Accidental hypothermia - Revision history

Neil.m.young: /* Active Internal */

2024-04-28T01:56:59Z

Active Internal

← Revisión anterior		Revisión del 01:56 28 abr 2024
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	*[[Peritoneal lavage]]		*[[Peritoneal lavage]]
	*Bypass/[[ECMO]]<ref>Ginty C, et al. Extracorporeal membrane oxygenation rewarming in the ED: an opportunity for success. American Journal of Emergency Medicine. 2014 December 3 (ahead of print).</ref>/AV Dialysis		*Bypass/[[ECMO]]<ref>Ginty C, et al. Extracorporeal membrane oxygenation rewarming in the ED: an opportunity for success. American Journal of Emergency Medicine. 2014 December 3 (ahead of print).</ref>/AV Dialysis
	***[https://www.hypothermiascore.org/ HOPE score] can predict probability of survival with ECMO		**[https://www.hypothermiascore.org/ HOPE score] can predict probability of survival with ECMO

	===Rewarming Rates===		===Rewarming Rates===

Neil.m.young: /* Active Internal */

2024-04-28T01:56:43Z

Active Internal

← Revisión anterior		Revisión del 01:56 28 abr 2024
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	*[[Peritoneal lavage]]		*[[Peritoneal lavage]]
	*Bypass/[[ECMO]]<ref>Ginty C, et al. Extracorporeal membrane oxygenation rewarming in the ED: an opportunity for success. American Journal of Emergency Medicine. 2014 December 3 (ahead of print).</ref>/AV Dialysis		*Bypass/[[ECMO]]<ref>Ginty C, et al. Extracorporeal membrane oxygenation rewarming in the ED: an opportunity for success. American Journal of Emergency Medicine. 2014 December 3 (ahead of print).</ref>/AV Dialysis
			***[https://www.hypothermiascore.org/ HOPE score] can predict probability of survival with ECMO

	===Rewarming Rates===		===Rewarming Rates===

Rossdonaldson1: /* Clinical Features */

2023-11-15T20:23:13Z

Clinical Features

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	==Clinical Features==		==Clinical Features==
	[[File:1024px-Medical students take to the water to learn about hypothermia 150407-G-NW142-051.jpg\|thumb\|Medical students learning about the effects of hypothermia on the body.]]		[[File:1024px-Medical students take to the water to learn about hypothermia 150407-G-NW142-051.jpg\|thumb\|Medical students learning about the effects of hypothermia on the body.]]
			[[File:US Navy 090408-N-3714M-289 A SEAL Qualification Training candidate looks out from a two-man tent during a re-warming exercise in which he spent five minutes in near freezing water.jpg\|thumb\|Man being rewarmed after spending five-minutes in near freezing water.]]
	{{Swiss staging system}}		{{Swiss staging system}}

Rossdonaldson1 at 22:36, 8 November 2023

2023-11-08T22:36:30Z

← Revisión anterior		Revisión del 22:36 8 nov 2023
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	*Cardiac dysfunction		*Cardiac dysfunction
	**[[Dysrhythmias]]		**[[Dysrhythmias]]
			***May occur spontaneously if temperature <30°C (86°F)
	**Afterdrop: Initial drop in temperature and MAP as rewarming is started due to loss of vasoconstriction/AV shunting colder peripheral tissues		**Afterdrop: Initial drop in temperature and MAP as rewarming is started due to loss of vasoconstriction/AV shunting colder peripheral tissues
	*[[Coagulopathy]]		*[[Coagulopathy]]
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	===[[Dysrhythmias]]===		===[[Dysrhythmias]]===
	*May occur spontaneously if temperature <30°C (86°F)
	*Rewarming is treatment of choice		*Rewarming is treatment of choice
	*Most dysrhythmias (e.g. sinus brady, [[a-fib]]/[[flutter]]) require no other therapy		*Most dysrhythmias (e.g. sinus brady, [[a-fib]]/[[flutter]]) require no other therapy

