Hypothermia: a case presentation and review of the pathophysiology and options for prevention and treatment MS Logan, MD; CM Watson MD, JE Morrison MD University of South Carolina, School of Medicine, Columbia, South Carolina - PowerPoint PPT Presentation

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Hypothermia: a case presentation and review of the pathophysiology and options for prevention and treatment MS Logan, MD; CM Watson MD, JE Morrison MD University of South Carolina, School of Medicine, Columbia, South Carolina

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Title: Hypothermia: a case presentation and review of the pathophysiology and options for prevention and treatment MS Logan, MD; CM Watson MD, JE Morrison MD University of South Carolina, School of Medicine, Columbia, South Carolina


1
Hypothermia a case presentation and review of
the pathophysiology and options for prevention
and treatmentMS Logan, MD CM Watson MD, JE
Morrison MDUniversity of South Carolina, School
of Medicine, Columbia, South Carolina
Rewarming
Case
The Bodys Response
A 20-year-old female presented to our level 1
trauma center after being found on a roadside
embankment. It appeared that she had been ejected
from her vehicle after a motor vehicle collision
the previous night. On arrival she was noted to
be in ventricular fibrillation. She had a core
body temperature of 27.5C by bladder probe,
blood pressure of 81/59, initial arterial blood
gas results of pH 7.03, pCO2 55 mmHg, paO2 86
mmHg and base deficit of -17 mmol/L on 100
nonrebreather. Advanced Trauma Life Support
guidelines were followed. Her initial
resuscitation lasted for approximately three
hours to include intubation, central venous
access, bilateral chest tube thoracostomy with
warm saline lavage, diagnostic peritoneal lavage
with warm saline lavage, bladder lavage,
orogastric lavage, multiple arterial blood gases
and multiple rounds of cardiopulmonary
resuscitation with cardioversion. She had
multiple thoracic, intraabdominal, orthopedic and
spinal injuries. Of significance, complete
spinal cord transection was recognized on
abdominal computed tomography (CT) scan (Figure
1). She required several operative procedures
(Figure 2). Her intensive care unit stay
included most major complications associated with
hypothermia, specifically, coagulopathy,
acidosis, cold bronchorrhea, cold diuresis,
ileus, cardiovascular conduction abnormalities,
and central nervous system depression. After
recovery she was transferred to a long term
rehabilitation center.

Tsuei BJ, Kearney PA. Hypothermia in the trauma
patient. Injury Int J Care Injured. 2004357-15
Kirkpatrick AW, Chun R, Brown R, Simons RK.
Hypothermia and the trauma patient. Can J Surg.
1999 Oct42(5)333-43. Tsuei BJ, Kearney PA.
Hypothermia in the trauma patient. Injury Int J
Care Injured. 2004357-15
Discussion
Fig 2 Intraoperative Photograph
Fig 1 CT Reconstruction of the Spine
  • Common
  • 12 pts arrive with hypothermia
  • 46 hypothermic on arrival to operating room (OR)
  • 76 leaving OR are hypothermic 3
  • Morbidity and Mortality
  • Critical Point lt 34C enzymatic dysfunction4
  • Core temp lt 32C
  • Exposure alone - 23 mortality
  • Trauma hypothermia - 100 mortality5
  • No threshold temperature below which mortality is
    assured6
  • Reported survival with core temperature below
    17C7

Classification of Hypothermia
Hildebrand Frank, Giannoudis Peter V, van
Griensven Martijn, Chawda Mayur, Pape
Hans-Christoph. Pathophysiologic changes and
effects of hypothermia on ourcome in elective
surgery and trauma patients. Am J Surg
2004187(3)363-71.
3Gregory JD, Flancbaum L, Townsend MC, Cloutier
CT, Jonasson O. Incidence and timing of
hypothermia in trauma patients undergoing
operations. J Trauma 1991 Jun31(6)795-8. 4
Watts DD, Trask A, Soeken K, Perdue P, Dols S,
Kaufmann C. Hypothermic coagulopathy in trauma
effect of varying levels of hypothermia on enzyme
speed, platelet function and fibrinolytic
activity. J Trauma. 1998 May 44(5)
846-54. 5Jurkovich GJ, Greiser WB, Luterman A,
Curreri PW. Hypothermia in trauma victims an
ominous predictor of survival. J Trauma.
1987271019-24. 6Rutherford EJ, Fusco MA, Nunn
CR, et al. Hypothermia in critically ill trauma
patients. Injury. 199829(8)605-8. 7Gilbert M,
Busund R, Skagseth A, Nilsen PA, Solbo JP.
Resuscitation from accidental hypothermia of 13.7
degrees C with circulatory arrest. Lancet.
2000355375-6.
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