You’re Not Dead Until You’re Warm and Dead – or are you?

Thanks to Dr. Bogoch for presenting today’s Morning Report!

You’re Not Dead Until You’re Warm and Dead- or are you?

Epidemiology:

• 1500 deaths in the USA are attributely to hypothermia yearly

Measuring Core Body Temperature:

• Distal third of the esophagus
• Bladder: inaccurate if performing peritoneal lavage
• Rectum: probe must be inserted 15cm (6 inches).

**Patients should be handled gently- rough movments may cause dysrrhythmias

Definitions:

• Swiss Staging System Treatment
  • HT I: 89˚F-95˚F
    • warm environment, warm clothing, drink warm drinks, active movement.
  • HT II: 82˚F-89˚F
    • cautious/minimal movements, full-body insulation, minimally invasive rewarming techniques (heating packs, warm parenteral fluids)
  • HT III: 75˚C- 82˚F
    • HT II treatments +airway management, ECMO or CPB with cardiac instability that is refractory to medical management.
  • HT IV: <75˚F
    • HT II and III management plus CPR and epinephrine x 3, defibrillation, rewarming with ECMO, or CPB or continuous CPR with active external rewarming.

Rescue Collapse: cardiac arrest that is related to extrication and transport of patient.

• Caused from placement of CVC, too much movement of patient, hypovolemia
• Afterdrop: not a real thing, afterall.

What actually helps:

• Active external rewarming: heat packs, “Arctic Sun”
• If there are no signs of life and no vital signs, ECMO/CPB survivorship is 47-63%, without is less than 37%- ECMO/CBP survivorship is attributed to establishing blood flow.

Serum Potassium of 12mmol/L is considered the point where resuscitation is futile.

Best article ever: http://www.nejm.org/doi/full/10.1056/NEJMra1114208

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Jay Khadpe MD

• Editor in Chief of "The Original Kings of County"
• Assistant Professor of Emergency Medicine
• Assistant Residency Director
• SUNY Downstate / Kings County Hospital

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