Hypothermia / Hyperthermia Flashcards Preview

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Flashcards in Hypothermia / Hyperthermia Deck (34)
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1

Dry hot skin, pupils constricted, very high body temperature

Heat stroke

2

Moist and clammy skin, pupils dilated, normal or subnormal temperature

Heat exhaustion

3

Core temperature indicative of heat stroke

104 F or 40 C

4

Two types of heat stroke

Exertional vs nonexertional (classic)

5

Generally occurs in young, otherwise healthy individuals who exercise heavily in hot, humid weather

Exertional heat stroke

6

Being unable to leave a hot environment might lead to

Nonexertional heat stroke

7

Certain underlying chronic medical conditions such as ______ might lead to nonexertional heath stroke

- cardiovascular
- neurologic / psychiatric
- obesity
- anhidrosis
- physical disability
- extreme ages
- certain drugs (anticholinergics, cocaine, alcohol)

8

Vital sign abnormalities seen in heat stroke

High core body temp
Sinus tachycardia
Tachypnea
Widened pulse pressure / Hypotension

9

Physical exam findings of heat stroke

Flushing
Pulm crackles (pulm edema)
Excessive bleeding?

Altered mentation (slurred speech, irritable)
Ataxia / poor coordination
Seizures
Coma

10

Risk factors for mortality in heath stroke

63% mortality rate overall

Presence of
- Anuria
- Coma
- Cardiovascular failure

**and of course higher body temp, longer time before cooling measures initiated**

11

Heat stroke management (4 steps)

1. Airway, breathing, circulation

2. Rapid cooling (water, ice, cooling pads)

3. Endotracheal intubation / ventilation often necessary

4. IV saline bolus for hypotension

12

Best tolerated cooling method for classic (nonexertional) heat stroke

Evaporative cooling methods (moistened skin, fans across)

13

How to control shivering during cooling

Benzodiazepines

14

Rapid, effective cooling method for young patients with exertional heat stroke

Immersion in ice water

15

What cooling method to avoid in elderly pts with classic heat stroke

Immersion - increased mortality

16

Core temperature indicative of hypothermia

below 95 F, or 35 C

17

Core temperature 32 to 35ºC (90 to 95ºF)

Mild hypothermia

18

Core temperature 28 to 32ºC (82 to 90ºF)

Moderate hypothermia

19

Core temperature below 28ºC (82ºF)

Severe hypothermia

20

A patient presenting with reductions in pulse rate and cardiac output, hypoventilation, central nervous system depression, hyporeflexia, decreased renal blood flow, loss of shivering, arrhythmias - might be at what stage of hypothermia?

Moderate hypothermia (82-90 F)

21

A patient presenting with tachypnea, tachycardia, initial hyperventilation, ataxia, dysarthria, impaired judgment, shivering, and "cold diuresis" - might be at what stage of hypothermia?

Mild hypothermia (90-95 F)

22

A patient presenting with pulmonary edema, oliguria, areflexia, coma, hypotension, bradycardia, ventricular arrhythmias (including ventricular fibrillation), and systole - might be at what stage of hypothermia?

Severe hypothermia ( < 82 F)

23

How long should resuscitative efforts be made for a patient with hypothermia?

Indefinitely, until core body temp reaches 90-95 F

24

Chest compressions for a patient with hypothermia - do em or not? Why?

No chest compressions if patient has an organized rhythm - their heart is working at an appropriate pace for that reduced body temperature

EVEN IF THEY HAVE NO PULSE / NO SIGNS OF LIFE

25

Potential complication of rewarming a patient with moderate - severe hypothermia, and how to manage that complication

Can become hypotensive during rewarming from severe dehydration / fluid shifts

2 large (14 or 16 gauge) peripheral IVs should be placed to support BP w WARMED (40-42 F) isotonic infusions

26

How is mild hypothermia treated

Passive external rewarming: remove wet clothing, cover with blankets

27

How is moderate and refractory mild hypothermia treated?

Active external rewarming:
- combo of warm blankets, heating pads, radiant heat, warm baths, or force warm air directly to skin

*WARM TRUNK FIRST*

28

How is severe hypothermia treated?

Active internal rewarming:
- IV administration of warmed (40-42 C) saline
- Extracorporeal blood warming
- Irrigation of peritoneum w warmed saline

29

Fever is defined as a rectal temp that exceeds

100.4 F (38 C)

30

Fever work-up in NON TOXIC child

- Look for visible sources of fever (URI, otitis media, strep throat)

- Rapid testing for viruses (influenza, RSV, mono)

- UA / culture (via cath if necessary)