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Accidental Hypothermia


Presentation

  • Generally, a cold climatic condition is present in a severe environmental setting. A case report is presented of a 58-year-old man who died from accidental hypothermia associated with immersion in cold water while on a farm during warm weather.[ncbi.nlm.nih.gov]
  • Thirty-two patients had a cardiac arrest (CA): 15 patients presented unwitnessed cardiac arrest (UCA) and 17 patients presented rescue collapse (RC).[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Patients presenting in cardiac arrest from accidental hypothermia may be rewarmed effectively using TL. Among survivors, normal neurological recovery is seen.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Vital signs can be present in hypothermic patients with core temperature[ncbi.nlm.nih.gov]
  • CASE PRESENTATION: We present a case were a 95 year-old man with severe accidental hypothermia and circulatory arrest was brought to our hospital under on-going CPR, and was successfully resuscitated with extracorporeal circulation.[ncbi.nlm.nih.gov]
Hypothermia
  • However, the role of accidental hypothermia as an independent prognostic factor is controversially discussed.[ncbi.nlm.nih.gov]
  • SETTING: Patients consulted and treated by the Severe Hypothermia Treatment Centre. PARTICIPANTS: Patients who underwent accidental hypothermia.[ncbi.nlm.nih.gov]
  • Mild hypothermia was diagnosed in 75.5% of the patients, moderate (32-28 C) in 16.5%, while severe hypothermia (less than 28 C) in 8% of the cases. Cardiopulmonary resuscitation was carried out in 7.5% of the patients.[ncbi.nlm.nih.gov]
  • These data provide a framework for understanding the molecular changes that occur during induction of and rewarming from severe hypothermia, and identifies potential targets for cardioprotective interventions in resuscitation of victims of hypothermia[ncbi.nlm.nih.gov]
  • RESULTS: Accidental hypothermia was present in 1,028 cases out of 1,915,435 discharges.[ncbi.nlm.nih.gov]
Shivering
  • Her neurologic disability was detrimental to thermoregulation by decreasing her ability to shiver actively and to vasoconstrict. The relationship between shivering and thermoregulation is discussed.[ncbi.nlm.nih.gov]
  • Over half of them identified the initial symptom of AH as obvious shivering (69.4%) and apathy (45.0%). As for the aggravate symptoms, 60.9% chose the wrong answer of more obvious shivering instead of the right one-absence of shivering (5.4%).[ncbi.nlm.nih.gov]
  • Other findings on electrocardiogram can assist in diagnosis as well, but the only factors shown to predict outcome are atrial fibrillation and shivering artifact.[ncbi.nlm.nih.gov]
  • […] hypothermia, no vital signs, asystole Stage Core temperature C ( F) Clinical symptoms HT I 35–32 (95–89.6 ) Conscious, shivering HT II 32–28 (89.6–82.4 ) Impaired consciousness, no shivering HT III 28–24 (82.4–75.2 ) Unconscious, no shivering, vital[omcr.oxfordjournals.org]
  • Shivering during prolonged hypothermia must be avoided as it tends to elevate the body temperature and increase metabolic needs, thereby defeating the purpose of hypothermia.[medical-dictionary.thefreedictionary.com]
Myxedema
  • Concomitant problems of alcoholism, stroke, myxedema, tuberculosis and paraplegia were also treated. Rapid external rewarming by immersion can result in a low mortality in patients with severe hypothermia.[ncbi.nlm.nih.gov]
  • Goiter was not palpable and pitting edema, not myxedema, was present.[ncbi.nlm.nih.gov]
  • If patients aren’t rewarming 1 C/hr and they’re above 32 C, consider: sepsis, cortisol deficiency, myxedema, ethanol. The J wave or “Osborn” wave is found in many cases of hypothermia, often quoted at 80%.[foamcast.org]
Malnutrition
  • The diagnosis of hypothermia is easy in patients with a history of prolonged exposure to a cold environment but accidental hypothermia may also occur as a consequence of prolonged immobilization and malnutrition.[ncbi.nlm.nih.gov]
  • KEYWORDS: Bio-heat transfer; Cardiomyopathy; Hypothermia modelling; Malnutrition; Thermoregulation[ncbi.nlm.nih.gov]
  • […] drowning, alpine environment, poverty (lack of heating or shelter) drugs/ tox – alcohol, sedatives, vasodilators Sepsis CNS disorders e.g. hypothalamic lesions, hypopituitarism Endocrine/ metabolic – hypothyroidism, adrenal insufficiency, hypothermia, malnutrition[lifeinthefastlane.com]
Chills
  • The rapid and complete recovery experienced in the case presented is not surprising since the patient's premorbid condition was good, chilling had been rapid, metabolic exhaustion was mild, and internal rewarming was accomplished without delay, using[ncbi.nlm.nih.gov]
  • Tourniquets are applied to the limb to inhibit circulation and avoid general chilling of the patient. The limb is chilled for 3 to 5 hours before amputation. General Hypothermia.[medical-dictionary.thefreedictionary.com]
  • When mild or moderate, hypothermic patients present with symptoms that can be fairly misleading, these include, but are not limited to dizziness, confusion, dyspnea and chills.[news-medical.net]
Hypotension
  • Abstract Accidental hypothermia has a mortality rate of 30-80% and should always be borne in mind with comatose, hypotensive patients. It is a preventable condition when adequate safety measures are ensured.[ncbi.nlm.nih.gov]
  • Rewarming using renal replacement therapy circuit was unsuccessful because of severe hypotension. We inserted the esophageal heat transfer device and rewarmed him successfully to target temperature 35-36 C.[ncbi.nlm.nih.gov]
  • Author information 1 Texas Health Harris Methodist Hospital Fort Worth, USA. robdavisrn@sbcglobal.net Abstract A potential cause of such emergent issues as cardiac arrhythmias, hypotension, and fluid and electrolyte shifts, accidental hypothermia can[ncbi.nlm.nih.gov]
  • Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med 1994; 331:1105-1109. 4. Gross D, Landau EH, Assalia A, Krausz MM.[books.google.it]
  • ‘not dead until warm and dead’ (30-32C) Passive warming – useful in conscious patients who are able to shiver (1.5C per hour) keep dry warm environment insulation with blankets (e.g. aluminium foil) and hat allow to mobilise if conscious (beware of hypotension[lifeinthefastlane.com]
Confusion
  • In recent years, alterations in resuscitation care that sometimes confused or discouraged resuscitation teams have largely been supplanted by an emphasis on safe, rapid, effective rewarming.[ncbi.nlm.nih.gov]
  • Victims of accidental hypothermia present year-round and in all climates with a potentially confusing array of signs and symptoms, but increasing severity of hypothermia produces a predictable pattern of systemic organ dysfunction and associated clinical[ncbi.nlm.nih.gov]
  • It can make you sleepy, confused and clumsy. Because it happens gradually and affects your thinking, you may not realize you need help. That makes it especially dangerous. A body temperature below 95![DEGREE SIGN]![fpnotebook.com]
Irritability
  • Moreover, these patients may be irritable and have mood changes, lassitude and poor judgment. These symptoms are misleading, because they may be mistaken for other medical conditions, such as alcohol intoxication and stroke.[news-medical.net]
  • Irritation to the cardiac membrane can precipitate ventricular fibrillation and cardiac arrest. Patient movement should be held to a minimum and invasive monitoring utilized only if absolutely necessary [ 4 ].[omcr.oxfordjournals.org]
Stupor
  • Subjects with core body temperatures dropping from 95 F to 90 F develop amnesia, dysarthria, confusion, and disruptive behavior. 1 Further cooling as the body temperature falls to 82.4 F yields stupor, paradoxical undressing, and hallucinations.[mdedge.com]
Apathy
  • Over half of them identified the initial symptom of AH as obvious shivering (69.4%) and apathy (45.0%). As for the aggravate symptoms, 60.9% chose the wrong answer of more obvious shivering instead of the right one-absence of shivering (5.4%).[ncbi.nlm.nih.gov]
Dysarthria
  • Subjects with core body temperatures dropping from 95 F to 90 F develop amnesia, dysarthria, confusion, and disruptive behavior. 1 Further cooling as the body temperature falls to 82.4 F yields stupor, paradoxical undressing, and hallucinations.[mdedge.com]

