Download - Hypothermia (Hyperthermia)
Hypothermia(Hyperthermia)Dr. Stella YiuStaff Emergency Physician
LMCC objectives
List clinical findings of hypothermia
Investigate
Initiate resuscitation for severe hypothermia
1. Clinical findings of hypothermia
Normal temp: 36.5 – 37.5 C
Effects
By Patrick J. Lynch, medical illustrator (Patrick J. Lynch, medical illustrator) [CC-BY-2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons
Image credit: US public domain
Mild (32-35C)
By Patrick J. Lynch, medical illustrator (Patrick J. Lynch, medical illustrator) [CC-BY-2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons
Image credit: US public domain
Moderate (28-32C)
Image credit: US public domain Photo credit: Greg O’Connell, Flickr creative commons
Moderate (28-32C)
Image credit: James Heilman, MD Photo credit: Greg O’Connell, Flickr creative commons
Severe (<28C)
Image credit: jer5150, Wikimedia commons, Jeffrey Bary, Flickr creative commons
What precipitates hypothermia?
Increased heat lossAlcohol
Sepsis
Burn
Impaired thermoregulation
Metabolic (Cirrhosis, uremia, DM, Hypothyroid)
CNS (stroke, trauma, MS, Parkinson)
Drugs (barbituates, TCAs)
2. Investigations
CDMQ: 4 investigations
InvestigationsCBC, Cr, Lytes
Coag profile (DIC)
TSH
EKG
Osborn J waves
3. Resuscitation
EM Ottawa
Mild (32-35C): Passive external rewarm
18
EM Ottawa
Mod (28-32C): Active external rewarm
19By U.S. Navy photo by Journalist 2nd Class J. Maurer. [Public domain],
via Wikimedia Commons
EM Ottawa
Mod (28-32C): Active external rewarm
20By Patrick J. Lynch, medical illustrator (Patrick J. Lynch, medical illustrator) [CC-BY-2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons
Warm humidified Oxygen
EM Ottawa
Severe (<28)Warm every cavity
butGentle handling
21
Severe: ArrhythmiaVF: CPR, defib x 1
If defib x 1 does not work, no defib (continue CPR) until >30C
Not dead until warm and dead
CDMQ: What cavities for rewarming? (6)
AirwayWarm humidified oxygen
CirculationWarm intravenous fluids
Pleural space
By Patrick J. Lynch, medical illustrator (Patrick J. Lynch, medical illustrator) [CC-BY-2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons
Bladder
By User:Lennert B [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/) or CC-BY-2.5
(http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons
Dialysis
By National Kidney and Urologic Diseases Information Clearinghouse, National Institute of Diabetes and Digestive
and Kidney Diseases, National Institutes of Health, USA [Public domain], via Wikimedia Commons
Photo credit: becre8tv, CC by 2.0, via Flickr Creative commons
Bypass
By Van Meurs, K, Lally, KP, Peek, G, Zwischenberger, Extracorporeal Life Support Organization, Ann Arbor 2005. [CC-BY-2.5
(http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons
MCQ 3: Patient is confused and bradycardic. Most appropriate warming method?
A. Pleural lavageB. Bladder irrigationC. IntubationD. Peritoneal dialysisE. Warm humidified oxygen
MCQ 4: 12 yo found in the snow. After 2hrs CPR and warming, asytolic and core temp is 27.5C. What is the most appropriate step?A. Stop resuscitation B. DefibrillationC. Continue CPR and warmingD. Warm water immersionE. Stop warming
Not dead until warm (>30-32) and dead
Hyperthermia
LMCC objectivesList predisposing illnesses
List clinical findings
Select investigations
Manage patient by various cooling methods
CausesEnvironm
ent Decreased heat dissipation
Metabolic heat
1. Predisposing illness
Metabolic causes: Heat production
Metabolic heatThyroid, pheochromocytomaMalignant hyperthermiaNMSSepsis
Decreased heat loss: Drugs
Decreased heat dissipation
ObesityDrugs (anticholinergics, serotonin, sympathomimetics)
2. Clinical findings
Case: The rave girl
Heat stroke: Hot + confusedT> 40Orthostatic BP, HR
CNS: Confusion, ataxic, cerebral edema, seizureCVS: CHF, pulmonary edema, CV collapse
Lab findings: Liver, RenalLiver: necrosis
Rhabdomyolysis
DIC
3. Cooling methods
Basic cooling:
Photo credit: Kenneth Lu, Flickr creative commons
Photo credit: yellowcloud, flickr creative commons
More aggressive coolingTub immersion
GI/Peritoneal lavage
Cardiac bypass
Stop cooling when temp < 40
LMCC objectivesList predisposing illnesses
List clinical findings
Select investigations
Manage patient by various cooling methods