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firedoc5

Deep Hypothermia

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Over night it had got to -10 to -20. Had a report of a man found on a porch. We couldn't believe what we found. At first we thought he had got locked out. The patient, male, mid 30's, slight build, was wearing only a heavy wind breaker. Had been drunk and was just waiting for his girlfriend to come home. I believe he was actually stalking her. Sat on the porch all night. She hadn't come home until she found him. He was completely "iced over", obvious frost bite to nose, chin, and cheeks. Resp. 16, pulse 50 weak, BP 60 sys. Did a quick load. It had warmed up to about 0 to 10 degrees at that time. Removed all clothing, placed on a monitor. Sinus brady @ 60. We couldn't find the hypo-thermometer in the ambulance. We did make a habit of taking IV fluids and throw them onto the defrost vents on the way to a call so they could be warmed up a bit. Miraculously two IV sites were established. We got another call so I wasn't able to ride in with him. But I reminded my partner who did to watch closely for a-fib and v-fib while warming up, and the need to warm him gradually.

When I got to the ER with my cardiac patient, they had the hypothermic patient in the cardiac room. I forget what his core temp. was but it was alarmingly low. The doc had worked in MI for a time and said that he never seen such a low temp. personally before. He did have enough experience though to request having a kiddie swimming pool tucked away in the ER. They inserted a rectal probe warmer. After wrapping the frost bit parts they placed him in the pool with luke-warm water. He was in the ER for about three hours before a helo arrived, they were grounded earlier that morning. Luckily he never had any dysrhythmias. He lost most of the finger tips on one hand, and I believe two fingers on the other. I know he had many surgeries for skin grafts to the exposed areas of his face, and reconstructive surgery on his nose.

I know some would disagree with the swimming pool part, of which I questioned, but it seemed to help greatly. Any other ideas?

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What is the issue with the pool? As far as other ideas, depending on what his temp actually was, I'd go for double b/l chest tubes, NG lavage, peritoneal lavage, bladder irrigation among other things.

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What is the issue with the pool? As far as other ideas, depending on what his temp actually was, I'd go for double b/l chest tubes, NG lavage, peritoneal lavage, bladder irrigation among other things.

Oh yea, they did do NG lavage. Actually had a little blood return from it. Hx. of ulcers. I don't believe it was from insertion of the NG tube. And they did insert a foley cath. I know they did not do chest tubes. That I would have remembered.

I've heard some docs disapproved of water immersion with the frost bite. But I think it helped with what little debridement they did in the ER.

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A kiddie pool, for initial rewarming of a frostbite/hypothermic patient in a facility?

Let's face it, sometimes we got to improvise, and that sounds like it was a good idea.

Sidenote: Keep an eye on the temperature of the water, too hot and you burn them, and the patient is, in essence, a piece of ice in the water, so keep it warm enough.

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A kiddie pool, for initial rewarming of a frostbite/hypothermic patient in a facility?

Let's face it, sometimes we got to improvise, and that sounds like it was a good idea.

Sidenote: Keep an eye on the temperature of the water, too hot and you burn them, and the patient is, in essence, a piece of ice in the water, so keep it warm enough.

We kept it "luke warm". He seemed to respond well to it. His core temp. went up substantually, but not too quick, keeping him from going into shock. A lot of people sort of rolled their eyes when Dr. Tarlow requested the pool to be stored in the ER. But having to use it just once (at that time), paid off.

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ERDoc- Why the chest tubes?

My best guess, have warm fluid running in one, and out the other. Warm him from the inside out.

-Kat

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My best guess, have warm fluid running in one, and out the other. Warm him from the inside out.

-Kat

;)/

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