Hypo-, Hyper-thermia & rhabdomyolysis

Question 1

Grade severity of hypothermia.

Answer 1

• Mild: 32-35C (90-95F).
• Mod: 28-32C (82-90F).
• Sev: <28C (<82F).

Question 2

EKG findings in hypothermia?

Answer 2

J-wave / Osborne Wave.

Question 3

Shivering stops below what temperature?

Answer 3

32C

Question 4

Renal response to hypothermia?

Answer 4

Increased Cr. Diuresis.

Question 5

Changes to ACLS in hypothermia?

Answer 5

Pulse check for 30-60 seconds to allow for bradycardia.

Question 6

Tx (VF) in hypothermic patient?

Answer 6

Defib x1-3, then hold on further shocks until warm.

Question 7

IVF considerations in hypothermia?

Answer 7

Avoid LR. Lactate is not metabolized when cold.

Question 8

Difference between heat stroke vs heat exhaustion?

Answer 8

Heat stroke has CNS Sx of cerebellar dysfxn, seizures, coma.

Question 9

Pathophysiology of malignant hypoerthermia?

Answer 9

Ranotidine receptor mutation which codes for Calcium transport in skeletal muscle.

Question 10

Triggers of neuroleptic malignant syndrome?

Answer 10

Haldol is MC. Atypicals are possible, as are any dopamine-affecting medication like reglan.

Question 11

Timeline of neuroleptic malignant syndrome?

Answer 11

1-3 days after inciting drug

Question 12

Tx (neuroleptic malignant syndrome)?

Answer 12

• Dantrolene for rigidity.

- Replete dopamine with dopaime-agonists such as bromocriptine, amantadine, sinemet.

Question 13

Type of surgery (2) associated with rhabdo?

Answer 13

Bariatric or spine surgery.

Question 14

Drugs associated with rhabdo?

Answer 14

statins, daptomycin, propofol, antipsychotics, chekcpoint inhibitors

Question 15

Tx (Rhabdo)?

Answer 15

• IVF with target UOP 2-3cc/kg/hr
• Montior for compartment syndrome.
• Treat hypocalcemia only if symptoms. Worry about precipitation of calcium salts.
• Bicarb thought to help but not proven benefit.