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36 Cards in this Set
- Front
- Back
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What is the most effective mechanism of heat loss?
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EVAPORATIVE COOLING
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Is heat stroke more likely in DESERT or in TROPICS?
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TROPICS
higher humidity --> less effective evaporative cooling |
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Heat damage to tissue - DIRECT EFFECTS?
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- protein denaturation
- cell membrane fluidity/breakdown - accelerate biochemical reactions --> metabolic abnl - apoptosis / necrosis |
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Heat damage to tissues - INDIRECT EFFECTS?
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-->+ inflammatory cytokines / SIRS
-->+ coagulation cascade / DIC |
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Heat edema
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hand/feet swelling
2/2 water retention occurs in NON-acclimated person |
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Heat rash
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"prickly heat"
maculo-papular rash 2/2 excessive weating and blockage of sweat ducts; occurs on parts of body coveed by tight clothing (waist band) |
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Heat cramps
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PAINFUL spasms of LARGE muscles AFTER exercise
Tx: gatorade, IVF, stretches |
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Heat tetany
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occurs in setting of heat stress + HYPERVENT
carpopedal spasms perioral paresthesias |
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Heat syncope
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2/2 vasodilation
NO PERSISTENT AMS/confusion |
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Heat exhaustion
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2/2 excessive sweating, electrolyte depletion
(EXHAUSTED compensation) |
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Heat stroke
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2/2 FAILED compensation
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Heat exhaustion
Sx? Tx? |
flu-like Sx, n/v, weakness
+ diaphoresis T < 40C Tx: PO or IVF |
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Heat stroke
Sx? |
AMS, SZ, n/v, weakness, DIC
ACUTE ORGAN FAILURES, ISCHEMIA - diaphoresis T > 40C |
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Heat stroke - DDx 2 types?
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Exertional:
-athletes, laborers, military recruits -NORMAL thermoregulatory system OVERWHELMED, not acclimatized Non-exertional: -infants, elders, EtOH, chronically ill, poor (NO A/C!) -ABNORMAL thermoregulatory system FAILS |
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Heat stroke - lab abnormalities?
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BMP: AKI, hyper/hypo-Na, hyper-/hypo-K, A-B abnl
CMP: transaminase elevation CBC: hemoconcentration, leukocytosis Coags: DIC RHABDO: CPK elevation, +blood dipstick |
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Heat stroke - Tx?
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** CANNOT cool TOO QUICKLY! **
RAPID COOLING (evaporative, cold IVF) IVF, O2, EKG E'lytes |
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Heat stroke - useful Rx?
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BZD to --| shivering
NO OTHER Rx with proven benefit (NO anti-pyretics, NO dantrolene) |
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Heat stroke - risk factors (lower the T threshold)
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- extremes of age
- dementia / inability to care for oneself - EtOH - B-BLOCKERS - chronically ill - obesity |
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Hyperthermia + AMS - DDx?
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- heat stroke
- Infx / sepsis / meningitis - status epilepticus - stroke - toxidromes (NMS, serotonin syndrome, malignant hyperthermia) - thyrotoxicosis - cocaine, amphetamines, caffeine - diuretics - phenothiazines, psychotropics |
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Immersion syndrome =
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sudden death after submersion in very cold water
likely 2/2 vagal-mediated asystole |
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wet drowning =
dry drownng = |
aspiration of water (80-90%)
asphyxia by laryngospasm WITHOUT aspiration (10-20%) |
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Events during drowning:
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Panic --> fatigue / air hunger --> reflex inspiration (aspiration) or laryngospasm (for minutes) --> asphyxia
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Drowning - pathophysiology:
Now believe that there is likely no difference btw fresh vs. salt water drownings |
Most victims do NOT aspirate enough water to case electrolyte abnormalities or non-cardiogenic pulmonary edema
#1 = asphyxia 2/2 laryngospasm |
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Drowning - PULMONARY pathophysiology
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#1 = asphyxia (hypoxemia) 2/2 laryngospasm
combined R@ + NG M@ pneumonitis 2/2 aspiration of H2O, emesis ARDS 2/2 pulmonary edema atelectrauma 2/2 loss of surfactant BACTERIAL INFX --> abscess or empyema |
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Drowning- CARDIOVASCULAR pathophysiology?
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hypoxemia, acidosis, hypothermia
--> Dysrhythmias, cardiac arrest |
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Drowning - Indications for INTUBATION?
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AMS, GCS<8, inability to protect airway
PaO2 < 60-90 on high-flow O2 non-rebreather |
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Drowning - adjunctive airway tx?
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nebulized B-agonists
bronchoscopy to remove particulate matter, secretions |
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Drowning - classic CXR findings?
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NORMAL CXR (EARLY)
pulmonary edema, peri-hilar infiltrates ARDS |
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Drowning - Indications for EMPIRIC ABx?
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ONLY if contaminated / sewage water
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Drowning - acidosis mgmt
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hyperventilation
NO role for bicarb |
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Drowning - glucocorticoid indications?
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NONE
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Drowning - barbiturate coma indications?
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NONE
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Drowning - therapeutic hypothermia indications?
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YES
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Cold-water submersion
- unique problems? |
INCR cardiac irritability 2/2 hypothermia
CONTINUE resuscitation UNTIL RE-WARMED before stopping |
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Submersion victim is recovering, doing well in ER.
Dispo? |
If ASx, MUST OBSERVE for at least 8 hours then discharge with return instructions.
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Drowning - POOR PROGNOSIS
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GCS =< 5
> 5 minutes submersion pH < 7.0 water temp > 10 C (77 F) Asystole upon arrival |
