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Cold man...Hypothermia

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Cold man...Hypothermia

  1. 1. ?Alive ?Dead……….Hypothermia<br />Dr Wahid Altaf<br />Ireland<br />
  2. 2.
  3. 3. Cold Man<br />
  4. 4. MRN 834269 J. P. SD. O. B. 7/2/1984, 25 y old<br />5/3/9 <br />Found at 0722 am<br /> collapsed, unconscious by passer by<br /> in St Finbarr’s (Glasheen) graveyard<br />Ambulance arrived 0728,<br /> Groaning in ambulance, <br /> GCS 3/15,<br /> ‘pulse present but irregular’<br /> Pupil size 4/8 bilateral. <br />Arrive in CUH 0747<br /> Smell of alcohol off breath,<br /> Abrasions on forehead, left arm, left leg<br />Previously ...<br />Recently released from prison<br /> History of depression, anxiety<br />Last seen evening before at 5.30 pm, <br />parents pills missing –<br /> aspirin, <br />plavix, <br />lipitor, <br />tritace, <br />emcor, <br />paracetamol.<br />
  5. 5. A&E 0747<br />Unresponsive, pulseless, asystole, <br />Pupils non reacting & dilated<br />Abrasions on head<br />Rectal temp 20oc<br />0820 rectal temp 22.2oc<br />9 mg adrenaline between 0755 and 0835, CPR, <br />intubation, ventilation(vomitus noted in throat)<br />2 L fluid given in A&E<br />Catheterised<br />0850 to theatre for rewarming on CPB<br />Theatre 0850 - 1230<br />Bloods in A&E<br />Na 141<br />K 5<br />Cl 105<br />Urea 6.9<br />Creat 79<br />Alb 33<br />AST 46<br />Phos 2.03<br />ECG na<br />
  6. 6. 0900 1000 1100 1200<br />
  7. 7.
  8. 8. C<br />CT brain 5/3/9<br />(contrast)<br />
  9. 9. ICU bloods<br />Theatre<br />R. Fem A > V CP Bypass<br />Spontaneous rhythm at nasopharyngeal temp 32oC<br />Rewarmed to 35oC<br />ICU<br />ventilate<br />Cefuroxime + metronidazole<br />R.Basal consolidation<br />
  10. 10. 5/3/9 ICU<br />ICU<br />
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  12. 12. 5/3/9 cxr<br />
  13. 13. Chest x ray ICU 6/3/9<br />
  14. 14. Cxr 8/3/9<br />
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  17. 17. Conundrums<br />Rewarming passive<br /> active<br />How to rewarm<br /> problems encountered<br />Rate of rewarming<br /> fast<br /> slow - risks of prolonged CPR<br /> poor cardiac output<br /> cerebral hypoxia<br /> # ribs, liver, spleen<br />Temperature at which to stop rewarming<br />Who gets hypothermia<br /> induced<br /> accidental<br />Hypothermia duration of exposure<br /> temp at discovery<br />ILCOR special resuscitation situations<br />
  18. 18. Cooling down - problems<br />Re-warming - problems<br />
  19. 19. Swiss study NEJM 1997<br />
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  21. 21.
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  24. 24. o<br />E<br />
  25. 25. Sigaard Anderson 1962<br />

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