hypothermia.... cold man
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Transcript of hypothermia.... cold man
?Alive?Dead……….Hypothermia
DrWahidAltaf
Ireland
ColdMan
MRN834269J.P.SD.O.B.7/2/1984,25yold
5/3/9
Foundat0722am
collapsed,unconsciousbypasserby inStFinbarr’s(Glasheen)graveyard
Ambulancearrived0728,
Groaninginambulance,GCS3/15,‘pulsepresentbutirregular’Pupilsize4/8bilateral.
ArriveinCUH0747
Smellofalcoholoffbreath,Abrasionsonforehead,leQarm,leQleg
Previously...
RecentlyreleasedfromprisonHistoryofdepression,anxiety
Lastseeneveningbeforeat5.30pm,parentspillsmissing–
aspirin, plavix, lipitor, tritace, emcor, paracetamol.
A&E0747
Unresponsive,pulseless,asystole,
PupilsnonreacVng&dilated
Abrasionsonhead
Rectaltemp20oc
0820rectaltemp22.2oc
9mgadrenalinebetween0755and0835,CPR,
intubaVon,venVlaVon(vomitusnotedinthroat)
2LfluidgiveninA&E
Catheterised
0850totheatreforrewarmingonCPB
Theatre0850‐1230
BloodsinA&E
Na141K 5
Cl 105
Urea6.9
Creat79
Alb33
AST46
Phos2.03
ECGna
TIME 0804
PaO2 3.0
PaCO2 13.4
pH 7.13
Lactate(0.5‐2.0)
3.1
Bic 33
Bdef +4.1
Na(BloodGas) 137
K(BloodGas) 4.7
Cl(BG)(98‐107) 96
CK 2134
Hgb 14.3
Glucose ?
0900100011001200
C
CTbrain5/3/9
(contrast)
ICUbloods
Theatre
R.FemA>VCPBypass
Spontaneousrhythmatnasopharyngealtemp32oC
Rewarmedto35oC
ICUvenVlate
Cefuroxime+metronidazole
R.BasalconsolidaVon
Time 5/3/09
Day01530
6/3/09
Day10620
7/3/09
Hgb 10.6 9.9
WCC 27.4 22
plat 335 242
INR 1.2 1.1
APTT 35 28
Bilirubin 7 6
ALT(4‐45) 145 142
CK(40‐180) 3677 NA
Creat 43 88
5/3/9ICU
Date 5/3/09(day0) 6/3/09(day1)
Time 1300 1400 1600 1800 2000 2200 2400 0200 0400 0600Adrenaline 16 14 14 12 12 12 12 10 6 off
MAP 67 87 69 72 72 70 68 68 84 86
Urineml/hr
500 70 100 320 290 150 100 125 100 120
TempoC 35
ICU
TIME 0804 1315 1500 1700 0047
PaO2 3.0 13.2 14 15.9 14.2
PaCO2 13.4 10.4 6.3 5.5 4.6
pH 7.13 7.19 7.34 7.38 7.48
Lactate(0.5‐2.0)
3.1 1.0 1.3 1.6 1.2
Bic 33 29.8 25.4 24.3 25.3
Bdef +4.1 1.6 ‐0.4 ‐0.8 +1.8
Na(BG) 137 140 139 135 139
K(BG) 4.7 4.4 4.4 4.0 3.7
Cl(BG)(98‐107)
96
CK 2134
Hgb 14.3
Glucose 8.1 8.5
5/3/9cxr
ChestxrayICU6/3/9
Cxr8/3/9
Conundrums
Rewarming passive
acVve
Howtorewarmproblemsencountered
Rateofrewarming
fast
slow‐risksofprolongedCPR
poorcardiacoutput
cerebralhypoxia
#ribs,liver,spleen
Temperatureatwhichtostoprewarming
Whogetshypothermia
induced
accidental
Hypothermia duraVonofexposure
tempatdiscovery
ILCORspecialresuscitaVonsituaVons
Coolingdown‐problems Re‐warming‐problems
SwissstudyNEJM1997
oE
SigaardAnderson1962