MyCpdZw - Protocols Details

HYPOTHERMIA

Hypothermia is a medical emergency that occurs when your body loses heat faster than it can produce heat, causing a dangerously low body temperature. Normal body temperature is around 98.6 F (37 C). Hypothermia (hi-poe-THUR-me-uh) occurs as your body temperature falls below 95 F (35 C).

Diagnosis

Defined as a core temperature <35 (measured via rectal or IDC probe).

Mild 32-35

· Increased basal metabolic rate

· Shivering

· Amnesia, dysarthria, ataxia, apathy

· Respiratory stimulation

· Normal BP

Moderate 28-32

· Stupor

· Cessation of shivering

· AF & dysrhythmias

· Heart rate declines

· Insulin ineffective

· Gradual loss of consciousness.

Severe <28

.Absent reflexes & voluntary movements

.Major acid-base disturbances

.Risk of developing pulmonary oedema

.Significant hypotension

.Arrhythmias common.

Results in multiorgan failure 9renal failure & pancreatitis are common.

Shivering stops at 30.

Tachycardia is followed by bradycardia & hypotension. Arrhythmias are common & often refractory to treatment.

Asystole & VT occur spontaneously below 25.

Respiratory stimulation is followed by depression.

Predisposing factors:

· Entrapment

· Cold water emersion

· Dermatological conditions (burns, erythroderma)

· Vasodilating drugs (Especially alcohol)

· Diabetes

· Elderly & neonates

· Endocrine failure

· Hypoglycaemia

· Immobility & inactivity

· CNS disfunction (drugs, trauma, acidosis, anoxia).

Management

General measures:

· ABC’s as indicated

· Remove wet clothing

· Handle gently (rough handling causes dysrhythmias!).

Investigations:

· IV access

· FBC, U&E’s, sugars, CK, Amylase/ lipase, Coagulation studies, venous gases

· ECG (bradycardias, dysrhythmias & Osbourne waves- ST elevation in II & V6)

Start warmed IV fluids (insulate lines), consider warmed humidified oxygen

Keep in a warm environment with warm clothing, space blankets

“Bair Hugger” should be used if <32 with aim to rewarm at 1-2/hr

Treat arrhythmias:

· Bradycardia & AF are common & usually revert with rewarming

· Other atria & transient ventricular arrhythmias should be ignored

· VF- defibrillation ineffective if <30,

CPR- CPR is difficult because of chest & myocardial compliance, DON’T COMMENCE if other lethal injuries are present.

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