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Normal temperature 37*c (98.6* f)
between 55-144*F a naked body can maintain a constant internal body temp
Thermoregulation regulated by Posterior Hypothalamus-thermostat(-negative feedback system)
Posterior hypothalamus recieves input from 1.Central thermoreceptors (anterior hypothakamus-deep body tissues.-spinal cord,abd viscera,around great veesels 2.Peripheral thermoreceptors-in skin, mucous membranes
Cold receptors stimulated by lower skin surface temp,body warms when stim-more cold receptors than hot in skin and organs
Warm receptors stimulated by higher temp-body cools when stim,more warm than cold in anterior hypothalmus-negative feedback
Thermogenesis internal heat production
1.Work induced thermogenesis exercise/shivering
2.Thermoregulatory thermogenesis controlled adrenal/Thyroid
3.Diet induced thermogenesis processing foods-affected by age,general health,nutritional state
(BMR) Basal metabloci rate rate body consumes energy to maintain stability
Exertional Metabolic rate rate body consumes energy during activity (faster than BMR)
Skeletal muscle largest producer of heat (shivering)-increases heat x400,motor center in hypothalamus is excited-piloerection occurs
Vasoconstirction conserves heat, hypothalamus stimulates SNS-A1 receptor stim
Endocrine glands regulate heat through release of hormones from thyroid and adrenal gland
Heat is recieved from enviornment via thermal gradient
Thermal gradient difference between temp of environment and body.Factors that effect:1.Ambient ai temp,2.infrared radiation,3.relative humidity,4.wind
Ambient air temp determines how conduction occurs-towards body or away
Heat loss by air or water currents passing over body
Factors that contribute to cooling effects of convection velocity and temp of air or water currents
Evaporation evaporation of fluids absorb heat from surrounding objects and air. affected by ambient temp/humidity
Respiration heat is lost in inhailed air and exhaled air, amount lost depends on air temp,rate and depth of respirations
Heat Elimination (THERMOLYSIS) body eliminates heat thru-vasodilation,perspiration, decreasing internal production,increased CO/RR, vasodilation,perspiration
Thermolysis SNS/Thyroid hormones are inhibited
Thermogenesis SNS/Thyroid hormones are stimulated
Hyperthermia when normal mechanisms are overwhelmed by environment,excessive exercise, thermoregulatory mech dails
Heat disorders heat cramps,heat exhaustion, heatstroke
Heat cramps -brief muscle cramps,occurs in fatigued muscles,caused by rapid change in extracellular fluid osmolarity-Na+ and H2o loss-sweats profusely/drinks H2o without enough salt, 1-2 liters can be lost/hr-20-50mEq of Na+-occur in limbs and abd
S/S-Tx diaphoresis,mentally alert,weak,dizzy,tachy,normotensive,normal core temp: remove from heat,replace water/salt,IV,NS,massage cramp,apply moist towel
Heat Syncope orthostatic syncopal-cause:seen in mass gathering in heat,dehydration,peripheral vasodilation
Heat exhaustion hot ambient temp-profuse sweating 1-2l/hr, inadequeate perfusion-osmosis occurs fluid shifts from vessels
S/S:Tx AMS,dizzy,nausea,HA,temp elevation <103*F,tachy,Dilated pupils,decreased urine output-Tx: remove,supine,
Heat Stroke thermoregulator mechanisms break down completely,>104-105*F(41*c),multi system tissue damage-leads to CNS disturbances
Classic Heat stroke high sustained ambient temp/humidity,affects young,old,without ac.med problems-DMI,CAD,alcoholism,schitzo
Exertional heat stroke exercise in hot humid conditions-heat accumalates faster than it can be lost.50% have diaphoretic skin due to SNS
S/S convulsions,hypozia,hypoglycemia,
Tx: lower temp to 102*F,remove from enviroment, rapid cooling, avoid overcooling,2 large bore iv's,monitor,AVOID vasopressorsand anticholinergics
Outcomes frrom heat stroke pulm edema,GI bldg,kidney dysfunction due to hypovolemia,hepatic injury,clotting disorders,electrolyte abnormalities
Dehydration in Heat disorders lead to orthostatic hypotensionS/S-n/v,abd distress,vison dist,
Water intoxification when drinking water > loss of water, water intake >1 liter per hour.Sodium levels drop leading to N/V,HA,AMS,polyuria,diluted urine.TX:encourage eating foods high in sodium
Fever (pyrexia) resetting of hypothalamic thermostat,pathogens enter,neutrophils and monocytes arrive,WBC's release PYROGENS=resent of thermosts.TX:if temp is >105*F,ams or seizure-tylenol 650mg,ibuprophen 600-800 mg
Neuroleptic Malignant syndrome caused by antipsychotic drugs and antimemetic med,S/S hyperthermia,muscle rigidity,ams,
Hypothermia when core tempis <95*F,caused by < heat production,>heat loss,excessive cold stress
. .
