how to deal with low core body temperature? joshua bennettm1073
TRANSCRIPT
Strategies for Treating Hypothermia
How to deal with low core body temperature?
Joshua BennettM1073
Relevance to Wilderness Medicine Medical emergency
>50% mortality in patients aged 70 or older with temperature <32°C (Longmore et al.,
2010)
Personal experience
Why I chose to talk about this
1 hour from car park, notice young man slumped against stone wall.
Mumbling inaudibly and shivering violently.
Half empty bottle of vodka. Equipment is your backpack
containing what you would normally take for a day outdoors.
What would you do?January 2011, Lake District, Sca Fell
Grades and types of hypothermia Need to know basics in order to treat.
Essentials of hypothermia management Do’s and Don'ts
Strategies to treat hypothermia Spontaneous rewarming Active external rewarming Active core rewarming
Resuscitation and hypothermia
Objectives
Severity Grade I – conscious and shivering Grade II – impaired consciousness /
no shivering Grade III – unconscious or cardiac
instability Grade IV – apparent death
Grades of hypothermia
KEY POINT: Cold patients who have stopped shivering will cool at an
accelerating rate (due to minimal heat generation).
Severity Grading system
Speed of onset Acute / immersion
Subacute / exhaustion / injury
Subchronic / urban
Types of hypothermia
irwayreathingirculationisability
Where hypothermia management fits
ABCD
Environment / evacuation
Hypothermia physiology
KEY POINT: ‘Core afterdrop’ or ‘rewarming collapse’ can occur if rewarming is too
quick.
Do: Remove from
cold Replace wet
clothing Insulate Handle gently Monitor regularly
For any hypothermic patient...
Don’t: Suppress
shivering Give alcohol Put in warm
shower/bath Warm peripheries
KEY POINT: Sudden movements may trigger ventricular fibrillation.
(NESRA Medical Sub-Committee, 2010)
Spontaneous rewarming
May reverse Grade I hypothermia
Requires patient to generate heat
Layer system Insulate from
ground Cover head and
neck (leave airway!)
‘Hypothermia wrap’
Active external rewarming
Indications: Grade II hypothermia or worse Trauma or other co-morbidity
Apply heat source to armpits, groin and flanks
Should be warm not hot- risk of burning patient
Airway warming Air humidifier devices Warm tubing in warm drink
Warmed IV fluids Microwave Can warm giving set in warm drink
Thoracic lavage Peritoneal dialysis Cardiopulmonary bypass
Active core rewarming
invasive
(Danzl and Lloyd, 2001)
Check carefully for pulse for 1 minute
“No-one is dead until they are warm and dead” >33°C
Resuscitation and hypothermia
“Active core rewarming techniques are the primary therapeutic modality in hypothermia victims in cardiac arrest or unconscious with a slow heart rate.”
(Emergency Cardiac Care Committee, 1992)
1 hour from car park, notice young man slumped against stone wall.
Mumbling inaudibly and shivering violently.
Half empty bottle of vodka. Equipment is your backpack
containing what you would normally take for a day outdoors.
What would you do?January 2011, Lake District, Sca Fell
Summary
KEY POINT: Cold patients who have stopped shivering will cool at an
accelerating rate (due to minimal heat generation).KEY POINT: ‘Core afterdrop’ or ‘rewarming
collapse’ can occur if rewarming is too quick.
KEY POINT: Sudden movements may trigger ventricular fibrillation.
References Danzl, D. F. and Lloyd, E. L. (2001) Medical
Aspects of Harsh Environments. Borden Institute. Emergency Cardiac Care Committee. (1992)
'Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care', Journal of the American Medical Association.
Longmore, M., Wilkinson, I. B., Davidson, E. H., Foulkes, A. and Mafi, A. R. (2010) Oxford Handbook of Clinical Medicine.8th ed:
NESRA Medical Sub-Committee. (2010) Mountain Rescue for Casualty Care student notes.2nd ed:
Questions?