Upload
lirit
View
88
Download
1
Tags:
Embed Size (px)
DESCRIPTION
Hypothermia (Hyperthermia). Dr. Stella Yiu Staff 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. - PowerPoint PPT Presentation
Citation preview
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)
Mild (32-35C)
Mild (32-35C)
Moderate (28-32C)
Image credit: James Heilman, MD
Moderate (28-32C)
Severe (<28C)
Image credit: jer5150, Wikimedia commons, Jeffrey Bary, Flickr creative commons
What precipitates hypothermia?
Increased heat loss
Alcohol
Sepsis
Burn
EM Ottawa
Exposure
14Photo credit: Jonathan Snyder, U.S. Air Force, UNC - CFC – USFK, CC by
2.0, via Flickr creative commons
Impaired thermostat
Metabolic (Cirrhosis, uremia, DM, Hypothyroid)
CNS (stroke, trauma, MS, Parkinson)
Drugs (Barbituates, TCAs)
2. Investigations
CDMQ: 25 M found passed out on street. Core temp 30C. Name 4 investigations.
Investigations
CBC, Cr, Lytes, Coag profile (DIC)
TSH
EKG
Osborn J waves
3. Resuscitation
Mild (32-35C): Passive external rewarm
Mod (28-32C): Active external rewarm
EM Ottawa
Mod (28-32C): Active external rewarm
23By 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 cavitybut
Gentle handling
24
CDMQ: How do we do active core rewarming in severe hypothermia? (6)
Airway
Intubate Warm humidified oxygen
Circulation
Warm 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 lethargic and bradycardic. Most appropriate warming method?
A. Pleural lavageB. Bladder irrigationC. IntubationD. Dry blanket and a snackE. Blanket with forced warm air
MCQ 4: 12 M found in snow. After 2hrs CPR and warming, asytolic. Core temp 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 objectives
List 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)
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, Renal
Liver: necrosis
Rhabdomyolysis
DIC
3. Cooling methods
Basic cooling:
Photo credit: Kenneth Lu, Flickr creative commons
Photo credit: yellowcloud, flickr creative commons
More aggressive cooling
GI/Peritoneal lavage
Cardiac bypass
Stop cooling when temp < 40
LMCC objectives
List predisposing illnesses
List clinical findings
Select investigations
Manage patient by various cooling methods