Hypothermia Frostbite

8/13/2019 Hypothermia Frostbite

http://slidepdf.com/reader/full/hypothermia-frostbite 1/19

Wiwi J., Isngadi., Karmini

Laboratorium/SMF Anestesiologi &

Reanimasi FK Unibraw/RSU

Dr Saiful Anwar – Malang



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



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.



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.



Several types of endocrine dysfunction :

- hypothyroidism.

- adrenal insufficiency.

- hypopytuitarism.

Acute spinal cord injury.

Sepsis (cold sepsis).

Shapiro syndrome ―‣ episodic hypothermia



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



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.



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)



MILD HIPOTHERMIA

5. Neuromuscular system :increased preshivering muscle tone,

then fatique.



Moderate hypothermia (28 ºC - <32,2 ºC)


every 8 ºC drop, decrease 50 % CO₂ pro-

duction ; hypoventilation ; absence of

protective airway reflex.


decrease pulse & cardiac output,




increase atrial & ventricular arrythmia.


depression of consciousness, pupillary

dilatation, hallucinations.

4. Renal and endocrine system :

50% decrease of renal blood flow and



4. Renal and endocrine system :

renal autoregulation intact but impaired

the effect of insulin.

5. Neuromuscular system :

hyporeflexia and rigidity.



SEVERE HYPOTHERMIA ( <28 ºC ) :


pulmonary edema, decrease O₂ con-sumption (75%) & apnea (breathless).


decrease heart rate, blood pressure &

cardiac output ; dysrhytmias and asystole.



SEVERE HYPOTHERMIA


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.



SEVERE HYPOTHERMIA

5. Neuromuscular System :no motion, decrease nerve conduction,

absent of corneal and occulocephalic

reflexes



- 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.



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.



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.

Hypothermia Frostbite

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