hypothermia-philadelphiauniversity：低溫-費(fèi)城大學(xué)(編輯修改稿)
2025-02-13 03:57 本頁面
【文章內(nèi)容簡介】 l Rewarming ? Warm H2O Immersion ? Heating blankets ? Heated objects ? Radiant Heat ? Forced air Rewarming Caution Afterdrop Phenomenon Temperature drop and acidosis provoke serious arrhythmias Cold acidotic blood causes drop in core temp Cold blood from dilated peripheral vessels carries high lactic acid levels to core vessels Peripheral vasodilation (BP drops) Initial active external rewarming leads to Hypothermia – Trauma Pt. Three mechanisms that contribute to hypothermiainduced coagulopathy in trauma include: 1. Platelet Dysfunction 2. Enhanced Fibrinolytic Activity 3. Alteration In Enzyme Functions Hypothermia – Trauma Pt. ? Platelet Dysfunction ? Inhibition of Thromboxane B2 production causes the normal response of platelet aggregation to decrease. The platelets are therefore stored in the spleen and liver, and left unavailable for use. Hypothermia – Trauma Pt. ? Enhanced Fibrinolytic Activity ? Traumainduced hypothermia causes a heparinlike substance to be released, thus causing a disseminated intravascular clotting (DIC)like syndrome. ? This is marked by an increase in prothrombin (PT) and partial thromboplastin times (PTT), and an increase in fibrin split products. Hypothermia – Trauma Pt. ? Alteration In Enzyme Functions ? Hageman factor and Thromboplastin are needed to form clots at the site of injured endothelium. ? Hypothermia alters the function of these enzymes and others, therefore increasing bleeding and clotting times. Hypothermia – Trauma Pt. ? Coagulopathy – Perpetuated ? Blood transfusions/fluid resuscitation may lead to or exacerbate hypothermia. ? Silbergleit et al report that room (or ambient) temperature IV fluids, used in resuscitation, increase hypothermia or may actually cause secondary hypothermia in trauma patients. ? Crystalloids dilute the availability of coagulation factors ? Banked blood is low in platelets and clotting factors, especially Factors V and VIII Hypothermia – Near Drowning ? Cerebral Protection ? Protective Hypothermia (H2O 5 ? C) core body temp 28 ? C ? W
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