Cold-Related Injuries and Conditions Overview
Thermia Jeopardy
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Final Jeopardy
What is the definition of a “non-freezing” cold related
injury and what are the types?
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What is the presentation and treatment of trench
foot?
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inflammatory lesions of the skin caused by
long-term intermittent exposure to damp,
nonfreezing ambient temperatures
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localized edema, erythema, cyanosis,
plaques, nodules, and, in rare cases,
ulcerations, vesicles, and bullae
•
Tingling and numbness
This is observed on the cheeks, thighs and buttocks
This is observed on the cheeks, thighs and buttocks
of patients, often in children or young women of
of patients, often in children or young women of
equestrian background.
equestrian background.
What is panniculitis?
“Popsicle panniculitis”
A young female complains that every time she goes in
A young female complains that every time she goes in
the cold, she feels her throat is closing and she is itchy.
the cold, she feels her throat is closing and she is itchy.
What is the most likely diagnosis?
What is the most likely diagnosis?
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Head, hands, feet
These ages and gender combinations are the
highest at risk for frostbite
Teenage males
Young males in the
military
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These are the three zones of frostbite injury.
Zone of coagulation
Zone of hyperemia
Zone of stasis
These are the degrees of frostbite
injury and what they mean.
These are all of the
appropriate frostbite
treatment steps in the ED
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Active external warming, minimally invasive rewarming (warm
environment, heating packs, hot air, warmed fluids, warm blankets)
Full body insulation, immobilization
Minimal, cautious movements
Core temperature monitoring
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Cardiac arrest
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Hemodynamic instability refractory to
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Co-morbid patients who are unlikely to
tolerate the low cardiac output associated
with severe hypothermia
If ECMO/CPB unavailable for
hypothermia, these measures
may save an arrested patient’s
life.
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Up to 3 defib attempts, withhold epinephrine
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These are the physiologic
response to heat stress.
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These are some of the medications
that make patients more susceptible
to heat injury.
Anticholinergic
Diuretics
Beta blockers
Calcium channel blockers
Sympathomimetic agents
Phenothiazines
Alcohol
Classic heat injury – high
environmental heat stress
Exertional heat injury – athletic
events or jobs under conditions of
stress
Confinement hyperpyrexia –
“children inside cars”
This is classic heat injury, exertional heat injury
and confinement hyperpyrexia.
Orthostatic pooling of interstitial fluid in gravity
dependent extremities due to cutaneous
vasodilation is known as this.
Heat edema
This is the pathogensis of heat cramps
Deficiency of sodium, potassium or
magnesium and fluid at he muscle
level.
A 22 year old who has been
working outside is complaining of
headache, nausea, vomiting,
malaise, dizziness, and muscle
cramps. He is tachycardic and his
temperature is 103.5 deg F. This is
his diagnosis.
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Patients suffering from heat stress require these treatment
methods
Oral electrolytes
1 – 2L IVF cooled or room temperature
Removal from hot environment
Removal of clothing
Fans
These two features are required for the
diagnosis of heat stroke.
Hyperthermia > 40 deg C/104 deg F
Altered mental status
These are the initial resuscitation measures for heat
stroke and the heat loss mechanism they utilize.
Removal from environment and remove
clothing
Spray patient with water and fans
Wet towels or sheets
Ice
Room temperature IVF
This treatment method has been found to be very
effective for cooling and was originally developed
for athletes.
Immersion Cooling
In patients with refractory
hyperthermia, you should consider the
following treatments.
CPB
Cold Water Gastric Lavage
Urinary bladder lavage
Rectal lavage
?peritoneal lavagae
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Explore the definition, presentation, and treatment of non-freezing cold-related injuries like trench foot, chillblains, panniculitis, and cold urticaria. Learn about the characteristics, observations, and diagnosis of these conditions and understand the risks associated with frostbite in specific age and gender groups.
