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PAR2022 - Trauma > Week 8 > Flashcards

Week 8 Flashcards

1
Q

how does our body regulate temp?

A

Thermoregulation

- feedback mechanisms

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2
Q

where are most regulating centres located?

A

Hypothalamus

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3
Q

what is the variance between tympanic temp and core temp?

A

-0.5 degrees

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4
Q

what are the bodies mechanisms used to preserve heat?

A
  • goosebumps
  • shivering and increased muscle tone
  • peripheral vasoconstriction
  • increased cardiac output
  • increased resp rate
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5
Q

What is the definition oh hypothermia?

A

condition where bodys temp drops below that required for normal metabolism and function.

Below 35 degrees

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6
Q

what are the neuroprotective benefits of hypothermia

A
  • reduced cerebral metabolism
  • reduce the risk of brain oedema
  • reduce risk of seizure activity
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7
Q

what are the cardioprotective benefits of hypothermia

A

may reduce infarct size

  • may help preserve ATP levels
  • improve microvascular flow
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8
Q

What is the ischaemic tolerance at temps less than 20 degrees?

A

10 x times the normothermic level

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9
Q

What are the major ways of losing heat?

A
  • Evaporation
  • Respiration
  • conduction
  • Convection
  • radiation
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10
Q

What are the predisposing risk factors to hypothermia

A
  • Age of patient (children and elderly art risk
  • health of patient
  • medications
  • length of exposure
  • intensity of exposure
  • coexisting weather conditions
  • alcohol or drug use
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11
Q

why are children at greater risk of hypothermia?

A
  • lose heat faster than adults
  • larger head to body ratio
  • ignore cold cos they having fun
  • lack judgement
  • infants have less efficient mechanisms for generating heat
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12
Q

why are elderly at greater risk of hypothermia?

A
  • reduced ability to generate heat due to decreased body mass
  • sympathetic thermogensis in brown adipose tissue reduced
  • reduced ability to vasoconstrict
  • reduced shivering response
  • impaired mobility
  • inadequate diet
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13
Q

what conditions can lead to impaired thermoregulation in the elderly?

A
  • stroke
  • cns trauma
  • infection
  • tumours
  • haemorrhage
  • renal disease
  • parkinsons
  • MS
  • Wenicke’s

Most common = Sepsis

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14
Q

What drugs precipitate hypothermia?

A
  • ethanol
  • barbituates
  • benzodiazapines
  • opiods
  • alpha blockers
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15
Q

What endocrine conditions can cause hypothermia?

A
  • Hypothyroidism
  • Hypoadrenalism
  • Hypopituitarism
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16
Q

why does hypothermia kill?

A
  • cell membranes ionic integrity decreased
  • ion leakage occurs
  • cell death occurs
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17
Q

What does hypothermia do to the oxyhaemoglobin dissociation curve?

A

shifts it left

  • increased affinity for o2 on haemoglobin
  • doesn’t release oxygen
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18
Q

how does hypothermia affect haemotology?

A
  • slow down clotting

- viscous blood due to increase cryofibrinogen

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19
Q

how does hypothermia affect nerve transmission?

A

slows down

- reduced flux of potassium and chloride across membrane

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20
Q

what happens to our joints with hypothermia>?

A

synovial fluid thickens making joints stiff

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21
Q

how much heat loss does respiratory account for?>

A

10-30%

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22
Q

what happens to urine level with mild hypothermia?

A

Mild:
increases initially then decreases.

Moderate:
glomerular filtration decreases

Severe:
H+ ion secretion reduced, contributing to acidosis

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23
Q

what percentage does the bodies metabolism decrease with every degree in temp it decreases?

A

6% for every degree

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24
Q

how does hypothermia impact the gastrointestinal tract?

A

slows under 34

stops under 28

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25
Q

What cardiovascular changes are seen in hypothermia?

A
  • decrease depolarisation of pacemaker cells = causing brady
  • MAP decreases
  • osborne waves on ECG
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26
Q

What temp do osborne waves start to show?

A

under 33 degrees

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27
Q

what are the stages of hypothermia?

A

Normal - 36-37
Mild - 35-32
Moderate - 32 - 28
Severe - below 28

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28
Q

What are the clinical manifestations of mild hypothermia? 32 - 35 degrees

A
  • shivering
  • increased RR
  • increased HR
  • Vasoconstriction
  • Lethargy
  • Ataxia
  • stiff uncoordinated muscles
  • poor judgement
  • slurred speech
  • amnesia
  • hyperglycaemia
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29
Q

what temp does shivering stop?

