Temperature Flashcards
Sx of heat edema?
mild swelling of the feet, ankles, and hands that appears within the first few days of exposure to a hot environment.
2) Usually resolves spontaneously in a few days but may take up to 6 weeks
Tx for heat edema?
No special treatment
Prickly heat names?
lichen tropicus, miliaria rubra, or heat rash
Prickly heat sx?
1) Pruritic,
2) maculopapular,
3) erythematous rash over clothed areas of the body
Tx of prickly heat sx?
Chlorhexidine in a light cream or lotion
Heat cramps sx?
Painful, involuntary, spasmodic contractions of skeletal muscles, usually those of the calves, although they may involve the thighs and shoulders
Heat cramps tx?
1) Fluid and salt replacement (Commercial Sport drinks)
2) rest in a cool environment.
3) Cases of heat cramps will respond to intravenous rehydration with NS
Heat tetany sx?
1) Hyperventilation resulting in respiratory alkalosis,
2) paresthesia of the extremities,
3) circumoral paresthesia,
4) carpopedal spasm.
How is heat tetany different from heat cramps?
- very little pain or cramps in the muscle compartments
* paresthesia of the extremities and perioral region are more prominent
Tx for heat tetany?
Removal from the heat and decreasing the respiratory rate
What is heat syncope?
Postural hypotension resulting from the cumulative effect of relative volume depletion, peripheral vasodilatation, and decreased vasomotor tone
Tx for heat syncope?
- remove from heat
- oral or iv rehydration
- rest
Heat exhaustion sx?
- nausea
- vomiting
- lightheadedness
- syncope
- Temp normal to 104F
- tachy
Tx for heat exhaustion?
- fluid and electrolyte therapy
Heat stroke sx?
Neurological symptoms
- Irritable
- comas
- CNS issues
- **Altered mental status
- Core temp >104F
** Not sweating (but not always)
How is heat stroke different from heat exhaustion?
- Altered mental status
* No sweating
Treatment for heat stroke?
- ABC
- O2
- ekg
- pulse ox
- IV fluids
- active cooling
- Cold packs
- Stop cooling once temp reaches 102F
Explain heat syncope:
- Hot out causes vasodilation
- You’re sweating out fluids and salts so blood volume decreases
- You go to do something and pass out due to low volume
Another name for chilblains?
Trench Foot
Sx of trench foot?
1) Patients may complain of pruritus and burning paresthesia.
2) Localized edema,
3) erythema,
4) cyanosis,
5) plaques,
6) nodules,
7) in rare cases, ulcerations, vesicles, and bullae
What does trench foot look like on exam?
pale, mottled, anesthetic, pulseless, and immobile, which initially does not change after rewarming
Tx for chilblains?
2) The affected skin should be rewarmed, gently bandaged, and elevated.
3) Topical corticosteroids (0.025% fluocinolone cream)
4) Or even a brief burst of oral corticosteroids, such as prednisone
So what causes chilblains?
- wet cold foot
First degree frostbite?
a) Transient stinging and burning, followed by throbbing.
b) Partial skin freezing, erythema, mild edema, lack of blisters, and occasional skin desquamation several days later.
c) Prognosis is excellent
Second degree frostbite?
a) The patient complains of numbness, followed later by aching and throbbing.
b) Full-thickness skin freezing, formation of substantial edema over 3 to 4 h, erythema, and formation of clear blisters.
c) Prognosis is good.
Third degree frostbite?
a) The patient may complain that the involved extremity feels like a “block of wood,” followed later by burning, throbbing, and shooting pains.
b) Hemorrhagic blisters form and are associated with skin necrosis and a blue- gray discoloration of the skin.
c) Prognosis is often poor.
Fourth degree frostbite?
a) The patient may complain of a deep, aching joint pain.
b) The skin is mottled, with little edema and nonblanching cyanosis, and eventually forms a deep, dry, black, mummified eschar.
c) Vesicles often present late, if at all, and may be small, bloody blebs that do not extend to the digit tips.
d) Prognosis is extremely poor
Tx for frostbite?
- elevate and wrap extremities
* basic shit you already know
How is frostbite best treated?
