TAILIEUCHUNG - Chapter 020. Hypothermia and Frostbite (Part 1)

Harrison's Internal Medicine Chapter 20. Hypothermia and Frostbite Hypothermia Accidental hypothermia occurs when there is an unintentional drop in the body's core temperature below 35°C (95°F). At this temperature, many of the compensatory physiologic mechanisms to conserve heat begin to fail. Primary accidental hypothermia is a result of the direct exposure of a previously healthy individual to the cold. The mortality rate is much higher for those patients who develop secondary hypothermia as a complication of a serious systemic disorder. Causes Primary accidental hypothermia is geographically and seasonally pervasive. Although most cases occur in the winter months and in colder climates, it. | Chapter 020. Hypothermia and Frostbite Part 1 Harrison s Internal Medicine Chapter 20. Hypothermia and Frostbite Hypothermia Accidental hypothermia occurs when there is an unintentional drop in the body s core temperature below 35 C 95 F . At this temperature many of the compensatory physiologic mechanisms to conserve heat begin to fail. Primary accidental hypothermia is a result of the direct exposure of a previously healthy individual to the cold. The mortality rate is much higher for those patients who develop secondary hypothermia as a complication of a serious systemic disorder. Causes Primary accidental hypothermia is geographically and seasonally pervasive. Although most cases occur in the winter months and in colder climates it is surprisingly common in warmer regions as well. Multiple variables make individuals at the extremes of age the elderly and neonates particularly vulnerable to hypothermia Table 20-1 . The elderly have diminished thermal perception and are more susceptible to immobility malnutrition and systemic illnesses that interfere with heat generation or conservation. Dementia psychiatric illness and socioeconomic factors often compound these problems by impeding adequate measures to prevent hypothermia. Neonates have high rates of heat loss because of their increased surface-to-mass ratio and their lack of effective shivering and adaptive behavioral responses. In addition malnutrition can contribute to heat loss because of diminished subcutaneous fat and because of depleted energy stores used for thermogenesis. Table 20-1 Risk Factors for Hypothermia Age extremes Endocrine-related Elderly Diabetes mellitus Neonates Hypoglycemia Environmental exposure Hypothyroidism Occupational Adrenal insufficiency Sports-related Hypopituitarism Inadequate clothing Neurologic-related Immersion Cerebrovascular accident Toxicologic pharmacologic Hypothalamic disorders Ethanol Parkinson s disease Phenothiazines Spinal cord injury Barbiturates Multisystem .

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