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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.
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?
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.
should the same rate of chest compressions and ventilations be used in CPR in hypothermic patients as is used in normothermic patients?
could you comment on bretylium, if its appropriate, and if so when?
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!
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?
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
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.
Are there any show notes attached to the Hypothermia PC? Looking for info Dr. Brown mentioned about an algorithm.
What you do matters.