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HYPOTHERMIA (DIFFERENTIAL DIAGNOSIS (Brain Trauma, Hypothermia due to…
HYPOTHERMIA
DIFFERENTIAL DIAGNOSIS
Brain Trauma
Hypothermia due to cardia arrest
Ischemic or Hemorrhagic stroke
Severe intoxication/drug overdose
Accidental hypothermia
DIAGNOSTIC TESTS
Labs
Rectal probe placement
ABG
:
CXR
CLINICAL S/S
Severe
:
Moderate
:
Mild
:
RESPIRATORY MANAGEMENT
Bear hugger, heated IV fluids
Oxygen Therapy Protocol
Mechanical Ventilation Protocol
ETIOLOGY
Decreased heat production
PATHOPHYSIOLOGY
Cold receptors stimulate the anterior hypothalamus causing peripheral vasoconstriction and causes the patient to start shivering which intern causes an increase in thyroxine and epinephrine levels. Soon thereafter a decrease in depolarization of the cardiac pacemaker cells start to cause bradycardia.
Heated Humidification 40-42 C
32-35 C (90-95 F)
Tachycardia, tachypnea, Inc BP, confusion, ataxia, dysarthria, shivering, excessive diuresis
28-32 C (82-90 F)
Reduced RR, HR, CO and consciousness, confusion; hallucinations; mydriasis; loss of shivering and airway protection
< 28 C (<82 F)
Coma, areflexia, apnea (<24 C), pulmonary edema, oilguria, hypotension, bradycardia, ventricular arrhythmias, asystole
Temperature probe to assess more accurate core temperature
Electrolytes- K+ , glucose, AG, BUN and creatinine, creatine phosphokinase, coagulation panel, toxicology, blood alcohol level
*Note- ABG needs to be corrected per temperature change for accurate ventilation.
Spo2 >90%
Due to left shift in oxy-hb curve-----> impairing tissue oxygen extraction
To assess aspiration PNA and pulmonary edema- both seen in accidental hypothermia.
Increased heat loss
Impaired hermoregulation
Lower the temp ----> higher the gas solubility, The higher the gas solubility ----> lower the partial pressure
PaO2 drops by 5 mmHg for every degree below 37 C PaCO2 drops 2 mmHg for every degree below 37 C