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Accidental Hypothermia - Part 1

Mel Herbert, MD MBBS FAAEM and Doug Brown, MD
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EM:RAP 2014 January - Summary 1 MB - PDF

Mel and Doug discuss the difference between a salvagable hypothermia patient and a human ice cube. Also, they discuss the Abyss, and being caught in an avalanche.

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Kathleen S., Md -

Are there any studies on rewarming using the CoolGuard system? New system but doesn't seem studied for severe hypothermia. We have that but not ECMO and I wonder which patients might have an indicated use. Future paper/discussion?

Aaron A. -

Quick review of literature shows a rate of rewarming for the venous catheters a bit less than 1 C/h, and quite a bit more than that--3-4 C/h for ECMO. Big, big difference. I think these are a good option if you can't transfer to an ECMO center, but if you can, better to ship 'em.

Mary C., M.D. -

should the same rate of chest compressions and ventilations be used in CPR in hypothermic patients as is used in normothermic patients?

michael s. -

could you comment on bretylium, if its appropriate, and if so when?

Brian D., M.D. -

This was probably one of the best EMRAP sections ever. I have read, seen and heard a lot about hypothermia over the past couple of decades but this was interesting, fanstastic and much new information for me. Well done Mel and Doug!

Medley G., M.D. -

ECMO is all well and good if you can get to it. what if you CAN'T get to ECMO center (bad weather= can't fly, none in area/region, etc). Of the other options like warmed dialysis etc, what should be the less good but backup method? chest tubes and perineal catheters are a flog (having done this in the past) and some method of warmed dialysis is likely more available to EVERYONE. thoughts?

MATT E. -

We have a Level 1 infuser and I was wondering has anyone got good experience adapting for rewarming profoundly hypothermic patients? There is a protocol for its use on EMCrit but in my centre in London everyone looked at me like I was mad. Not unreasonable normally, but this seems to have merit if you have to do something in your own resus room and have access to little else.
http://emcrit.org/wp-content/uploads/2012/02/cavr-protocol.pdf

Jack G. -

Great discussion. This was one of my residency projects at Maine Medical Center. Here's the guideline we came up with (link), which I think is mostly in line with the above discussion.

http://www.mainehealth.org/workfiles/mmc_em/Accidental-hypothermia-v2.pdf

Thomas K. -

Are there any show notes attached to the Hypothermia PC? Looking for info Dr. Brown mentioned about an algorithm.

Thanks,
Matt.

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Episode 148 Full episode audio for MD edition 251:04 min - 119 MB - M4AEM:RAP 2014 Janvier - Résumé en Français Français 42:20 min - 58 MB - MP3EM:RAP 2014 Enero - Resumen Español Español 89:14 min - 122 MB - MP3EM:RAP 2014 January - Bogan Version Australian 83:04 min - 114 MB - MP3EM:RAP 2014 January MP3 267 MB - ZIPEM:RAP 2014 January - Summary 1 MB - PDFEM:RAP 2014 January - Board Review Questions 572 KB - PDFEM:RAP 2014 January - Board Review Answers 534 KB - PDF

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