A

under 32 degrees

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30
Q

What are the clinical manifestations of moderate hypothermia? 32 - 28 degrees

A
  • shivering stops
  • Pale
  • Lips, ears, fingers turn white (from blue)
  • pupils dilate
  • stupor - sleepy
  • BP unobtainable
  • Cardiac arrhythmias - start around 30 degrees
  • progressive decrease in HR, RR and BP
  • Eventually unconscious
  • bottom of range - VF likely
  • no muscle reflexes or voluntary movements
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31
Q

What are the clinical manifestations of severe hypothermia? below 28 degrees

A
  • lose ability to spontaneously return to normal
  • further declinein HR, RR and BP
  • bloodPH drops (become acidodic)
  • electrolyte imbalances emerge
  • hypovolaemia due to cold diuresis
  • cerebral blood flow decreased by 66%
  • hypotension
  • pulmonary oedema
  • pupils not reactive
  • prolonged PR, QRS, QT intervals, and diminished or absent p waves
  • osborne waves
  • ventricular standstill
  • no response to pain
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32
Q

what are some local effects of cold?

A

frostbite:

  • anaesthesia
  • skin with waxy cold and stiff
  • mottling and blisters
  • discoloured
  • oedema

Trench foot:
- like frostbite but occurs at temperatures above freezing

Chillblains:
- damage to nerves and small blood vessels in hands and feet

Raynaud’s syndrome:
- small arteries that supply your skin narrow, collapsing circulation

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33
Q

how do you treat someone with frostbite?

A
  • do not thaw if posibility of re-freezing
  • don’t rewarm if pt needs to walk out
  • dont massage
  • dont break blisters
  • administer pain relief before thawing/warming
  • elevate and immobilise body part
  • cover with loose, dry, sterile dressing
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34
Q

how do you treat trench foot?

A
  • dry
  • gradually warm
  • aerate foot
  • analgesia
  • do not break blisters
  • elevate foot
  • cover with loose, dry, sterile dressing
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35
Q

How do you treat chillblains?

A

gradually warm

  • avoid direct heat
  • elevate
  • anaglesia for pain
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36
Q

How do you treat raynauds?

A
  • warm affected area

- emmerse in water

37
Q

what can happen to gag reflex in hypothermia?

A

may be depressed so increased risk of aspiration

38
Q

how long should you measure pulse and resp in hypothermic patient?

A

30 seconds to 1 min

39
Q

What temperature do you warm your fluids to for hypothermic patients?

A

37 - 42 degrees

40
Q

What is the treatment for hypothermia in the CPG’s?

A

mild: no fluids. warm

moderate/sever hypothermia (below 32):
10ml/kg (max 40) warmed to 37-42

Fluids only for under 32 degrees

41
Q

What changes in hypothermic cardiac arrest?

A

under 30 degrees
no more than 3 shocks
adrenaline intervals double to 8 mins

42
Q

what is rewarming shock?

A

as warming occurs, blood vessels dilate causing the return of cold blood and acids to the core

causes paradoxical core temp decrease

causes bp to drop

43
Q

what effects does hyperthermia have on cell structure?

A

damages proteins

  • collapse of cytoskeleton
  • swelling mitochondria
44
Q

what happens to Na+/K+ pump during hyperthermia?

A

during heat stress various processes increase such as the Na=/K= pump.

this utilises ATP and consequentially produces more heat

eventually cells become energy depleted and regular cellular functions are effected.

45
Q

What happens in the liver with hyperthtermia?

A

reduced blood flow through liver, hence reduced o2 and nutrients

can lead to thermal damage and ischaemia of liver

46
Q

what happend to haematology during hyperthermia?

A

heat damages vascular endothelium

  • coagulation cascades and platelet aggrigation can occur
  • thrombosis can occur leading to organ damage and failure

Can use up all clotting factors and bleed out

47
Q

What is rhabdomyolysis?

A

where skeletal muscle is damaged and cell contents leak out into the blood

48
Q

What is a key issue occuring with rhabdomyolysis?

A

myoglobin cannot be filtered properly by kidneys, ends up building up in kidney tubules leading to renal failure/damage

49
Q

what happens with the kidneys in hyperthermia?

A

Plasma K+ increasing due to loss of ions in cells

  • excess K+ not excreted leading to hyperkalaemia
  • can lead to VF
50
Q

WHat happens in cardiovascular systems with hyperthermia?

A
  • increased HR and CO
  • Vasoconstriction to organs and skeletal muscles, pushes blood to skin… increase in BP
  • Over time HR + BP decrease due to fluid loss
  • Arrhythmia can occur
51
Q

WHat happens in lungs and resp systems with hyperthermia?

A

TV and RR increase to meet metabolic demand

RR usually increases faster than HR, leading to CO2 levels diminishign too quickly

  • decreased co2 leads to resp alkalosis
  • over time rr drops leading to resp acidosis
52
Q

What does hyperthermia do to the oxyhaemoglobin dissociation curve?

A

shifts right

decreases affintiy of o2

due to temp and also low pH

53
Q

What temp classifies hyperthermia?

A

over 40 degrees

54
Q

what happens at ekevated core body temps?

A

enzymes cease to function
proteins denature
- cellular metabolism is hampered

55
Q

what temp is critical thermal maximum?

A

over 43 degrees.

56
Q

what areas are responsible for thermo regulation?

