Hypothermia & Burns Flashcards
Define:
* Mild hypothermia
* Moderate or severe hypothermia
- Mild: temp <35 degrees C
- Moderate or severe: temp <32 degrees C
State some potential causes of hypothermia
- Impaired homeostatic mechanisms (young or old)
- Low room temperature/homeless
- Impaired thermoregulation e.g. heart failure, pneumonia, MI
- Reduced metabolism e.g. hypothyroidism
- Excessive heat loss e.g. TEN, erythrodermic psoriasis
- Decreased cold awareness e.g. dementia
- Drugs e.g. alcohol, general anaesthetics
Describe presentation of hypothermia
- shivering
- cold and pale skin. Frostbite occurs when the skin and subcutaneous tissue freeze, causing damage to cells.
- slurred speech
- tachypnoea
- arrhythmias (AF, VT, VF)
- hypotension
- respiratory depression
- bradycardia
- confusion/ impaired mental state
What should you use to measure temperature if you suspect hypothermia?
Use a low reading rectal thermometer or thermistor probe
What invesigations would you do in hypothermia?
- VBG/glucose
- ABG
- ECG
- FBC
- U&Es
- LFTs
- Coagulation
- Amylase
- CXR
What might you find on ECG of hypothermic patient?
- Acute ST elevation (MI)
- J waves/Osborne waves
Remember may have arrhythmias e.g. AF, VT, VF*
Why do you need to monitor blood glucose in hypothermic patient?
Release of stress hormones including ACTH and TSH
You should continue resuscitating a hypothermic patient until their core temperature is > ____?
> 33 degrees C
Discuss the management of hypothermia
A-E
- Secure airway
- Remove pt from cold environment, remove any wet clothing etc…
- Warm the body with blankets or bear hugger
- Warm IV fluids
- Cardiac monitoring
- Consider abx in (routine in >65yrs)
- Consider urinary catheterisation
Explain why rapid rewarming in hypothermia is dangerous
Rapid rewarming causes peripheral vasodilation and shock (hence if BP is falling may be sign that temperature is rising too quickly)
The NHS have advice on what NOT to do when a person has hypothermia; what is this advice?
Don’t put the person into a hot bath
Don’t massage their limbs
Don’t use heating lamps
Don’t give them alcohol to drink
State some potential complications of hypothermia
- Pneumonia
- Pancreatitis
- AKI
- DIC
Discuss the immediate first aid for burns
- airway, breathing, circulation
- burns caused by heat: remove the person from the source. Within 20 minutes of the injury irrigate the burn with cool (not iced) water for between 10 and 30 minutes. Cover the burn using cling film, layered, rather than wrapped around a limb
- electrical burns: switch off power supply, remove the person from the source
- chemical burns: brush any powder off then irrigate with water. Attempts to neutralise the chemical are not recommended
Describe the appearance of the following depth of burns:
- Superficial epidermal
- Partial thickness (both superifical dermal and deep dermal)
- Full thickness
State two methods you can use to assess the extent of burns
- Lund & Browder chart (most accurate)
- Wallace’s Rule of Nines (head + neck = 9%, each arm = 9%, each anterior part of leg = 9%, each posterior part of leg = 9%, anterior chest = 9%, posterior chest = 9%, anterior abdomen = 9%, posterior abdomen = 9%)
What formula is used to calculate fluid resuscitation in burns patients?
**Parkland formula **
(4 x weight x % burn= mL in Hartmann’s solution in 24hrs. Give 1/2 in first 8hrs)
