Hypothermia Hyperthermia

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Hypothermia Hyperthermia. Dr. Stella Yiu Staff Emergency Physician. S Yiu, 2012. Hypothermia: LMCC wants you to. List causes List illnesses that precipitate hypothermia Conduct neurological, CVS and resp assessment List and monitor investigations - PowerPoint PPT Presentation

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Hypothermia Hyperthermia

HypothermiaHyperthermiaDr. Stella YiuStaff Emergency Physician

S Yiu, 2012

Hypothermia: LMCC wants you toList causesList illnesses that precipitate hypothermiaConduct neurological, CVS and resp assessmentList and monitor investigations Manage a hypothermic patient by contrasting different warming methods Normal temperature: 36.5 37.5 celsius

CausesDecreased heat production

Increased heat loss

Impaired thermoregulation1. Decreased heat productionNot enough fuel (poor nutrition, hypoglycemia)

Engine slower (hypothyroid, hypopituitarism, adrenal insufficiency)

Engine unable to produce heat (age, impaired shivering)

Photo credit: RaGardner4 and Pedro J Perrieira, , flickr creative commons2. Increased heat loss

Immersion/exposure2. Increased heat lossVasodilation: drugs, alcohol, sepsis, toxins2. Increased heat lossSkin disorders (burn, dermatitis)

Iatrogenic (trauma bay, 3 L cold NS)3. Impaired thermoregulationCentralMetabolic (Cirrhosis, uremia), drugs (barbituates, TCAs), CNS (stroke, trauma, MS, Parkinson)

PeripheralSpinal cord transection, neuropathy, DM

Physiological effectsPacemaker cells slllllooooow

Cardiovascular: Bradycarida, arrhythmia, VF, asytole (30 and no CVS- Surface rewarmingWarm blanketsRemoval or cold, wet clothingSevere: ArrhythmiaVF:CPR, defib, If first defib does not work, do not defib (continue CPR) until warmed to >30

Patient not dead until warm and deadSevere: Active rewarmingGently handle, no CPR on frozen chest

Airway: IntubateBreathing: Warm OxygenCirculation: Warm saline (heated to 65)Severe: Active rewarmingInhalationIntravenousGI lavageBladder lavagePeritonealPleuralECMODialysisInvasive

Not dead until warm (>30-32) and deadHyeprthermiaHyperthermia: LMCC wants you toList causes List illnesses that predispose to hyperthermiaKnow abnormal exams of hyperthermic patients Select investigations Manage hyperthermic patient by various cooling methodsUnderstand how dantrolene worksCausesEnvironment (heat stroke)Decreased heat dissipation

ObesityDrugs (anticholinergics, serotonin syndrome, sympathomimetics)Metabolic heat

Thyroid, pheochromocytomaMalignant hyperthermiaNeuroleptic malignant syndrome

SepsisExaminationHeat stroke

T> 40Orthostatic BP, tachycardia, tachypneaCNS: Confusion, cerebellar, cerebral edemaNMS/MH PhysicalNMS (post antipsychotic) or MH (post anesthetic)

T>40, autonomic dysfunction, lead-pipe rigidityMotor: Myoclonus, dystonia, dysphagiaCNS: confusion, agitation, coma

Hyperthemia: Clinical and lab findingsCVS: CHF, pulmonary edema, CV collpase

Liver: necrosis

Rhabdomyolysis

DICCoolingEvaporative:Mist + FaceIce packs

Con: shivering, cannot attach electrodesMore aggressive coolingTub immersionCon: Cumbersome

GI/Peritoneal lavageCon: Invasive

Cardiac bypassCon: Invasive, not readily availableStop cooling when temp < 40DantroleneMuscle relaxer(interferes with coupling-excitation of skeletal muscle cells)

Only effective treatment in MH