accidentalhypothermia[意外低溫](ppt-79)(完整版)
【正文】 rming in Accidental Hypothermia, Ann Emerg Med, April 1996。 175:389. Osborne (J) Wave… ? Amplitude proportionnal to degree of hypothermia ? Usually V3V6 ? At junction of QRS and ST segment Osborn JJ: Experimental hypothermia: respiratory and blood pH changes in relation to cardiac function. Am J Physiol 1953。 35: 337345. Electrical heating Results ? Core heat content electrical heating ? Rates ? ?C/h with electical heating ? No afterdrop both groups Greif R and al, Resistive heating is more effective than metallicfoil insulation in an experimental model of accidental hypothermia: a randomized controlled trial. Ann Emerg Med. April 2022。 18:703707. Afterdrop conclusion ? Rectal T? lags behing esophageal T? and is often than esophageal and pulmonary T?. ? Think about it but you can probably not prevent it. ? Issue with active external rewarming ? Other concerns about external rewarming: – Acidosis – Hypotension Management: ED issues Intubation ? General belief it can induce arythmias ? Danzl, Multicenter Hypothermia Survey, Annals Emerg Med, . – Data from 13 ED – 428 cases – 117 intubation – NO arythmias Management: ED issues Bretylium ? Remended for in hypothermia ? Removed from new ACLS 2022: ? ? availability and limited supply ? ? occurrence of side effects ? Still remend in textbooks (Rosen) ? Remended by US Wilderness Emergency Medical Services Institute ? Based on Dogs studies ? Good for prophylaxis only Management: ED issues Drugs / Shocks ? NO drugs if T? 30?C – Not efficacious – Not metabolised ? If 30?C, ? intervals between doses ? If 30?C and failure of 3 shocks Management: ED issues Drugs / Shocks ? NO drugs if T? 30?C – Not efficacious – Not metabolised ? If 30?C, ? intervals between doses ? If 30?C and failure of 3 shocks Defer subsequent shock + Rx until T? 30?C ACLS 2022 The algorithm… Conclusion ? Hypothermia is rare but treatable ? Good oute after prolonged arrests ? Include Hypothermia in your ? Dx ? Include T? as a 5th vital sign… ? Call early to anize CPB if available if patient in cardiac arrest ? Prevention is still the best…and… Play carefully… From Journal Le Soleil, february 2022 The End 。19:204206. Mediastinal lavage ? Requires certain expertise ? Limited clinical experience ? Case reports ? Internal cardiac massage ? 8?C / h Douglas D. Brute, Hypothermic cardiac arrest: An 11 year review of ED management and oute. Am J Emerg Med 2022。 18:7282. So… ? 1st ABG (30?C): ? pH = ? pCO2 = 27 ? 2nd ABG (37?C): ? pH = ? pCO2 = 40 ABG in Hypothermia… …the rationale ? ABG machines usually warms blood to 37?C. ? So use the UNCORRECTED ABG for normal T? . Delaney KA and al. Assessment of AcidBase Disturbances in Hypothermia and their physiologic consequences. Ann Emerg Med, Jan 1989。 175:389. ECG in Hypothermia ? Muscle tremors artifacts ? Early changes – Bradycardia – T wave inversion – Prolonged PR, QRS and QT intervals ? when T? 32?C ? when T? 28?C Lab fi
教學(xué)課件相關(guān)推薦
鄂ICP備17016276號-1