Hypothermia: stop cold insufflating

Hypothermia :stop cold insufflating !Halte à l’insufflation froide ! Claude Hébette, Hôpital de Moûtiers 1971 - 1998 Véronique Legrand, Annecy Lucien Cadoz, FIPS FIPS 15th World Congress, Tignes, april 2005

To be read with comments pages.A lire avec pages de commentaires. Jean Chièze FIPS 15th World Congress, Tignes, april 2005

Vital risk of hypothermia = heart inefficiency FIPS 15th World Congress, Tignes, april 2005

Heart contraction chemical conditionsand physical conditions : minimal temperature. FIPS 15th World Congress, Tignes, april 2005

During the rescue,riskof passing below the threshold cardiac arrestor ventricular fibrillation drugs ineffective defibrillation ineffective FIPS 15th World Congress, Tignes, april 2005

Why ? 1 Cold blood shell  coreHow ?• abrupt shifts of postures• sometimes external rewarming FIPS 15th World Congress, Tignes, april 2005

hypothermicnormal FIPS 15th World Congress, Tignes, april 2005

cautionsDMTM Chamonix • winch pulling up • stretcher carrying horizontally FIPS 15th World Congress, Tignes, april 2005

cautions• external rewarming may be dangerous• internal rewarming is safer FIPS 15th World Congress, Tignes, april 2005

Why ? (contind.)2 Heat loss • through the skin • but also through the airway = caloric haemorrhage (Conn) 70 m² FIPS 15th World Congress, Tignes, april 2005

cautions• blankets, caps...• but also « caloric tourniquet » FIPS 15th World Congress, Tignes, april 2005

Why ? (contind.) 3 Inhalation of cold air or oxygen  lungs , near heart especially in case of intubation FIPS 15th World Congress, Tignes, april 2005

If the first responder thinksrespiratory assistance is necessary cautiongas insufflated must be warmed FIPS 15th World Congress, Tignes, april 2005

The rescuer must knowif the core temperatureis near the critical level (28-30°C)A special thermometer is indispensable FIPS 15th World Congress, Tignes, april 2005

How to rewarm air or oxygen ? • soda lime + CO2 • electricity • cooking pot + water ! • « solid oxygen » • hydrogen + oxygen ( + catalyst) FIPS 15th World Congress, Tignes, april 2005

How rewarm the gas ? Soda lime Ca(OH)2 + CO2  CaCO2 + H2O 2NaOH + CO2  Na2CO3+ H2O + FIPS 15th World Congress, Tignes, april 2005

Lloyd Soda lime sl O2  CO2 FIPS 15th World Congress, Tignes, april 2005

Soda limeLloyd FIPS 15th World Congress, Tignes, april 2005

Soda limeReviva FIPS 15th World Congress, Tignes, april 2005

Soda limeLittle Dragon FIPS 15th World Congress, Tignes, april 2005

Parachutethermique Electricity FIPS 15th World Congress, Tignes, april 2005

ElectricityRes-Q-Air FIPS 15th World Congress, Tignes, april 2005

Cooking potUvic (butane/propane)Heat Treat FIPS 15th World Congress, Tignes, april 2005

Solid state oxygenAviox FIPS 15th World Congress, Tignes, april 2005

hydrogen combustionApplinc O² air + 0,1 % H catalyst platinum FIPS 15th World Congress, Tignes, april 2005

Available nowLittle Dragon Res-Q-Airjopo@freenetname.co.uk www.hypothermia-ca.com/res-q-air.htm FIPS 15th World Congress, Tignes, april 2005

Conclusion 1Every rescue teampossibly dealing with hypothermia(everywhere !)must have - an hypothermic thermometer - an air warmerat one’s disposal FIPS 15th World Congress, Tignes, april 2005

Conclusion 2Insufflationamong hypothermic patient : • none (cardiac arrest) • or hot FIPS 15th World Congress, Tignes, april 2005

Cold insufflation =bear’s cobblestoneof resuscitation FIPS 15th World Congress, Tignes, april 2005

Hypothermia: stop cold insufflating

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