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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A dramatic decrease in mortality from Hemophilus influenzae meningitis has occurred in recent years. Morbidity and long-term sequellae remain significant problems. A follow-up investigation of 73 cases of H. influenzae meningitis seen over a three-year period revealed: 2 deaths, 6 children with major sequellae (retardation, spastic quadriplegia, blindness, persistent seizure disorder), 10 with minor residua, and 55 with no detectable disability. Statistical analysis of clinical parameters demonstrated a significant risk of death or major morbidity in those patients who, at the time of admission, had seizures, coma, hypothermia, shock, age less than 12 months, hemoglobin less than 11 gm/100 ml, pretreatment symptoms for longer than three days, a spinal fluid white blood cell count less than 1,000/cu mm, or a spinal fluid glucose value less than 20 mg/100 ml. Using these parameters, those patients at highest risk of having lasting major morbidity with H. influenzae meningitis can be predicted, allowing more vigorous intensive care which may reduce the mortality and morbidity further.
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PMID:Prediction of morbidity in Hemophilus influenzae meningitis. 84 May 37

The combined evaluation of the motor response to stimulation and the oculovestibular (OV) reflex gives useful indicants to the outcome of medical coma. We examined 48 patients during the first 12 h and at 24 h after the onset of medical coma. We excluded patients who had ingested drugs or who had hypothermia. Motor responses to a noxious stimulus were scored on a 6 'best' and 1 'worst' scale, and the presence or absence of oculovestibular responses to icewater irrigations was recorded. Subjects were divided by outcome at three months into three groups: death or persistent vegetative state, severe disability, and moderate disability or good recovery. On the basis of the present series it was often possible to distinguish among the outcomes at or before 24 h. The patient's age and the presence or absence of pupillary responses, spontaneous eye movements and oculocephalic responses were not predictive of outcome, nor were the respiratory pattern, blood gases, blood pressure, heart rate and temperature. A minimal motor score and an absence of oculovestibular responses at 12 h always were assoicated with death. With higher motor scores, the absence of oculovestibular responses at either 12 or 24 h implied an outcome no better than severe disability. The results of the present study imply that early bedside assessments can yield accurate predictive information in medical coma.
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PMID:Can one predict outcome of medical coma? 104 89

Hyperthermia has recently been recognized as a manifestation of hypoglycemia. We describe two episodes of hypoglycemia associated with nausea, vomiting, chills, and impaired consciousness which were followed by marked hyperthermia. We suggest that the hyperthermia may result from excessive reaction to preceding hypothermia caused by the hypoglycemia. We would like to alert the clinician to the possibility of a previous, severe hypoglycemic episode in any diabetic patient with hyperthermia and coma.
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PMID:Marked hyperthermia as a manifestation of hypoglycemia in long-standing diabetes mellitus. 115 46

Five patients, 4 female and 1 male, aged 45 to 73, were observed in myxedema coma between 1984 and 1992. In three patients hypothyroidism was not known. Depressed consciousness, hypothermia, bradycardia and no goiter were common to all and a precipitating factor could be identified in 3 of them. Therapy included L-thyroxine and/or triiodothyronine by nasogastric tube, hydrocortisone and supportive measures. Outcome was good in the 2 patients with known precipitating event, less impaired consciousness and normalization of body temperature by the third day of treatment.
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PMID:[Myxedema coma]. 129 58

The diagnosis of brain death (BD) relies primarily on prerequisites (clear knowledge of the cause of coma, all remedial procedures proven unsuccessful) and clinical arguments (areactive coma, loss of brainstem reflexes, apnea). Confirmatory tests should be applied whenever any misleading factor (CNS depressant drugs, hypothermia, metabolic disturbances) can interfere with the clinical diagnosis. This paper reviews the different available confirmatory methods (EEG, four-vessel angiography, radioisotopic techniques, intracranial Doppler, evoked potentials). Both the author's own experience and the data from the literature indicate that evoked potentials are actually a safe and rapid BD confirmatory tool that can be performed at the patient's bedside. It is suggested that they be used in association with the clinical examination for all BD-suspected patients, except for children younger than 6 months of age in whom the guidelines of the Task Force for Brain Death in children (1987) are still recommended.
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PMID:Evoked potentials: a safe brain-death confirmatory tool? 134 51

A 22-year-old man eventually had a good neurologic recovery following prolonged coma after extracorporeal rewarming from profound hypothermia (24 degrees C) due to exposure. The patient was in full arrest for 60 minutes prior to institution of cardiopulmonary bypass (CPB). Total bypass time was 50 minutes. Cardiopulmonary bypass is the current rewarming method of choice for severe hypothermia associated with a persistent nonperfusing cardiac rhythm. CPB provides the most rapid core rewarming with the additional benefit of circulatory support during the period of cardiac instability.
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PMID:Accidental hypothermia with cardiac arrest: recovery following rewarming by cardiopulmonary bypass. 143 Sep 79

