baby its cold outside...

Today's POTD inspired by two similar yet very different resus patients this morning...So lets talk HYPOTHERMIA.. tis the season!

Definition/Classification:

Causes: AGE IS BIGGEST RISK FACTOR- THINK ELDERLY AND INFANTS!

• Heat loss- environmental exposure, vasodilation
• Decreased or impaired thermogenesis:

Endocrine	Hypothyroid, adrenal insufficiency, malnourishment
CNS	Hypothalamic lesions, hypopituitarism
Trauma	Burn, spinal cord injuries
Sepsis
Tox	ETOH, sedatives, vasodilators
Skin	Psoriasis, exfoliating conditions
Psych
Iatrogenic	Cold fluids, intraop

Evaluation:

• Get that probe in! Core temperature is actually better obtained from esophageal or bladder > rectal
• BGM!
• Labs: Coags, CBC, BMP, CPK, TSH, sepsis workup?
• EKG: Osborn waves, T wave inversions, prolongation of PR/QRS/QT, AV block, PVC
  • VF highest when T, 28C

Management: Think about and treat causes!

• Passive Warming: Mild- think pts able to shiver
  • Warm blankets, keep dry, insulation
• Active Warming
  • External/Peripheral- Bairhugger, warm fluids,chemical heat pads ( watch for burns)
    • May have drop in temperature from cold diuresis and release of cold peripheral blood to core
  • Central active warming
    • Warmed (40-46C) humidified inspired gases (1 C/h; 1.5°C/h ET tube)
    • Warm IV fluids (42C)
    • Body cavity lavage with 40C fluid e.g. peritoneal (3C/h), gastric, bladder, right-sided thoracic lavage (3-6C/h – use 2 ICCs for continuous flow)
    • CRRT
    • ECMO/ bypass (9-18C/h)
• Coding:
  • Gentle handling of patient- can cause VF!
  • Cold heart is resistant to meds and pacing hold until temp >30C
  • Double the dose when temp bwn 30-35C
  • Shock Resistant- sources say shock max of 1-3times, goal is to get them warm!

Complications: Acid base disorders, pneumonia, bleeding, other cold injuries, dysrhythmias, DIC, rhabdomyolysis, thromboembolism, pancreatitis, multiorgan failure. Hope everyone is staying warm outside, enjoy the snow

sources: life in the fast lane, emdocs