ACCIDENTAL HYPOTHERMIA. Melanie Stander. Defined as decline in core body temperature below 35C. Mild : 35-32 C Moderate : <32 – 28 C Severe : <28 C. Risk Factors. Extremes of age Ethanol abuse Malnutrition Poverty Mental disease Neuroleptic drugs Hypothyroidism Cold-water immersion
1. Radiation (55%)
2. Evaporation (airway-5%, skin-25%)
3. Conduction (10%)
4. Convection (5%)
ABG shows higher O2 and CO2 levels and lower pH than pt’s actual values.
Current practise – correction of ABGs for temp is unnecessary as a guide for therapy.
- Volume resus
1. Humidified, heated oxygen
Via face mask or ETT.
Inspired air should not exceed 40 C.
Avoidance of afterdrop.
Maintenance of adequate oxygenation is vital (shift of oxyHb dissociation curve).
2. heat to the pt.Warmed IV fluids
3. Peritoneal Lavage
Infuse 1L of warmed balanced salt
solution for one min and then drain.
Fluid rates of 10-12L/hr are possible.
Rosen’s suggests 2L infused and retained for 20-30 mins and then aspirated.
Hepatic rewarming reactivates depressed
detoxification and enzymes.
4. heat to the pt.Pleural Lavage
Preferably left side.
Infuse 1L warmed N/S for 1 min and then drain.
Can use one tube anteriorly in 2nd or
3rd ICS MCL and second tube in PAL
at 5th to 6th ICS.
5. heat to the pt.Diathermy
Restores body heat by ultrasonic waves, microwaves or shortwaves.
Involves the conversion of energy waves into heat.
Noninvasive way to deliver heat to core tissues.
6. heat to the pt.Extracorporeal Blood Warming
CPB, AV rewarming, VV rewarming & haemodialysis.
CPB: major advantage is preservation of flow if mechanical cardiac activity is lost during rewarming.
CAVR: blood pressure must be at least 60mmHg. Ipsilateral femoral artery and contralateral femoral vein.
VVR heat to the pt.: blood removed from CVP, heated to 40 C and returned via second CVP or large peripheral venous catheter.
Haemodialysis: portable and efficient. Consider in electrolyte abns, RF or intoxication with a dialysable substance.
NO ONE IS DEAD UNTIL THEY ARE WARM AND DEAD! heat to the pt.
5. heat to the pt. State of Alaska Cold Injuries Guidelines, Alaska Multi-level, 2003 version. Prepared by Dept of Health & Social Services, Division of Public Health, Section of Community Health and EMS.
6. Robert Douwens, Hypothermia Recognition and Treatment.
7. Rosen’s Emergency Medicine, Concepts and Clinical Practice, 5th edition, volume 3.
8. Oxford Handbook of Trauma for Southern Africa, Nichol & Steyn 2004.