Rossdonaldson1: /* General Management */

2023-11-08T22:30:54Z

General Management

← Revisión anterior		Revisión del 22:30 8 nov 2023
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	==General Management==		==General Management==
	===~~Handling~~===		===Basic Measures===
	*Handle patient gently		*Handling
	*[[V-fib]] may be induced by rough handling of patient due to irritable myocardium (anecdotal)		**Handle patient gently
	~~===~~[[O2]]~~===~~		**[[V-fib]] may be induced by rough handling of patient due to irritable myocardium (anecdotal)
	*[[Hypothermia]] causes leftward shift of oxyhemoglobin dissociation curve		*[[Oxygen therapy]]
	*[[Intubation]]		**[[Hypothermia]] causes leftward shift of oxyhemoglobin dissociation curve
	*Intubate gently		**[[Intubation]]
	*if [[RSI]] is given medications may act at a slower rate		**Intubate gently
			**If [[RSI]] is given medications may act at a slower rate
	~~===~~[[IVF]]~~===~~		*[[IVF]]
	*Patients are also hypovolemic since [[hypothermia]] causes impaired renal concentrating ability, in turn causing cold diuresis		**Patients are also hypovolemic since [[hypothermia]] causes impaired renal concentrating ability, in turn causing cold diuresis
	*Patients are prone to [[Rhabdomyolysis\|rhabdomyolysis]] and will need hydration		**Patients are prone to [[Rhabdomyolysis\|rhabdomyolysis]] and will need hydration
	*Intravascular volume is lost due to extravascular shift		**Intravascular volume is lost due to extravascular shift
	*NS preferred over LR as cold liver poorly metabolizes LR		**[[Normal saline]] preferred over [[Lactated Ringers]], as cold liver poorly metabolizes LR

	===[[Dysrhythmias]]===		===[[Dysrhythmias]]===

Rossdonaldson1: /* Coding Patient Management */

2023-11-08T21:51:14Z

Coding Patient Management

← Revisión anterior		Revisión del 21:51 8 nov 2023
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	\|}		\|}

	==~~Coding Patient Management~~==		==[[Cardiac Arrest]]==
			*Only perform if patient truly does not have a pulse (unnecessary CPR may lead to [[V-fib]])
			*Spend 30-45s attempting to detect respiratory activity and pulse before starting CPR
	*Rhythms can quickly degenerate into unstable rhythms		*Rhythms can quickly degenerate into unstable rhythms
	*Be careful when inserting guidewires, persistent shocks can degenerate fib into asystole		*Be careful when inserting guidewires, persistent shocks can degenerate fib into asystole
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	**[[Asystole]] persists beyond >32°C		**[[Asystole]] persists beyond >32°C
	*''Lactate and pH have less consistent prognostic significance in hypothermia''		*''Lactate and pH have less consistent prognostic significance in hypothermia''

	~~===[[CPR]]===~~
	*Only perform if patient truly does not have a pulse (unnecessary CPR may lead to [[V-fib]])
	*Spend 30-45s attempting to detect respiratory activity and pulse before starting CPR

	==Disposition==		==Disposition==

Rossdonaldson1: /* General Management */

2023-11-08T21:48:51Z

General Management

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	**Reasonable to perform further defibrillation attempts concurrent with rewarming<ref name=Hoek />		**Reasonable to perform further defibrillation attempts concurrent with rewarming<ref name=Hoek />

