accidentalhypothermia[意外低溫](ppt-79)-資料下載頁
2025-01-12 07:36本頁面
【正文】 to 2?C – 10 – 30 min ? Used calorimeter, rectal, esophageal and tympanic probes. ? Heat loss calculation Webb, Paul. Afterdrop of body temperature during rewarming: an alternative explanation. . 60(2): 385390, 1986. 2 mecanisms for afterdrop ? Convection mecanism – Return of cold blood from periphery – Minimal is any contribution ? Conduction mecanism – Thermal gradient principal – Heat flow principal Webb, Paul. Afterdrop of body temperature during rewarming: an alternative explanation. . 60(2): 385390, 1986. Skin/Tissues Blood vessel Environement Heat transfer Conduction Mecanism Heat transfer Afterdrop: an alternative explanation ? Active external rewarming ? increase threat of further cooling of the heart…as much as thought before. ? Correlated by many other papers ?Savard, ., . Cooper, . Veale, and . Malkinson. Peripheral blood flow during rewarming from mild hypothermia in humans. J. Appl. Physiol. 58(1): 413, 1985. ?Romet, Tiit T. Mechanism of afterdrop after cold water immersion. . 65(4): 15351538, 1988. The Alcatraz/San Francisco Swim Study ? San Francisco Bay…contest… ? Swims from Alcatraz Island to shore ? No wetsuits or protective clothing ? Water T? = 12?C (53?F) ? Outside : T? = 10?C ? 3 Km ? 11 subjects for study ? 23 to 70 (!) ? Measured T? after contest. Thomas J. Nuckton and al. Hypothermia and afterdrop following open water swimming: The Alcatrax/San Francisco Swim Study. Am J Emerg Med 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
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