thermal injuries - hypothermia & frostbite

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Author:
giep
ID:
80224
Filename:
thermal injuries - hypothermia & frostbite
Updated:
2011-04-17 18:53:32
Tags:
nurse
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final
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  1. hypothermia. body temp?
    <95 F (35 C)
  2. body temp of mild hypothermia?
    89.6 F - 95 F (32C - 35C)
  3. manifestations of mild hypothermia
    • dysarthria (diff w/ speech)
    • impaired cognitation
    • ^ HR
    • shivering
    • decrased msuc coordination
    • cold diuresis
    • tachypnea
  4. what causes COLD DIURESIS?
    peripheral vasoconstriction --> blood shunted to core --> ^ blood flow to kidney --> ^ uo

    *increased risk for dehydration
  5. #1 cause of hypothermia?
    weather
  6. #1 nurse intervention for hypothermia
    • remove from ELEMENT
    • body heat
  7. body temp in moderate hypothermia
    82.4-89.6F (28-32C)
  8. body temp in severe hypothermia
    <82.4 F (28C)
  9. 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
  10. what is paradoxical undressing
    when they think they're warm but they're not
  11. general management for moderate to severe hypothermia
    • protect from heatloss
    • careful handling to minimize cardiac availability
    • positioning - horizontal
  12. hypothermia - why do we position pt horizontally?
    prevent orthostatic hypotension
  13. what happens to the body's ability to metabolize drugs wtih hypothermia?
    decreased drug metabolism
  14. why would there be increased drug accumulation?
    toxicty w/ rewarming
  15. at what temp does the body ahve to be at for the defibrillator be effective?
    >86F (30C)

    *cold decreases excitability

    *also with IV drugs, hold if body temp not warm enough
  16. what does "after-drop" mean?
    body temp continues to drop even after pt removed from cold
  17. 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
    • NOT
    • COLD AND DEAD
  18. 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
  19. what is passive warming
    • warm clothes
    • blanket
  20. what is active warming
    • heated blankets
    • warm packs
    • air heaters
    • body heat transer
    • warm highcarb liquids
    • *avoid caffeine and ETOh
  21. risk factors for hypothermia
    • cold water immersion
    • shock states
    • age
    • malnutrition
    • traumatic injury
    • immobilization
    • meds
    • hypothyroidism
    • illness
    • weather
    • ETOH
    • exposure
  22. treatment out of the hospital.. pt hasn't reached hospital
    • early intervention
    • seek shelter
    • rewarming
    • body heat to warm affected area
  23. 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
    • debridement
    • amputation
    • *thaw, rewarm, decrease further complications, do not rub, handle gently
  24. thermal injury characterized by degree of tissue freezing and resulting damage

    classified similar to burns
    frostbite
  25. superficial cold injury of face, fingers, toes
    frostnip
  26. manifestations of frostnip
    • pain
    • numbness
    • pallor
    • no tissue damage
  27. how do we remedy frostnip
    warming

    *if left untreated --> more serious forms
  28. risk factors for frostbite
    • exposure
    • fatigue
    • wet clothing
    • insufficient coverage/protection*
    • dehydration behaviors - smokers, ETOH
    • impaired peripheral circulation
  29. active external warming in contraindicated in which stage of hypothermia?
    severe hypothermia

    *active external warming for moderate-severe hypothermia

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