A

Posterior hypothalamus

57
Q

Where are the bodies thermoreceptors located?

A
  • skin
  • peripheral (body core and blood vessel walls)
  • central thermoreceptors (hypothalamus)
58
Q

What are some factors affecting thermoregulation?

A
  • age
  • health
  • medications
  • exposure time
59
Q

Where is most heat produced in the body?

A

deep organs:

  • liver
  • brain
  • heart
  • skeletal muscles during activity
60
Q

What are the signs and symptoms of hyperthermia?

A

Heat Stress:

  • sweating
  • increased skin temp

Thermolysis:
- altered level of consciousness

Manifestations:

  • heat cramps
  • heat exhaustion
  • heat stroke
61
Q

what are signs and symptoms of dehydration in heat disorders?

A
  • nausea
  • vomitting
  • abdominal distress
  • vision disturbance
  • decreased dark urine
  • poor skin turgor
  • signs of hypovolaemic shock
62
Q

how do you treat dehydration in heat disorders?

A

oral fluids if people are alert

iv fluids

63
Q

signs and symptoms of heat exhaustion and EAC?

A

cool (warm) skin with heavy perspiration

breathing is shallow and rapid

weak pulse

headache/anxiety/paresthesia/impaired jugement

64
Q

what defines heat stroke?

A
  • over 40.5 degrees
  • hot dry skin
  • altered mental status
65
Q

what are the 2 categories of heat stroke?

A
  • exertional

- non-exertional

66
Q

Define the categories for heat exhaustion (moderate) and heat stroke (severe)?

A

Heat exhaustion:
- under 40 degrees

Heat stroke:
- over 40 degrees

67
Q

What are the signs for heat exhaustion?

A
  • under 40 degrees
  • tachycardia
  • hypotension
  • syncope
  • diaphoresis
68
Q

What are the symptoms for heat exhaustion?

A
  • headache
  • weakness
  • nausea & vomiting
  • ALtered CS
  • muscle cramps
69
Q

What are the signs for heat stroke?

A
  • over 40 degrees
  • tachycardia
  • hypotension
  • tachypnoea
  • absence of sweating
70
Q

What are the symptoms for heat stroke?

A
  • nausea & vomiting
  • agitated state
  • altered conscious state
  • unconscoious
71
Q

how do you treat hyperthermia as per AV CPG’s?

A

use colling techniques till temp is 38 degrees

if dehydrated - saline max 40ml/kg

if pt is over 40 degrees use cool fluids

stop cool fluids at 39 degrees

72
Q

what is pyrexia?

A

fever

73
Q

Describe BOYLES LAW?

A

volume of gas inversely related to pressure.

74
Q

Describe DALTONS LAW?

A

in gas mixtures, partial pressure is exerted in proportion to the percentage of mixture

75
Q

Describe HENRY’s LAW?

A

more gas will be dissolved into a liquid at high pressure, less gas at low pressures

76
Q

What is barotrauma?

A

tissue damage resulting from the expansion or contracting of enclosed gas spaces, due to changes in gas volumes

77
Q

What are the 2 types of gas filled compartments in the body?

A
  • compressible compartments

- non-compressible compartments

78
Q

what are compressible compartments in the body?

A
  • middle ear space
  • sinuses
  • lungs
79
Q

what are non- compressible compartments in the body?

A

Teeth
bone
liquids

80
Q

What types of ear barotrauma are there?

A

External ear barotrauma
Middle ear
Inner ear

81
Q

What are the signs and symptoms of sinus barotrauma?

A

pain and fullness over sinus

82
Q

What does CAGE stand for?

A

cerebral arterial gas embolism

83
Q

what are signs and symptoms of CAGE and AGE?

A
  • sudden on set
  • altered GSC
  • cardiorespiratory collapse
  • confusion/disorientation
  • parasesthia
  • paralysis
  • weakness
  • visual and speech disturbances
  • convulsions
84
Q

what is the treatment for CAGE and AGE?

A 
lie flat
100% o2
treat for shock
IV access
monitor
recompression facility
85
Q

what is decompression illness?

A

multisystem disorder resulting from nitrogen in compressed air

  • forms bubbles in tissues and blood
  • occurs when ambient pressure decreases
  • diver ascends too quickly >10M/min
86
Q

what factors affect decompression illness?

A 
alcohol
smoking
dehydration
fatty tissues
drugs
fatugue
medication
87
Q

What are S&S of decompression illness?

A
  • rarely occur immediately
    50% begin less than 1 hour
    90% occur within 6 hours
    small % over 24 hours
  • skin discolouration and itching
  • joints ache and pain
  • nervous system numbness, weakness, balance, paraysis
  • heart and lungs - low BP, shock, cyanosis, double vision
88
Q

how do you treat DCI?

A

lie flat
100% o2
IV
transport to recompression

89
Q

what considerations are there for transporting DCI patients?

A

can’t go above 300m
consider diving buddy
transport diving comp and diving equipment with pt

PAR2022 - Trauma (12 decks)

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