Heat and Cold Emergencies Lecture

Question 1

What are the 2 main control mechanisms for thermoregulation?

Answer 1

Hypothalamus

Peripheral Thermo receptors

Question 2

What are the four modes of heat loss?

Answer 2

Conduction
Convection
Radiation
Evaporation (skin/ respiratory)

Question 3

Failure of the thermal regulatory system occurs in what 2 main patient populations

Answer 3

Geriatric and Pediatric

Question 4

Five minor heat related disorders

Answer 4

Dehydration
Heat rash
Heat edema
He tetany
Heat syncope

Question 5

Pathophysiology of heat cramps

Answer 5

Profuse sweating
Excessive sodium loss
Lack of sodium and causes muscle cramps

Question 6

Signs and symptoms of heat cramps

Answer 6

Hot humid environment
Muscle cramping
Nausea
Normotensive to mild hypertension
Tachycardia
Cool pale skin
Alert
Normal temp

Question 7

Management of heat cramps

Answer 7

Passive cooling and rest
Give electrolyte solution
IV NS
Avoid massage and activity

Question 8

Pathophysiology of heat exhaustion

Answer 8

Vasodilation
Hypovolemic due to excessive sweating
Decreased CNS perfusion

Question 9

Signs and symptoms of heat exhaustion

Answer 9

Headache, dizziness, fatigue, nausea, confusion, weakness, syncope
Excessive sweating, pallor
Tachycardia, hypotension, tachypnea
Positive orthostatic
Core temp >104

Question 10

Management of heat exhaustion

Answer 10

Remove from the environment
Elevate legs
Active cooling
IV NS
Blood glucose monitor
02 and EKG monitor

Question 11

Pathophysiology of heat stroke

Answer 11

Body temperature> 106

Question 12

Two types of heat stroke

Answer 12

Exertional

Classic

Question 13

Characteristics of exertional heatstroke

Answer 13

Young healthy people
Rapid heat accumulation
Damage the hypothalamus
Excessive sweating

Question 14

Characteristics of classic heatstroke

Answer 14

Elderly, alcoholics, obese, heart disease patient populations
Slow chronic buildup of heat
Dry skin, absence of sweating

Question 15

Signs and symptoms of heat stroke

Answer 15

Headache, dizzy, irritable
DLOC, seizure
Bounding pulse progressing to weak and rapid
Hypotension 2nd to vasodilation

Question 16

ALOC + Hot Environment =

Answer 16

Heat Stroke

Question 17

Heatstroke management

Answer 17

Secure airway
High flow O2
Rapid cooling
IV NS
EKG
Glucose or benzodiazepines as needed for BG or seizure
Reassess for dysrhythmias or pulmonary edema
Transport

Question 18

Two classifications of local cold injuries

Answer 18

Non freezing - chilblains, trench foot

Freezing - frostnip, frostbite

Question 19

What are chilblains

Answer 19

Chronic exposure two damp environments
Painful lesions on skin
Pruritis, burning
Reoccurs

Question 20

Chilblain treatment

Answer 20

Rewarm, Bandage, elevate

Question 21

Characteristics OF TRENCH FOOT

Answer 21

Prolonged exposure to cool wet conditions
Skin pale, modeled, Wrinkled
Loss of sensation
Sloughing or gangrene may occur

Question 22

Treatment of TRENCH FOOT

Answer 22

Clean, warm, dry bandages elevate

Question 23

Risk factors for frostnip to frostbite

Answer 23

Poor nutrition, diabetes, poor tissue perfusion, vasodilation caused by ETOH or medications

Question 24

Two phases a frostnip or frostbite pathophysiology

Answer 24

Phase I Cold injury

Phase II Rewarming complications

Question 25

Describe phase I of frosting/frostbite

Answer 25

Exposure to cold, vasoconstriction, ice crystal formation in extracellular space, ischemia, Cellular dehydration

Question 26

Describe phase II of frosting/frostbite

Answer 26

Rewarming, capillaries leak fluid, edema, thrombus formation

Question 27

Frostbite classifications and descriptions

Answer 27

1st degree - partial freezing, mild edema, no blisters 2nd Degree - full thickness freezing, blisters, edema 3rd degree - Subcutaneous freezing, hemorrhagic blisters, skin necrosis, blue-gray 4th degree - damage to muscles, little edema, black, mummified

Question 28

Management of frostbite

Answer 28

``` Dry patient Warm IV fluids Dry sterile dressing Pain management Avoid rewarming unless extremely long transport If indicated re-warm and 100-105 degree water Do not allow refreezing Do not massage Do not drain blisters ```

Question 29

Temperature below which hypothermia occurs

Answer 29

< 95

Question 30

Risk factors for hypothermia

Answer 30

``` Pediatric and geriatric Hypothyroid Diabetes Alcoholic Depression and drug abuse Poor nutrition ```

Question 31

Pathophysiology of hypothermia

Answer 31

``` Vasoconstriction Catecholamine release Initial increased HR, RR, BP Shivering, unless temp < 90 Cardiac arrest if < 86 Ischemic tissues Depression of ADH Cold diuresis Depression of insulin release ```

Question 32

Signs and symptoms of hypothermia

Answer 32

``` Pallor, shivering Ataxic gate Drowsiness, coma Slowing HR and RR Cardiac arrest ```

Question 33

ALOC + Cool Environment =

Answer 33

Hypothermia

Question 34

EKG changes in hypothermia

Answer 34

Bradycardia (may be unresponsive to atropine) Absent P-wave Abnormal ST segment's and T-wave J wave

Question 35

Mild hypothermia temperature range

Answer 35

90-95

Question 36

Mild hypothermia management

Answer 36

Prevent further heat loss Hot packs to head neck chest groin Warm oral fluids

Question 37

Moderate hypothermia temperature range

Answer 37

86-89

Question 38

Management of moderate hypothermia

Answer 38

Prevent further heat loss Active rewarming Warm IV fluids EKG

Question 39

Severe hypothermia temperature

Answer 39

< 86

Question 40

Severe hypothermia management

Answer 40

``` Secure airway Do not hyperventilate Handle gently Prevent further heat loss EKG IV with NS Active rewarming ```

Question 41

Hypothermic cardiac arrest if temperature < 86

Answer 41

1 shock | no meds

Question 42

Hypothermic cardiac arrest temperature > 86

Answer 42

Increase drug dosing intervals | Repeat shocks has Core temp rises

Question 43

You are not dead until...

Answer 43

You are warm and dead