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121 Cards in this Set
- Front
- Back
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What is the most inaccurate way to take temp measurement?
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Axillary
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What temp measurement has a wide variability?
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TM
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What temp measurement is affected by ventilation?
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Oral
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What temp measurement needs a hypothermia thermometer?
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Rectal
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__ is the temp of deep structures of body that usually don't vary >1-2 degrees from normal temp and maintained by metabolism
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Core temp
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__ is generation of energy where heat is the byproduct
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Metabolism
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What regulates body temp?
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Hypothalmus
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__ is when heat production exceeds heat loss
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hyperthermia (inc body temp; core temp>101 degrees F)
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__ is when heat loss exceeds heat production
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hypothermia (dec body temp; core temp<35 degrees C/ <95 degrees F)
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What are the 5 mechanisms of heat loss/transfer?
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convection, radiation, respiration, evaporation, conduction
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__ is heat loss directly into the environment by electromagnetic waves; larger the temp gradiant, the larger the heat loss
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Radiation (55-60% heat loss)
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__ is heat transfer from object to another by direct physical contact (i.e. water chill and water immersion)
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Conduction (3% heat loss)
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__ is transfer of heat thru circulating air; effect dec as temp inc (i.e. wind chill)
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Convection (10% heat loss)
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__ conversion of liquid to gas by sweating and cooling effect occurs thru drying of sweat on surface of body; ambient temp inc, primary way to eliminate heat (i.e. humidity)
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Evaporation (25% heat loss)
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__ accounts for 2-9% heat loss
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Respiration
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What are the factors that affect body temp?
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physical condition, age, nutrition/hydration, environmental condtions
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What are the 4 types of local cold emergencies?
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nonfreezing:
Chilblains Trench foot freezing: Frostnip Frostbite |
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__ is a localized condition in which specific body tissues freeze; water lies in and around the cells damaging the cells when the water freezes eventually causing gangrene
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Frostnip
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__ is caused by chronic exposure to damp nonfreezing ambient temp leading to painful, inflammatory lesions on skin, pruritus, burning, and paresthesias
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Chilblains (Pernio)
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tx of Chilblains
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supportive: gentle rewarming, bandage, elevate
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__ is caused by prolonged exposure of foot to cold water leading to tissue damage thru soft tissue cell, blood vessels, and nerves; skin becomes pale, mottled, and anesthetic (sloughing, gangrene possible)
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Trench foot (immersion foot)
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tx of Trench foot
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local skin care, elevation, rest
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__ is freezing of the skin but not the deeper surface; extremity appear pale, discomfort present, no extracellular ice crystal formation
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Frostnip
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tx of Frostnip
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rewarming
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__ is localized cold injury causing freezing of tissue (usually toes, feet, hands, fingers, nose, ears); permanent inflammation, tenderness, cold intolerance (gangrene possible)
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Frostbite
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tx of Frostbite
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save as many cells as possible
pre-hospital tx: remove from cold/wet clothing, rapid transport, protect extremity/elevate, splint extremity, remove jewelry (DON"T rub/massage, allow refreezing, allow smoking, puncture blisters, apply heat, rewarm, use affected extremity) ED tx: correct hypothermia, rapid rewarm (104-108 degree F bath), wound care, parenteral analgesics, tetanus prophylaxis, debridement, aloe vera cream, elevation, ibruprofen, hydrotherapy, penicillin G |
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What is the difference between superficial and deep Frostbite?
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Superficial: affect dermis & shallow subcutaneous layer
Deep: affect dermal & subdermal layers |
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S/S of local cold injury
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Early/Superficial: blanching, feeling/sensation loss, soft skin, tingling sensation on rewarming
Late/Deep: white/waxy skin, firm/frozen, swelling, blisters, flush/purple/blanche/mottled/cyanotic when thawed |
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What is Phase I of Frostbite?
