Hypothermia ...........................ppt

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1. Hypothermia
Moderator - Dr. Urgi (MD)
By Ahmed (C1)

2. DEFINITION
•internal temperature <358C [<958F] (by
rectal, tympanic, or esophageal
thermometer).
•Hypothermia may be mild(34 358C [93
958F]), moderate (30 348C[86 938F]), or
severe (<308C [<868F])

3. CAUSES
INCREASED HEAT LOSS
ENVIRONMENTAL ; cold exposure
DERMATOLOGIC ; burns, extensive
psoriasis, vasodilation (drugs, alcohol,
sepsis, pancreatitis)
IATROGENIC cold fluid infusion, CPR,
renal replacement therapy

4. ALTERED REGULATION
•CENTRAL :
stroke, Parkinson’s disease,
multiplesclerosis, hypothalamic dysfunction,
anorexia nervosa,
drugs (barbiturate, TCA, sedatives, alcohol)
•PERIPHERAL
neuropathies, diabetes

5. DECREASED METABOLISM
•ENDOCRINE
hypothyroidism, hypopituitarism, adrenal
insufficiency, hypoglycemia
•METABOLIC
anorexia nervosa, malnutrition

6. RISK FACTORS
•extremes of age,
•alcoholism,
•malnutrition, homelessness,
• mental illness

7. HISTORY
exposure to cold (duration, environment)
shivering,
confusion,
delirium,
palpitations,
weakness, ulcers, frostbite, fever, weight loss,
past medical history (hypothyroidism,
diabetes,alcoholism, psoriasis),
medications,
social history

8. Physical examination
vitals(bradycardia,apnea,hypertension/
hypotension,hypoxemia),
respiratory and cardiovascular examination
(arrhythmia),
skin examination (frostbite, burns, psoriasis)
GCS(rigidity, hyporeflexia),

9. INVESTIGATIONS
BASIC
•LABS
CBC, lytes, urea, Cr, glucose, CK, troponin,
AST, ALT, ALP, bilirubin, TSH, urinalysis,
blood cultures
•ECG Osborn wave (elevated J point),
prolonged RR, PR, QRS, and QT intervals

10. COMPLICATIONS
hypothermia affects most organs,
causing cognitive (coma),
neuromuscular(rigidity),
respiratory (pulmonary edema),
cardiac(arrhythmia), and
cutaneous complications (frostbite).
Sepsis, pneumonia, hypokalemia,
hypoglycemia, and rhabdomyolysis may
also occur

11. MANAGEMENT
•ABC, O2 to keep sat >94%, IV. Caution
with fluid overload (decreased cardiac
output in hypothermic patients) and
vasopressors (arrhythmogenic potential).
•Resuscitation should continue until patient
completely rewarmed

12. MONITORING
continuous cardiac monitoring. Also
closely monitor electrolytes and glucose.
Vagotonic maneuvers (e.g. intubation or
suctioning) may precipitate asystole

13. •REWARMING environment (remove cold
clothing. Warming blanket). Active
rewarming (warm IV fluids 40 428C [104
1088F]. If severe hypothermia,consider
colonic/bladder irrigation, peritoneal or
pleural lavage, extracorporeal blood
rewarming.
•Goal of rewarming is 0.5 28C/h [1.88F/h]
to minimize risk of VF and hypovolemic
shock)

14. Hyperthermia
•Heat related illnesses (Heat cramp,
exhaustion, stroke…)
•Malignant hyperthermia
•Neuroleptic malignant syndrome
•Hormonal hyperthermia
•Therapeutic hyperthermia
•Miscellaneous causes of hyperthermia