thermal injuries - hypothermia & frostbite
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hypothermia. body temp?
<95 F (35 C)
body temp of mild hypothermia?
89.6 F - 95 F (32C - 35C)
manifestations of mild hypothermia
- dysarthria (diff w/ speech)
- impaired cognitation
- ^ HR
- decrased msuc coordination
- cold diuresis
what causes COLD DIURESIS?
peripheral vasoconstriction --> blood shunted to core --> ^ blood flow to kidney --> ^ uo
*increased risk for dehydration
#1 cause of hypothermia?
#1 nurse intervention for hypothermia
- remove from ELEMENT
- body heat
body temp in moderate hypothermia
body temp in severe hypothermia
<82.4 F (28C)
manifestations of moderate to severe hypothermia
- deteriorating musc and cognitive function
- confusion deteriorates to unconsciousness
- no shivering (paradoxical undressing)
- bradycardia and hypotension
- atrial and ventrilc arrythmias
- VS threshold decreased
- absent neuro reflexes
- absent pain sensation
- acid/base abnormalities
- decrased clotting function - hemorrhage
what is paradoxical undressing
when they think they're warm but they're not
general management for moderate to severe hypothermia
- protect from heatloss
- careful handling to minimize cardiac availability
- positioning - horizontal
hypothermia - why do we position pt horizontally?
prevent orthostatic hypotension
what happens to the body's ability to metabolize drugs wtih hypothermia?
decreased drug metabolism
why would there be increased drug accumulation?
toxicty w/ rewarming
at what temp does the body ahve to be at for the defibrillator be effective?
*cold decreases excitability
*also with IV drugs, hold if body temp not warm enough
what does "after-drop" mean?
body temp continues to drop even after pt removed from cold
what should be warmed first? trunk or extremity?
warm trunk first, then extremities
(blood circulates from extremities back to the core, to the heart, increases risk for cardiac arrest)
- *we want warm body!!!!!
- WARM BODY!!!
- WARM AND DEAD
- COLD AND DEAD
how do we manage severe hypothermia
- extracorporal warming
- cardiopulm bypass
- cont arteriovenous rewarm (like dialysis warm fluids)
- resuscitate efforts continue til pt is warmed sufficiantly
- anoxia before hypothermia
what is active warming
- heated blankets
- warm packs
- air heaters
- body heat transer
- warm highcarb liquids
- *avoid caffeine and ETOh
risk factors for hypothermia
- cold water immersion
- shock states
- traumatic injury
treatment out of the hospital.. pt hasn't reached hospital
- early intervention
- seek shelter
- body heat to warm affected area
treatment of pt when they reach the hospital
- aggressive management
- rapid water re-warming 104-108F or warm towels
- do not rub INCREASES TISSUE DAMAGE
- monitor for compartment syndrome
- tetanus prophylaxis
- loose non-adhering/noncompression dressing
- *thaw, rewarm, decrease further complications, do not rub, handle gently
thermal injury characterized by degree of tissue freezing and resulting damage
classified similar to burns
superficial cold injury of face, fingers, toes
manifestations of frostnip
- no tissue damage
how do we remedy frostnip
*if left untreated --> more serious forms
risk factors for frostbite
- wet clothing
- insufficient coverage/protection*
- dehydration behaviors - smokers, ETOH
- impaired peripheral circulation
active external warming in contraindicated in which stage of hypothermia?
*active external warming for moderate-severe hypothermia
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