COLD INJURIES

Question 1

Another name for Chilblains?

Answer 1

Trench Foot

Question 2

Signs and Symptoms:

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.

Initial examination:

1)The skin is pale, mottled, anesthetic, pulseless, and immobile, which initially does not change after rewarming.

Answer 2

Chilblains / Trenchfoot

Question 3

What are the signs and symptoms of Chilblains / Trench Foot?

Answer 3

Signs and Symptoms:

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.

Initial examination:

1)The skin is pale, mottled, anesthetic, pulseless, and immobile, which initially does not change after rewarming.

Question 4

What is the treatment for Trench Foot?

Answer 4

1) Supportive
2) Rewarm, bandage and elevate affected skin
3) Fluocinolone cream (Topical Corticosteroids)

Question 5

What are the preventative measure for Trench Foot / Chilblains?

Answer 5

1) Keeping warm.
2) Ensuring good boot fit.
3) Changing out of wet socks
4) Never sleeping in wet socks and boots.

Question 6

What degree of frostbite?

1) Transient stinging and burning, followed by throbbing.
2) Partial skin freezing, erythema, mild edema, lack of blisters, and occasional skin desquamation several day slater.

Answer 6

First Degree Frostbite

Question 7

What is the prognosis for first degree frostbite?

Answer 7

Excellent

Question 8

What degree of frostbite?

1) The patient complains of numbness, followed later by aching and throbbing.
2) Full-thickness skin freezing, formation of substantial edema over 3 to 4 h, erythema, and formation of clear blisters.

Answer 8

Second Degree Frostbite

Question 9

What is the prognosis of Second Degree Frostbite?

Answer 9

Good

Question 10

What degree of frostbite?

1) The patient may complain that the involved extremity feels like a “block of wood,” followed later by burning,throbbing, and shooting pains.
2) Hemorrhagic blisters form and are associated with skin necrosis and a blue- gray discoloration of the skin.

Answer 10

Third Degree Frostbite

Question 11

Frostbite:

Hemorrhagic blister are associated with what?

Answer 11

Skin Necrosis

Question 12

What is the prognosis of Third Degree Frostbite?

Answer 12

Often Poor

Question 13

What degree of frostbite?

1) The patient may complain of a deep, aching joint pain.
2) The skin is mottled, with little edema and non- blanching cyanosis, and eventually forms a deep, dry, black, mummified eschar.
3) Vesicles often present late, if at all, and may be small, bloody blebs that do not extend to the digit tips

Answer 13

Fourth Degree Frostbite

Question 14

What is the prognosis of Fourth Degree Frostbite?

Answer 14

Extremely Poor

Question 15

What are important questions to ask in the history of a patient with frostbite?

Answer 15

1) What was the temperature and wind velocity?
2) How long was the extremity frozen, and if it was thawed,did any refreezing occur?
3) Was there any self- treatment, such as rubbing with snow or use of aloe vera cream or ibuprofen?
4) Were recreational drugs, alcohol, or tobacco involved?
5) Are there any predisposing medical conditions?

Question 16

What is the “Field Management” for frostbite?

Answer 16

1) Remove wet constrictive clothing
2) Elevate and wrap involved extremities
3) Separate toes and fingers with dry sterile gauze
4) Avoid further cold injuries

Question 17

What is the is the core of frostbite therapy and should be initiated as soon as possible?

Answer 17

Rapid rewarming

Question 18

What is the “Clinical Management” for frostbite?

Answer 18

1) Rapid Rewarming
2) Warm in water 104° - 107.6°F for 10 - 30 minutes
3) Debride or aspirate CLEAR blisters
4) Aloe Vera on blisters
5) Separate digits
6) Elevate

Question 19

What temperature should the water be for rapid rewarming of frostbite be?

Answer 19

104° - 107.6°F for 10 - 30 minutes

Question 20

Hypothermia is defined as a core temperature below _____.

Answer 20

95ºF

Question 21

What are the TEMPERATURE stages for hypothermia?

Answer 21

Mild - 90-95ºF

Moderate – 82-90ºF

Severe below 82°F

Question 22

Mild Hypothermia

Answer 22

90-95ºF

Question 23

Moderate Hypothermia

Answer 23

82-90ºF

Question 24

Severe Hypothermia

Answer 24

Below 82°F

Question 25

What are the CLINICAL stages of hypothermia?

