39 - hypothemia and cold Flashcards Preview

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Flashcards in 39 - hypothemia and cold Deck (15)
1

6 groups and increased risk

1. extremes of age
2. altered sensorium
3. acute incapacitating illness
- infections, DKA,
4. metabaolic abnomalities
5. immersion in cold water
6. deficiency in muscle or fat
7. peripheral or autonomic neuropathy

2

4 types of heat loss

1. radiation - 55%
2. evap - 30%
3. conduction - 15% - worse in water
4. convection - minor

3

2 CNS Sx

1. LOC
2. shivering

4

ECG sign

J waves right after QRS

5

resp sign

initial tach followed by decrease

6

5 CV signs

1. brady
2. afib
3. slow vent response
4. V fib
5. asystole

7

behavior signs

undressing and burrowing

8

mgmt steps

1. ABC
2. intubate if necc
3. check glucose and D50W if needed
4. bloodwork
5. assume dehydration
6. hypotension should get dopa
7. begin rewarming

9

3 methods of rewarming

1. passive external
- for mild
-warm blankets
2. active external
- healthy, acute and hemo unstable
- may be assoc. with arrythmias due to after drop
- immersion in warms water
3. active core rewarming
- Tx of choice for those who have arrested, but no sig. trauma
- warms IV fluids
- warm humidified O2
- warm peritoneal lavage
- warm saline pleural irrigation

10

3 predisposing factors for frostbite

1. prior cold injury
2. conditions that impede circ.
3. conditions affecting judgement

11

4 forms of peripheral cold injuries

1. chillblains
- mild from drycold
- young females with raynauds
- pruritis, erythemia, mild edema
2. trench foot
- prolonged exposure to wet cold above freezing
- bullae can dev. and leads to gangrene
- pain during weight bearing, cold sens
3. frostnip
- supeficial - like 1st degree burn
4. frsot bite
- actual freezing of tissue

12

ominous presentation of frost bite

1. not possible to roll dermis over bony promininces
2. small hemmoargic blebs
3. residual hue
4. lack of edema

13

3 stages of cold injury

1. burning and numbness warms to pallor and edema
2. insensate, warms to blistering, still perfuses
3. insensate, warms to blister, necrosis

14

steps to rewarm peripheral

1. remove non-adherent wet cloths
2. immerse in warm water bath
3. don't end warming early
4. avoid refreezing at all costs
5. avoid direct heat

15

adjunt therapy

- active gentle movement
- parenteral analgesia
- keep elevated
- admit for all but minor