name 14 february 2007durham links 17th january 2013 hot and cold extremes

Name 14 February 2007Durham LINKS 17th January 2013

Hot and Cold Extremes

Heat Extremes Durham LINKS 17th January 2013

Getting too hot…

Heat Exhaustion

Heat Stroke


The Largest Organ in the Body

• The Skin!• Why do we have skin?

Epidermis

Dermis

Fatty Tissue


Skin – The Epidermis

• The outermost layer• Varies in thickness• Cells travel up through the

epidermis, taking about 4 weeks


Skin – The Dermis

• Sweat glands• Sebaceous (oil) glands• Hair follicles• Blood vessels• Specialised nerve endings


Skin – Fatty Bit (Subcutaneous Layer)

• Between the dermis and the muscles/other deeper structures

• Insulates• An energy store


How bad is the burn?

• 3 key severity indicators:

- How deep is the burn?- What is the extent of the burn?- Where is the burn?


Superficial (1st Degree)

• Involve only top layer of skin• Skin turns red but doesn’t blister

or burn through• Tender and painful• Sunburn is a good example


Partial Thickness (2nd Degree)

• Involves epidermis and some portions of dermis

• Doesn’t destroy entire thickness of skin

• Moist, mottled and white to red• Blisters with severe pain• Causes could include scalds from

boiling water or fat.


Partial Thickness (2nd Degree)


Full Thickness (3rd Degree)

• Extends through all skin layers and may involve other structures

• Area dry and leathery• Appear white, dark brown or

charred• Pain (although possibly not in

centre)• Caused by prolonged exposure to

heat source


Full Thickness (3rd Degree)


Extent

• The size of area affected• Patient’s palm is approx. 1% of

total body surface area


When to call 999?

• Golden Rule: If unsure, call an ambulance

• Medical attention should be sought for any children or more elderly burns victims.

• ALL full thickness burns (skin grafts will be needed)

• ALL burns affecting face, hands, feet, or genital area

• Burns that extend all the way round an arm or leg

• All partial thickness burns covering greater than 1% of the body

• All superficial burns covering greater than 5% of the body


Treatment

• Primary Survey! (DRSABC)• If necessary, treat for shock• Stop the burning process• Keep Patient Warm• Prevent risk of infection• Obs


Stop the burning…

• Pour cold water onto the burn for at least 10 minutes

• Keep patient warm• Cover to reduce infection risk


Any questions (Burns)?

Burns


Moving to the Cold Side…


Factors to consider

• Different factors affect how a person reacts to an extreme heat exposure:

- Physical condition- Age- Nutrition and hydration- Environmental conditions


A Bit of Physics…

• Heat only moves from hot to cold• Body can lose heat by the

following:- Conduction- Convection- Evaporation- Radiation- Respiration


Hypothermia

• ‘low temperature’• Normal body temp is 37 degrees• Core temperature < 35 degrees C• As Temp lowers body functions

begin to slow


Signs and Symptoms

Core Temperature

34-35C 32-33C 27-31C <27C

Signs and Symptoms

Shivering, foot stampting

Loss of coordination, muscle stiffness

Coma Apparent death

Cardiorespiratory Response

Constricted blood vessels, rapid breathing

Slowing resps, slow pulse

Weak pulse, arrhythmias, very slow resps

Cardiac Arrest

Level of Conciousness

Withdrawn Confused, lethargic, sleepy

Unresponsive

Unresponsive


Local Cold Injuries

• Exposed extremities are particularly vulnerable

• Frostnip/chilblains/immersion foot• Frostbite


Treatment

• Primary Survey!

• Two types of warming:- Active rewarming- Passive rewarming


Any Questions (Coldness)?

Cold


Back to the Hot Side


Hyperthermia

• ‘high temperature’• Normal body temp = 37 degrees• Effects of hyperthermia often happen

above a core temp of about 38.3 degrees

• 3 main hyperthermia problems:- Heat Cramps- Heat Exhaustion- Heat Stroke


Heat Cramps

• Painful muscle spasms• Occur often after vigorous exercise• Exact cause unclear• Often in leg and abdomen


Heat Exhaustion

• Number of causes• Hypovolemia due to profuse

sweating• For sweating to work…must

evaporate!


Heat Exhaustion – Signs and Symptoms

• Dizziness• Weakness• Faint• Altered level of AVPU• Nausea• Vomiting• Headache• Muscle Cramps• Profuse Sweating• Flushed skin• Dry tongue and thirst

• Low Diastolic• Dilated pupils• Slightly elevated core

temp.• Onset during exercise in

hot/humid/poorly ventilated environment

• Onset at rest for young/old


Heat Stroke

• More serious that heat exhaustion• Rapid rise in core body temp.• Body’s cooling mechanisms totally

overrun

Heat

+

Stroke

= Heat Stroke?


Heat Stroke- Signs and Symptoms

• Initially the same as heat exhaustion

• Develops to:- Hot, dry flushed skin- Constricted Pupils- Change in behaviour- Possible seizures- Pulse initially rapid and strong but then

weakens- BP falls- Resps Increase- Sweating stops- Will end in unresponsiveness (could be

rapid)


Treatment – Heat Cramps

• Primary Survey!• Remove Pt from hot environment• Loosen any tight clothing• Consider O2 as necessary• Rest cramping muscles• Replace Fluids

- Don’t use salt tablets or high salt solution

• Cool Pt with water spray/mist or fan Pt• Do they need further help?


Treatment – Heat Exhaustion

• Primary Survey!• Remove excessive clothing, particularly

around head and neck• Move to cooler environment• Consider O2 therapy• Cool Pt – splash with cool (not ice) water and

fan• Encourage to lie down and raise legs• If alert – rehydrate• Symptoms should get better promptly…else

hosp!


Treatment - Heat Stroke

• Primary Survey• Move to cooler environment• Lower body temperature ‘by any means

possible’• Remove clothing• Consider O2 therapy• Apply cool things to body• Cover with wet towels or sheets or spray with

cool water• Needs 999!


Any Questions (Heat)?

Heat


To Summarise…

Burns

Hypothermia

Heat Stroke

Heat Exhaustion

Primary Survey

Assess Severity

Cool or heat as appropiate Help?

name 14 february 2007durham links 17th january 2013 hot and cold extremes

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