Hypothermia-1 - Accidental Hypothermia Franois Dufresne...

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Accidental Hypothermia François Dufresne McGill Emergency Medicine May 2 nd 2001
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The Case of Tommy 23h10 Call from MD working in James Bay Male, 27 y.o. Unresponsive. Found in snow, cross-country skiing • Normal Airway. Breathing. O 2 sat. Femoral pulse + (35) BP. GCS=3 T R ° = 28 ° C. • IV. Monitor. Mask with 100% O 2
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The Case of Tommy… Friend told MD: PMH. Rx. drugs. EtOH Major foot deformity Looks like fell in ski and could not return home by himself… MD has some questions for you…
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The Case of Tommy… Should he intubate? Are there risks to precipitate dysrythmias? Cold myocardium prone to arythmias? How should he rewarm the patient? Danger of afterdrop? He wants an ABG but should he ask for the blood to be warmed to normal T ° for analysis…or it doesn’t matter? Answer: You’ll call him back…
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The Case of Tommy… MD calls you back 30 minutes later Pt in cardiac arrest : V.fib. Now 27 ° C 3 shocks Epinephrine + re-shock Having Amiodarone prepared… How long should he do CPR and rescussitation? Anything wrong ? Answer ?
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Introduction EtOH Mental illness Homelessness Province of Quebec Cold
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Plan Definitions Physiology Pathophysiology Labs findings : ABG, ECG Rewarming methods Afterdrop ACLS 2000 guidelines
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Definitions Primary VS Secondary Primary Normal thermoregulation Overwhelming cold exposure Secondary Abnormal thermogenesis Multiple causes
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Definitions Hypothermia : < 35 ° C Mild : 32-35 ° C Moderate : 28-32 ° C Severe : < 28 ° C
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Physiology: Heat production Basal metabolism (Metabolic rate) Heart / Liver Anterior hypothalamus Thyroid / Sympathetic Preshivering muscle tone (2x) Shivering (2-5x) Posterior hypothalamus
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Physiology: Heat dissipation Radiation (55-65%) Gradient between environement and exposed body area. Conduction (2-3%) Direct contact with cold substance Convection (10-15%) Wind… Evaporation (20-35%)
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Physiology… Above 32 ° C: Vasoconstriction Shivering Basal metabolic rate Below 32 ° C: No shivering Below 24 ° C: No basal metabolic rate
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Pathophysiology Cardiovascular Initial tachycardia Gradual bradycardia : HR 50% at 28 ° C. Not consistent ? Hypoglycemia, intoxication, hypovolemia,…? Refractory to atropine BP CI A.fib (T ° < 32 ° C) V.fib (T ° < 28 ° C)
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Pathophysiology… CNS Cerebral metabolism 6% / 1 ° C Normal autoregulation until 25 ° C EEG flat at 19 ° C Renal Cold diuresis Peripheral vasoconstriction Failure to reabsorb Na + and water.
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Pathophysiology… Respiratory – CO 2 production 50% at 30 ° C Decreased RR ARDS possible Hematology Hemostasis and coagulation impaired Problems with CPB
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This note was uploaded on 01/11/2012 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Hypothermia-1 - Accidental Hypothermia Franois Dufresne...

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