- Rapid rewarming in gentle circulating water at temp 104-107.6F for 10-30 min until the distal extremity is pliable
Block of wood?
Third degree
First degree
Red, swollen, numb
Second
Fluid filled blisters
Third degree
Block of wood blood blisters
Fourth degree
Mumification
More treatment notes for frostbite?
Clear blisters should be debrided or at least aspirated
(4 Hemorrhagic blisters should not be debrided because this often results in
tissue desiccation.
(5 Blister types should be treated with topical aloe vera cream every 6hrs.
(6 Digits should be separated with cotton and wrapped with sterile, dry
gauze.
(7 Elevation of the involved extremities helps decrease edema and pain.
What temperature is the core of the body with hypothermia?
Below 95F
Mild hyo temp?
90-95
Severe hypo temp?
Below 82
What is cold stressed?
Not hypothermia, just above 95F
- Normal mental status with shivering
Mild hypo symptoms?
- Alert but altered mental status
- Shivering
- Not functioning normally
- Not able to self care
- Temp 90 - 95
Mdoerate hypo sx?
a) Decreased level of consciousness.
b) Conscious or unconscious, with or without shivering.
c) Estimated core temperature 28 to 32°C (82 to 90°F).
Severe/Profound Hypo?
a) Unconscious.
b) Not shivering.
c) Estimated core temperature <28°C (<82°F).
Most common causes of heat loss?
Convection and conduction
Sx of mild hypo now with vitals?
demonstrates tachypnea, tachycardia, initial hyperventilation, ataxia,
Sx of mod hypo?
CNS depression, drop in heart rate and cardiac output, hypoventilation, and hyporeflexia
- Afib
- dilated pupils
Sx of severe hypo?
a) Pulmonary edema, oliguria, hypotension, bradycardia, ventricular dysrhythmias. (V fib/tach/asystole)
b) Loss of oculocephalic reflexes
1) Hypothermic patients are extremely sensitive to movement and prone to arrhythmias (V Fib)
Ok
- this is why cardiac monitoring is required
Most thermometers go to?
93F
Labs?
Fingerstick glucose *
b) Electrocardiogram (ECG) * (Osborne Waves)
c) Basic serum electrolytes, including potassium and calcium
d) BUN and creatinine
e) Serum hemoglobin, white blood cell, and platelet counts
f) Serum lactate
g) Fibrinogen
h) Creatine kinase (CK)
i) Arterial blood gas, uncorrected for temperature, in ventilated patients
j) Chest radiograph (take care to avoid jostling the patient)
Management of hypo?
- ABC
* Rewarming
Efforts should be continued (occasionally for several hours) until the
patient’s core temperature reaches 32 to 35°C (90 to 95°F)
OK
Rewarming for mild hypo?
Passive rewarming
Rewarming for moderate and refractory hypo?
Active external rewarming
Rewarming for severe hypo?
active internal rewarming and possibly extracorporeal rewarming
What is HACE?
High alt cerebral edema
What causes HACE?
cerebral
vasogenic edema and hypoxia
What elevation does HACE occur?
8250 feet (2500 meters)
Symptoms of HACE?
Neurological symptoms
TX for HACE/AMS/HAPE?
Immediate descent for at least 610 meters (2000 feet), continuing until
symptoms improve.
2) Oxygen (100% 2-4 L/min) should be administered by mask.
3) Acetazolamide (250 mg orally every 8-12 hours)
4) Dexamethasone, 4-8 mg orally every 6 hours, is recommended thereafter.
5) If immediate descent is impossible, a portable hyperbaric chamber should
be used until.
Specific sx of HACE?
Severe headaches,
(b) confusion,
(c) truncal ataxia,
(d) urinary retention or incontinence,
(e) focal deficits,
(f) papilledema,
(g) nausea and vomiting,
(h) seizures.
Drugs for HACE and HAPE?
Acetazolamide
Dexamethasone
O2
What is the leading cause of death?
HAPE
Alt for HAPE?
3000 meters (9840 feet)
Sx of HAPE?
incessant dry cough, 2) shortness of breath disproportionate to exertion, 3) headache, 4) decreased exercise performance, 5) fatigue, 6) dyspnea at rest, 7) chest tightness Hepoptysis
