1. Question 6 Hypothermia
Tony Bottrall

2. 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

3. 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!

4. 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

5. 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,

6. 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