AccidentalHypothermia[意外低温](PPT-79).pptVIP

Accidental Hypothermia Fran?ois Dufresne McGill Emergency Medicine May 2nd 2001 The Case of Tommy 23h10 Call from MD working in James Bay Male, 27 y.o. Unresponsive. Found in snow, cross-country skiing Normal Airway. Breathing. ? O2 sat. Femoral pulse + (35) ? BP. GCS=3 TR? = 28?C. IV. Monitor. Mask with 100% O2 The Case of Tommy… Friend told MD: ? PMH. ? Rx. ? drugs. ? EtOH Major foot deformity Looks like fell in ski and could not return home by himself… MD has some questions for you… The Case of Tommy… Should he intubate? Are there risks to precipitate dysrythmias? Cold myocardium prone to arythmias? How should he rewarm the patient? Danger of afterdrop? He wants an ABG but should he ask for the blood to be warmed to normal T? for analysis…or it doesn’t matter? The Case of Tommy… MD calls you back 30 minutes later Pt in cardiac arrest : V.fib. Now 27?C 3 shocks Epinephrine + re-shock Having Amiodarone prepared… How long should he do CPR and rescussitation? Introduction Maritime / War litterature Hannibal experience in 218 B.C Introduction EtOH ? Mental illness ? Homelessness ? Province of Quebec ? Cold Plan Definitions Physiology Pathophysiology Labs findings : ABG, ECG Rewarming methods Afterdrop ACLS 2000 guidelines Definitions Primary VS Secondary Primary Normal thermoregulation Overwhelming cold exposure Secondary Abnormal thermogenesis Multiple causes Definitions Hypothermia : 35?C Mild : 32-35?C Moderate : 28-32?C Severe : 28?C Physiology: Heat production Basal metabolism (Metabolic rate) Heart / Liver Anterior hypothalamus Thyroid / Sympathetic Preshivering muscle tone (2x) Shivering (2-5x) Posterior hypothalamus Physiology: Heat dissipation Radiation (55-65%) Gradient between environement and exposed body area. Conduction (2-3%) Direct contact with cold substance Convection (10-15%) Wind… Evaporation (20-35%) Physiology… Above 32?C: Vasoconstriction Shivering Basal metabolic rate Below 32?C: No shivering Below 24?C: No basal metabolic