Temperature at admission in the ED was 31.6 ± 2.6°C (mean ± SD), lowest temperature 24.2°C. Fourteen different rewarming treatments were used resulting in a wide range of rewarming speeds. Seventy-nine complications occurred: pulmonary, renal and neurological complications in 20, 17 and 10 patients respectively.
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Introduction Rewarming is a delicate phase of therapeutic hypothermia (TH). Adverse consequences of rewarming on the whole body may seriously limit the protective effects of hypothermia, leading to secondary injury. Thus, understanding, predicting, and managing possible systemic side effects of rewarming is important for guaranteeing TH efficacy.
Admission hypothermia is associated with increased mortality following major trauma. Generally hypothermic patients are actively rewarmed as part of the trauma protocol; however, when the patient has a traumatic brain injury (TBI), this active rewarming may be detrimental.
Generally hypothermic patients are actively rewarmed as part of established protocols. These rates vary significantly from 0.20°C to 2.95°C/h.12,22However, when the patient has a TBI, this more rapid and active rewarming may be detrimental.
Hypothermia, either accidental or therapeutic, is when the body's core temperature is less than 35.0°C. This article examines the pathophysiology, clinical features and management of both intentional and unintentional hypothermia with a focus on the current literature regarding treatment protocols.
Active external rewarming provides an effective initial strategy for most spontaneously perfusing, severely hypothermic patients.
Active external rewarming is simply the application of heat directly to the skin, and is only effective in the presence of intact circulation that can return peripherally rewarmed blood to the core. Hot water bottles and heating pads (applied to truncal areas only) may cause burns to cold and vasoconstricted skin.
Pathophysiology of Hypothermia Hypothermia slows all physiologic functions, including cardiovascular and respiratory systems, nerve conduction, mental acuity, neuromuscular reaction time, and metabolic rate.
A warmed intravenous solution of salt water may be put into a vein to help warm the blood. Airway rewarming. The use of humidified oxygen administered with a mask or nasal tube can warm the airways and help raise the temperature of the body.
The most effective method of active core rewarming is extracorporeal blood warming, accomplished by cardiopulmonary bypass, arteriovenous rewarming, venovenous rewarming, or hemodialysis. These techniques are highly effective and increase core temperature by 1°C to 2°C (3.6°F) every three to five minutes.
Patients who become acutely hyperthermic often display signs of neurological dysfunction. The neurological injury may manifest in several ways, including cognitive dysfunction, agitation, seizures, unsteadiness, or disturbance of consciousness from lethargy to coma.
Hypothermia is caused by prolonged exposures to very cold temperatures. When exposed to cold temperatures, your body begins to lose heat faster than it's produced. Lengthy exposures will eventually use up your body's stored energy, which leads to lower body temperature.
Hypothermia may be lead to a collapse in ionic regulation, leading to an uncontrollable and lethal calcium influx. Subfreezing temperatures may cause injury due to cellular freezing with subsequent excessive osmotic swelling, lyotropic effects or excessive osmotic shrinking due to extracellular freezing.
Certain medical conditions such as diabetes and thyroid conditions, some medications, severe trauma, or using drugs or alcohol all increase the risk of hypothermia.
Warming the extremities first can cause shock. It can also drive cold blood toward the heart and lead to heart failure. DO NOT warm the victim too fast. Rapid warming may cause heart arrhythmias.
At this stage careful handling becomes imperative to avoid deterioration and inducing cardiac arrhythmias due to heart muscle irritability from the cold.
Give warm liquids to rehydrate and rewarm, but never give the victim alcohol to drink. Give high-calorie foods, such as chocolate, peanuts, or raisins, which provide quick energy that helps your body produce heat. For mild cases, use fire, blankets, or another person's body heat to warm the victim.