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43 Cards in this Set
- Front
- Back
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radiation
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Heat loss directly into the environment. Heat is transferred by electromagnetic waves. Accounts for 55-65% of heat loss by people in cool climates. The larger the temperature gradient, the larger the heat loss
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conduction
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Heat transfer form object to another The transfer of heat energy from warmer to cooler objects by direct physical contact.
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convection
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inc w/wind Transfer of heat through circulating air.
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evaporation
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the conversion of a liquid to a gas. The body accomplishes this through sweating. The cooling effect which occurs through drying of sweat on the surface of the body.
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Hypothermia
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o A state of low body temperature, specifically low body core temperature below 35oC
o Based on heat loss versus heat gained o If heat loss exceeds heat gain → hypothermia |
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non freezing, local cold emergencies
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• Chilblains
• Trench foot |
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What is chilblains
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o Caused by chronic exposure to damp, nonfreezing ambient temperatures
o Painful, inflammatory lesions on skin • Hands, ears, lower legs, feet common sites o Pruritus, burning, paresthesias |
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Frostnip?
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o Freezing of the skin but not the deeper surface
o Extremity appears pale, discomfort present o No extracellular ice crystal formation o Symptoms resolve on rewarming |
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frost bite
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o Localized cold injury causing freezing of tissue
o Treatment is directed at saving as many cells as possible in the skin and underlying tissue |
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1st degree frost bite
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• Partial skin freezing; redness, mild edema; firm white or yellow plaque in the area of injury, lack of blisters
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second degree frost bite
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• Superficial skin blisters with clear and milky fluid, surrounding erythema and edema
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3rd degree frost bite
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• Full-thickness skin and subcutaneous freezing; hemorrhagic blisters, skin necrosis, bluish-gray discoloration. Extends into the deep dermis.
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4th degree frost bite
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• Involves tissue below the dermis, with muscle and bone involvement. Digit or extremity eventually becomes dry, black and mummified
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What layers does deep frost bite affect
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dermal & subdermal layers of tissue
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Primary hypothermia
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• Spontaneous reduction in body temperature from exposure to a cold environment without adequate protection
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Secondary hypothermia
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• Occurs as a complication in patients with a systemic disease that compromises the body’s thermoregulatory mechanisms
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What causes cold diuresis
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Depression of ADH release → Increased urine output, “cold diuresis
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Mild, mod and severe hypothermia
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o Mild: core body temperature 93.2-96.8oF
o Moderate: core body temperature 86-93.2oF o Severe: core body temperature <86oF |
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Possible causes of paradoxical undressing
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o May occur as a cold-induced malfunction of the hypothalamus
o May also occur secondary to loss of vasomotor tone resulting in vasodilatation |
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hypothermia ECG
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o Bradycardia (possibly unresponsive to atropine)
o Small, absent P wave o Abnormal ST segments, T waves o J (Osborn) wave – will disappear as you warm up the patient • No prognostic significance |
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heat stroke versus heat exhaustion?
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Heat Stroke
o Dry, hot skin o Very high body temperature Heat Exhaustion o Moist clammy skin o Normal or subnormal temperature |
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Heat stroke triad
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o Temp > 40.50 C (104.90)
o CNS dysfunction o Anhidrosis |
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what can increased temp do?
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damages hypothalamus
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exertional heat stroke?
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• Occurs in healthy, young people in hot environments
• Due to vigorous activity • Heat builds up faster than it is removed • Damage to hypothalamus occurs • Patient sweats heavily |
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classic heat stroke
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• Seen in times of high ambient heat and humidity
• Slow evolution, onset insidious • Increases exogenous heat gain with decreased heat dispersal • Elderly, poor, infants, and chronically ill at greatest risk. |
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Antipyretics in heat stroke?
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o NO ROLE FOR ANTIPYRETICS!!!! - tylenol
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Hymenoptera includes
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o Honeybees (apis sp.)
o Wasps, yellow jackets, hornets (vespid sp) – fire ants, harvester ants |
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delayed reaction?
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eadache
• Malaise • Fever • Polyarthritis • Generalized pruritus |
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mild to mod epi dose
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• Epinephrine 1:1000
• Usual dose 0.3 mg (same as epi-pen) • IM dosing in thigh preferred (multiple studies demonstrating benefit over SC dosing in deltoid) • Repeat every 15 minutes prn |
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severe epi
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• Epinephrine 1:10,000
• Usual dose 0.1mg (100ug) • Can use cardiac epinephrine - 1cc = 100ug • Infuse over ~3-5 minutes |
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two dangerous spiders
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o Black widow (Latrodectus mactans)
o Brown recluse (Loxosceles reclusa) |
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What do black widows look like? describe venom
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o Glossy black with characteristic red “hourglass” on abdomen
o Venom is a potent neurotoxin that causes acetylcholine depletion from nerve terminals, leading to painful muscle spasm |
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systemic black widow sx
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dizziness, headache, nausea, itching, increased salivation, weakness
o Patient may develop cramps that mimic an acute abdomen or myocardial infarction |
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local black widow sx
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: Immediate sharp, stinging pain at the bite site followed by cramping and numbness that slowly spreads
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TX brown recluse
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o Prehospital care includes ice to the wound and possibly bringing the arachnid in for identification
o Stabilize patient o Appropriate monitoring o Treat hypertension with nitroprusside if BP > 130mm Hg o Local cleansing (chlorhexidine) of the bite and tetanus administration o Muscle relaxants (Valium) and analgesia to treat muscle spasm (calcium chloride) o Anti-venin: very old, very young, pregnant women, patients with pre-existing conditions and those with serious symptoms |
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brown recluse venom does what
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local tissue damage (as opposed to the neurotoxin of the black widow)
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brown recluse w/in two hours
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Local pain, blue-gray halo develops with a central, dark blister or bleb
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brown recluse progression
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•12 to 18 hours: Bleb formation, growing ischemic zone
•5 to 7 days: Aseptic necrosis, necrotic ulcer → need for debridement, wound care, possibly skin graft •Severe lesions up to 30 cm in diameter |
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Poisonous snakes in US
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o Rattlesnake
o Cottonmouth o Copperhead o Coral snake |
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How can you tell it is a coral snake?
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o “Red on yellow, kill a fellow. Red on black, venom lack”
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most deaths from coral snakes?
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respiratory arrest within 36 hours
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What should you avoid with marine stings
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• Avoid irrigating the wound with fresh water because it can stimulate the release of toxin
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o If venomous glands remain in the wound of puncture what should you do
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immerse the area in as hot water as the patient can stand for one hour. This will neutralize the heat-labile venom
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