TAILIEUCHUNG - Chapter 020. Hypothermia and Frostbite (Part 4)

Rewarming Strategies The key initial decision is whether to rewarm the patient passively or actively. Passive external rewarming simply involves covering and insulating the patient in a warm environment. With the head also covered, the rate of rewarming is usually ° to °C per hour. This technique is ideal for previously healthy patients who develop acute, mild primary accidental hypothermia. The patient must have sufficient glycogen to support endogenous thermogenesis. The application of heat directly to the extremities of patients with chronic severe hypothermia should be avoided because it can induce peripheral vasodilatation and precipitate core temperature "afterdrop"—a response characterized by a. | Chapter 020. Hypothermia and Frostbite Part 4 Rewarming Strategies The key initial decision is whether to rewarm the patient passively or actively. Passive external rewarming simply involves covering and insulating the patient in a warm environment. With the head also covered the rate of rewarming is usually to C per hour. This technique is ideal for previously healthy patients who develop acute mild primary accidental hypothermia. The patient must have sufficient glycogen to support endogenous thermogenesis. The application of heat directly to the extremities of patients with chronic severe hypothermia should be avoided because it can induce peripheral vasodilatation and precipitate core temperature afterdrop a response characterized by a continual decline in the core temperature after removal of the patient from the cold. Truncal heat application reduces the risk of afterdrop. Active rewarming is necessary under the following circumstances core temperature 32 C poikilothermia cardiovascular instability age extremes CNS dysfunction hormone insufficiency or suspicion of secondary hypothermia. Active external rewarming is best accomplished with forced-air heating blankets. Other options include radiant heat sources and hot packs. Monitoring a patient with hypothermia in a heated tub is extremely difficult. Electric blankets should be avoided because vasoconstricted skin is easily burned. There are numerous widely available active core rewarming options. Airway rewarming with heated humidified oxygen 40 -45 C is a convenient option via mask or endotracheal tube. Although airway rewarming provides less heat than some other forms of active core rewarming it eliminates respiratory heat loss and adds 1 -2 C to the overall rewarming rate. Crystalloids should be heated to 40 -42 C but the quantity of heat provided is significant only during massive volume resuscitation. The most efficient method for heating and delivering fluid or blood is with a countercurrent .

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