Answer 25

1) Cold stressed (not hypothermic)
2) Mild hypothermia
3) Moderate hypothermia
4) Severe/profound hypothermia

Question 26

What Clinical Stage of hypothermia?

1) Normal mental status with shivering.
2) Functioning normally.
3) Able to care for self.
4) Estimated core temperature 35 to 37°C (95 to 98.6°F).

Answer 26

Cold stressed (not hypothermic)

Question 27

What Clinical Stage of Hypothermia?

1) Alert, but mental status may be altered.
2) Shivering present.
3) Not functioning normally.
4) Not able to care for self.
5) Estimated core temperature 32 to 35°C (90 to 95°F).

Answer 27

Mild Hypothermia

Question 28

What Clinical Stage of Hypothermia?

1) Decreased level of consciousness.
2) Conscious or unconscious, with or without shivering.
3) Estimated core temperature 28 to 32°C (82 to 90°F).

Answer 28

Moderate Hypothermia

Question 29

What Clinical Stage of Hypothermia?

1) Unconscious.
2) Not shivering.
3) Estimated core temperature <28°C (<82°F).

Answer 29

Severe/profound hypothermia

Question 30

Heat is generated by cellular metabolism (most prominently in the _________ and _________.

Answer 30

Heart and Liver

Question 31

Heat is lost by the skin and lungs via what processes?

Answer 31

Evaporation

Radiation

Conduction

Convection

Question 32

What are the most common mechanisms of accidental hypothermia?

Answer 32

Convective heat loss to cold air
and
Conductive heat lost to water

Question 33

What clinical stage of hypothermia shows:

1) Tachypnea
2) Tachycardia
3) initial hyperventilation
4) Ataxia
5) Dysarthria
6) Impaired judgment
7) Shivering
8) “cold diuresis”

Answer 33

Mild Hypothermia

Question 34

What clinical stage of hypothermia shows:

1) CNS depression
2) drop in heart rate and cardiac output
3) hypoventilation
4) hyporeflexia.
5) No Shivering
6) ATRIAL Fib
7) Dilated Pupils

Answer 34

Moderate Hypothermia

Question 35

What clinical stage of hypothermia shows:

1) Pulmonary edema
2) Oliguria
3) Hypotension
4) Bradycardia
5) VENTRICULAR dysrhythmias. (V fib/tach/asystole)
6) Loss of oculocephalic reflexes

Answer 35

Severe Hypothermia

Question 36

Pupils will dilate in a hypothermic patient with a core temperature below ______.

Answer 36

29 C

Question 37

Many standard thermometers only read to minimum of ______

Answer 37

93 F

Question 38

What are the Important Labs for hypothermia?

Answer 38

1) Fingerstick glucose*

2) Electrocardiogram (ECG)* (Osborne Waves)

Question 39

What are the differential that can cause hypothermia and should be suspected if the vitals due not align to the vitals in the clinical stages of hypothermia?

Answer 39

1) Hypothyroidism
2) Sepsis
3) Adrenal insufficiency
4) Neuromuscular disease
5) Thiamine deficiency
6) Hypoglycemia

Question 40

What are the management procedures for hypothermia?

Answer 40

1) ABC
2) Prevent further heat loss
3) Rewarming
4) Treatment of complications
5) Duration of resuscitation:

Question 41

Resuscitation efforts should be continued in a patient with hypothermia (occasionally for several hours) until the patient’s core temperature reaches ___________.

Answer 41

32 to 35°C (90 to 95°F)

Question 42

Rewarming:

Mild Hypothermia =

Answer 42

Passive External Rewarming

Blankets

Question 43

Rewarming:

Moderate and Refractory Mild Hypothermia =

Answer 43

Active External Rewarming

“Bear Huggers” or Warming blankets

Question 44

Rewarming:

Severe (and some cases of refractory moderate)hypothermia =

Answer 44

active internal rewarming andpossibly extracorporeal rewarming

(Warm IV or Warm Gastric Lavage)

Question 45

What factors were associated with death within 24 hours of presentation of a hypothermic patient?

Answer 45

1) Prehospital cardiac arrest,
2) Low or absent blood pressure on presentation
3) Elevated BUN
4) The need for endotracheal intubation

CORE TEMP IS NOT A FACTOR