Thursday, March 11, 2010

Hypothermia

Hypothermia - Acute
Rahul Soman, M. Pharm


 

Definition  

Hypothermia is defined as an undesired lowering of core body temperature below 35°C; the condition is classified as mild (less than 35°C down to 34°C), moderate (less than 34°C down to 30°C), or severe (less than 30°C) . Primary hypothermia results directly from an overwhelming cold stress; whereas secondary hypothermia arises from other clinical conditions. Clinical syndromes associated with secondary hypothermia may be acute and severe (eg, shock, sepsis) .


 

Medical History  

* Alcohol Abuse

* Medication use

* Environmental Exposure

* Traumatic injury

* Nutritional disorder

* Impaired mobility

* Mental disorder

* Pediatric, Infant (0-2 years) , Infectious disease

* Anorexia nervosa

* Hypoglycemia [Hypoglycemia - Acute]

* Traumatic brain injury

* Acute spinal cord injury [Acute spinal cord injury - Acute]


 

Findings  

* Bradyarrhythmia - Acute

* Coma

* Hypotension

* Hypothermia - Acute

* Slow respiration

* Moribund

* Oliguria and anuria

* Amnesia

* Confusion

* Decreased tendon reflex

* Disorder of oculomotor system

* Dysarthria

* Dyspnea - Acute

* Hyperventilation - Acute

* Lethargy

* Palpitations - Acute

* Personality change

* Swollen abdomen

* Ataxia

* Corneal reflex reduced

* Dizziness

* Joint stiffness

* Muscle rigidity

* Mydriasis

* Opisthotonus

* Paravertebral muscle spasm

* Abdominal pain - Acute

* Absence of sensation

* Decreased bowel sounds

* Erythema

* Facial edema

* Flushing

* Hunger

* Hyperesthesia

* Impaired cognition

* Increased frequency of urination

* Myalgia

* Pallor

* Shivering


 

Tests  

Suspected hypothermia  

* White blood cell count: Leukopenia may occur from splenic, hepatic, or splanchnic sequestration . Leukocytosis is common in neonatal hypothermia.


 

Suspected hypothermia  

* Platelet count: Thrombocytopenia may occur after rewarming, and is a common finding in the elderly and in neonates. Platelet decrease secondary to sequestration occurs at 32°C .


 

Suspected hypothermia  

* Blood coagulation panel: A physiologic increase in coagulation occurs with hypothermia. Disseminated intravascular coagulation may be present, along with associated reticulocytosis .


 

Hypothermic patients in cardiac arrest  

* Serum potassium measurement: Serum potassium levels as high as 11.8 mEq/L have been reported in survivors of hypothermic cardiac arrest .


 

Hypothermia with preexisting renal disease, oliguria, or following rewarming if renal failure is induced.  

* Blood urea nitrogen measurement


 

Hypothermia with preexisting renal disease, oliguria, or after rewarming if renal failure is induced.  

* Creatinine measurement, serum


 

Suspected and known hypothermia  

* Plasma random glucose measurement: Shivering associated with hypothermia depletes glycogen stores and further aggravates hypoglycemia .


 

Suspected hypothermia  

* Arterial blood gas analysis: Hypothermia results in respiratory acidosis, metabolic acidosis, and hypoxia. As the blood temperature rises above 32 C° in rewarming, so does the pH.


 

Suspected and known hypothermia  

* 12 lead ECG: Classic ECG findings in hypothermic patients include the presence of J (Osborn) waves, prolongation of PR, QRS, QT intervals, and atrial and ventricular arrhythmias.


 

Suspected hypothermia  

* Plain chest X-ray: Base-to-apex redistribution of vascularity, cardiomegaly, and atelectasis may be seen, as well as preexisting pneumonia and congenital pediatric heart disease.


 

Suspected or known hypothyroidism  

* Thyroid stimulating hormone measurement: Overt hypothyroidism is classified as a TSH above the upper limit of the reference range in the presence of a low serum free thyroxine (FT4) . Subclinical hypothyroidism is a laboratory diagnosis defined as a TSH above the upper limit of the reference range in the presence of a normal FT4.


 

Suspected or known substance use -  

* Drugs of abuse urine screening test: A positive urine drug screen is generally qualitative intended only to verify exposure to the assayed substances and may require confirmatory testing .


 

Hypothermia when a spinal cord lesion is suspected .  

* Radiography of spine


 

Differential Diagnosis  

* Myxedema coma - Acute

* Cerebrovascular accident


 

Treatment  


 

Drug Therapy  


 

All alcoholic, cachectic, or malnourished patients early during rewarming procedures for hypothermia  


 

THIAMINE

Adults: 100 mg IV; continue in doses of 50 to 100 mg/day


 

Procedural Therapy  


 

Respiratory distress  

* Airway management: Airway management must assume the first priority in the management of any seriously ill or injured patient .


 

Hypothermia  

* Endotracheal intubation: Unresponsive patients with hypothermia whose pulse or breathing are absent should be intubated during resuscitative efforts to ensure dependable ventilation and oxygenation .


