Temperature Emergencies Flashcards

1
Q

Cold urticaria

A

hypersensitivity to cold air or water

may lead to FATAL anaphylaxis

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2
Q

cold urticaria diagnosis

A

confirmed with cold water test during follow up

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3
Q

cold urticaria tx

A

Antihistamine

then go to anaphylaxis management if severe rxn

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4
Q

Chiliblains

A

mild but unconfortable inflammatory lesions of the skin precipitated by acute exposure to cold

12 hrs of exposure

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5
Q

pernio

A

aka chilblains

pruritus or burning paresthesia

hands, ears, lower legs, feet MC

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6
Q

re warming and chilblains

A

may cause formation of tender blue nodules that persist for days

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7
Q

tx of pernio

A

affected skin rewarmed, bandaged, elevated

some evidence of pharm tx in European studies

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8
Q

immersion injury patho

A

direct injury to soft tissue following prolonged cooling in wet conditions

vasoconstriction, red cell and thrombocyte pudding, tissue edema, nerve and small vessel injury

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9
Q

clinical features of trench foot

A

numbness and tingling of affected tissue

pale, mottled, anestehtic, pulseless, immobile

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10
Q

hyperemic phase

A

immersion injury

hours after re=warming, severe burning pain and reappearance of proximal sensation

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11
Q

late phase immersion injury

A

excessive sweating and cold sensitivity

persist for months to years

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12
Q

tx of immersion in jury

A

supportive +/- pain control

clean, warm, dry bandage, elevate affected area

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13
Q

frostbite

A

frozen tissue secondary to heat loss

causes ice crystal formation in superficial or deep tissue

MC in peripheral locations

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14
Q

clinical summary frostbite

A

numbness + sensory loss in digit

thawed tissue but mottled blue, violet, yellow or waxy color

hyperemia

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15
Q

Favorable prognostic signs frostbite

A

return of normal sensation/color/warmth
edema w.in 3 hrs of thawing
early formation of bulla to tips of digit

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16
Q

poor prognostic indicators frostbite

A

lack of edema
small dark hemorrhagic bulla that DO NOT go to tips of digit

necrotic tissue

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17
Q

superficial frostbite (1st degree)

A

frost nip

numbness, white tissue, erythema

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18
Q

superficial frostbite (2nd degree)

A

clear vesicle or blebs with erythema

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19
Q

deep frostbite (3rd degree)

A

hemorrhagic blisters

not extend to tip of appendage

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20
Q

deep frostbite (4th degree)

A

necrotic tissue involving muscles, tendon bone

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21
Q

tx of frostbite (gen)

A

SHOULD NOT be attempted until risk of refreezing is eliminated

soak warm water (98-102) for 20-30 MIN

elevation + pain + PCN

22
Q

hypothermia

A

core temperature below 95 degrees

23
Q

hypothermia clinical features

A

tachycardia –> Bradycardia

ECG prolonged (PR –> QRS –> QT)

Osborn J wave/hypothermic hump

MUST get proper vitals (esophagus)

atrial arrhythmia (resolve)

24
Q

causes of body temp drop

A

conduction
convection
radiation
evaporation

25
Q

conduction

A

transfer of head by direct contact down concentration gradient

I.e. submersion

26
Q

convection

A

movement o heated material causes transfer of heat

I.e. wind

27
Q

radiation

A

heat loss by environment (ie non insulated areas)

28
Q

evaporative

A

heat loss thru vaporization

29
Q

heat is conserved by

A

peripheral vasoconstriction and behavioral responses

MC behavioral responses are affected

30
Q

heat gain is increased by

A

shivering and non shivering thermogenesis

hypothalamus attempts to stimulate heat production (shiver) and increased thyroid catecholamine and adrenal activity

31
Q

mild hypothermia

A

89.6-95 F

shivering 
tachypnea/tachycardia/hypertension
ataxia/dysarthria
loss of fine motor coordination 
confusion/lethargy
32
Q

moderate hypothermia

A

89.6-82.4 F

bradycardia, Osborn waves
AMS
slowed reflexes
cold diuresis 
pupil dilation
33
Q

severe hypothermia

A

< 82.5 F

unresponsive/coma
HoTN
VFib/Asystole
Acidemia
Loss of reflexes
34
Q

labs and hypothermia

A

BMP (watch K)

HcT will rise according to 1C change

35
Q

active rEWARMING

A

ALL pts

warmed IV fluid and humidified warmed O2, warmed water immersion

MUST monitor closely

36
Q

passive rewarming

A

SLOW method

remove from environment, remove wet clothes, give blankets

37
Q

severe hypothermia

A

lavage warm fluids in all areas

hemodyalis, heart bypass

38
Q

forms of heat loss

A

radiation and evaporation

increased internal heat production, external heat exposure
impaired heat dispersion

39
Q

Exogenous heat

A

high ambient temp (minimized radiation loss)
high humidity (minimized heat loss)
direct sunlight

40
Q

endogenous heat

A

physical activity

drugs (Molly, coke, meth, bath salts, LSD, PCP, etc)

41
Q

impaired heat dispersal caused by

A
CV disease 
obesity 
extremes of age 
unventilated confinement 
dehydration
42
Q

acclimatization

A

body ability to acclimize to heat

allows it to protect kidneys and increase sweat, improved cardiac response to vasodilation

43
Q

heat edema

A

cutaneous vasodilation

resolves spontaneously

DO NOT USE DIURETICS

44
Q

heat rash

A

block sweat ducts = rash due to rupture and inflammation

prevent with loose clothes

tx: antihistamine

45
Q

heat syncope

A

peripheral vasodilation + decreased vasomotor tone + volume depletion

tx: remove from heat source, fluids, rest

46
Q

heat cramps

A

dehydration + electrolyte imbalance

give hydration with electrolytes, IV fluids

47
Q

heat exhaustion clinical features

A

elevated body temp, <105 F

fatigue/weakness/syncope

profuse sweating

48
Q

tx of heat exhaustion

A

cool with fans.ice
oral rehydration w/electrolyte fluid

monitor vital signs (Urine output and orthostatic vitals)

49
Q

heat stroke clinical features

A

body temp >105

hyperdynamic cardiac parameters
oliguria, anhidrosis
CNS dysfunction

50
Q

tx of heat stroke

A

ABCs, IV access, IV boluses, foley and NG tube

rapid cooling, GOAL is 100.4 F

51
Q

methods of cooling in heat stroke

A

evaporation immersion internal cooling

52
Q

adjunct therapy heat stroke

A

Anti-pyretics have NO role

benzos

renal failure can have dialysis