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exposure to cold, vasoconstriction, dec blood flow to periphery, ice crystal formation in extracellular space, ischemia, cellular dehydration, hyperosmolarity, edema, inc pressure, blood vessel damage, worsened ischemia, cellular component destruction
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What is Phase II of Frostbite?
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tissue rewarmed, blood flow return, damaged capillaries leak fluid, swelling, sludging blood, thrombus formation
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Name Frostbite injury:
__ is partial skin freezing; redness, mild edema; firm white/yellow plaque in area of injury, lack of blisters |
1st degree injury
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Name Frostbite injury:
__ is superficial skin blisters with clear/milky fluid, surrounding erythema/edema |
2nd degree injury
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Name Frostbite injury:
__ is full-thickness skin/ subcutaneous freezing; hemorrhagic blisters, skin necrosis, bluish-gray discoloration; extend into deep dermis |
3rd degree injury
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Name Frostbite injury:
__ involves tissue below dermis, with muscle/bone involvement; digit/extremity eventually becomes dry, black, mummified |
4th degree injury
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What is the difference between primary hypothermia and secondary hypothermia?
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Primary (accidental): spontaneous reduction in body temp from cold exposure without adequate protection
Secondary: occurs as complication with systemic dz that compromises body's thermoregulatory mechanisms |
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Risk factors for hypothermia
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extreme ages
chronic illness drug use/poisons (etoh, barbs, benzos, phenothiazines) cold environment dementia insufficient clothes/shelter outdoors sports |
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What are the 3 levels of hypothermia?
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mild: core body temp 93.2-96.8 degree F
mod: core body temp 86-93.2 degree F severe: core body temp <86 degree F |
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S/S of mild hypothermia
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mild-strong shiver
fine motor/complex motor skill loss lack of sound judgment confusion, apathy pale/cool/red/cyanotic skin piloerection rapid pulse/resp nausea visual disturbances lethargy warm sensation/paradoxical undressing |
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S/S of mod-severe hypothermia
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fine motor coordination loss
slurred speech/violent shiver irrational behavior dazed consciousness mood changes/lethargy/impaired judgment stiff muscle/joints shiver stops muscular activity dec/stop pale, cyanotic lips/ears/fingers/toes |
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S/S of severe hypothermia
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dec vital signs
shallow/absent resp cardiac arrhythmias slow pupillaryrxn cardioresp activity cessation skin pale pupils dilated bradycardic shiver stops fetal position muscle rigidity (dec peripheral blood flow/inc lactic acid & CO2) |
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What is seen on ECG with hypothermia?
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bradycardia
small/absent P waves abnormal ST seg/ T waves J (Osborn) waves |
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What are the 3 methods of rewarming?
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Passive external rewarming (PER)
Active external rewarming (AER) Active core rewarming (ACR) |
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When and how is PER used?
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mild hypothermia
includes: shelter, blankets, heated environment, removal of wet clothing |
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When and how is AER used?
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mod-severe hypothermia
includes: warm bath, hot water bottles, heat lamp, heating blankets |
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When and how is ACR used?
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mod-severe hypothermia
includes: heated humidified O2, warmed IVF, warm fluid lavage (NG, peritoneal, thoracic, colonic), extracorporeal rewarming |
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How is extracorporeal rewarming accomplished?
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hemodialysis, arteriovenous extracorporeal rewarming, cardiopulm bypass
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Causes of dec heat dispersal
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dehydration, obesity, heavy/impermeable clothing, poor physical fitness, lack of acclimatization, CVD, skin changes, extreme ages, lack of mobility, febrile illnesses, hyperthyroidism, alcoholism, drug use (cocaine/amphetamines/opiates/LSD/PCP), poor socioeconomic, prolonged exertion, meds (antipsychotics/anticholinergics/CCB/BB/diurectics/alpha agonists/sympathomimetics)
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What are 4 types of heat illnesses?
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minor heat illness
heat exhaustion heat stroke unusual heat d/o |
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What is included in minor heat illness?
