Heat and Cold Emerg. Ch. 30 Flashcards
(23 cards)
How do peds and adults differ r/t temp regulation (6 ways )
- peds cant regulate temp well,
- have less SC fat
- cant shiver to increase temp,
- have higher BSA,
- higher metabolic rate,
- decreased ability to sweat
Definition of hyperthermia
temp > 99.5 degrees 2* to dysregulation (not the same a fever)
Hypothermia pathophysiology (5)
directly toxic to cells release of cytokines injury to vascular endothelium leads to ^ permeability can cause DIC
Heat rash
obstructed sweat glands
What are heat cramps? and what causes them?
2* DHN and electrolyte loss caused by exertion
Sings of heat exhaustion (5) and temp.
weakness, N/V, cramps, mental status ok, T* ,102.2
Signs of heat stroke (2) including temp.
T* > 104, AMS up to coma
heat stroke TX
NO NSAIDS, benzos to control shivering,
Hypothermia grades
I. mild T* 89.6-95 awake and shivering
II. moderate T* 82.4-89.6 AMS, not shivering
III. severe T* 75.2-82.4 coma, vfib
IV. severe T* <75.2 death, asystole
Osborn waves
At T* of 91.4 due to irritiblity knows as J waves
Hypothermia effect on CV system
tachy, then brady , then asystole
Hypothermia effect on Heme system
coagulation 2* to enzyme reactions
lab test may not be reliable as they rely on T*
Hypothermia effect on Resp system
hypoxia, ^ lactic acid levels
Hypothermia effect on renal system
fluid shifts 2* to cold diuresis leads to hypovolemia
rhabdo may occur
Rewarming types
passive, active
Passive rewarming
dry off and cover up, let body do its work
Active rewarming
forced air, heated blankets, heated IV fluids
rewarm TRUNK then LIMBS
Physiologic changes with hypothermia (4)
- metabolism is lower drugs take longer to work
- will need fluids avoid rewarming shock
- POX unreliable 2* vasoconstriction
- Avoid LR 2* to impaired hepatic metabolism
What is the Order of rewarming body parts?
trunk, then limbs
Would you give NSAIDs with heat injuries and rationale?
No, not a dysregulation issue
How does hypothermia affect acid -base balance?
causes acidosis elevating lactic acid levels
How does hypothermia affect fluid balance?
Causes hypovolemia
Vasoconstriction causes increased glomerular blood flow, increased UO
Pathophysiology of Hypothermia
Diuresis plus fluid leakage into the interstitial tissues causes hypovolemia. Vasoconstriction, which occurs with hypothermia, may mask hypovolemia, which then manifests as sudden shock or cardiac arrest during rewarming (rewarming collapse) when peripheral vasculature dilates. (Merk Manual).
How can you control shivering with heat stroke?
Benzodiazepines
