MAPColdInj

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Author:
jakeschis
ID:
89114
Filename:
MAPColdInj
Updated:
2011-06-04 15:01:16
Tags:
MAP Cold Injury
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Description:
MAP Final - Cold Injury
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  1. Production of Heat
    • 1. Exertion
    • 2. Shivering
    • 3. Food Ingestion
    • 4. Fever
    • 5. Cold Stress
  2. Impairments of Thermoregulation
    • 1. Age extremes
    • 2. malnutrition
    • 3. sleep deprivation
    • 4. fatigue - affects hypothal's ability to autoregulate temp
  3. Physical Responses to cold
    • 1. peripheral vasocontriction - increases risk to freezing
    • 2. hunting reflex - blood vessels relax every 3-5 minutes in a cyclic fashion to protect extremeties- genetically variable
    • 3. cold-induced diuresis - more blood through kidneys, higher GFR....hypervolemia secondary to vasoconstriction. **risk of dehydration
    • 4. cold air can lead to increased respiratory water loss = insensible loss
  4. Chilblains (pernio)
    • cause: repeated exposure of bare skin to cold weather with high humidity
    • symptoms: swollen, red, hot, tender, itchy skin
    • treatment: warm with body heat, no rubbing or intense heat
    • -rubbing with ice crystals- damage cells, so more important in frostbite
  5. Prevention of Chilblains
    • 1. do not remove clothing after exertion in extreme cold environment
    • 2. good gloves, no cotton clothing
  6. Cause of Hypothermia
    Cause: prolonged exposure to body heat loss, can occur in warmer environments if pt is wet
  7. Hypothermia Pathophysiology
    • Transmitted to hypothal via lateral spinothalamic tract to cause:
    • 1. increase metabolic rate, bp, muscle tone
    • 2. shivering -
    • 3. tachnypea
  8. Clinical Signs of Hypothermia
    • 1. mental status changes**
    • 2. ataxia
    • 3. paradoxical undressing
    • 4. hypotension, bradycardia (nothing will work except warming to fix)
  9. Hypothermia Treatment - Mild
    • 1. dry them
    • 2. insulate them
    • 3. passive warming
    • 4. calories
    • 5. warmed fluids
  10. Hypothermia - Moderate to Severe
    • 1. ABCs
    • 2. move pt as little as possible
    • 3. prevent heat loss
    • 4. body warming oreo
    • 5. heat pack to neck, axilla, groin
    • 6. volume resuscitation with warm fluids
    • 7. warmed humidified 02

    more active warming instead of passive
  11. Rewarming Techniques
    • 1. Passive External
    • 2. Active External - warmed blankets, oreo, water bath, hot packs
    • 3. Active Internal - cardiopulmonary bypass...take out blood, warm, and put back in
  12. Hypothermia Prevention - C.O.L.D.
    • C:lean
    • O:avoid overheating
    • L:loose, layers
    • D:ry

    -also hydration, nutrition, work-rest cycles
  13. Important Physiological Changes at different Temps (35, 33, 31, 29)
    • 37.0:NormalTemp
    • 36.0:IncreasedMetabolicRate,BP,muscletone
    • 35.0:Maximumshiveringresponse
    • 34.0:Poorjudgment,dysarthria,tachycardia
    • 33.0:Ataxiaandapathy;tachypnea
    • 32.0:Stupor
    • 31.0:Extinguishedshiveringthermogenesis
    • 30.0:Atrialfibrillation;poikilothermia
    • 29.0:Decreasedventricularfibrillationthreshold
    • 27.0:Lossofreflexesandvoluntarymotion
    • 26.0:Majoracid-­‚Äźbasedisturbances;areflexia
    • 18.0:Asystole
  14. Cellular Phase of Frostbite
    • - extracellular and intracellular ice formation
    • - cell dehydration and shrinkage
    • - abnorm intracell electrolytes
    • - denaturing of lipid-protein complexes
  15. Four Pathologic Phases of Frostbite
    • 1. Prefreeze: plasma leakage, vasospacicity
    • 2. freeze-thaw: ice crystal formation
    • 3. vascular stasis: dilation, stasis coag, shunting, same symptoms as prefeeze too
    • 4. late ischemic phase: thrombosis and AV shunting, ischemia, gangrene, autonomic dysfunction
  16. fristnip, superficial, and deep frostbite
    • - depends on tissue level, superficial heals on it's own, deep doesn't heal well.
    • - deep freeze joints, no capillary refill
    • - clear vs hemorrhagic blisters
    • - edema vs, no edema
  17. Management of Frostbite
    • 1. **prevent freeze thaw refreeze**
    • 2. rapid rewarming*
    • 3. unroof clear blisters
    • 4. narcotics*
    • 5. hydrotherapy
    • 6. hyperbaric oxygen therapy* - increase p02
  18. Trenchfoot
    • warm, cold, warm, cold
    • vasoconstriction and ischemic tissue
    • rest and narcotics
  19. Snow Blindness
    • Cause: intense UV light from snow reflection
    • -get out of sun, eye will heal

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