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heat rash
heat edema heat cramps heat syncope heat tetany |
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__ is a skin ailment marked by small/itchy rashes that is especially common in tropics/summer and children/infants
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Miliaria (sweat rash/prickly heat)
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tx of Heat rash
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cool/less humid environment
cool showers/baths loose clothes/light fabric mild cortisone cream/calamine lotion/oral antihistamines/powder |
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__ is d/t cutaneous vasodilation/ orthostatic pooling of interstitial fluid in extremities most often seen in elderly/non-acclimated travelers; tx self limited/ leg elevation
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Heat edema
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__ is painful spasmodic contractions of skeletal muscle that usually occurs after exercise/latent period; tx with rest, oral salt(0.1%) rehydration, IVF(0.9% saline)
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Heat cramps
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__ occurs (esp elderly) to hot exposure resulting from cumulative effect of peripheral vasodilation, relative hypovolemia, dec cardiac output, and dec cerebral perfusion; tx with rehydration, removal from heat, rest, support hose, flex legs, and sitting
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Heat syncope
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__ is hyperventilation resulting in resp alkalosis, paresthesia, and carpopedal spasm; tx with removal from heat and dec resp
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Heat tetany
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__ is a clinical syndrome characterized by vol depletion by heat stress exposure that can occur at rest with young/old people;
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Heat exhaustion
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S/S of heat exhaustion
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dizziness, weakness, fainting, dry tongue/mouth, inc thirst, cold/clammy skin, normal-inc vitals/body temp
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dx and tx of heat exhaustion
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dx: H+P, CBC, lytes, LFT, BUN/Cr, urine specific gravity
tx: remove clothes/hot environment, cool mist/fan/packs to neck/axilla/groin, correct fluid/lytes, rest |
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__ is an acute dangerous rxn to heat exposure that results when body fails to cool sufficiently (105 degree F/ 40 degree C) leading to brain damage, hot/flush skin, behavior change, dec LOC, slowing of rapid pulse, drop BP, and death
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Heat stroke
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heat stroke classic triad
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temp>40.5 degee C/ 104.9 degree F
CNS dysfunction anhidrosis |
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What are the 2 types of heat stroke?
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exertional
classic |
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What is exertional heat stroke?
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d/t vigorous activity
heat builds up faster than removed hypothalamus damage heavy sweating |
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What is classic heat stroke?
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slow evolution/onset insidious
inc exogenous heat gain with dec heat dispersal risks: elderly, poor, infant, chronically ill, lack of AC, CV dz, CV/anticholinergic drugs |
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S/S of heat stroke
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hot dry flush skin
rapid-slow pulse HA/dizziness/irritability weakness, n/v confusion, disorientation behavior change, unresponsiveness coma, death sweating, sz, hypoglycemia, resp alkalosis, lactic acidosis |
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DDx of heat stoke
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meningitis, encephalitis, status epilepticus, falciparum malaria, meds, malignant hyperthermia, DTs, typhoid fever, hypothalamic hemorrhage, thyroid storm
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dx and tx of heat stroke
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dx: H+P, CBC, lytes, cx, clotting studies, LFT, lactate, CK, myoglobin, pancreatic enzymes, LP, ECG
tx: stabilization, monitor, correct lytes, cooling, supportive (no antipyretics) benzos - shiver fluid/mannitol - myoglobinuria |
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Insects, spiders, and scorpions are what type of species?
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arthropods
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Pit viper, coral snakes are what type of species?
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reptiles
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What are the MC bite/sting death?
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insects (50%)
snakes (30%) spiders (14%) other (6%) |
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Hymenoptera includes what families?
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honeybees, wasps, yellow jackets, hornets, fire ants, harvester ants
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What is contained in Hymenoptera venom?
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histamine, serotonin, amines, phospholipase, hyaluronidase
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What are the 5 types of reactions from bite/sting?
