Page 12 - Emergency medicine for students ebook

Hypothermia
Symptoms:
Ø Apathy, amnesia, ataxia, dysarthria, coma, hypotension, arrhythmias, respiratory depression, muscular rigidity
Ø Ventricular fibrillation may occur when temperature is below 28 degrees or upon limb movement/invasive procedures.
Stages of hypothermia: Oxford Handbook of emergency medicine- Page 254
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Pre-hospital Treatment:
1. If wet, change into dry clothes
2. Cover body and head with blankets
3. Protect from cold ground by lying them on a mat/pine branches/heather
4. Give hot drink/food
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Treatment in hospital
1. Treat in warm room above 21 degrees
2. Handle patient gently to reduce risk of VF
3. Remove wet clothes and dry skin
4. Monitor ECG- AF with slow ventricular response, prolong of QRS,
delayed repolarization and ST-T wave abnormalities
5. Give warmed humidified O2 by mask
6. IV access
7. Correct hypoglycaemia with IV glucose
8. Hypothermic cardiac arrest can make heart unresponsive to defib, pacing
and drug therapy, so avoid drugs until temp above 30 degrees
9. Defibrillation is appropriate if VF/VT occurs- if 3 shocks unsuccessful
stop shocks until temp above 30 degrees
• Passive rewarming: wrap in warm blankets and polythene sheets. Aim
for rate of 0.5-2 degrees/hr. Suitable for mild above 32 degrees
• Active rewarming: water bath at 41 degrees. Useful for immersion
hypothermia but not used if injured or if CPR required.
• Core rewarming: Airway warming with 40-45 degree humidified O2 can
reduce risk of arrhythmia. Peritoneal lavage saline at 45 degrees run in via DPL catheter for 10-20 mins. Directly heats liver and retroperitoneal
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