 

Cardiac arrest  

* Advanced cardiac life support: Establishing a hemodynamically effective cardiac rhythm, optimizing ventilation, and maintaining and supporting circulation are the major goals of ACLS .


 

Cardiac arrest  

* Basic life support: Victims of cardiac arrest need immediate cardiopulmonary resuscitation, and survival improves with early defibrillation .


 

Cardiac arrest due to ventricular fibrillation, pulseless ventricular tachycardia (VT), or unstable polymorphic VT  

* Automated external defibrillation: The protocol for cardiac arrest due to VF or pulseless VT is delivery of 1 unsynchronized electric shock followed immediately by resumption of CPR .


 

Hypothermia  

* Automated external defibrillation: Defibrillation should be attempted for hypothermic patients (core over 30°C) with ventricular fibrillation or tachycardia without a pulse .


 

Hypothermia  

* Warming measures: Rewarming techniques vary depending on the severity of hypothermia.

No comments:

Post a Comment

SYSTEM BASED CLASSIFICATION OF DISEASES

SYSTEM BASED CLASSIFICATION OF DISEASES

Bone and Joint Diseases

  1. Gout and Hyperurecemia
  2. Osteoarthritis
  3. Rheumatoid Arthritis
  4. Acute coronary Syndroms

Cardiovascular Diseases

  1. Arrhymias
  2. Cardiopulmanary Resuscitation
  3. Heart Failure
  4. Hypertension
  5. Hyperlipidemia
  6. Ischemic Heart Diseases
  7. Shock
  8. Stroke
  9. Venous Thromboembolism

Dermatrologic Diseases

  1. Acne
  2. Psoriasis
  3. Skin Disorders and Cutaneous Drug Eruptions

Endocrine Diseases

  1. Cirrhosis
  2. Portal Hypertension

Gastrointestinal Diseases

  1. Irritable Bowel Syndrome
  2. Constipation
  3. Diarrhea
  4. Gastroesophagal Reflux Disease
  5. Hepatitis, Viral
    1. Hepatitis A
    2. Hepatitis B
    3. Hepatitis C
  6. Nausea and Vomiting
  7. Pancreatitis
  8. Peptic Ulcer disease

Gynecologic and Obstetric Diseases

  1. Contraception
  2. Hormone therapy

Hematologic Diseases

  1. Anemia
    1. Megaloblastic Anemia

i. Megaloblastic Anemia due to Folate Deficiency

ii. Megaloblastic Anemia due to Vitamine B12 Deficiency

    1. Sickle Cell anemia
    2. Hemolytic Anemia
    3. Iron Deficiency Anemia
    4. Aplastic Anemia
    5. Iron Deficiency Anemia

Infectious Diseases

  1. Central Nervous System infections
  2. Endocarditis
  3. Fungal infections, Invasive
  4. Gastrointestinal Infection
  5. HIV / AIDS
  6. Intra-Abdominal Infection
  7. Respiratory Tract infections, Lower
  8. Respiratory Tract infections, Upper
  9. Sepsis and Septic Shock
  10. Sexually transmited Diseases (STD)
  11. Skin and soft tissue infection
  12. Tuberculosis
  13. Urinary tract infection and prostatitis

Neurologic Diseases

  1. Epilepsy
  2. Headache
    1. Migraine
    2. Cluster Headache
  3. Pain management
  4. Parkinson’s Diseases
  5. Status epilepticus

Nutritional Diseases

  1. Enteral Nutrition
  2. Obesity
  3. Parentaral Nutrition

Onchologic Diseases

  1. Breast cancer
  2. Colorectal Cancer
  3. Lung cancer
  4. Lymphomas
  5. Prostate cancer
  6. Cervical Cancer
  7. Esophageal Cancer
  8. Gastric Cancer
  9. Head and Neck Cancer
  10. Lung Cancer
  11. Ovarian Cancer
  12. Pancreatic Cancer
  13. Primary bone Cancer
  14. Primary Brain cancer
  15. Testicular Cancer
  16. Thyroid Gland Cancer
  17. Urinar Bladder cancer
  18. Uterine Cancer

Ophtalmic Diseases

  1. Glaucoma

Psychiatric Diseases

  1. Alzhimer’s Diseases
  2. Anxiety Disease
  3. Bipolar Diseases
  4. Depressive diseases
  5. Schizophrenia
  6. Sleep Diseases
  7. Substance-Related Diseases

Renal Diseases

  1. Acid base Diseases
  2. Acute renal Failure
  3. Chronic Renal Failure
  4. Drug Dosing in renal insufficiency
  5. Electrolyte Homeostasis

Respiratory Diseases

  1. Allergic Rhinitis
  2. Asthma
  3. Chronic Obstructive Pulmonary Diseases

Urologic Diseases

  1. Benign Prostatic, Hyperplasia
  2. Erectile Dysfunction
  3. Urinary Incontinence