0071643192.pdf

ENVIRONMENTAL EMERGENCIES

■ Debridement of skin overlying hemorrhagic blister may result in marked
desiccation of the underlying tissues.
■ Prevent further tissue loss:
■ Splint and elevated limb to minimized edema formation
■ Smoking cessation
■ NSAIDs (inhibit arachidonic acid cascade)
■ Topical aloe vera (inhibits thromboxane)
■ Manyother therapies have been proposed: Nifedipine, topical corti-
costeroids, prednisone, hyperbarics, etc., but none has been proven
beneficial.
■ Delayed surgical debridement and escarotomy
■ Unless severe gangrene or sepsis present

COMPLICATIONS

■ Core afterdrop
■ Occurs when skin or extremities are warmed before the core →
cold peripheral blood returns to core →core temperature drops
further.
■ Rewarm core beforeperiphery in all cases of hypothermia.
■ Secondary bacterial/fungal infections

ACCIDENTAL HYPOTHERMIA

Hypothermia is defined as a core body temperature <35°C (95°F).

Risks for hypothermia can be divided into three groups (see Table 13.8):

■ Decreased heat production
■ Increased heat loss
■ Impaired ability to move to warm environment

Core afterdrop: Cold

peripheral blood returns core

→further decrease in core

temperature.

TABLE 13.8. Factors Predisposing to Accidental Hypothermia

DECREASEDHEAT

PRODUCTION INCREASEDHEATLOSS IMPAIREDMOBILITY

Hypothyroidism Inadequate clothing Infants and young children

Hypoadrenalism Vasodilation Physical or mental impairment

Malnutrition Alcohol Acute CNS process

Hypoglycemia Medications Alcoholism

Dehydration Spinal cord injury Tranquilizer or sedative use

Physical exhaustion Neuropathies

Extremes of age Skin disorders

Inactivity Burns

Impaired shivering Exfoliative dermatitis

Infants