Workup

  • Results of an extensive diagnostic workup revealed only adrenal insufficiency, and the electrocardiographic abnormalities resolved after warming.[ncbi.nlm.nih.gov]
Prolonged PR Interval
  • Multiple other findings eventually develop including a shortened QT interval, ST depression, bundle branch blocks, widened QRS, prolonged PR interval, flattened T wave and ultimately a sine wave. Hyperparathyroidism (D) may lead to hypercalcemia.[foamcast.org]
Electrocardiogram Change
  • CONCLUSIONS: Electrocardiogram changes in accidental hypothermia are frequent and characteristic for this entity improving diagnosis in usually unconscious patients, and in many cases, it may be the diagnostic clue in patients with conscience deficit[ncbi.nlm.nih.gov]

Treatment

  • The actual treatment costs were evaluated based on current medication, equipment, and dressing pricing.[ncbi.nlm.nih.gov]
  • Clinical treatment protocols seems to be based on experience from younger patients.[ncbi.nlm.nih.gov]
  • By combining methods used for the resuscitation of burn injury with the treatment principles for frostbite, a highly effective treatment protocol results.[ncbi.nlm.nih.gov]
  • Although normothermia was achieved in 92% of patients, none of them had been weaned-off VA-ECMO in the first 6 h of treatment.[ncbi.nlm.nih.gov]
  • Abstract We sought to organize a functional system of recognition and advanced treatment of hypothermic patients with extracorporeal rewarming as a treatment option.[ncbi.nlm.nih.gov]

