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.
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.
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).
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.
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.
Full access? Get Clinical Tree
