Small Ani. Med- Enviro Emergencies 2

wilsbach's version from 2016-05-02 05:18


Question Answer
3 mechanisms of hypothermia?Increased heat loss, Reduced heat production, Disruption of thermoregulation
explain primary vs secondary hypothermiaPRIMARY: exposure to low temps. SECONDARY: Result of disease, trauma, surgery, drug Induced alteration <--more common (both can have mild, mod or severe ranges but dont need to mem)
Rate of heat production dependent on ...metabolic rate
where is most heat generated?metabolically active systems: Brain, organs, and active muscles
3 mechanisms of heat loss (again)(1) convection (body surface to air- think fan) (2) conduction (body to object like floor) (3) radiation heat transfer (surrounding structures not in contact) (4) Evaporative heat transfer (Loss from moisture on body surfaces (respiratory tract) to envt.)
how does hypothermia affect the CV system?Bradycardia, Hypotension, Arrhythmias, Reduced CO, Asystole! (can be mispronounced dead bc heart so slowed down!)
hypothermia affect on resp system? Reduced RR & depth, Pulmonary tissue injury, Oxygen dissociation disturbances, (lower CO2 production in tissues= less respiratory stimulus= reduced RR)
what stimulates breathing?CO2! and hypo-->dec metabolism--> dec CO2--> slow breathing
neuro effects of hypothermia?unconsciousness common, Cerebral metabolism drops 6-7% for each ‘C decrease in core body temp! This is protective at first-- patient might appear dead (bradycardia and unconsciousness).
explain metabolic effects of hypothermiathere is Cold diuresis (perceived hypervolemia bc dec CO and bradycardia-- careful this can lead to dehydration). Reduction in hepatic enzyme systems (reduced metabolism). Acidosis (mixed), Immune impairment
explain primary vs secondary coagulation in the face of hypothermiaPRIMARY: Apparent thrombocytopenia due to sequestration in the spleen, Platelet dysfunction (reduced THROMBOXANE B2), Disruption of the fibrinolytic system. SECONDARY: Prolongation PT, PTT. Warming blood results in NORMAL coag results!
**what should you know about the clotting probs caused by hypothermia?******ONCE PATIENT NORMOTHERMIC COAG PARAMETERS NORMALIZE
how do you reheat with mild hypothermia?passive rewarming (insulating blankets) (think jrsx)
how do you reheat with moderate hypothermia?active rewarming, forced heat, heat lamps, heated water blankets
******when you are rewarming hypothermia pt, what is super important to know about how you are doing it? where should you focus your re-warming?~***NO DIRECT CONTACT BETWEEN PT AND WARMING DEVICE-- vasoconstricted skin unable to transfer heat away= burns! FOCUS ON TRUNK
what is "rewarming shock"?Heating extremities initially causes pooling of “warm blood” in extremities, and Cool blood stays in core circulation and returns to the heart. This results in peripheral vasodilation--> HYPOTENSION AND SHOCK. ****THIS IS WHY WARMING THE CORE IS MORE IMPORTANT THAN WARMING THE EXTREMITIES
How do you rewarm a SEVERE hypothermia pt?Warm IV fluids, Pleural –peritoneal lavage ( Fluids warmed to 104 –113 ‘F), Admin warm humidified air via face mask, ET tube, cannulas...basically want to inc core temp, can be invastive