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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) 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

  7. Moderate (28-32C) Photo credit: Greg O’Connell, Flickr creative commons Image credit: US public domain

  8. Moderate (28-32C) Photo credit: Greg O’Connell, Flickr creative commons Image credit: James Heilman, MD

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

  10. What precipitates hypothermia?

  11. Increased heat loss • Alcohol • Sepsis • Burn

  12. Impaired thermoregulation • Metabolic (Cirrhosis, uremia, DM, Hypothyroid) • CNS (stroke, trauma, MS, Parkinson) • Drugs (barbituates, TCAs)

  13. 2. Investigations

  14. CDMQ: 4 investigations

  15. Investigations CBC, Cr, Lytes Coag profile (DIC) TSH EKG

  16. Osborn J waves

  17. 3. Resuscitation

  18. Mild (32-35C): Passive external rewarm EM Ottawa

  19. Mod (28-32C): Active external rewarm By U.S. Navy photo by Journalist 2nd Class J. Maurer. [Public domain], via Wikimedia Commons EM Ottawa

  20. 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

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

  22. Severe: Arrhythmia VF: CPR, defibx 1 If defib x 1 does not work, no defib (continue CPR) until >30C Not dead until warm and dead

  23. CDMQ: What cavities for rewarming? (6)

  24. Airway • Warm humidified oxygen

  25. Circulation • Warm intravenous fluids

  26. 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

  27. 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

  28. 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

  29. 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

  30. MCQ 3: Patient is confused and bradycardic. Most appropriate warming method? • A. Pleural lavage • B. Bladder irrigation • C. Intubation • D. Peritoneal dialysis • E. Warm humidified oxygen

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

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

  33. Hyperthermia

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

  35. Causes Environment Decreased heat dissipation Metabolic heat

  36. 1. Predisposing illness

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

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

  39. 2. Clinical findings

  40. Case: The rave girl

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

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

  43. 3. Cooling methods

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

  45. Photo credit: yellowcloud, flickr creative commons

  46. More aggressive cooling Tub immersion GI/Peritoneal lavage Cardiac bypass

  47. Stop cooling when temp < 40

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

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