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EM200 > Temp Related Emergencies > Flashcards

Temp Related Emergencies Flashcards

1
Q

Heat Edema =

A

seen early in heat exposure, mostly in elderly, increased aldosterone, self-limited

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2
Q

Heat tetany =

A

results from hyperventilation (paresthesias, carpopedal spasm, tetany 2/2 resp. alkalosis)

self-limited

remove person from heat

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3
Q

Heat rash =

A

pruritic, erythematous rash on clothing-covered parts of body

Inflammation of obstructed sweat glands

Tx w/ antihistamines, avoid heat, light/loose clothing

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4
Q

Heat syncope =

A

early in heat exposure

combo of vasodilation + decreased vasomotor tone + mild dehydration

tx in cool enviro w/ rehydration

check for injuries and other syncope causes, esp. in elderly patients

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5
Q

Heat cramps =

A

seen when cooling muscles off

likely 2/2 hypoNa/hypoCl from water w/out electrolytes

needs salt + fluids

may be predisposed to malignant hyperthermia

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6
Q

Heat exhaustion:

A

excessive water/salt loss

generally develops over days

non-specific symptoms (HA, N/V, diarrhea, LH, diaphoresis, malaise, myalgias)

temp < 40C

normal neuro exam

may be hard to distinguish from resolving heat stroke

tx as above

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7
Q

Heat stroke:

A

altered MS w/ core temp > 40.5C (105F)

peripheral cooling precedes central cooling so temp may be a bit lower

seen often in patients w/ compromised homeostatic mechanism (i.e., elderly, small children, chronically ill/addicted, obese, those w/out AC)

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8
Q

Diagnostic tests for heat stroke:

A

Exam

Labs

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9
Q

Exam findings in heat stroke:

A

temperature should be measured rectally

anyhydrosis not a criterion for diagnosing heat stroke

may have wet lungs 2/2 vascular endothelial dysfxn

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10
Q

Lab results for heat stroke:

A

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 lactic acidosis

elevated LFTs in almost all cases (carry prognostic significance, AST > 1000 = poor)

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11
Q

ECG findings in heat stroke:

A

QT and ST prolongation

RBBB

sinus tach

atrial fibrillation

SVT

evidence of MI

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12
Q

Treament of Heat stroke:

A
  • aggressive cooling is crucial:
    • options =
      • submerse in ice water
      • hose w/ cold water
      • ice-soaked towels
      • wet+windy
      • iced lavage
      • endovascular cooling
      • Cold hemodialysis
      • stop cooling when ~39C to avoid overshoot hypothermia
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13
Q

Pathophysiology of heat-related illnesses:

A

Heat dissipation achieved by evaporation, conduction, convection, and radiation

thermoregulation controlled at hypothalamus

Ox-Phos is uncoupled once > 42C

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14
Q

Major complications of heat related illness include:

A

DIC

ARDS

Rhabdomyolysis

ARF

liver failure

Seizures

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15
Q

Components of ED Evaluation for Cold-Related illnesses:

A
  • ABG, electrolytes
    • BUN may be elevated, possible hyperK
  • CBC
    • may see decreased WBC and PLT
    • Increased 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
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16
Q

Define Hypothermia and its classes =

A

hypothermia at core temperature < 35C

mild (33-35C)

moderate (28-32C)

severe (<28C)

17
Q

Signs and Sx of Mild Hypothermia

A
  • shivering and increased pulse/RR/BP/CO
  • ataxia
  • hyperreflexia
  • dysarthria
  • impaired judgment
  • cold diuresis
  • bronchorrhea
  • bronchospasm
  • decreased GI motility
18
Q

Signs and sx of moderate hypothermia

A
  • shivering stops
  • decrased pulse/RR/CO
  • CNS depression
  • hyporeflexia
  • paradoxical undressing
  • potential cardiac dysrhythmmias (sinus, brady, atrial fib w/ slow ventricular response, VFib, asystole)
  • can see Osborn J wave
  • patient is sensitive to movement and jostling can precipitate VFib
19
Q

Signs and sx of severe hypothermia:

A

pulmonary edema

oliguria

loss of reflexes (patellar last to go)

hypotension

acidosis

coma

VFib

asystole

20
Q

Management of hypothermia:

Rate of rewarming in stable vs unstable ptns

A

minimize further heat loss + ABCs

Lay person flat to avoid worsening hypotension

Likely volume depleted (give IVF)Give glucose, but avoid caffeine

Watch for hyper K

Hemodynamically unstable patients should be rewarmed faster (>2C/hour), if stable just @ 1-2C/hour

21
Q

Frostnip =

A

mild case of cold injury, reversible

22
Q

Pernio/chilblains =

A

chronic vasculitis resulting from repeated exposures

see red/purple macules/papules/plaques/nodules often on feet

23
Q

Trenchfoot =

A

aka immersion foot

characterized by redness/swelling/throbbing pain/ulcers

can occur at temps up to 60F if feet are constantly wet

24
Q

Surfer’s ear:

A

exostosis of bone in ear canal, seen in cold water surfers

25
Q

Frostbite

Describe:

A

frozen tissue

smokers, people w/ prolonged arm/hand vibration, and people w/ vascular disease are at increased risk

26
Q

Management of frostbite

A

rewarm w/ water 40-42C

analgesia

leave blood-filled blisters alone

drain clear blisters

aloe vera to affected area

tetanus prophylaxis if not current

EM200 (15 decks)

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