Environmental Emergencies - Heat Illness

Front 1

a hypothermic patient with a normal Hct is likely

Back 1

anemic

Front 2

in hypothermia atrial dysrythmias resolve with

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rewarming and dont need tretment

Front 3

insulin is innefective at

Back 3

temperatures less than 30 degrees

Front 4

IV fluid rewarming

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can take place in a microwave, the bag should be shaken to prevent hot spots

Front 5

unreliable temps

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tympanic, oral and bladder temperatures

Front 6

caution of drug adm in hypothermia

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cardiac and other drugs are not absorbed well orally or IM and are likely to remain inactive until rewarming occurs

Front 7

failure to handle a hypothermic patient gently may precipitate

Back 7

VF

Front 8

mandatory in hypothermia is

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intubation unless patient is alert and protecting airway also both an NG tube and foley should be carefull inserted...monitor temperature using an esophageal probe

Front 9

in the hypothermic patient in VF

Back 9

CPR with three defibrillation attempts hoever this is usually unsuccesful if the temp is less than 30 start CPR if the patient does not have a perfusing rhythm . Atrial dysrhythmias do not require medical treatment as they resolve with rewarming

Front 10

replace volume in a hypothermic patient with what

Back 10

D5NS

Front 11

All IVs in the hypothermic patient should be heated to

Back 11

40-42 C

Front 12

protein binding of drugs does what in hypothermia

Back 12

increases further limiting there availability

Front 13

passive rewarming refers to

Back 13

methods which use heat generated by the patient

Front 14

when to use passive rewarming

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mild hypothermia of 32-35 degrees celsius

Front 15

when to use active rewarming

Back 15

hypothermic patients with core body temperatures less than 32 with cardiovascular instability, or with underlying conditions predisposing to hypothermia

Front 16

what is the most common method of active core rewarming

Back 16

peritoneal lavage and blood rewarming techniques

Front 17

these patients can generally be D/Ced safely

Back 17

otherwise healthy patients with mild hypothermia due to cold exposure usually have no difficulty in rewarming all others require admission

Front 18

serum potassium levels in hypothermis

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levels greater than 10meq/L may correlate with an inability to resuscitate the hypothermic patient this degree of hyperkalemia is amrker for cell lysis

Front 19

with every 1 degree drop in celsius hematocrit ...

Back 19

increases by 2%

Front 20

blood glucose is what during hypothermia

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increased because endogenous insulin is inactive at temperatures below 30-32

Front 21

immobility is associated with hypothermia and immobility is can cause

Back 21

rhabdomyolysis

Front 22

should corrected blood gases be used to guide treatment in hypothermics

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nope

Front 23

Most common dysrhythmia other than sinus origin rate disturbances (tach, brady)

Back 23

a fib

Front 24

ECG changes associated with hypothermia

Back 24

prolongation of PR, QRS and QT interval and the J wave (slow deflection at the junction of the QRS complex and ST segment, is acommon finding these waves are usually upright in left sided precordial leads

Front 25

J wave

Back 25

slow deflection at the junction of the QRS complex and ST segment, is acommon finding these waves are usually upright in left sided precordial leads

Front 26

hypothermia is defined as

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core temp less than 35, primary hypothermia effects ptherwise healthy patients and is caused by cold environmental exposure

Front 27

secondary hypothermia is associated with

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sepsis, trauma, dz of hypoendocrine state, any condition that effects hypothalimic fxn

Front 28

DKA can cause hypothermia

Back 28

DKA can cause hypothermia

Front 29

IAtrogenic hypothermia is of particularl importance in trauma patients this is why

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all trauma patients should be resucitated with IV fluids wamred to 40

Front 30

drugs that can decrease the shivering effect

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phnothiazines, meperidine, buspirone

Front 31

patients with ALOC and hypothermia should

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other (other than hypothermia) etiologies considered as the cause

Front 32

if a glass thermometer is used it must be

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a low reading one

remember rectal temps lag behind changes in core, bladder temps are less reliable than rectal

Front 33

what occurs intially when a patient cools

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tachycardia after which there is progressive bradycardia...the heart rate is about 50% normal at a core temperature of 28 therefore if the heart rate is faster than would be expected other causes of tach should be sought i.e hypoglycemia or drug ingestions

blood pressure and RR initially increase before declining

Front 34

neurologic findings in hypothermia

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dysrthria and ataxia, shivering is maximal at 35 degrees and decreases until gone at 31 degrees