Question 6 Hypothermia Tony Bottrall

Big picture Simple question – many right answers to choose from (see below Not done brilliantly well by many You should look at yourself if you got 8 (66%) 9 could easily have been made the pass mark (3 out of 4 for each part) It could have been 12/12 easy points to carry more difficult questions

part a –ECG changes of hypothermia Bradyarrhythmias Sinus bradycardia (may be marked) Atrial fibrillation with slow ventricular response Slow junctional rhythms Varying degrees of AV block (1st-3rd) Osborne Waves (= J waves) NOT EPSILON WAVES (which are ARVD) Prolonged PR, QRS and QT intervals Shivering artefact Ventricular ectopics Cardiac arrest due to VT, VF or asystole ANY 4 OF THESE CHANGES!

PART B rewarming techniques remove cold/wet clothing and gently dry patient reflective blanket, warmed air blanket WARMED humidified air, ‘humidified air’ not enough! warmed i.v. fluid prevents heat loss, but not really heat gain hot water bottles neck/axillae/groins,(beware burns, see part C) bladder washout, peritoneal lavage, pleural lavage, ECMO BEST ANSWERS HAD A SIMILAR BASIC->ADVANCED ESCALATION

Part C – complications to anticipate Rewarming shock, or hypotension secondary to marked vasodilatation of rewarming Rewarming acidosis due to recirculation of pooled lactic acid in the peripheral circulation Rewarming electrolyte disturbances, in particular hypocalcemia and hypomagnesemia, indicate a poor prognosis Aspiration pneumonia Pulmonary edema Pancreatitis Burns to cold and vasoconstricted skin secondary to application of hot water bottles and heating pads Neutropenia, thrombocytopenia, and infection` Iatrogenic hyperthermia Ventricular fibrillation Peritonitis GI bleeding Acute tubular necrosis Intravascular thrombosis Metabolic acidosis Rhabdomyolysis Gangrene Compartment syndrome I did not give points for secondary isssues Infarct, hyperkalemia,

From the above lists there were straightorward marks to get… 1. read the question – answer the question ideally in a way that shows your understanding and perspective 2. a blank line is always wrong 3. There is no ‘tricks’ needed, people make unforced errors all by themselves 2 similar answers do NOT usually make 2 points