MedSurgII-Cold related ER's

cdunbar4's version from 2017-03-21 03:15

Cold related emergencies

Can be localized or systemic ; frostbite or hypothermia
Question Answer
Contributing factorsage, duration of exposure, environmental temps, homelessness, pre-existng conditions (DM, PVD)
Meds that suppress shiveringopioids, psychotropic agents, antiemetics.
Also, ETOH intoxication which does what to thermoregulation?causes peripheral vasodilation, increases sensation of warmth, and depresses shivering
Frostbitetrue tissue freezing that results in the formation of ice crystals in the tissues and cells.
Superficial frostbiteinvolves skin and subcutaneous tissue, usually the ears, nose, fingers, and toes. The skin appearance ranges from waxy pale yellow to blue to mottled, and the skin feels crunchy and frozen.

ER Management Table 69-9

Question Answer
Environmental etiology• Inadequate clothing for environmental temperature • Prolonged exposure to cold • Prolonged immersion or near-drowning
Metabolic etiologyHypoglycemia or hypothyroidism
Health care associated etiology• Administration of neuromuscular blocking agents • Blood administration • Cold IV fluids • Inadequate warming or rewarming in the ED or operating room
Other etiologies (substance/drug classes)alcohol, barbituates, phenothiazines, shock, trauma
Core body temp. of mild hypothermia93.2-98.6F
Core body temp moderate hypothermia86-93.2
Core body temp SEVERE hypothermia< or = 86F
Assessment findings respirations & BPhypoventilation & hypotension
Mental statusranges from confusion to coma
Areflexiaabsence of reflexes
Skin characteristicspale, cyanotic, blue, white or frozen extremeties
Dysrhythmiasbrady, afib, vfib, asystole
Pupilsfixed, dilated
Initial ER interventions similar to burnsremove pt. from cold area, ABCs, high-flow O2 via nonrebreather; anticipate intubation or absent gag reflex; 2 large bore IVs for fluids
Passive rewarming of patientremove wet clothes, put on warm clothes (no shit?)
Active external rewarmingApply heating devices (e.g., air or fluid-filled warming blankets), use warm water immersion.
Active internalProvide warmed IV fluids; heated, humidified O2. Peritoneal lavage with warmed fluids. Extracorporeal circulation (e.g., cardiopulmonary bypass, rapid fluid infuser, hemodialysis).
Other initial ER interventions12-lead ECG; anticipate defib; warm trunk first; assess for other injuries; keep pt.'s head covered with warm, dry towels or stocking cap
Ongoing monitoring• Monitor ABCs, temperature, level of consciousness, vital signs. • Monitor O2 saturation, heart rate and rhythm. • Monitor electrolytes, glucose.

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