TAILIEUCHUNG - Chapter 020. Hypothermia and Frostbite (Part 3)

Source: Modified from RR Kempainen, DD Brunette: Resp. Care 49:192, examination findings can also be altered by hypothermia. For instance, the assumption that areflexia is solely attributable to hypothermia can obscure and delay the diagnosis of a spinal cord lesion. Patients with hypothermia may be confused or combative; these symptoms abate more rapidly with rewarming than with the use of restraints. A classic example of maladaptive behavior in patients with hypothermia is paradoxical undressing, which involves the inappropriate removal of clothing in response to a cold stress. The coldinduced ileus and abdominal rectus spasm can mimic, or mask,. | Chapter 020. Hypothermia and Frostbite Part 3 Source Modified from RR Kempainen DD Brunette Resp. Care 49 192 examination findings can also be altered by hypothermia. For instance the assumption that areflexia is solely attributable to hypothermia can obscure and delay the diagnosis of a spinal cord lesion. Patients with hypothermia may be confused or combative these symptoms abate more rapidly with rewarming than with the use of restraints. A classic example of maladaptive behavior in patients with hypothermia is paradoxical undressing which involves the inappropriate removal of clothing in response to a cold stress. The cold-induced ileus and abdominal rectus spasm can mimic or mask the presentation of an acute abdomen Chap. 14 . When a patient in hypothermic cardiac arrest is first discovered cardiopulmonary resuscitation is indicated unless 1 a do-not-resuscitate status is verified 2 obviously lethal injuries are identified or 3 the depression of a frozen chest wall is not possible. As the resuscitation proceeds the prognosis is grave if there is evidence of widespread cell lysis as reflected by potassium levels 10 mmol L 10 meq L . Other findings that may preclude continuing resuscitation include a core temperature 10-12 C a pH or evidence of intravascular thrombosis with a fibrinogen value g L 50 mg dL . The decision to terminate resuscitation before rewarming the patient past 33 C should be predicated on the type and severity of the precipitants of hypothermia. There are no validated prognostic indicators for recovery from hypothermia. A history of asphyxia with secondary cooling is the most important negative predictor of survival. Diagnosis and Stabilization Hypothermia is confirmed by measuring the core temperature preferably at two sites. Rectal probes should be placed to a depth of 15 cm and not adjacent to cold feces. A simultaneous esophageal probe should be placed 24 cm below the larynx it may read falsely high during heated .

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