Hypothermia

Question 1

Hypothermia

Mild =

Answer 1

32-35 (89.6-95)
Shivering, tachypnea/tachycardia/hypertension, confusion/lethargy, dysarthria/ataxia, decreased O2 delivery

Question 2

Hypothermia

Mod =

Answer 2

28-32 (82.4-86.6)
Shivering stops, bradycardia/bradypnea, osborn waves (J waves-31 degrees), altered mental status, slowed reflexes, cold
diuresis, pupil dilation

Question 3

Hypothermia

Severe =

Answer 3

< 28 (82.4)
Unresponsive/coma, hypotension, dysrhythmias, acidemia, loss of reflexes

Question 4

Hypothermia

ASAP:

Answer 4

ABCs, 2 LB IVs, O2, monitor, VS w/ cont core temp, EKG, accu✓ (D50 prn),   RSI/ETT for AMS

Question 5

Hypothermia

Hx/Exam:

Answer 5

Circumstances (medical vs environmental, EtOH/drugs, burns/ derm prob, hx of endocrine prob, pupils, lethargy, trauma, SAMPLE hx

Question 6

Hypothermia

Labs:

Answer 6

CBC (Hct↑ 2/2 temp), BMP CK, LFTs, coags, lipase (cold-induced panc), TSH/FT4, UA, ± ABG

Question 7

Hypothermia

Rads:

Answer 7

CXR, head CT

Question 8

Hypothermia

Tx:

Answer 8

If mild sx… Passive rewarming: shivering, warm Blankets, Heat lamps.
If mod sx… Active external rewarming: Heat packs to axilla/groin, Warm IVF (NS) plus passive methods.
If severe sx… all of the above plus Warmed/humidified O2; NGT/foley/CT/ peritoneal 45C lavage, ±Thoracotomy (ECMO).
If cardiac arrest… CPR after minute-long pulse check. Hold ACLS drugs and shock till > 30C. (Pacing not indicated for ↓HR)- shock may not be effective- continue warming and reshock
If pt not warming… hydrocortisone 250 mg IV and levothyroxine 500 mcg IV
If dead… not till warm and dead