Test 1 - Burn and Heat/Cold Injuries

Question 1

What conditions increase risk for heat/cold injuries?

Answer 1

DM
CV
Obesity
CNS Disorders
Malnourishment
Endocrine - menopause, thyroid, addison

Question 2

Frost Nip: What is it? S/Sx? Treatment?

Answer 2

What is it?: no tissue damage from prolonged exposure to cold; affects fingers, nose, toes; decreased blood flow to extremities

S/Sx: Pallor, numbness, tingling

Treatment: Remove from cold, remove wet clothing, blanket, warm room

Question 3

Frost Bite: What is it? S/Sx? Treatment?

Answer 3

What is it? Localized injury (not systemic), tissue damage, skin is frozen;

Decreased blood flow –> ischemia –> hypoxia –> tissue necrosis –> cell death

S/Sx: Based on grades

Treatment: remove from cold, dry clothes, warm fluids, pain management (via IV), whirlpool baths with circulating water, tetanus shot to protect from clostridium tetany

Question 4

Frost Bite: Grade I

Answer 4

hyperemia/edema, hypovolemia, decreased bp

Question 5

Frost Bite: Grade II

Answer 5

Blisters with milky/clear white drainage with white blood cells

Question 6

Frost Bite: Grade III

Answer 6

Blisters with black/red fluid (dead tissue/sticky skin)

Question 7

Frost Bite: Grade IV

Answer 7

Gangrene (amputation needed)
Toe/Finger may fall off

Question 8

What happens when cell death occurs?

Answer 8

Dead cells release potassium and fluid mobilization occurs and SWELLING is due to capillary leak

Question 9

Hypothermia: What is it? S/Sx? Treatment?

Answer 9

What is it? Core temp <95F causing SYSTEMIC issues; vasoconstriction as body tries to increase blood flow to heart/brain

S/Sx: Initial increase BP, then HR/BP will fall if sustained, altered mental state/confusion

Treatment: SAME interventions as frost bite/nip, BUT ACTIVE REWARMING too

Question 10

What is active rewarming?

Answer 10

Extracorporeal warming:
dialysis
NG tube for gastric lavage (push in warm fluids, then pull out)
Bladder irrigation (push in warm fluid then drain)

Medication: THORAZINE to stop/prevent shivering

Warm peripherally, then centrally

Question 11

Risks of active rewarming

Answer 11

Afterdrop - giving warm fluid in IV line, but as water becomes cold during circulation, temp might drop back down;

Question 12

Heat Cramps: What is it? S/Sx? Treatment

Answer 12

What is it? F/E imbalance

S/Sx: Sweating (increased evaporation), muscle cramps POST activity

Treatment: Remove from heat/cool room, replace lost electrolytes, wet clothes, fans/mist, push fluids PO - gatorade (must see-threw)

Question 13

Heat Exhaustion: What is it? S/Sx? Treatment?

Answer 13

What is it? Dehydration due to profuse sweating and prolonged exposure, exacerbation of f/e imbalance

S/Sx: normal to low grade fever (99), cool, clammy, diaphoretic, light-headed, headache, nausea

Treatment: remove from heat, IV with cool crystalloid fluids (LR), ice packs on neck, groin and arm pit), wet clothes, plus heat cramp interventions

Question 14

Heat Stroke: What is it? S/Sx? Treatment?

Answer 14

What is it? SYSTEMIC reaction (this is differentiator), patient core temp >104/105

Antipyretics DO NOT HELP, NOT INFECTION

S/Sx: hot, dry altered mental state, confusion, VS (variable hr, abnormal, decrease bp),

Treatment: Active Cooling

Question 15

What is active cooling?

Answer 15

NGT/gastric lavage with cool fluids
Dialysis with cool fluids
Bladder irrigation with cool fluids