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local rxn
toxic rxn anaphylactic rxn delayed rxn unusual rxn |
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__ is sudden sharp, burning pain that usually disappears over few hrs accompanied with edema, erythema, itching, wheal at site and airway obx (if around throat)
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local rxn
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__ is dramatic swelling, redness, and pain that persist for up to a wk and area adjacent to site may be involved including airway loss with tongue/throat sting
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large local rxn
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__ is when >10 stings induce systemic rxn secondary to large toxin load leading to vomiting, dizziness, syncope, edema, diarrhea, and possible convulsions/death
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toxic rxn
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__ is major cause of death assoc. with bee/wasp sting usually occurring within 1/2 hr of sting which induces antigen-antibody, IgE mediated systemic response (histamine/SRS-A released)
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anaphylactic rxn
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S/S of anaphylaxis
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pruritis, generalized urticaria, dry cough, wheezing, angioedema, laryngeal stridor, anxiety, distant edema, dyspnea, bronchospasm, cyanosis, ab cramps, n/v, shock, LOC, hypotension, death
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__ is serum sickness like presentation appearing ~2wk after sting with sx of HA, malaise, fever, polyarthritis, generalized pruritus
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delayed rxn
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__ may present similar to encephalopathy, vasculitis, neuritis, autonomic dysfunction
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unusual rxn
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tx of local rxn
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scrape out stinger
wash wound ice packs oral antihistamines/analgesics elevation/oral steroids (mod swelling) |
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tx of anaphylactic rxn
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ABCs
endotracheal intubation/surgical airway (Severe) local wound care IVF antihistamine steroids H2 blockers epinephrine (life-threatening) albuterol nebulizer (bronchospasm) dopamine infusion (hypotensive) |
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T/F: All spiders are venomous
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True
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What are the 2 dangerous spiders in the US?
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black widow (Latrodectus mactans)
brown recluse (Loxosceles reclusa) |
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__ are found in all states except Alaska; forms irregular webs in wood piles/trash dumps/outdoor structures/under rock; only females bite humans; glossy black with red hourglass on abdomen; neurotoxin venom causing painful muscle spasm
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black widow
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Sx of black widow venom
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local: immediate sharp stinging pain at site followed by cramping and numbness
systemic: dizziness, HA, nausea, itching, inc salivation, weakness mimic acute abdomen/MI |
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What is the timing of sx with black widow venom?
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onset: immediate
peak: few hrs duration: <24hrs - 4 days *most recover completely |
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tx of black widow venom
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Pre-hospital: ice/ ID arachnid
stabilization monitor nitroprusside (BP>130mmHg) local cleansing/tetanus admin muscle relaxants/analgesia (muscle spasm) anti-venom (old/young/pregnant/pre-exist conditions) |
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__ is a fiddle-back spider; violin shape on thorax; mc in SE/south central US; shy/nocturnal found in woodpiles, dry bark, dark closets, basements, attics; causes local tissue damage
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brown recluse
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What is the timing of s/s in brown recluse?
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onset: sharp little/no pain with mild stinging
within 2 hrs: local pain, blue-gray halo with central dark blister/bleb leading to rupture/ulcer with severe pain 12-18hrs: bleb formation with ischemic zone 5-7d: aseptic necrosis, necrotic ulcer |
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What is the difference between mild/ severe systemic effects of brown recluse?
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mild: fever, chills, malaise, n/v, joint pain
severe: DIC, hemolysis, renal failure, convulsion, HF, death |
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tx of brown recluse
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wound cleanse with soap and H2O
tetanus prophylaxis monitor steroids (within 24hrs) - no Dapsone abx/analgesics wound management/ surg consult |
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__ are nocturnal arachnids found mostly in SW US with only 1 potentially lethal type
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scorpions
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Presentation of Centuroides sculpturatus
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neurotoxin venom
only lethal scorpion in US Arizona/New Mexico mc sx: extreme restlessness, agitation, roving eye movements, poor coordination, slurred speech, difficulty swallowing, salivation, wheezing, stridor, tachycardia, tachypnea, htn, n/v |
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tx of Centuroides sculpturatus
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antivenin
ventilator support atropine diazepam opiates (contraindicated) |
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When are snake bites mc?
