hypothermia frostbite
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8/13/2019 Hypothermia Frostbite
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Wiwi J., Isngadi., Karmini
Laboratorium/SMF Anestesiologi &
Reanimasi FK Unibraw/RSU
Dr Saiful Anwar – Malang
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Hypothermia is an unintentional condition,
hence the term of ‘accidental hypothermia’
is preferred to used.
Hypotermia :
- unintentional drop in the body’s core
temperature
- it’s temperture is below 35º C
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Primary accidental hypothermia :
a result of the direct exposure of the cold
to a previously healthy individual.
Secondary hypothermia :
happened to patient as a complication of
serious systemic disorder.
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Most cases occur in winter & colder climates.
Elderly & neonates particularly vulnerable to
this condition.
Few drugs (phenothiazine, barbiturates,
benzodiazepine and cyclic antidepressant)
reduce centrally mediated vasoconstriction.
Overdose of them can result hypothermia.
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Several types of endocrine dysfunction :
- hypothyroidism.
- adrenal insufficiency.
- hypopytuitarism.
Acute spinal cord injury.
Sepsis (cold sepsis).
Shapiro syndrome ―‣ episodic hypothermia
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The diagnosis of hypothermia based on :
1. History of exposure to cold environment.
2. Decrease of core/body temperature :
- 32,2 ºC to 35 ºC : mild
- 28 ºC to <32,2 ºC : moderate
- less than 28 ºC : severe
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MILD HYPOTHERMIA (32,2 ºC – 35 ºC)
1. Respiratory System :
tachypnea then decreased minute volume,
bronchorrhea, bronchospasm.
2. Cardiovascular System :
tachycardia then bradycardia, vasocons-
triction & increased blood pressure.
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MILD HIPOTHERMIA :
3. Central Nervous System :
depression of cerebral metabolism,
amnesia, apathy and dysarthria.
4. Renal and Endocrine System :
diuresis, increase thyroxin and shivering
(increase in metabolism)
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MILD HIPOTHERMIA
5. Neuromuscular system :increased preshivering muscle tone,
then fatique.
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Moderate hypothermia (28 ºC - <32,2 ºC)
1. Respiratory System :
every 8 ºC drop, decrease 50 % CO₂ pro-
duction ; hypoventilation ; absence of
protective airway reflex.
2. Cardiovascular System :
decrease pulse & cardiac output,
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2. Cardiovascular System :
increase atrial & ventricular arrythmia.
3. Central Nervous System :
depression of consciousness, pupillary
dilatation, hallucinations.
4. Renal and endocrine system :
50% decrease of renal blood flow and
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4. Renal and endocrine system :
renal autoregulation intact but impaired
the effect of insulin.
5. Neuromuscular system :
hyporeflexia and rigidity.
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SEVERE HYPOTHERMIA ( <28 ºC ) :
1. Respiratory System :
pulmonary edema, decrease O₂ con-sumption (75%) & apnea (breathless).
2. Cardiovascular System :
decrease heart rate, blood pressure &
cardiac output ; dysrhytmias and asystole.
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SEVERE HYPOTHERMIA
3. Central Nervous System :
loss of cerebral autoregulation & ocular
reflexes, decline CBF and coma.
4. Renal and Endocrine System :
decrease RBF (pararel with cardiac output),
poikilothermia & decrease basal metab.
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SEVERE HYPOTHERMIA
5. Neuromuscular System :no motion, decrease nerve conduction,
absent of corneal and occulocephalic
reflexes
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- Occurs when the tissue temperature drops
below 0º C.
- Ice crystal formation distort & destroy the
celullar architecture.
- After the tissue thaw, there is progressive
dermal ischemia.
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Microvasculature begin to collapse.
Arteriovenous shunting increases tissue
pressures, and edema forms.
Thrombosis, ischaemia and superficial ne-
crosis appear.
Mummification & demarcation develop in
several weeks to months.
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Simptomps : sensory deficiency affecting
light touch, pain and temperature.
Some patients complain of a clumsy or
‘chunk of wood’ sensation in extremity.
Sign : affected tissue appear waxy, mottled,
yellow or violaceous white.
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