Drugs that impair thermoregulator mech. alcohol,antidepressants(vistaril),antipyretics(ASA,phenothiazines(thorazine),sedatives,antiseizure meds,
Mild hypothermia temp 93.2-97*F,increased metabolic rate,vasocoonstriction+increased CO,shivering,
Moderate hypothermia temp 86-93.2*F,slurred speech,apathetic,amnesia,uncoordinated,decreased shivering,dilated pupils,a-fib,CO<33%,bld becomes acidotic,hypovolemia develops
@ 86*F shivering stops due to glucose/glycogen depletion or insulin not available for transfer
Severe Hypothermia <86*F,Shivering stops,BMR <50%,ascess pulse n resp for 30sec
S/S disoriented,confused,supor,coma,stiff,rigid,loss of deep reflexes,Fixed dilated pupils,prolonged PR,QRS,QT,Osborn wave,A-fib(most common),brady
Mild/Mod Tx passive/active rewarming,no acess activity,warm drinks and sugar sources,warm iv fluid
Afterdrop phenomenon rewarming shock leads to V-fib
Severe w/pulse remove cloth,warmed o2,warm to 102-104*, no meds
Severe w/no pulse asscess pulse for 1-2 min,rectal temp,cpr,IV meds longer interval-lidocaine/procainamide,mag, only 1 shock
Frost Nip mildest form of cold injury,involves extremities,localized injury-fingers n hands less common
Frostbite ice crystals form in the extracellular tissue,intracellular water is drawn to ext t cellular,Intracellular lytes reach toxic levels-w/in mins bld flow declines
Superficial frostbite some loss of sensation-S/S:cold,numb,skin red, white or gray.extreme pain w/rewarming-post warming:edema in 3 hrs, blisters 3-24 hrs,skin blackens
Deep frostbite disrupted nutritional cap flow.cold, mottled blue or gray skin,edema develops slowly
TX analgesic,place in hot H2o,warm to 102-104*f,cover with dry dressing,elevate thawed part
Trench Foot emersion foot,exposure to cold/wet-H2o temp >32*F,tissue sloughing or gangrene-TX-warm, dry,elevate feet
Drowning asphyxiation resulting from submersion in liquid, death within 24 hrs post sub
Dry drowing Laryngospasm drowning 10%
Fresh water washes away surfactant,alveoli collapse-V-fib occurs-leads to hyperkalemia and anemia
Salt water draws fluids from bloodstrea,.pulmonary edema occurs
Mammalian diving reflex trigeminal nerve (V) takes message to brainstem=breathing inhibited,brady,decreased metabolic rate,vasoconstriction
Factors affecting outcome 1.Water temp 70*F or below,2.length of submersion3.cleanliness of H2o,4.age/health-younger is better
Drowing TX safety,c-spine,rescue breathing,ALS.IV @75 ml/hr
ARDS due to water in lungs-lungs leak fluid into alveoli,fluid loaded with chemicals causing inflammation of tissue-can cause:pulm parenchymal injury,destruction of surfactant,pneumothorax
water rescues reach,throw and tow,row,go
33 ft of water 2 atmosphere (14lbs)per square inch
Boyles Law POPS-pulmonary overpressurization syndrome:volume of gas inversly proportional to its pressure-cause of barotrauma
Daltons law high altitudes:
Henry's law Decompression illness:
Descent problems (squeeze) barotrauma, results from compression of gas-usually from blocked eustachian tubes
S/S pain,HA,disorientaiton,vertigo,nausea, bleeding from ears/nose, ringing in ears
Nitrogen Narcosis (bottom injury) dissolved nitrogen crosses BBB-S/S evident @70-100 ft,>200ft becomes impaired,300-350ft unconsious-S/S: impaired judgement, sensation of alcohol intox,euphoria,TX: ascent,helium,O2
Ascent injuries (boyles law) air in spaces expand as pressure decreases. if released to fast POP occurs=alveolar rupture
other Ascent injuries *Systemic arterial gas embolism (AGE)-enters circulatory system from damaged lungs,*pneumomediastinum:release of air thu visceral pleura into mediastinum,*pneumopericardium,pneumothorax,pneumoperitoneum
