Hypothermia：低温.pptVIP

Hypothermia – Why Am I So Cold? David Feldstein, MD Primary Care Conference 5/26/04 Objectives Etiologies of hypothermia Clinical manifestations of hypothermia Causes of hypothermia in psychiatric patients I have not received any financial compensation for this talk Case CC: Delerium HPI: 48 y.o. institutionalized man with hx schizophrenia behavioral changes X 2 weeks slurring of speech and decrease in ambulation and eating labored breathing day of admission. temperature 33.3 orally at his institution. Case (cont) PMH Gunshot wound to the head Paranoid schizophrenia HTN NMS secondary to Clozaril Meds: Aripiprazole (Abilify), Clonazepam SH Institutionalized for 20 years No access to tobacco, alcohol or illicit drugs Case (cont) PE: T 33.2 rectal; HR 60; 129/76; RR 16; 95% RA Gen: Spontaneously opening eyes and moving extremities. NAD HEENT: Pupils 1mm and sluggish Neck: Nonpalpable thyroid Lungs: Bibasilar crackles with poor effort CVS/Abd – WNL Neuro: Not following commands, Nml tone, 1+ DTRs, No clonus Skin: Cool to touch, no rashes Ext: 1+ pitting edema to knees bilaterally Hospital Course Head CT and LP were performed Blood cultures sent Vancomycin and Zosyn started empirically 12 hours after arrival in ED patient was found to be completely unresponsive to painful stimuli Temp 33.3 rectal; HR 52; BP 125/72 Definition of Hypothermia Mild 32-35°C (90-95°F) Moderate 28-32°C (82-90°F) Severe 28°C (82°F) Causes of Hypothermia Decreased Heat Production Increased Heat Loss Impaired Thermoregulation Miscellaneous Decreased Heat Production Endocrine Hypopituitarism Hypoadrenalism Hypothyroidism Insufficient Fuel Hypoglycemia Malnutrition Neuromuscular Inefficiency Extreme Age Impaired Shivering Inactivity Increased Heat Loss Environmental Exposure Induced Vasodilation EtOH Drugs Skin Burns Psoriasis Iatrogenic Cold Infusions Impaired Thermoregulation Peripheral Failure Neuropathies Central Failure Metabolic Drugs Trauma CVA Hypothalamic dysfunction MS W