essentially prisma, and what this is like dialysis, so you’re circulating the blood in smaller volumes so dialysis, so if you think of dialysis, the clients who generally have to go through hemodialysis, is what HD means, that is usually a 3-4 hour treatment. Now if you have a patient who is hypothermic and their BP is already low, you’re think your dialysis patients before treatment, their BP is usually elevated and afterward dialysis, their BP tends to be on the low side because of shifting of the fluid volume away so their BP naturally drops. Now if you think of someone who is hypothermic, you don’t want those large volume shifts for that client because their BP is already low and you are going to pullover 3-4 hours the same amount of volume off, they are probably not going to be able to tolerate that, so we can do something like slow dialysis which is prisma, which actually just pulls smaller volumes off for a longer period of time, and by slow I mean this can go on for several days, sometimes even weeks if necessary and depending on what we are actually using the treatment for. And we’ll talk about that more in depth when we talk about renal systems but just want you to know that sometimes, oftentimes it can be an indication for, not for the sake of correcting electrolytes, which is what we normally use hemodialysis for, but just for the sake of having to warm that clients blood up some. I spent too much time on this slide but I wanted you to understand this whole concept of the after drop and even the systemic effect and goal of rewarming and what these methods may need to include at these times. Ok so frostbite, don’t know if you’ve seen before, frostbite essentially means tissue freezing. Most times it’s accompanied by initial pain, numbness, pallor of the affected area, of course it is going to be from extreme cold temperatures. Deep frostbite requires aggressive management in a medical facility, of course this picture that you see here is what we would definitely would be what we would consider to be deep frostbite. Very low grade tissue freezing is termed, frost nip. Altitude related illness, this is going to be elevations, altitude related illness, going to likely occur in elevations greater than 5000 ft. which can cause or can produce physiological responses and can be fatal at times. You think altitude increases atmospheric pressure, it actually comes down and can result in hypoxia and which actually generates the release or manufacturing of erythropoietin, which actually can cause this of course multiple blood cells, which is termed polycythemia. This is a complication of hypoxia, can be anyway. So ideally it only makes sense that we want to acclimate when they know they are going to be experiencing or travelling to an area on vacation or you know travelling for a couple days, actually acclimate, there are ways that we can do that to actually decrease perhaps the possibility of these things occurring. You want to watch for hypocapnia which would be related to tachypnea.
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- Winter '16
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