Morning Report

Morning Report: 2/20/2015

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Thanks to Dr. Bogoch for presenting today’s Morning Report!

 

You’re Not Dead Until You’re Warm and Dead- or are you?

 

Epidemiology:

  • 1500 deaths in the USA are attributely to hypothermia yearly

 

Measuring Core Body Temperature:

  • Distal third of the esophagus
  • Bladder: inaccurate if performing peritoneal lavage
  • Rectum: probe must be inserted 15cm (6 inches).

**Patients should be handled gently- rough movments may cause dysrrhythmias

 

Definitions:

  • Swiss Staging System Treatment
    • HT I: 89˚F-95˚F
      • warm environment, warm clothing, drink warm drinks, active movement.
    • HT II: 82˚F-89˚F
      • cautious/minimal movements, full-body insulation, minimally invasive rewarming techniques (heating packs, warm parenteral fluids)
    • HT III: 75˚C- 82˚F
      • HT II treatments +airway management, ECMO or CPB with cardiac instability that is refractory to medical management.
    • HT IV: <75˚F
      • HT II and III management plus CPR and epinephrine x 3, defibrillation, rewarming with ECMO, or CPB or continuous CPR with active external rewarming.

 

Rescue Collapse: cardiac arrest that is related to extrication and transport of patient.

  • Caused from placement of CVC, too much movement of patient, hypovolemia
  • Afterdrop: not a real thing, afterall.

 

What actually helps:

  • Active external rewarming: heat packs, “Arctic Sun”
  • If there are no signs of life and no vital signs, ECMO/CPB survivorship is 47-63%, without is less than 37%- ECMO/CBP survivorship is attributed to establishing blood flow.

 

Serum Potassium of 12mmol/L is considered the point where resuscitation is futile.

 

Best article ever: http://www.nejm.org/doi/full/10.1056/NEJMra1114208

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital
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