test 7 hypothermia

Question 1

Accidental Hypothermia

Answer 1

o unintentional decrease in core temperature below 35ºC (95ºF)
 Difficult to differentiate death from effects of severe hypothermia
 Very few survivors if core temp is <20ºC (68ºF)
 Survival rates may approach 60% based on patient age, health, and time to resuscitation

Question 2

Mild Hypothermia 32-35ºC symptoms

Answer 2

 Patient incapable of responding to cold
 Shivering to produce heat
 Elevated blood pressure
 Increased heart rate
 Diuresis => vasoconstriction => volume backing up into the heart-> bring in a lot of volume to create reasonable flow so tells kidneys to urinate

Question 3

Mild Hypothermia 32-35ºC treatment

Answer 3

 External

 Passive re-warming

Question 4

Moderate Hypothermia 30-32ºC symptoms

Answer 4

 Patient: diminished shivering
 Decreased heat producing ability
 Lower blood pressure
 Lower heart rate
 Stiffer muscles
 Possible supraventricular arrhythmias

Question 5

Moderate Hypothermia 30-32ºC treatment

Answer 5

 Active core re-warming
 External warming devices
 Convert to CPB if:
         Unstable
         Circulatory collapse

Question 6

Severe Hypothermia Below 30ºC symptoms

Answer 6

 Patient: cardiac arrhythmias

 High blood viscosity & sludging in microcirculation

Question 7

Severe Hypothermia Below 30ºC treatment

Answer 7

 CPB

Question 8

Hypothermia perfusion considerations

Answer 8

 No cardioplegia necessary
 Ultrafiltration device may (will) be necessary
 Normal heparinization protocol
 If circulation absent, may be necessary to add more heparin to prime ensuring adequate anticoagulation upon initiation
 Rewarming rate of 4ºC per hour
o Compromised venous return
o More even warming distribution
 Flow rates excess of 2L/min-adults
 Copious amounts of volume necessary to maintain flows
 As core temperature approaches 32ºC patient can be defibrillated
 Due to circulatory arrest status, metabolic acidosis is always present
 Normal acid/base balance must be restored
 After rewarming vascular permeability may be increased and coagulopathies may occur
 Patients may have high urinary output
 Potassium levels may be elevated