ICU · Environmental emergencies
Accidental Hypothermia
Also known as Hypothermia · Accidental hypothermia · Osborn waves · J waves · Rewarming · ECMO hypothermia · Not dead until warm and dead
The accidental hypothermia — the core below 35 degrees C. The severity (the mild 32 to 35, the moderate 28 to 32, the severe below 28). The clinical (the shivering → the bradycardia, the decreased the LOC, the loss of shivering, the Osborn / J waves, the VF / the asystole). The rewarming (the passive, the active the external, the active the internal — the ECMO for the severe). The handle gently (the cold heart irritable). The NOT the dead until the warm and the dead. The drugs the extended intervals (the below 30).
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A 32-year-old previously well man is found unconscious in a park on a winter morning, exposed overnight. Rectal core temperature reads 26.5 °C; the ECG shows sinus bradycardia at 28 with prominent Osborn J waves. He looks dead — fixed pupils, a barely palpable pulse — and the team reaches for the warming blanket. The moment he is rolled onto the bed he flips into ventricular fibrillation. That single beat distils the whole topic: the cold myocardium is exquisitely irritable, and a patient who appears dead may still be salvageable.[1]
References23ShowHide
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