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Year 3 > Hyperthermia and hypothermia (E&M) > Flashcards

Hyperthermia and hypothermia (E&M) Flashcards

1
Q

Define hypothermia.

A

Core body temperature <35C

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2
Q

What are the three classes of hypothermia?

A
  • mild (32-35C)
  • moderate (28-32C)
  • severe (<28C)
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3
Q

What happens in hypothermia?

A

Heat generation exceeded by heat loss

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4
Q

What are some causes of hypothermia? (5)

A
  • environmental cold exposure e.g. drowning
  • can be due to insulin resistance, hyperglycaemia, cardiac arrest
  • inadequate insulation in the operating room
  • cardiopulmonary bypass
  • newborn babies
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5
Q

What are some risk factors for hypothermia? (10)

A
  • general anaesthetic use
  • older age
  • very young age
  • immobility
  • substance misuse
  • hypothyroidism
  • impaired mental status
  • stroke
  • homelessness
  • Parkinson’s disease
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6
Q

What are the features of mild hypothermia? (6)

A
  • tachycardia
  • tachypnoea
  • vasoconstriction
  • shivering
  • hypertension
  • frostbite
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7
Q

What are the features of moderate hypothermia? (6)

A
  • cardiac arrhythmias
  • hypotension
  • respiratory depression
  • bradycardia
  • reduced consciousness
  • may cease to shiver
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8
Q

What are some features of severe hypothermia? (4)

A
  • coma
  • apnoea
  • arrhythmia
  • fixed and dilated pupils
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9
Q

What are the two main investigations done for hypothermia?

A
  • core temperature measurement - via oesophageal probe, <35C
  • 12-lead ECG
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10
Q

What would ECG show in hypothermia? (7)

A
  • J wave / Osborn wave (QRS has two peaks)
  • broad (prolonged) QRS complexes
  • sinus bradycardia
  • atrial fibrillation
  • ST elevation or depression
  • T wave inversion
  • prolonged PR
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11
Q

What might we see on ABG in hypothermia?

A
  • respiratory alkalosis, metabolic acidosis or both
  • core temperature decrease –> respiration depressed –> hypoxaemia and hypercapnia
  • combined alkalosis and acidosis due to hypoventilation, CO2 retention, decreased HCO3, impaired hepatic metabolism, increased lactic acid production
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12
Q

What is the management plan for hypothermia?

A
  1. CPR + ALS (if cardiac arrest)
  2. supportive care:
    • remove cold clothing, warm blankets
    • secure airway
    • treat hypoglycaemia
  3. humidified O2
  4. warmed IV fluids
  5. active internal rewarming - irrigation with warm saline (lavage), which can be peritoneal, pleural, gastric, bladder or colonic
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13
Q

How do we manage mild hypothermia? (1+3)

A

Passive external rewarming:

  • remove wet clothing
  • cover with blankets
  • warm room
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14
Q

How do we manage moderate hypothermia? (1+4)

A

Active external rewarming:

  • warm blankets
  • radiant heat
  • forced warm air
  • irrigation with warm saline
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15
Q

How do we manage severe hypothermia?

A

IV administration of warmed crystalloid

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16
Q

How do we manage cardiac arrest in hypothermia?

A

3 shocks should be administered before the patient is rewarmed to 30C

Chest compressions should continue

17
Q

What are some complications of hypothermia? (5)

A
  • cardiac arrhythmias
  • hypoglycaemia
  • hyperkalaemia
  • rhabdomyolysis
  • GI disorders
18
Q

Define hyperthermia.

A

Core body temperature >40C

19
Q

What is heat stroke (hyperthermia)?

A

Life-threatening condition that presents with hyperthermia and CNS dysfunction

20
Q

What are some risk factors for hyperthermia? (6)

A
  • older age
  • impaired cognition
  • medicines
  • lack of acclimatisation to hot environments
  • dehydration
  • patients unable to care for themselves
21
Q

What are the classifications of hyperthermia? (3)

A
  • classic heat stroke - passive exposure to severe environmental heat
  • exertional heat stroke - strenuous physical exercise
  • heat exhaustion - no CNS dysfunction
22
Q

What are the clinical features of hyperthermia? (9)

A
  • Hx of exposure to severe environmental heat or strenuous physical exercise
  • CNS dysfunction - altered level of consciousness, agitation, lethargy, seizures, irritability
  • anhidrosis - hot and dry skin
  • intense thirst
  • weakness
  • anxiety
  • dizziness
  • nausea and vomiting
  • syncope
23
Q

What signs of CNS dysfunction are seen in hyperthermia? (5)

A
  • altered level of consciousness
  • agitation
  • lethargy
  • seizures
  • irritability
24
Q

What investigation will give you the most accurate measurement of core hyperthermia?

A

Rectal temperature (>40C)

25
Q

What might FBC show in hyperthermia?

A

May show neutrophilia, anaemia and thrombocytopenia

26
Q

What might LFTs show in hyperthermia?

A

Elevated ALT and AST due to heat-induced liver damage

27
Q

What might renal function tests show in hyperthermia?

A

Elevated creatinine and blood urea - due to reduced renal perfusion

28
Q

How do we manage heat stroke/hyperthermia?

A
  1. stabilisation - ABC approach, remove clothing
  2. rapid active cooling:
    • whole body cold/iced water immersion - exertional heat stroke
    • wetting and fanning the skin - classic heat stroke
    • aim to achieve a target temperature of no less than 39C - stop cooling once reached to avoid overshoot hypothermia
  3. supportive care and monitoring - oxygen if <94%, IV fluids if volume depletion
  4. transfer to ICU - if no improvement and signs of organ failure
29
Q

How would you manage heat exhaustion (no CNS dysfunction)? (2)

A
  • oral isotonic fluids
  • active cooling
30
Q

What are some complications of hyperthermia? (8)

A
  • ARDS
  • shock
  • AKI
  • DIC
  • CVD
  • acute liver failure
  • rhabdomyolysis
  • multi-organ failure

Year 3 (208 decks)

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