hypothermia (hyperthermia)
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 PresentationTRANSCRIPT
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Hypothermia(Hyperthermia)
Dr. Stella YiuStaff Emergency Physician
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LMCC objectives
List clinical findings of hypothermia
Investigate
Initiate resuscitation for severe hypothermia
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1. Clinical findings of hypothermia
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Normal temp: 36.5 – 37.5 C
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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
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Mild (32-35C)
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Mild (32-35C)
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Mild (32-35C)
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Moderate (28-32C)
Image credit: James Heilman, MD
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Moderate (28-32C)
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Severe (<28C)
Image credit: jer5150, Wikimedia commons, Jeffrey Bary, Flickr creative commons
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What precipitates hypothermia?
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Increased heat loss
Alcohol
Sepsis
Burn
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EM Ottawa
Exposure
14Photo credit: Jonathan Snyder, U.S. Air Force, UNC - CFC – USFK, CC by
2.0, via Flickr creative commons
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Impaired thermostat
Metabolic (Cirrhosis, uremia, DM, Hypothyroid)
CNS (stroke, trauma, MS, Parkinson)
Drugs (Barbituates, TCAs)
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2. Investigations
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CDMQ: 25 M found passed out on street. Core temp 30C. Name 4 investigations.
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Investigations
CBC, Cr, Lytes, Coag profile (DIC)
TSH
EKG
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Osborn J waves
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3. Resuscitation
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Mild (32-35C): Passive external rewarm
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Mod (28-32C): Active external rewarm
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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
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EM Ottawa
Severe (<28)
Warm every cavitybut
Gentle handling
24
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CDMQ: How do we do active core rewarming in severe hypothermia? (6)
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Airway
Intubate Warm humidified oxygen
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Circulation
Warm intravenous fluids
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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
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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
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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
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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
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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
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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
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Not dead until warm (>30-32) and dead
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Hyperthermia
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LMCC objectives
List predisposing illnesses
List clinical findings
Select investigations
Manage patient by various cooling methods
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CausesEnvironm
ent Decreased heat dissipation
Metabolic heat
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1. Predisposing illness
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Metabolic causes: Heat production
Metabolic heatThyroid, pheochromocytomaMalignant hyperthermiaNMSSepsis
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Decreased heat loss: Drugs
Decreased heat dissipation
ObesityDrugs (anticholinergics, serotonin)
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2. Clinical findings
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Case: The rave girl
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Heat stroke: Hot + confusedT> 40Orthostatic BP, HR
CNS: Confusion, ataxic, cerebral edema, seizureCVS: CHF, pulmonary edema, CV collapse
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Lab findings: Liver, Renal
Liver: necrosis
Rhabdomyolysis
DIC
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3. Cooling methods
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Basic cooling:
Photo credit: Kenneth Lu, Flickr creative commons
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Photo credit: yellowcloud, flickr creative commons
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More aggressive cooling
GI/Peritoneal lavage
Cardiac bypass
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Stop cooling when temp < 40
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LMCC objectives
List predisposing illnesses
List clinical findings
Select investigations
Manage patient by various cooling methods