1. Hypothermia (Hyperthermia) Dr. Stella Yiu Staff Emergency Physician

2. LMCC objectives List clinical findings of hypothermia Investigate Initiate resuscitation for severe hypothermia

3. 1. Clinical findings of hypothermia

4. Normal temp: 36.5 – 37.5 C

5. Effects By Patrick J. Lynch, medical illustrator (Patrick J. Lynch, medical illustrator) [CC-BY-2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons Image credit: US public domain

6. Mild (32-35C)

9. Moderate (28-32C) Image credit: James Heilman, MD

10. Moderate (28-32C)

11. Severe (<28C) Image credit: jer5150, Wikimedia commons, Jeffrey Bary, Flickr creative commons

12. What precipitates hypothermia?

13. Increased heat loss Alcohol Sepsis Burn

14. Exposure EM Ottawa 14 Photo credit: Jonathan Snyder, U.S. Air Force, UNC - CFC – USFK, CC by 2.0, via Flickr creative commons

15. Impaired thermostat Metabolic (Cirrhosis, uremia, DM, Hypothyroid) CNS (stroke, trauma, MS, Parkinson) Drugs (Barbituates, TCAs)

16. 2. Investigations

17. CDMQ: 25 M found passed out on street. Core temp 30C. Name 4 investigations.

18. Investigations CBC, Cr, Lytes, Coag profile (DIC) TSH EKG

19. Osborn J waves

20. 3. Resuscitation

21. Mild (32-35C): Passive external rewarm

22. Mod (28-32C): Active external rewarm

23. EM Ottawa 23 By Patrick J. Lynch, medical illustrator (Patrick J. Lynch, medical illustrator) [CC-BY-2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons Warm humidified Oxygen

24. Severe (<28) Warm every cavity but Gentle handling EM Ottawa 24

27. CDMQ: How do we do active core rewarming in severe hypothermia? (6)

28. Airway Intubate Warm humidified oxygen

29. Circulation Warm intravenous fluids

30. Pleural space By Patrick J. Lynch, medical illustrator (Patrick J. Lynch, medical illustrator) [CC-BY-2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons

32. Bladder By User:Lennert B [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by- sa/3.0/) or CC-BY-2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons

33. Dialysis By National Kidney and Urologic Diseases Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, USA [Public domain], via Wikimedia Commons Photo credit: becre8tv, CC by 2.0, via Flickr Creative commons

34. Bypass By Van Meurs, K, Lally, KP, Peek, G, Zwischenberger, Extracorporeal Life Support Organization, Ann Arbor 2005. [CC-BY-2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons

35. MCQ 3: Patient is lethargic and bradycardic. Most appropriate warming method? A. Pleural lavage B. Bladder irrigation C. Intubation D. Dry blanket and a snack E. Blanket with forced warm air

36. MCQ 4: 12 M found in snow. After 2hrs CPR and warming, asytolic. Core temp 27.5C. What is the most appropriate step? A. Stop resuscitation B. Defibrillation C. Continue CPR and warming D. Warm water immersion E. Stop warming

37. Not dead until warm (>30-32) and dead

38. Hyperthermia

39. LMCC objectives List predisposing illnesses List clinical findings Select investigations Manage patient by various cooling methods

40. Causes Environment Decreased heat dissipation Metabolic heat

41. 1. Predisposing illness

42. Metabolic causes: Heat production Metabolic heat Thyroid, pheochromocytoma Malignant hyperthermia NMS Sepsis

43. Decreased heat loss: Drugs Decreased heat dissipation Obesity Drugs (anticholinergics, serotonin)

44. 2. Clinical findings

45. Case: The rave girl

46. Heat stroke: Hot + confused T> 40 Orthostatic BP,  HR CNS: Confusion, ataxic, cerebral edema, seizure CVS: CHF, pulmonary edema, CV collapse

47. Lab findings: Liver, Renal Liver: necrosis Rhabdomyolysis DIC

48. 3. Cooling methods

49. Basic cooling: Photo credit: Kenneth Lu, Flickr creative commons

50. Photo credit: yellowcloud, flickr creative commons

51. More aggressive cooling GI/Peritoneal lavage Cardiac bypass

52. Stop cooling when temp < 40

53. LMCC objectives List predisposing illnesses List clinical findings Select investigations Manage patient by various cooling methods