POPS S/S increasing CP,hoarsness,neck fullness,dyspnea,dysphagia(impaired swalling),subcutaneous emphysema
Decompression Illness(sickness) (henrys law) AKA the bends development of nitrogen bubbbles within tissues due to a rapid reduction of air pressure when returning to surface, or exposure to compressed air. Severe pain in abd and joints-effects most cpmmpn in joints and spinal cord
Direct effects of nitrogen ischemia,infarct due to hypoperfusion,tissue displacement,vertigo,platelet aggregation,intravascular coagulation due to air emboli,edema,electrolyte imbalance, lopid emboli are released
Decompression S/S-TX SOB,itch/rash,crepitus,fatigue,vertigo, paresthesias,paralysis,seizures,unconsiousness: develop within 24hrs-ABC's,supine position,dexamethasone,heparin,valium
Recompression (hyperbaric O2 chamber) treats barotrauma,O2 under greater tan atmopspheric pressure,forces nitrogen to redissolve into tissue,when recompressed nitrogen escapes without forming bubbles
Arterial gas embolism (boyles law) alveolar membranes rupture caused by rapid ascent or holding breath during ascent=hemorrhage,cap/alv inflammation,pneumo,sub Q emphysema-onset 2-10min after ascent
S/S-TX neuro def,LOC,sharp,tearing pain,parylysis,unequeal- pupils,blindness,wide pulse pressure,aphasia,confusion,dizzy,vertigo,abd pain,convulsions,arrest-TX:LLR thorax elevate 15*,hyperbaric chamber
Pneumomediastinum result of POPS-air released thru visceral pleura to mediastinum-S/S=substernal CP,abn heart sounds,narrow PP,change in voice,
High altitude Ilness (daltons law) high altitude low O2 environment,barometric pressure decreases,starts at >8,000 ft above sea level-S/S= malaise,anorexia,HA,sleep disturb,resp distress
Acclimatization gradual ascent,days to weeks.within 2 hrs RBC prod increased,>aldosterone and ADH=retained fluid
Prevention of altitude effects 1.limit exertion.2.sleeping.3.high carb diet-Meds-Acetazolamide (Diamox)-diuretic, forces bicarb out.Nifedipine (procardia,adalat) blood vessel dilation, helps prevent pulm HTN and edema
(AMS)Acute Mountain Sickness occurs in unacclimated person that ascends rapidly to 6,600 ft-
S/S-TX mild:light head,breathless,weak,HA,N/V,disturbed sleep 6-24hrs after ascent:mod:weak,severe vomit,SOB,Altered LOC,
(HAPE) High altitude pulmonary Edema result of increased pulmonary pressure and HTN.arterioles become permeable-kids and men more suseptible
S/S-TX dry cough,mild SOB on exertion,slight crackles,lethargy,disorientation then cyanosis,frothy sputum,coma and death-TX:descent,o2,portable hyperbaric bag,Diamox,procardia,lasix,morphine
(HACE) High altitude Cerebral Edema cause unknown,starts with HAPE or acut mont sickness. Increased ICP develops due to edema
S/S-TX AMS,poor judgement,ataxia,HA(common sign),
Radionuclide/radioisotope radioactive substance that emits ionizing radiation
Protons + charged particles,located in nucleus
Neutrons subatomic particles-not charged, avg life <17 mins
Electrons minute particles with a negative charge,called beta particles when emitted
Alpha particles slow moving, large,travel only few mm, stopped by paper, clothes and skin-least dangerous unless internally exposed, most dangerous form of exposure
Beta particles penetrate subcuatneous tissue, enter thru damaged skin,ingestion and inhalation-causes less local damage than alpha, stopped by aluminim
Gamma 100x's penetrating power of beta,only lead protects, produces localized burns and ext internal damage. Causes internal tissue to release alpha and beta particles from electrons
Created by: rebeccabelleth