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Emergency Medicine > Temperature > Flashcards

Temperature Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Sx of heat edema?

A

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

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2
Q

Tx for heat edema?

A

No special treatment

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3
Q

Prickly heat names?

A

lichen tropicus, miliaria rubra, or heat rash

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4
Q

Prickly heat sx?

A

1) Pruritic,
2) maculopapular,
3) erythematous rash over clothed areas of the body

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5
Q

Tx of prickly heat sx?

A

Chlorhexidine in a light cream or lotion

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6
Q

Heat cramps sx?

A

Painful, involuntary, spasmodic contractions of skeletal muscles, usually those of the calves, although they may involve the thighs and shoulders

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7
Q

Heat cramps tx?

A

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

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8
Q

Heat tetany sx?

A

1) Hyperventilation resulting in respiratory alkalosis,
2) paresthesia of the extremities,
3) circumoral paresthesia,
4) carpopedal spasm.

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9
Q

How is heat tetany different from heat cramps?

A
  • very little pain or cramps in the muscle compartments

* paresthesia of the extremities and perioral region are more prominent

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10
Q

Tx for heat tetany?

A

Removal from the heat and decreasing the respiratory rate

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11
Q

What is heat syncope?

A

Postural hypotension resulting from the cumulative effect of relative volume depletion, peripheral vasodilatation, and decreased vasomotor tone

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12
Q

Tx for heat syncope?

A
  • remove from heat
  • oral or iv rehydration
  • rest
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13
Q

Heat exhaustion sx?

A
  • nausea
  • vomiting
  • lightheadedness
  • syncope
  • Temp normal to 104F
  • tachy
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14
Q

Tx for heat exhaustion?

A
  • fluid and electrolyte therapy
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15
Q

Heat stroke sx?

A

Neurological symptoms

  • Irritable
  • comas
  • CNS issues
  • **Altered mental status
  • Core temp >104F

** Not sweating (but not always)

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16
Q

How is heat stroke different from heat exhaustion?

A
  • Altered mental status

* No sweating

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17
Q

Treatment for heat stroke?

A
  • ABC
  • O2
  • ekg
  • pulse ox
  • IV fluids
  • active cooling
  • Cold packs
  • Stop cooling once temp reaches 102F
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18
Q

Explain heat syncope:

A
  • 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
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19
Q

Another name for chilblains?

A

Trench Foot

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20
Q

Sx of trench foot?

A

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

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21
Q

What does trench foot look like on exam?

A

pale, mottled, anesthetic, pulseless, and immobile, which initially does not change after rewarming

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22
Q

Tx for chilblains?

A

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

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23
Q

So what causes chilblains?

A
  • wet cold foot
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24
Q

First degree frostbite?

A

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

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25
Q

Second degree frostbite?

A

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.

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26
Q

Third degree frostbite?

A

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.

27
Q

Fourth degree frostbite?

A

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

28
Q

Tx for frostbite?

A
  • elevate and wrap extremities

* basic shit you already know

29
Q

How is frostbite best treated?

A
  • Rapid rewarming in gentle circulating water at temp 104-107.6F for 10-30 min until the distal extremity is pliable
30
Q

Block of wood?

A

Third degree

31
Q

First degree

A

Red, swollen, numb

32
Q

Second

A

Fluid filled blisters

33
Q

Third degree

A

Block of wood blood blisters

34
Q

Fourth degree

A

Mumification

35
Q

More treatment notes for frostbite?

A

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.

36
Q

What temperature is the core of the body with hypothermia?

A

Below 95F

37
Q

Mild hyo temp?

A

90-95

38
Q

Severe hypo temp?

A

Below 82

39
Q

What is cold stressed?

A

Not hypothermia, just above 95F

  • Normal mental status with shivering
40
Q

Mild hypo symptoms?

A
  • Alert but altered mental status
  • Shivering
  • Not functioning normally
    • Not able to self care
  • Temp 90 - 95
41
Q

Mdoerate hypo sx?

A

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).

42
Q

Severe/Profound Hypo?

A

a) Unconscious.
b) Not shivering.
c) Estimated core temperature <28°C (<82°F).

43
Q

Most common causes of heat loss?

A

Convection and conduction

44
Q

Sx of mild hypo now with vitals?

A

demonstrates tachypnea, tachycardia, initial hyperventilation, ataxia,

45
Q

Sx of mod hypo?

A

CNS depression, drop in heart rate and cardiac output, hypoventilation, and hyporeflexia

  • Afib
  • dilated pupils
46
Q

Sx of severe hypo?

A

a) Pulmonary edema, oliguria, hypotension, bradycardia, ventricular dysrhythmias. (V fib/tach/asystole)
b) Loss of oculocephalic reflexes

47
Q

1) Hypothermic patients are extremely sensitive to movement and prone to arrhythmias (V Fib)

A

Ok

  • this is why cardiac monitoring is required
48
Q

Most thermometers go to?

A

93F

49
Q

Labs?

A

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)

50
Q

Management of hypo?

A
  • ABC

* Rewarming

51
Q

Efforts should be continued (occasionally for several hours) until the
patient’s core temperature reaches 32 to 35°C (90 to 95°F)

A

OK

52
Q

Rewarming for mild hypo?

A

Passive rewarming

53
Q

Rewarming for moderate and refractory hypo?

A

Active external rewarming

54
Q

Rewarming for severe hypo?

A

active internal rewarming and possibly extracorporeal rewarming

55
Q

What is HACE?

A

High alt cerebral edema

56
Q

What causes HACE?

A

cerebral

vasogenic edema and hypoxia

57
Q

What elevation does HACE occur?

A

8250 feet (2500 meters)

58
Q

Symptoms of HACE?

A

Neurological symptoms

59
Q

TX for HACE/AMS/HAPE?

A

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.

60
Q

Specific sx of HACE?

A

Severe headaches,

(b) confusion,
(c) truncal ataxia,
(d) urinary retention or incontinence,
(e) focal deficits,
(f) papilledema,
(g) nausea and vomiting,
(h) seizures.

61
Q

Drugs for HACE and HAPE?

A

Acetazolamide
Dexamethasone
O2

62
Q

What is the leading cause of death?

A

HAPE

63
Q

Alt for HAPE?

A

3000 meters (9840 feet)

64
Q

Sx of HAPE?

A 
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

Emergency Medicine (13 decks)

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