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apr-oct (jun/aug peak)
2pm-9pm 18-28 y/o men fingers/hands ethanol intoxication (risk factor) |
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What are the 4 types of poisonous snakes in the US?
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rattlesnake
cooperhead cottonmouth coral snake |
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Where are venomous snakes NOT found?
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Maine, Alaska, Hawaii
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Rattlesnakes, Copperheads, and Water moccasins (cotton mouth) are what type of venomous snakes?
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pit vipers (crotalidae)
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T/F: Colubrids are non-native to the US
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True
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Where do pit vipers store their poison and how do they inject it?
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stored: pits behind nostrils
inject poison to victum thru movable front fangs |
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Characteristics of pit vipers
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heavy bodies, diamond-shaped heads, vertical/elliptical pupil, heat sensing pit, erectile fangs, rattle tails, hemotoxic/neurotoxic venom
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What are the 2 common rattlesnakes of US?
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western diamondback and eastern diamondback
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What is the difference between eastern diamondback and western diamond back?
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eastern diamondback: largest, sullen disposition, 1in fangs, toxic venom, 5-7ft length
western diamondback: large amt venom in 1 bite, 4 1/2-6 1/2ft length |
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__ is CT species of mild temper that rattles with positive fatalities averaging 3 1/2-6 1/2ft length
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timber rattlesnake
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__ has very rare deaths, minimal edema and pain
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Copperhead
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__ is related to copperhead; >danger; highly toxic venom; South US; dark/black; 3 1/2-6 1/2ft length
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water moccasin
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__ are small thin bodies snakes with red/yellow/black bands, small fixed front fangs, small rounded head, injects venom with teeth, neurotoxic venom
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coral snake (elapids)
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S/S of coral snake bite
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little/no pain/swelling
tingling muscular incoordination weakness inc salivation difficulty swallowing/talking visual disturbances resp distress/failure shock |
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What is composed of crotalid venom?
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mix of enzymes, polypeptides, glycoproteins (tissue/nerve/capillary damage, hemolysis, host cell/coagulation factors breakdown)
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What is composed of coral snake venom?
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neurotoxin and enzymes (systemic neuro sx)
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__ is local swelling and other local changes; no systemic manifestations; normal lab findings
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minimal envenomation
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__ is swelling progressing beyond site of bite and >1 systemic manifestations (e.g. abnormal lab findings)
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moderate envenomation
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__ is marked local response, severe systemic manifestations, and significant alteration in lab findings
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severe envenomation
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tx of snake bite
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pre-hospital: transport
ed management: stabilize, exam, prophylaxis, debridement, antivenin (within 4hrs-questionable after 12hrs) |
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Adverse rxn of snake bite antivenin
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serum sickness
anaphylaxis contraindications (low severity/known sensitivity to horse/horse serum) |
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What should not be utilized in snakebite management?
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ice, arterial tourniquets, cut/suck, electrical shock, locating snake, bringing live snake to hospital
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What are the 3 classes of marine envenomation?
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envenomation by bite (sea snakes, octopus)
envenomation by nematocyst (coral, anemone, jellyfish) envenomation by stinger (sea urchinsm, stingray, lionfish) |
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__ are jellyfish/Portuguese man-of-war; responsible for more envenomation than any other marine life; nematocyte stinging cells
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coelenterates
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S/S of nematocytes
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intense burning pain
red hemorrhagic lesions n/v fever chills angioedema dyspnea, wheez, stridor hypotension, shock resp arrest CV collapse |
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tx of nematocytes
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Rinse affected area with seawater, inactivate nematocysts with 5% acetic acid (vinegar), and remove any tentacles to prevent further injury.
Avoid irrigating wound with fresh water b/c can stimulate release of toxin. |
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T/F: For Portuguese man-of-war stings, saltwater rinse can be used. Vinegar should not be used because it can activate undischarged nematocysts.
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True
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