Heat and Cold Illness

159 Heat and Cold Illness




Clinical Case Problem 1: A 51-Year-Old Alcoholic Man Brought to the Emergency Department


A 51-year-old alcoholic man is brought into the emergency department after having been found in a snow bank. He is unconscious, and no history can be obtained. No family is known. On physical examination, his blood pressure is 90/60 mm Hg. His pulse is 36 beats/minute and regular. His core body temperature is 28° C (82.4° F). His electrocardiogram (ECG) reveals sinus bradycardia and a J wave after each QRS complex.



Select the best answer to the following questions




1. Which of the following statements regarding the hypothermia in this patient is (are) true?


a. body temperatures between 32° C and 35° C do not constitute mild hypothermia

b. the Osborne (J) wave on the ECG is characteristic of hypothermia (Fig. 159-1)

c. arrhythmias are not common when the core body temperature drops below 30° C (86° F)

d. intravascular volume is usually maintained in patients with hypothermia

e. all of the above

2. What is the treatment of choice for this patient?


a. passive rewarming

b. active external rewarming

c. active core rewarming

d. vigorous rubbing

e. all of the above

image

Figure 159-1 J wave (Osborne wave).


Characteristic ECG finding with hypothermia



Clinical Case Problem 2: A 46-Year-Old Man with Blanched Feet


A 46-year-old man is brought to the emergency department from his work site with numbness of both feet after working in 0° C (32° F) weather for 6 hours. On examination, both feet are blanched. Sensation is decreased in both feet to the level of the ankles. Both feet are cold to touch and are bloodless. You suspect frostbite.



3. What is the most appropriate treatment of this patient at this time?


a. passive rewarming

b. vigorous rubbing

c. immersion in water at 42° C (107.6° F)

d. placement close to a radiant heater

e. immersion in water at 30° C (86° F)


Clinical Case Problem 3: A 4-Year-Old Boy with a Low Core Temperature


A 4-year-old boy is brought to the emergency department after having fallen through the ice into a lake. He was rescued approximately 15   minutes later. Cardiopulmonary resuscitation (CPR) was begun at the scene and is in progress on arrival. On examination, you note no spontaneous breathing or cardiac activity. The core temperature is 28° C (82.4° F).



4. At this time, what is the most appropriate action?


a. stop CPR

b. rewarm the patient with active external rewarming

c. rewarm the patient with inhalation warming therapy

d. rewarm the patient with peritoneal dialysis

e. follow advanced cardiac life support (ACLS) protocol while rewarming

5. If the patient is still unresponsive after the initial treatment just selected and current temperature is now 30° C (86° F), what would be your next step?


a. stop CPR

b. continue CPR while rewarming the patient with active external rewarming

c. continue CPR while rewarming the patient with inhalation warming therapy

d. continue CPR while rewarming the patient with active core rewarming

e. none of the above


Clinical Case Problem 4: An Overheated 34-Year-Old Man


A 34-year-old male soldier is brought to the emergency department after having been outdoors on patrol all day in temperatures exceeding 42° C (107.6° F). He complains of painful spasms of the skeletal muscles, which are worse in the legs and in the abdomen. He denies other symptoms. He is alert and cooperative, with a blood pressure of 120/80   mm Hg and a pulse of 108 beats/minute. His temperature is 38° C (100.4° F). The remainder of the physical examination is normal.



6. Which of the following conditions does this patient have?


a. heat cramps

b. heatstroke

c. heat exhaustion

d. b or c

e. none of the above

7. What is the treatment of choice for this patient at this time?


a. oral electrolyte replacement therapy

b. core body cooling

c. warm intravenous (IV) fluids

d. intensive care monitoring and Swan-Ganz catheter insertion

e. none of the above


Clinical Case Problem 5: An Exhausted 23-Year-Old Female Marathon Runner


A 23-year-old female marathon runner presents to the emergency department after she completed a marathon. During the last mile, she became lightheaded and experienced nausea, vomiting, headache, tachycardia, and tachypnea. Her blood pressure is 90/70 mm Hg, and the pulse is 120 beats/minute and regular. She is orthostatic. Her temperature is 37.5° C (99.5° F). The rest of the physical examination is normal.



8. Which of the following conditions does she have?


a. heat cramps

Related posts:

  1. Alcohol
  2. Pancreatic Carcinoma
  3. Urticaria Angioneurotic Edema
  4. Illustrated Review

Stay updated, free articles. Join our Telegram channel
Tags:
Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Heat and Cold Illness

Full access? Get Clinical Tree
Get Clinical Tree app for offline access