Adult Emergency Medicine: cold

Tuesday, 26 November 2019

Hypothermia

Awake and Conscious Patient
Assess symptoms:

With the temperature dropping recently I thought it might be a good time to retweet the first infographic from my #infographic challenge. Hypothermia, the correlation of core temperature and physiological changes. I hope it's useful. More at https://t.co/Bvm7MMLro2 #FOAMed pic.twitter.com/udjKgDuPlE
— Strata5 (@Nrtaylor101) November 20, 2019

Investigations:
Put the temperature on the gas machine
Look for J waves (osborn). The upward deflection of the terminal S wave (at the junction of the QRS and the ST segment) occurs at or near 32 C. It is first seen in leads II and V6.

Treatment:
Rewarming - consider bypass in cardiac arrest, haemodynamic instability and a core temperature below 32°C, frozen extremities and rhabdomyolysis with hyperkalaemia.
Treat electrolyte disturbances - being careful of hypokalaemia as potassium will increase with re-warming
Remember coagulopathy is common
Haemocrit will rise.

Frostnip
Frostbite
Treat with 40 degrees water, aspirin

In cardiac arrest
Don't give up too soon. Watch this great youtube video. It's true!