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Hyperthermia and Hypothermia

Case 1:. 22 y.o. femaleOut with friends celebrating her birthday (February 19th)Dropped off at her front door by friendsFound by her parents in the morning, passed out just inside the screen doorUnable to wake her? call 911. Case 2:. 85 y.o. maleMid-August, during heat waveSon goes to apartmen

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Hyperthermia and Hypothermia

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    1. Hyperthermia and Hypothermia Back to Basics April 2011 Dr. J. Clow, ER

    2. Case 1: 22 y.o. female Out with friends celebrating her birthday (February 19th) Dropped off at her front door by friends Found by her parents in the morning, passed out just inside the screen door Unable to wake her… call 911

    3. Case 2: 85 y.o. male Mid-August, during heat wave Son goes to apartment and finds patient confused and lethargic Patient unable to give history

    4. Heat Regulation Four mechanisms of heat loss/dissipation: Radiation Convection Conduction Evaporation

    5. Radiation Physical transfer of heat between the body and the environment by electromagnetic waves 65% of heat transfer under normal circumstances Modified by insulation (clothing, fat layer), cutaneous blood flow

    6. Convection Energy transfer between the body and a gas or liquid Affected by temperature gradient, motion at the interface, and liquid Not usually a major source for heat loss or dissipation, but this increases with wind and body motion

    7. Conduction Direct transfer of heat energy between two surfaces Responsible for only a small proportion of heat loss under normal circumstances Increases significantly with immersion in cold water Major cause of accidental hypothermia

    8. Evaporation Most important source of cooling under extreme heat stress; important for hypothermia when in wet environment 25% of heat loss in temperate/cool conditions… may be increased significantly by sweating, increased respiratory rate Affected by relative humidity and clothing

    9. Hypothermia…

    10. Definition Core body temperature less than 35oC Mild: 32.2 - 35oC Moderate: 28 - 32.2oC Severe: < 28oC

    11. Causes… Decreased heat production Endocrine, insufficient fuel, neuromuscular inactivity Increased heat loss Accidental/immersion hypothermia, vasodilatation, skin disorders, iatrogenic Impaired thermoregulation Central (metabolic, drugs, CNS) Peripheral (spinal cord injury, neuropathy, diabetes, neuromuscular disorders)

    12. Predisposing Factors

    13. Signs and Symptoms

    14. Signs and Symptoms, cont’d

    15. History Often from bystanders/medics Circumstances surrounding exposure Where, submersion, ambient temperature? Length of exposure Mental status changes Any predisposing illness – acute/chronic? Alcohol/drugs?

    16. Physical Exam Vitals… Temperature – want a core temperature Where do we take it? Signs of other injuries? Can you find the cause of hypothermia? Any focal findings? Esp. neurologic, cardiovascular, respiratory

    17. Diagnositics ECG (always), CXR (most patients) Other tests depend on the clinical scenario Any signs of trauma? May need imaging… Are you able to take a history? Past medical history? Labs for all: CBC, electrolytes, glucose, renal function, toxicology, coags, ABGs, LFTs, lipase/amylase, cultures

    18. ECG Changes May see J waves late, terminal upright deflection of QRS complex; best seen in leads V3-V6 Multiple arrhythmias Heart block Atrial fibrillation Ventricular fibrillation

    19. ECG Changes, cont’d

    20. Management…

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