Prognosis

  • In the patient with the poorer prognosis, the plasma IL-8 level on admission was not elevated remarkably but after rewarming the level rose significantly.[ncbi.nlm.nih.gov]
  • Abstract BACKGROUND: Accidental hypothermic cardiac arrest is associated with unfortunate prognosis and large studies are rare.[ncbi.nlm.nih.gov]
  • Cardiopulmonary resuscitation procedures should not be abandoned until the body temperature is more than 30 degrees C, because the prognosis in cases of accidental hypothermia without associated disease is excellent if cardiac function can be re-established[ncbi.nlm.nih.gov]
  • Hypothermia, along with acidosis and coagulopathy, is part of the lethal triad that worsen the prognosis of severe trauma patients.[ncbi.nlm.nih.gov]
  • The prognosis in accidental hypothermia depends on the patient's premorbid condition, the depth and duration of the hypothermia and the degree of exhaustion and metabolic acidosis that result from physiologic attempts to compensate for the heat loss.[ncbi.nlm.nih.gov]

Etiology

  • The etiology of hypothermia was exposure to cold air (64%) and cold water immersion (36%). Two (18%) were treated with extracorporeal membrane oxygenation and the rest with cardiopulmonary bypass.[ncbi.nlm.nih.gov]
  • The etiology of hypothermia was exposure to a cold environment (n 27), avalanche (n 13) or immersion in cold water (n 8). Mean age was 47 22 years, and 58% were males.[ncbi.nlm.nih.gov]
  • […] decline in the core (body) temperature below 35ºC ,' a temperature at which thermoregulatory systems begin to fail, as compensatory responses intended to reduce heat loss through conduction, convection, evaporation, radiation, and respiration are limited Etiology[medical-dictionary.thefreedictionary.com]

Epidemiology

  • LEVEL OF EVIDENCE: Prognostic/epidemiological study, level III.[ncbi.nlm.nih.gov]
  • A predefined set of epidemiological and clinical data was retrieved. RESULTS: Eighty-four patients were included (median age: 47 years).[ncbi.nlm.nih.gov]
  • LEVEL OF EVIDENCE: Prognostic and epidemiological study, level III.[ncbi.nlm.nih.gov]
  • This section reviews the epidemiology, clinical effects, and management options for accidental hypothermia in children. Copyright Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.[ncbi.nlm.nih.gov]
  • The loss of body heat, either from the decreased heat production, increased heat loss, or alterations in thermoregulation are important in the epidemiology of this injury.[dtic.mil]
Sex distribution
Age distribution

Pathophysiology

  • This review will detail the pathophysiological consequences of hypothermia, as well as the most recent principle recommendations in dealing with it. Copyright 2016. Published by Elsevier Masson SAS.[ncbi.nlm.nih.gov]
  • This article reviews the epidemiology, pathophysiology, clinical presentation, and treatment of accidental hypothermia.[ncbi.nlm.nih.gov]
  • Pathophysiology Breath holding underwater involuntary gasp aspiration/laryngospasm LOC active aspiration death 90% “wet drowning” and 10% “dry drowning” Aspiration leads to loss of surfactant, atelectasis, V/Q mismatch, and ARDS Hypoxemia leads to a significant[emdocs.net]
  • Hypothermia: pathophysiology, clinical settings, and management. Ann Intern Med . 1978 ; 89 : 519 –527. Steinman AM. Cardiopulmonary resuscitation and hypothermia. Circulation . 1986 ; 74 (pt 2): IV29 –IV32. Southwick FS, Dalglish PH Jr.[circ.ahajournals.org]

Prevention

  • This issue focuses on methods of effective rewarming and prevention of further morbidity and mortality.[ncbi.nlm.nih.gov]
  • Treatment is to protect from further heat loss, minimize afterdrop, and prevent cardiovascular collapse during rescue and resuscitation. The patient should be handled gently, kept horizontal, insulated, and actively rewarmed.[ncbi.nlm.nih.gov]
  • It is a preventable condition when adequate safety measures are ensured. One should act in the case of early symptoms, because collapse may soon follow and evacuation of a patient on a stretcher is time-consuming, dangerous and a major undertaking.[ncbi.nlm.nih.gov]
  • If feasible extracorporeal circulation represents the method of choice because it combines the advantage of immediate central rewarming with the benefit of efficient circulatory support, the heart is rewarmed before the shell, thus preventing the "rewarming[ncbi.nlm.nih.gov]
  • Regular consumption of high-energy food rich in carbohydrates aids the body in heat production, while 13-17 c (3-4L) of water a day prevents rapid dehydration from evaporation.[science.jrank.org]

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