	===[[Antibiotics]]~~===~~		===Medications for Unexplained Hypothermia in Specific Patient Populations===
	*Give if suspect [[sepsis]] (e.g. hypothermia fails to correct with rewarming measures)		*[[Antibiotics]]
			**Give if suspect [[sepsis]] (e.g. hypothermia fails to correct with rewarming measures)
	~~===~~[[Thiamine]]~~===~~		*[[Thiamine]]
	*Consider if [[Wernicke disease]] is possible cause of hypothermia (e.g. alcoholic patient)		**Consider if [[Wernicke disease]] is possible cause of hypothermia (e.g. alcoholic patient)
			*[[Hydrocortisone]]
	~~===~~[[Hydrocortisone]]~~===~~		**Consider if patient has history of adrenal suppression or insufficiency
	*Consider if patient has history of adrenal suppression or insufficiency		***100mg hydrocortisone
	**100mg ~~Hydrocortisone~~		*[[Levothyroxine]]
			**Consider if any suspicion for [[hypothyroidism]]/[[myxedema coma]]
	~~===~~[[Levothyroxine]]~~===~~		**Could cause dysrhythmia or cardiac ischemia if not in myxedema coma
	*Consider if any suspicion for [[hypothyroidism]]/[[myxedema coma]]		*[[Hyperglycemia]]
	*Could cause dysrhythmia or cardiac ischemia if not in myxedema coma		**Hyperglycemia common in hypothermia:
			***Stimulates catecholamine induced glycogenolysis
	~~===~~[[Hyperglycemia]]~~===~~		***Inhibits insulin release and uptake by cell membranes
	*Hyperglycemia common in hypothermia:		**Rebound hypoglycemia during rewarming can occur if clinicians too aggressively deliver exogenous insulin
	**Stimulates catecholamine induced glycogenolysis
	**Inhibits insulin release and uptake by cell membranes
	*Rebound hypoglycemia during rewarming can occur if clinicians too aggressively deliver exogenous insulin

	==Rewarming==		==Rewarming==

Rossdonaldson1: /* Associated Problems */

2023-11-08T21:40:21Z

Associated Problems

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	**Afterdrop: Initial drop in temperature and MAP as rewarming is started due to loss of vasoconstriction/AV shunting colder peripheral tissues		**Afterdrop: Initial drop in temperature and MAP as rewarming is started due to loss of vasoconstriction/AV shunting colder peripheral tissues
	*[[Coagulopathy]]		*[[Coagulopathy]]
	**Decreased platelet function and inhibition of coagulation cascade		**Decreased clotting function
	**Part of the [[Trauma_(main)#Lethal_Triad_of_Major_Trauma\|lethal triad of trauma]]		***platelet function and inhibition of coagulation cascade
	*[[Thromboembolism]]		***Part of the [[Trauma_(main)#Lethal_Triad_of_Major_Trauma\|lethal triad of trauma]]
	**Secondary to hemoconcentration, increased blood viscosity, and poor circulation		**[[Thromboembolism]]
	**[[Disseminated intravascular coagulation]]		***Secondary to hemoconcentration, increased blood viscosity, and poor circulation
			***[[Disseminated intravascular coagulation]]
	*Ineffective Drugs		*Ineffective Drugs
	**Protein binding increases as body temperature drops, and most drugs become ineffective		**Protein binding increases as body temperature drops, and most drugs become ineffective

Rossdonaldson1: /* Associated Problems */

2023-11-08T21:39:13Z

Associated Problems

← Revisión anterior		Revisión del 21:39 8 nov 2023
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	*[[Coagulopathy]]		*[[Coagulopathy]]
	**Decreased platelet function and inhibition of coagulation cascade		**Decreased platelet function and inhibition of coagulation cascade
	**Part of the [[/Trauma_(main)#Lethal_Triad_of_Major_Trauma\|~~letha~~ triad of trauma]]		**Part of the [[Trauma_(main)#Lethal_Triad_of_Major_Trauma\|lethal triad of trauma]]
	*[[Thromboembolism]]		*[[Thromboembolism]]
	**Secondary to hemoconcentration, increased blood viscosity, and poor circulation		**Secondary to hemoconcentration, increased blood viscosity, and poor circulation

Rossdonaldson1: /* Associated Problems */

2023-11-08T21:38:58Z

Associated Problems

← Revisión anterior		Revisión del 21:38 8 nov 2023
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	*[[Coagulopathy]]		*[[Coagulopathy]]
	**Decreased platelet function and inhibition of coagulation cascade		**Decreased platelet function and inhibition of coagulation cascade
	**Part of the [[trauma]] ~~triangle of death~~		**Part of the [[/Trauma_(main)#Lethal_Triad_of_Major_Trauma\|letha triad of trauma]]
	*[[Thromboembolism]]		*[[Thromboembolism]]
	**Secondary to hemoconcentration, increased blood viscosity, and poor circulation		**Secondary to hemoconcentration, increased blood viscosity, and poor circulation