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Presentation Transcript
Thermia Jeopardy The Pen Is Mightier Catch These Men I have a Famous Horsemen The Rapists Japan US Relations Chardonnay 200 200 200 200 200 200 200 200 200 200 200 400 400 400 400 400 400 400 400 400 400 400 400 600 600 600 600 600 600 600 600 600 600 600 600 800 800 800 800 800 800 800 800 800 800 800 1000 1000 1000 1000 1000 1000 1000 1000 1000 1000 1000 1000 Final Jeopardy
What is the definition of a non-freezing cold related injury and what are the types? Exposure to wet conditions when temperatures are > freezing Trench foot, chilblains/pernio, panniculitis, cold urticaria
What is the presentation and treatment of trench foot? Pale, mottled, anesthetic, pulseless, immobile -> Hypermia -> bullae -> sloughing Supportive treatment Consider vasodilators, oral prostaglandins (may improve circulation), clean, warm, dry bandaged, elevated
What is characterized by the following? Chillblains/pernio inflammatory lesions of the skin caused by long-term intermittent exposure to damp, nonfreezing ambient temperatures localized edema, erythema, cyanosis, plaques, nodules, and, in rare cases, ulcerations, vesicles, and bullae Tingling and numbness
This is observed on the cheeks, thighs and buttocks of patients, often in children or young women of equestrian background. What is panniculitis? Popsicle panniculitis
A young female complains that every time she goes in the cold, she feels her throat is closing and she is itchy. What is the most likely diagnosis? Malingering (Cold urticaria)
What are the 3 most common areas of frostbite in order? Head, hands, feet
These ages and gender combinations are the highest at risk for frostbite Teenage males Young males in the military
This is the temperature and wind speed at which rate of cold injuries starts to increase 12 deg C (10.4 deg F) Wind speed > 4.5 m/s (10 mph)
The depth of freezing depends on the following three elements Temperature Duration of exposure Velocity of freezing
These are the three zones of frostbite injury. Zone of coagulation Zone of hyperemia Zone of stasis
These are the degrees of frostbite injury and what they mean.
These are all of the appropriate frostbite treatment steps in the ED Rapid rewardming in hot water (100 deg) Clear blisters? Ppx abx? Aloe vera topical cream q6hours Dry gauze Thrombolysis? NSAIDS Methimazole? Steroids?
These are risk factors for hypothermia Burns Iatrogenic Impaired shivering Young Old Malnourished Medications (etoh, beta blockers, sedatives, vasodilators) Metabolic disorders Sepsis Shock Trauma
These are the stages and temperatures of hypothermia. Stage 1 35-32 Stage 2 32 28 Stage 3 - < 28 Stage 4 cardiac arrest
These are the treatments for a patient in moderate hypothermia with a temperature of 30. Active external warming, minimally invasive rewarming (warm environment, heating packs, hot air, warmed fluids, warm blankets) Full body insulation, immobilization Minimal, cautious movements Core temperature monitoring
These are the indications for ECMO or CPB in hypothermia. Cardiac arrest Hemodynamic instability refractory to medical management Co-morbid patients who are unlikely to tolerate the low cardiac output associated with severe hypothermia
If ECMO/CPB unavailable for hypothermia, these measures may save an arrested patient s life. Thoracic Lavage Bladder Lavage Peritoneal Lavage Gastric Lavage Rectal Lavage
If your hypothermic patient is in cardiac arrest, this is the most appropriate management. Rewarming CPR May be reasonable to use vasopressors (AHA) Up to 3 defib attempts, withhold epinephrine until core temp is > 30, double the frequency of administration until temp > 35 (ERC) CPR and up to 3 doses of epinephrine and defibrillation (Tintinalli s)
These are the methods for the body to dissipate heat and how they work Radiation electromagnetic transfer from warm to cool Conduction heat exchange between two surfaces Convection heat transfer from air or liquid moving across an object Evaporation heat loss by vaporization of water or sweat
These are the physiologic response to heat stress. Vasodilation Increased sweat production Decreased heat production Behavioral heat control
These are some of the medications that make patients more susceptible to heat injury. Anticholinergic Diuretics Beta blockers Calcium channel blockers Sympathomimetic agents Phenothiazines Alcohol
This is classic heat injury, exertional heat injury and confinement hyperpyrexia. Classic heat injury high environmental heat stress Exertional heat injury athletic events or jobs under conditions of stress Confinement hyperpyrexia children inside cars
Orthostatic pooling of interstitial fluid in gravity dependent extremities due to cutaneous vasodilation is known as this. Heat edema
This is the pathogensis of heat cramps Deficiency of sodium, potassium or magnesium and fluid at he muscle level.
A 22 year old who has been working outside is complaining of headache, nausea, vomiting, malaise, dizziness, and muscle cramps. He is tachycardic and his temperature is 103.5 deg F. This is his diagnosis. Heat Stress
Patients suffering from heat stress require these treatment methods Oral electrolytes 1 2L IVF cooled or room temperature Removal from hot environment Removal of clothing Fans
These two features are required for the diagnosis of heat stroke. Hyperthermia > 40 deg C/104 deg F Altered mental status
These are the initial resuscitation measures for heat stroke and the heat loss mechanism they utilize. Removal from environment and remove clothing Spray patient with water and fans Wet towels or sheets Ice Room temperature IVF
This treatment method has been found to be very effective for cooling and was originally developed for athletes. Immersion Cooling
In patients with refractory hyperthermia, you should consider the following treatments. CPB Cold Water Gastric Lavage Urinary bladder lavage Rectal lavage ?peritoneal lavagae
DAILY DOUBLE Avoid cooling less than this temperature to avoid overshoot hypothermia. 102.2 deg F
FINAL JEAPORDY Complete this famous SNL quote Alex Trebec: "The category is "rhymes with dog," and the question is, "It's been a Hard Day's night and I should be sleeping like a ................"
