Lecture 191

Question 1

What is trench foot?

Answer 1

Cold injury caused by prolonged cooling of the feet without freezing, worsened by moisture, resulting in damage to peripheral nerves.

Question 2

What occurs after rewarming of trench foot?

Answer 2

Extreme pain, the area becomes hyperemic and edematous.

Question 3

How is trench foot treated?

Answer 3

Elevation, dry, loose dressing, debridement if necessary.

Question 4

What is chilblains (pernio)?

Answer 4

Cold injury resulting from exposure to intermittent, long-term, damp, non-freezing conditions.

Question 5

What type of cold injury is common in the UK and individuals with Raynaud’s phenomenon?

Answer 5

Chilblains (pernio).

Question 6

Rewarming of chilblains may lead to formation of ____?

Answer 6

Tender, blue nodules.

Question 7

How are chilblains treated?

Answer 7

Supportive care.

Question 8

What is panniculitis?

Answer 8

Necrosis of subcutaneous fat due to long-term exposure to above freezing temperatures.

Question 9

What type of athletes are commonly affected by panniculitis?

Answer 9

Equestrian riders.

Question 10

Cold urticaria is associated with?

Answer 10

Atopy.

Question 11

What cascade is triggered upon thawing of frost-bitten tissue?

Answer 11

Arachidonic acid cascade.

Question 12

What helps distinguish frostbite from non-freezing injuries?

Answer 12

Frostbite related ischemia caused by thrombosis manifests as late pallor or cyanosis.

Question 13

What condition must be met before rapid rewarming of frostbite can be initiated?

Answer 13

Only after risk of re-freezing has been eliminated.

Question 14

Frostbite should be immersed in water at what temperature?

Answer 14

37C to 39C.

Question 15

What prophylaxis should be considered in frostbite injuries?

Answer 15

Tetanus immunization.

Question 16

How should ruptured clear blisters related to frostbite be treated?

Answer 16

Debrided.

Question 17

How should hemorrhagic blisters related to frostbite be treated?

Answer 17

Left intact.

Question 18

Hypothermia is defined as a core body temperature below ____?

Answer 18

35C.

Question 19

At what core temperature does shivering become suppressed?

Answer 19

31C and below.

Question 20

What physiological response to cold is a consequence of peripheral vasoconstriction increasing central blood volume?

Answer 20

Cold diuresis (increased urine production).

Question 21

What is the cause of paradoxical undressing?

Answer 21

After catecholamines are depleted, leading to a sudden surge of warm blood to the cold peripheries.

Question 22

What EKG change is characteristic of hypothermia?

Answer 22

Osborn wave (J wave).

Question 23

What lab should ALWAYS be run in cases of hypothermia?

Answer 23

Glucose.

Question 24

How should temperature be measured in cases of hypothermia?

Answer 24

Thermistor (electrical device whose resistance varies with temperature).

Question 25

Where in the body best reflects the temperature of the heart?

Answer 25

Lower esophagus.

Question 26

What temperature range defines stage 1 hypothermia?

Answer 26

35C-32C.

Question 27

What should be avoided in treating stage 1 hypothermia?

Answer 27

No hot baths.

Question 28

How should stage 1 hypothermia be treated?

Answer 28

Warm environment, dry clothing, warm, sweet drinks, active movement.

Question 29

What temperature range defines stage 2 hypothermia?

Answer 29

<32C-28C.

Question 30

How should stage 2 hypothermia be treated?

Answer 30

Active external rewarming and minimally invasive rewarming.

Question 31

What temperature defines stage 3 hypothermia?

Answer 31

<28C, BP or pulse present.

Question 32

How should drug dosages be managed during stage 3 hypothermia treatment?

Answer 32

Medications have altered metabolism at low temperatures, potential for drug overdose as metabolism normalizes when rewarmed.

Question 33

What defines stage 4 hypothermia?

Answer 33

No BP or pulse present, cardiac arrest.

Question 34

How many doses of epinephrine should be administered in hypothermia induced cardiac arrest?

Answer 34

3 doses.

Question 35

What type of vasopressors are preferred in hypothermia?

Answer 35

Vasopressors with beta1-adrenergic effects are preferred over those with predominantly alpha-adrenergic effects.

Question 36

A serum potassium of ____ is a poor prognostic sign in hypothermia?

Answer 36

>12mmol/L.

Question 37

Termination of resuscitative efforts should be considered if core temperature is greater than ____ with no pulse of forward blood flow?

Answer 37

>32C.

Question 38

Ultrasound showing no forward flow of blood in hypothermia suggests that ____ will be ineffective?

Answer 38

Vasopressors.