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Hypothermia (Hyperthermia)

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.

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Hypothermia (Hyperthermia)

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  1. Hypothermia(Hyperthermia) Dr. Stella Yiu Staff Emergency Physician

  2. LMCC objectives • List clinical findings of hypothermia • Investigate • Initiate resuscitation for severe hypothermia

  3. 1. Clinical findings of hypothermia

  4. Normal temp: 36.5 – 37.5 C

  5. 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

  6. Mild (32-35C)

  7. Mild (32-35C)

  8. Mild (32-35C)

  9. Moderate (28-32C) Image credit: James Heilman, MD

  10. Moderate (28-32C)

  11. Severe (<28C) Image credit: jer5150, Wikimedia commons, Jeffrey Bary, Flickr creative commons

  12. What precipitates hypothermia?

  13. Increased heat loss • Alcohol • Sepsis • Burn

  14. Exposure Photo credit: Jonathan Snyder, U.S. Air Force,UNC - CFC – USFK, CC by 2.0, via Flickr creative commons EM Ottawa

  15. Impaired thermostat • Metabolic (Cirrhosis, uremia, DM, Hypothyroid) • CNS (stroke, trauma, MS, Parkinson) • Drugs (Barbituates, TCAs)

  16. 2. Investigations

  17. CDMQ: 25 M found passed out on street. Core temp 30C. Name 4 investigations.

  18. Investigations CBC, Cr, Lytes, Coagprofile (DIC) TSH EKG

  19. Osborn J waves

  20. 3. Resuscitation

  21. Mild (32-35C): Passive external rewarm

  22. Mod (28-32C): Active external rewarm

  23. Mod (28-32C): Active external rewarm Warm humidified Oxygen 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 EM Ottawa

  24. Severe (<28) • Warm every cavity • but • Gentle handling EM Ottawa

  25. CDMQ: How do we do active core rewarming in severe hypothermia? (6)

  26. Airway • Intubate • Warm humidified oxygen

  27. Circulation • Warm intravenous fluids

  28. 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

  29. 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

  30. Dialysis Photo credit: becre8tv, CC by 2.0, via Flickr Creative commons 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

  31. 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

  32. MCQ 3: Patient is lethargicand bradycardic. Most appropriate warming method? • A. Pleural lavage • B. Bladder irrigation • C. Intubation • D. Dry blanket and a snack • E. Blanket with forced warm air

  33. 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. Defibrillation • C. Continue CPR and warming • D. Warm water immersion • E. Stop warming

  34. Not dead until warm (>30-32) and dead

  35. Hyperthermia

  36. LMCC objectives • List predisposing illnesses • List clinical findings • Select investigations • Manage patient by various cooling methods

  37. Causes Environment Decreased heat dissipation Metabolic heat

  38. 1. Predisposing illness

  39. Metabolic causes: Heat production Metabolic heat Thyroid, pheochromocytoma Malignant hyperthermia NMS Sepsis

  40. Decreased heat loss: Drugs Decreased heat dissipation Obesity Drugs (anticholinergics, serotonin)

  41. 2. Clinical findings

  42. Case: The rave girl

  43. Heat stroke: Hot + confused T> 40 Orthostatic BP, HR CNS: Confusion, ataxic, cerebral edema, seizure • CVS: CHF, pulmonary edema, CV collapse

  44. Lab findings: Liver, Renal Liver: necrosis Rhabdomyolysis DIC

  45. 3. Cooling methods

  46. Basic cooling: Photo credit: Kenneth Lu, Flickr creative commons

  47. Photo credit: yellowcloud, flickr creative commons

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