EDN: Hypothermia

Hypothermia

is a condition in which the core body temperature drops below 95°F (35°C) due to prolonged exposure to cold.

1. shivering

2. peripheral vasoconstriction

3. raising basal metabolic rate

In response to a decreased core temperature, the body conserves and generates heat through: (3 processes)

shivering

increases heat production via muscle activity.

peripheral vasoconstriction

reduces blood flow to the skin and minimizes heat loss.

raising basal metabolic rate

enhances internal heat production to maintain core temperature.

fast gluconeogenesis

When basal metabolic rate increases — bodily functions will speed up, heart rate will go _____, ______.

Malignant Hyperthermia

is a life-threatening genetic disorder in which exposure to certain anesthetic agents or succinylcholine triggers uncontrolled skeletal muscle contractions, leading to excessive heat production, severe hyperthermia, and metabolic acidosis.

Atrial or Ventricular Fibrillation

what is the common problem for patients with hypothermia that is related to the heart?

not be audible even though the heart is still beating.

If the body temperature falls below 30 C, the heart sounds may ______________

near the fibrillation threshold.

Extreme caution should be used when moving, transporting, and intubating hypothermic patients because their heart is

Cardiac monitor

Because the patient is in critical line for fibrillation threshold, sudden movement or interventions can easily induce cardiac arrest, so because of this the patient should be attached to a _________

cold tissue conducts sound waves poorly

BP readings may be extremely difficult to HEAR because _______

fixed and dilated

Pupil reflexes may be blocked by a decrease in cerebral blood flow, so pupils may appear

Central/ Arterial line (Swan Ganz)

Patient with hypothermia may present NO BP, NO PULSE, FIXED DILATED PUPILS — Traditional BP auscultation is unreliable in hypothermia due to poor sound conduction, weak circulation, and vasoconstriction. THEREFORE, it is IDEAL for the patient to have _____________ for ACCURACY and be properly monitored.

Korotkoff sounds

are the pulsatile circulatory sounds heard through a stethoscope when measuring blood pressure. This SOUND is faint or may be absent to hear when patient is HYPOTHERMIC

slow or slurred / dysarthria

How is the speech of hypothermic patient? and in medical term?

Dysarthria

is where you have difficulty speaking because the muscles you use for speech are weak

32.2 C

Shivering may be suppressed if temperature falls BELOW?

Fibrillation

drugs and defibrillation

A very cold heart is SUSCEPTIBLE to what cardiac complication? and Conversely, they DO NOT RESPOND TO _____________ AND _______. Remember hypothermia is included in H & Ts in ACLS, it should be correct FIRST while providing ACLS.

Cold Diuresis

an increase in urinary output due to peripheral vasoconstriction as a result of hypothermia

Tachypnea then slow shallow breathing

What is INITIAL respiration of patient with hypothermia? and later on become?

fruity or acetone odor breath

this happens due to metabolizing fat (gluconeogenesis) as a result of decrease insulin levels?

low reading RECTAL thermometer

Continuously monitor core temperatures with a?

PNSS

What is the RECOMMENDED fluid of choice for HYPOTHERMIA?

Because COLD liver may not metabolize lactate can lead to lactic acidosis.

WHY PLR is not recommended fluid for Hypothermia?

passive external rewarming

active external rewarming

active core rewarming

what are 3 rewarming techniques for hypothermia?

Passive external rewaring

Gradually warm the patient using external insulation and warmth, allowing the body to rewarm naturally.

passive external rewarming

active external rewarming

what are 2 rewarming techniques used for temperature ABOVE 28 C?

active core rewarming

what is the rewarming technique used for temperature BELOW 28 C?

passive external rewarming

• Remove wet or cold clothing to prevent further heat loss and replace with warm clothing.

• Wrap the patient in several blankets for insulation to trap heat.

• Provide warm fluids to drink, if the patient is conscious and able to swallow, to promote internal warming.

Active external rewarming

Use external heat sources to actively warm the body more quickly, focusing on areas with major blood vessels to speed up rewarming.

active external rewarming

• External heat sources: Apply warm water bottles to the armpits, groin, and neck (areas with large blood vessels).

• Warm water immersion: Immerse the patient in warm water (temperature around 37-39°C) to rapidly warm the skin and underlying tissues.

active core rewarming

Use more invasive methods to directly warm the core body temperature when the body is unable to rewarm itself effectively. For Temperature Below 28°C

Active core rewarming

• Inhalation of warmed humidified oxygen

• Warmed IV fluids

• Warmed gastric lavage

• Peritoneal dialysis with warmed standard dialysate

• Warmed mediastinal irrigation through open thoracotomy

• Cardiopulmonary bypass

cardiopulmonary bypass (CPB)

In severe cases of hypothermia this may be used to circulate warmed blood throughout the body, effectively rewarming the patient’s core.

Warm mediastinal irrigation through open thoracotomy

Warm fluids are irrigated directly into the mediastinum (the space between the lungs) to warm the chest cavity.

Peritoneal dialysis with warmed standard dialysate

Use dialysis solution that is warmed before being infused into the peritoneal cavity to warm the body from the inside.

Warmed gastric lavage

Infuse warmed fluids into the stomach to provide internal warmth.

Warmed IV fluids

Administer intravenous fluids that have been warmed to body temperature (around 37°C) to help rewarm the bloodstream.

Inhalation of warmed, humidified oxygen

via mask or ventilator: This provides both oxygen and warmth directly to the lungs to aid in internal warming.