0071643192.pdf

ENVIRONMENTAL EMERGENCIES

■ Adjuncts:

■ Place ice packs to groin, axillae, and neck.

■ Cooling blanket

■ If refractory, consider invasive methods.

■ Cardiopulmonary bypass

■ Gastric, pleural, or bladder lavage

■ IV benzodiazepines (or paralysis) to prevent shivering (which generates

heat); treat seizures

■ Intravenous fluids to CVP of 12 mL H 2 O or urine output = 0.5 mL/

kg/hr

■ Fluid requirements vary with underlying cause.

■ Dopamine for persistent hypotension despite adequate fluid resuscitation

■ Dantrolene: If suspected malignant hyperthermia.

■ Avoid

■ Antipyretics—noteffective and may be harmful!

■ Prophylactic steroids—noteffective.

■ Norepinephrine—causes vasoconstriction and decreases cutaneous

heat exchange.

■ Poor prognostic indicators:

■ Coma

■ AST > 1000 IU/L.

■ Delay in rapid cooling (morbidity and mortality are directly related to

the duration of hyperpyrexia)

■ DIC

■ Hypotension

■ Renal failure in <48 hours

■ Lactic acidosis

COMPLICATIONS

■ ARDS, electrolyte abnormalities, renal failure, rhabdomyolysis, hepatic

injury, DIC

■ If left untreated cerebral edema and multisystem organ failure will

develop.

A homeless man presents to your ED after walking over 3 miles in freezing

snow. He is complaining of numbness and swelling to his lower extremities.

On exam you see diffuse erythema, edema, and both clear and hemorrhagic

blisters. How will you treat this man’s blisters?

With frostbite, damaged tissue releases arachidonic acid breakdown products

(prostaglandins and thromboxane). These released products promote platelet

aggregation, leading to thrombosis and ischemia. Blisters should be left intact

or sterilely aspirated. Debride blisters only if broken.

COLD-RELATED INJURIES

There are four physiologic mechanisms of heat loss/gain (see Table 13.7).

Radiation is responsible for the majority of normalheat loss.

Antipyretics are noteffective

(and may be harmful) in

treatment of heat stroke!