Vocalization in the ultrasonic range (USV) has been reported to occur in young rodents in response to isolation, novelty, handling, and cold. Heretofore these calls have been known to occur only in alert, attentive, or emotionally aroused animals. These studies describe the emission of USV by comatose 9- to 10-day-old rat pups during recovery from deep hypothermia. Calling began at 15-18 degrees C core temperature while pups were virtually unresponsive to stimulation. Experimental results describe the patterns of call production in relation to respiration, cardiac function, colonic temperature, and brown adipose tissue thermogenesis. These vocalizations were 32-42 kHz in frequency, reached peak rates of 50/min at 23 degrees C, and were eliminated by laryngeal denervation, thus resembling isolation-induced vocalizations. However, contact with their dams failed to reduce call rates until pups had warmed above 25 degrees C. Newborn and weanling pups also emitted USV in deep hypothermia, but no USV were observed in pups recovering from general anesthesia. The possible functions and evolution of this behavior are discussed.
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PMID:Ultrasonic vocalization by rat pups during recovery from deep hypothermia. 145 45

In a five year period, 39 children (29 boys, 10 girls) aged 2 months to 13 years (mean 7.8 years) were studied who had suffered a major head injury (29 road traffic accidents, six falls, and four non-accidental injury). The injury had been assessed clinically and by cranial computed tomography or cranial ultrasound (in a single baby of 2 months). Initial Glasgow coma scores for all subjects ranged from 3-11 (mean 5.5), intact survivors 5-11 (7.4), minor handicap 4-11 (6.1), major handicap 3-6 (4.3), fatalities 3-6 (4.1). All were treated with sedation, paralysis, hyperventilation (arterial carbon dioxide tension 3.0-3.5 kPa), intracranial pressure monitoring and moderate body surface hypothermia to 32 degrees C. Nine children died and 30 survived (nine intact, 13 minor disability, and eight major disability). The worst cerebral perfusion pressure was over 40 mm Hg in all but one survivor, and less than 40 mm Hg in seven of nine fatalities. Severe hypocapnia both in the first 24 hours and overall was correlated with poor outcomes (dead or major disability), as were bilateral contusions or diffuse axonal injury.
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PMID:Management and outcome of severe head injuries in the Trent region 1985-90. 833 80

Numerous and extremely varied conditions (intense muscular activity, ischemia, metabolic and genetic disorders, infections, immunological diseases and toxic causes) may play a role in the genesis of non-traumatic rhabdomyolysis. Over the past years there has been an increased number of reports of forms due to drug or narcotic intoxication. Seven cases of rhabdomyolysis are reported in patients admitted to emergency wards in a state of coma due to heroin overdose (4 cases), cocaine overdose (1 case), carbamazepin (1 case), and tricyclic anti-depressives (1 case). In all cases it was possible to hypothesise a multifactorial pathogenesis of the disease in which other factors, such as acidosis, hypoxia, hypothermia and compression of the muscle mass during coma, were associated with the direct toxic damage caused by the drug. The most frequent complication was acute renal failure. One case of myocardial involvement with non-Q infarction characteristics was also observed.
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PMID:[Rhabdomyolysis during acute poisoning with drugs and narcotics. Experience with 7 clinical cases]. 149 66

We report the case of a 59-year-old woman suffering from profound accidental hypothermia promoted by intoxication with codeine, sedatives, and a beta-blocking agent ingested in a suicidal attempt. Treatment was further complicated by ventricular fibrillation and asystole that was refractory to therapeutic interventions. The comatose patient (Glasgow score 3) was found outdoors in rainy weather--environmental temperature approximately 10 degrees C (50 degrees F)--by children. The skin was rosy when the emergency team arrived. The respiratory rate was low and the ECG showed sinus rhythm with a heart rate of 28/min. No arterial pulsations were detectable, even at the carotid and femoral sites. Because catecholamine therapy failed to increase the heart rate, the patient was suspected to be profoundly hypothermic. After confirming core hypothermia with a rectal temperature of 25 degrees C (77 degrees F) at the initial receiving hospital, transfer to an institution with cardiac surgery facilities was initiated. During this transport and after arrival, ventricular fibrillation occurred at decreasing intervals followed by asystole, which was refractory to large doses of epinephrine. The patient was transferred to the operating room under continuous resuscitation maneuvers and cardiopulmonary bypass was instituted via the femoral vessels. After 110 min of extracorporeal circulation (ECC, flow 4.5 l/min) normothermia was achieved and the asystole reverted spontaneously to sinus rhythm. The patient's course was subsequently complicated by worsening pulmonary gas exchange with signs of pulmonary edema on X-ray films and cardiac failure, which was treated successfully with epinephrine and dopamine. No neurological deficits were detectable after consciousness had returned.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Successful therapy of a cardiac arrest during accidental hypothermia using extracorporeal circulation]. 156 99


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