Temperature Emergencies

Question 1

Cold urticaria

Answer 1

hypersensitivity to cold air or water

may lead to FATAL anaphylaxis

Question 2

cold urticaria diagnosis

Answer 2

confirmed with cold water test during follow up

Question 3

cold urticaria tx

Answer 3

Antihistamine

then go to anaphylaxis management if severe rxn

Question 4

Chiliblains

Answer 4

mild but unconfortable inflammatory lesions of the skin precipitated by acute exposure to cold

12 hrs of exposure

Question 5

pernio

Answer 5

aka chilblains

pruritus or burning paresthesia

hands, ears, lower legs, feet MC

Question 6

re warming and chilblains

Answer 6

may cause formation of tender blue nodules that persist for days

Question 7

tx of pernio

Answer 7

affected skin rewarmed, bandaged, elevated

some evidence of pharm tx in European studies

Question 8

immersion injury patho

Answer 8

direct injury to soft tissue following prolonged cooling in wet conditions

vasoconstriction, red cell and thrombocyte pudding, tissue edema, nerve and small vessel injury

Question 9

clinical features of trench foot

Answer 9

numbness and tingling of affected tissue

pale, mottled, anestehtic, pulseless, immobile

Question 10

hyperemic phase

Answer 10

immersion injury

hours after re=warming, severe burning pain and reappearance of proximal sensation

Question 11

late phase immersion injury

Answer 11

excessive sweating and cold sensitivity

persist for months to years

Question 12

tx of immersion in jury

Answer 12

supportive +/- pain control

clean, warm, dry bandage, elevate affected area

Question 13

frostbite

Answer 13

frozen tissue secondary to heat loss

causes ice crystal formation in superficial or deep tissue

MC in peripheral locations

Question 14

clinical summary frostbite

Answer 14

numbness + sensory loss in digit

thawed tissue but mottled blue, violet, yellow or waxy color

hyperemia

Question 15

Favorable prognostic signs frostbite

Answer 15

return of normal sensation/color/warmth
edema w.in 3 hrs of thawing
early formation of bulla to tips of digit

Question 16

poor prognostic indicators frostbite

Answer 16

lack of edema
small dark hemorrhagic bulla that DO NOT go to tips of digit

necrotic tissue

Question 17

superficial frostbite (1st degree)

Answer 17

frost nip

numbness, white tissue, erythema

Question 18

superficial frostbite (2nd degree)

Answer 18

clear vesicle or blebs with erythema

Question 19

deep frostbite (3rd degree)

Answer 19

hemorrhagic blisters

not extend to tip of appendage

Question 20

deep frostbite (4th degree)

Answer 20

necrotic tissue involving muscles, tendon bone

Question 21

tx of frostbite (gen)

Answer 21

SHOULD NOT be attempted until risk of refreezing is eliminated

soak warm water (98-102) for 20-30 MIN

elevation + pain + PCN

Question 22

hypothermia

Answer 22

core temperature below 95 degrees

Question 23

hypothermia clinical features

Answer 23

tachycardia –> Bradycardia

ECG prolonged (PR –> QRS –> QT)

Osborn J wave/hypothermic hump

MUST get proper vitals (esophagus)

atrial arrhythmia (resolve)

Question 24

causes of body temp drop

Answer 24

conduction
convection
radiation
evaporation

Question 25

conduction

Answer 25

transfer of head by direct contact down concentration gradient I.e. submersion

Question 26

convection

Answer 26

movement o heated material causes transfer of heat I.e. wind

Question 27

radiation

Answer 27

heat loss by environment (ie non insulated areas)

Question 28

evaporative

Answer 28

heat loss thru vaporization

Question 29

heat is conserved by

Answer 29

peripheral vasoconstriction and behavioral responses MC behavioral responses are affected

Question 30

heat gain is increased by

Answer 30

shivering and non shivering thermogenesis hypothalamus attempts to stimulate heat production (shiver) and increased thyroid catecholamine and adrenal activity

Question 31

mild hypothermia

Answer 31

89.6-95 F ``` shivering tachypnea/tachycardia/hypertension ataxia/dysarthria loss of fine motor coordination confusion/lethargy ```

Question 32

moderate hypothermia

Answer 32

89.6-82.4 F ``` bradycardia, Osborn waves AMS slowed reflexes cold diuresis pupil dilation ```

Question 33

severe hypothermia

Answer 33

< 82.5 F ``` unresponsive/coma HoTN VFib/Asystole Acidemia Loss of reflexes ```

Question 34

labs and hypothermia

Answer 34

BMP (watch K) | HcT will rise according to 1C change

Question 35

active rEWARMING

Answer 35

ALL pts warmed IV fluid and humidified warmed O2, warmed water immersion MUST monitor closely

Question 36

passive rewarming

Answer 36

SLOW method remove from environment, remove wet clothes, give blankets

Question 37

severe hypothermia

Answer 37

lavage warm fluids in all areas hemodyalis, heart bypass

Question 38

forms of heat loss

Answer 38

radiation and evaporation increased internal heat production, external heat exposure impaired heat dispersion

Question 39

Exogenous heat

Answer 39

high ambient temp (minimized radiation loss) high humidity (minimized heat loss) direct sunlight

Question 40

endogenous heat

Answer 40

physical activity drugs (Molly, coke, meth, bath salts, LSD, PCP, etc)

Question 41

impaired heat dispersal caused by

Answer 41

``` CV disease obesity extremes of age unventilated confinement dehydration ```

Question 42

acclimatization

Answer 42

body ability to acclimize to heat allows it to protect kidneys and increase sweat, improved cardiac response to vasodilation

Question 43

heat edema

Answer 43

cutaneous vasodilation resolves spontaneously DO NOT USE DIURETICS

Question 44

heat rash

Answer 44

block sweat ducts = rash due to rupture and inflammation prevent with loose clothes tx: antihistamine

Question 45

heat syncope

Answer 45

peripheral vasodilation + decreased vasomotor tone + volume depletion tx: remove from heat source, fluids, rest

Question 46

heat cramps

Answer 46

dehydration + electrolyte imbalance give hydration with electrolytes, IV fluids

Question 47

heat exhaustion clinical features

Answer 47

elevated body temp, <105 F fatigue/weakness/syncope profuse sweating

Question 48

tx of heat exhaustion

Answer 48

cool with fans.ice oral rehydration w/electrolyte fluid monitor vital signs (Urine output and orthostatic vitals)

Question 49

heat stroke clinical features

Answer 49

body temp >105 hyperdynamic cardiac parameters oliguria, anhidrosis CNS dysfunction

Question 50

tx of heat stroke

Answer 50

ABCs, IV access, IV boluses, foley and NG tube rapid cooling, GOAL is 100.4 F

Question 51

methods of cooling in heat stroke

Answer 51

evaporation immersion internal cooling

Question 52

adjunct therapy heat stroke

Answer 52

Anti-pyretics have NO role benzos renal failure can have dialysis