tx by removing person from heat

Question 3

heat rash

Answer 3

pruritic, erythematous rash on clothing-covered body parts. inflammation of obstructed sweat glands, tx w/antihistamines, avoid heat, light/loose clothing

Question 4

heat syncope

Answer 4

early in heat exposure, combo of vasodilation, dec. vasomotor tone, mild dehydration, tx in cool environment w/rehydration, check for injuries and other syncope causes, esp. in elderly pts

Question 5

heat cramps

Answer 5

seen when cooling muscles off, likely 2/2 hypo Na/hypoCl from water w/o lytes, needs salt + fluids, may be predisposed to malignant hyperthermia

Question 6

heat exhaustion

Answer 6

excessive hater/salt loss, generally develops over days, non-specific Sx (HA, H/V, diarrhea, LH, diaphoresis, malaise, myalgias), temp <40C, normal neuro exam, may be hard to distinguish from resolving heat stroke, tx as above

Question 7

heat stroke

Answer 7

AMS w/core temp >40.5C (105), peripheral cooling precedes central cooling so temp may be a bit lower, seen often in pts w/compromised homeostatic mechanism (e.g. elderly, children, chronically ill, addicted, obese, those w/o AC).

Question 8

heat stroke: PE

Answer 8

rectal temp, anhydrosis is not a criteria for Dx, may have wet lungs 2/2 vascular endothelial dysfxn

Question 9

heat stroke: labs

Answer 9

ABG/CXR to r/o ARDS, CBC/coags to assess DIC, may see leukocytosis 20-30K w/thrombocytopenia, UA to screen for ARF/rhabdo, elevated AG from LA, elevated LFTs (almost always, has prognostic sig - AST > 1000 = poor), ECG shows QT + ST prolongation, RBBB, sinus tach, afib, SVT, MI

Question 10

heat stroke: Tx

Answer 10

aggressive cooling = crucial. options: submerse in ice water, hose w/cold water, ice-soaked towels, wet+windy, iced labage, endovascular cooling, cold hemodialysis, stop cooling when ~39C to avoid overshoot hypothermia

Question 11

heat-illness pathophys

Answer 11

heat dissipation achieved by evaporation, conduction, convection, and radiation, thermoreg controlled at hypothalamus, ox-phos is uncoupled once > 42C

Question 12

heat-illness complications

Answer 12

DIC, ARDS, rhabdo, ARF, liver failure, seizures

Question 13

ED eval: cold

Answer 13

ABG, lytes (BUN may be high, possible hyperK), CBC (may see low WBC, PLT, high Hb/Hct due to hemoconcentration), PT/PTT (can see cold-induced coagulopathy), amylase may be elevated 2/2 cold-induced pancreatitis. CXR may show evidence of aspiration pna or pulmonary edema

Question 14

hypothermia

Answer 14

hypothermia at core temp < 35C

Question 15

mild hypothermia

Answer 15

core T 33-35C, shivering and inc. P, RR, BP, CO, ataxia, hyperreflexia, dysarthria, impaired judgment, cold diuresis, bronchorrhea, bronchospasm, dec. GI motility

Question 16

moderate hypothermia

Answer 16

core T 28-32C, shivering stops, dec. P, RR, CO, CNS depression, hyporeflexia, paradoxical undressing, potential cardiac dysrhythmias (sinus brady, afib w/slow ventricular response, vfib, asystole, can see osborn J waves, pt is sensitive to movement and jostling can precipitate vfib

Question 17

severe hypothermia

Answer 17

core T <28C, pulmonary edema, oliguria, loss of reflexes (patellar is last to go), hypotension, acidosis, coma, vfib, asystole

Question 18

hypothermia mgmt

Answer 18

minimize further heat loss, ABCs, lay person flat to minimize hypotension, give IVF, give glucose, avoid caffeine, watch for hyperK, rewarm faster (>2C/hr) if unstable. 1-2C/hr if stable.

Question 19

frostnip

Answer 19

mild cold injury, reversible

Question 20

pernio/chillblains

Answer 20

chronic vasculitis resulting from repeated exposures, see red/purple macules/papules/plaques/nodules, often on feet

Question 21

trenchfoot

Answer 21

aka immersion foot, characterized by redness/swelling/throbbing pain/ulcers, can occur at temps up to 60F if feet are constantly wet

Question 22

surfer’s ear

Answer 22

exostosis of bone in ear canal

Question 23

frostbite

Answer 23

frozen tissue, smokers, people w/prolonged arm/hand vibration, and people w/vascular dz are at increased risk

Question 24

frostbite mgmt

Answer 24

rewarm w/water 40-42C, analgesia, leave blood-filled blisters alone, drain clear blisters, aloe vera to affected area, tetanus prophylaxis (if not current)