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hypothermia. body temp?
<95 F (35 C)
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body temp of mild hypothermia?
89.6 F - 95 F (32C - 35C)
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manifestations of mild hypothermia
- dysarthria (diff w/ speech)
- impaired cognitation
- ^ HR
- shivering
- decrased msuc coordination
- cold diuresis
- tachypnea
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what causes COLD DIURESIS?
peripheral vasoconstriction --> blood shunted to core --> ^ blood flow to kidney --> ^ uo
*increased risk for dehydration
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#1 cause of hypothermia?
weather
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#1 nurse intervention for hypothermia
- remove from ELEMENT
- body heat
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body temp in moderate hypothermia
82.4-89.6F (28-32C)
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body temp in severe hypothermia
<82.4 F (28C)
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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
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what is paradoxical undressing
when they think they're warm but they're not
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general management for moderate to severe hypothermia
- protect from heatloss
- careful handling to minimize cardiac availability
- positioning - horizontal
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hypothermia - why do we position pt horizontally?
prevent orthostatic hypotension
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what happens to the body's ability to metabolize drugs wtih hypothermia?
decreased drug metabolism
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why would there be increased drug accumulation?
toxicty w/ rewarming
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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
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what does "after-drop" mean?
body temp continues to drop even after pt removed from cold
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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
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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
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what is active warming
- heated blankets
- warm packs
- air heaters
- body heat transer
- warm highcarb liquids
- *avoid caffeine and ETOh
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risk factors for hypothermia
- cold water immersion
- shock states
- age
- malnutrition
- traumatic injury
- immobilization
- meds
- hypothyroidism
- illness
- weather
- ETOH
- exposure
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treatment out of the hospital.. pt hasn't reached hospital
- early intervention
- seek shelter
- rewarming
- body heat to warm affected area
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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
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thermal injury characterized by degree of tissue freezing and resulting damage
classified similar to burns
frostbite
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superficial cold injury of face, fingers, toes
frostnip
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manifestations of frostnip
- pain
- numbness
- pallor
- no tissue damage
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how do we remedy frostnip
warming
*if left untreated --> more serious forms
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risk factors for frostbite
- exposure
- fatigue
- wet clothing
- insufficient coverage/protection*
- dehydration behaviors - smokers, ETOH
- impaired peripheral circulation
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active external warming in contraindicated in which stage of hypothermia?
severe hypothermia
*active external warming for moderate-severe hypothermia
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