Cold/Heat emergencies

Question 1

First degree frost bite

Answer 1

Numbness, swelling, erythema

Question 2

Second degree frost bite

Answer 2

Blisters of the skin

Question 3

Third degree frostbite

Answer 3

Tissue loss involving entire thickness of the skin

Question 4

Fourth Degree

Answer 4

Tissue loss involving the entire thickness of the part - including deep structures

Question 5

1st degree fb tx

Answer 5

Numbness swelling erythema
Remove wet and cold clothing
Prevent further cold injury
Warm them up

Question 6

2nd degree fb tx

Answer 6

Effects dermal layers, redness and blanching, no necrosis if stopped here
Don’t rub, warming then refreezing will cause further damage

Question 7

3rd degree fb tx

Answer 7

Loss of tissue involving all layers of skin, don’t warm then re freeze, rewarming will be very painful

Question 8

4th degree fb tx

Answer 8

Effects dermal, subq and muscular layers

Obvious necrosis, solid white appearance, same tx as 1st-3rd

Question 9

Overall tx for frostbite

Answer 9

Do not heat area (dry heat may increase injury)
All wet clothing removed
Prevent further cooling
Consider analgesia

Question 10

Mild hypothermia temp range

Answer 10

32-35

Question 11

Mild hypothermia presentation

Answer 11

Shivering, pt feels cold, confusion and lethargy, poor judgement, loss of fine motor control, ataxia

Question 12

Mild hypothermia tx

Answer 12

Remove wet clothes, remove pt from cold environment, prevent heat loss with blankets

Question 13

Moderate hypothermia temp range

Answer 13

30-34

Question 14

Moderate hypothermia presentation

Answer 14

Progressive loss of congnitive functions, stupor, delirium, slow reflexes, dysrhthmias

Question 15

Moderate hypothermia TX

Answer 15

Heating packs or heating blankets, increase ambient heat

Question 16

Severe hypothermia temp

Answer 16

Less than 30

Question 17

Severe hypothermia presentation

Answer 17

Unconscious, loss of papillary light reflexes, apnea, pulseless, decreased CO and BP. blood volume can decrease by 1/3. Arrythmias, J wave

Question 18

Severe hypothermia tx

Answer 18

Warm IV fluids, peritoneal lavage, pleural lavage, cardiopulmonary bypass, extracorporeal circulation

Question 19

J wave

Answer 19

Positive deflection between QRS and ST, negative in aVR and V1, usually seen below 30 degrees

Question 20

Overall rewarming EMS strategies

Answer 20

Stop heat loss, keep pt still (supine ideally) and remove wet clothing, provide supportive care prn, consider analgesics, warm blankets and warm IV fluid

Question 21

Bradycardia in hypothermia

Answer 21

DON’T TCP, leave bradycardic and rewarm first, bradycardia is a normal physiological response to severe hypothermia

Question 22

Physiologic response to heat

Answer 22

Dilation of blood vessels (primarily in skin), increased sweat production, decreased heat production

Question 23

Mechanisms of heat loss

Answer 23

22% evaporation
60% radiation (heat waves)
15% air currents (convection)
3% Conduction to objects

Question 24

Heat cramps

Answer 24

Normal body temp, usually from prolonged strenuous activity.

Brief, intermittent, severe, abdo and ext

Question 25

Heat cramps manifestations

Answer 25

Prolonged and profuse sweating, no core temp elevation, tachy, normal or slightly up BP

Question 26

Heat cramp tx

Answer 26

Passive cooling, remove from environment, fluid and lyte replacement

Question 27

Heat exhaustion

Answer 27

From prolonged high core or environmental temp, develops over hours to days, core temp not over 40C

Question 28

Heat exhaustion characterized by

Answer 28

Increased lyte imbalances, vasodilatory disturbances causing inadequate peripheral and cerebral perfusion

Question 29

Heat exhaustion manifestations

Answer 29

``` Profuse sweating/pallor, cool/clammy skin. Weakness Syncope N/V Dizzy/headache Tachy-cardia and pnea ```

Question 30

Heat exhaustion tx

Answer 30

Passive cooling, remove from environment, fluid replacement

Question 31

Heat stroke temp

Answer 31

Greater than 40C because mechanisms for heat dissipation become exhausted. Can cause hypothalamus and multi-system tissue damage

Question 32

Heat stroke death %

Answer 32

30-80%. Altered LOC at heat stroke temps

Question 33

2 classifications of heat stroke

Answer 33

Classic is passive fluid loss by sweating, usually in oldies and develops over a few days Exertional from fit people working hard in hot and humid environment

Question 34

Heat stroke manifestations

Answer 34

``` Confusion, agitation, irritability, delirium, ataxia, seizures Dry/hot/flushed/red skin Tachy - cardia/pnea Hypotension Circulatory shock ```

Question 35

Tx heat stroke

Answer 35

True emergency, active external cooling using wet towels and AC, cold packs to axillae, neck and groin, removal from environment, fluid replacement