Hypothermia-PhiladelphiaUniversity：低温-费城大学.pptVIP

HYPOTHERMIAAlcohol Related Illness Hypothermia - Alcohol Hypothermia Epidemiology Physiology of Temperature Control Etiology of Hypothermia Pathophysiology/Treatment Hypothermia and Trauma Alcohol Ethanol Intoxication Pathophysiology/Treatment Alcohol Abuse Hypothermia Epidemiology Defined as temp 35O C (95O F) 700 die each year in US from hypothermia ? of those are 65+ years old Individuals at age extremes and those with AMS are at greatest risk Physiology of Temperature Control Conduction Transfer of heat by direct contact down temperature gradient. Convection Transfer of heat by movement of heated material. (i.e. wind) Radiation Loss of heat from non-insulated areas H2O Evaporation Loss of heat through exhalation Temperature Homeostasis Opposition of Heat Loss Hypothalamus Stimulation of sympathetic nervous system if temp below ‘set point’ Behavioral responses Wearing clothes when it’s cold Leaving cold environment Heat Gain Shivering “Non-shivering thermogenesis” Etiology of Hypothermia Accidental Immersion and non-immersion cold exposure Metabolic Hypoendocrine states (hypothyroid, hypoadrenalism, hypopituitarism) Hypoglycemia Head trauma Tumor Etiology of Hypothermia (cont.) Wernicke’s disease. Drug induced Alcohol (majority of hypothermic pt’s in US are intoxicated) Sedatives Phenothiazines Insulin Sepsis Etiology of Hypothermia (cont.) Severe dermal disease Burns Exfoliative dermatitis Acute incapacitating illness Severe infections DKA Psychotic disorders Other conditions causing impaired thermoregulatory function Resuscitation with room temperature fluid Pathophysiology Mild Hypothermia 34-36? C (93.2-96.8? F) Excitation Physiologic adjustments to retain heat Moderate Hypothermia 32-34? C (89.6-93.2? F) Adynamic Metabolism slows Decreased O2 demand Decreased CO2 production Severe Hypothermia 32? 9 (89.6? F) Shivering ceases Pathophysiology (cont.) Excitation Sympathetic response (HR, BP, and Cardiac Output all rise). Adynamic HR, CO, BP decrease due to