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

It is recognized that some people die from hypothermia even though they are alive and uninjured when rescued. The traditional explanation is that this is due to ventricular fibrillation resulting from the afterdrop of core temperature. This hypothesis was based on inadequate measurement and failure to consider the physiology of cold. It should now be discarded. Most deaths after rescue occur through an imbalance between the active vascular capacity and the circulating fluid volume i.e. relative hypovolaemia or fluid overload. The actual mechanism in any individual case depends both on the history of the cooling and the method of rewarming used. Some deaths will however occur due to continued cooling of the body or to ventricular fibrillation precipitated by rough handling.
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PMID:The cause of death after rescue. 148 74

The keys to a better outcome in the management of ruptured aneurysm are early diagnosis, aggressive resuscitation, and early operation, with prompt achievement of proximal control. Having achieved these goals, there is a tendency to let down one's guard and relax; indeed, the principles of aneurysm repair beyond this point are similar to those of elective surgery. However, it should be remembered that nearly every complication is more likely in emergency than in elective operations. Therefore, even more care needs to be taken with the technical details at this point to avoid the complications discussed in the following article. The perioperative management must continue at the same heightened level to combat acidosis, hypothermia, coagulation disorders, cardiac dysfunction, fluid overload with pulmonary edema, renal failure, and other common sequelae of this challenging undertaking.
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PMID:Ruptured abdominal aortic aneurysms. Special considerations. 266 51

The present study tests the effectiveness of pulse oximetric measurement in attaining reliable saturation values even in patients with hypothermia and centralization. 20 patients who had all required endoprosthetic surgery of the lower extremities were included in the study. During the process of removing 98 samples for arterial blood-gas analysis, pulse oximetric saturation, heart rate (pulse oximeter and ECG), rectal temperature, peripheral temperature at the back of the fingers, arterial pressure (catheter) and central venous pressure were registered. The results can be summarized as follows: 1. Acute changes in arterial saturation can be very quickly recognized with the help of pulse oximetry. 2. The reliability of pulse oximetric measurement is, in the area examined, dependent neither on the peripheral nor the rectal temperature, nor on the temperature difference between the core and surface temperature of the body, and, therefore not dependent on the degree of centralization. 3. In the area examined, the reliability of pulse oximetric measurement is influenced neither by blood pressure fluctuations nor by intravascular hypo- or hypervolemia. 4. There is merely a sharp increase in the Pulsoximeter when the temperature decreases. The Pulsoximeter still indicates the correct saturation as long as the peripheral pulse rate corresponds to the heart rate on the ECG Monitor.
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PMID:[The reliability of pulse oximetry monitoring of arterial oxygen saturation in centrally intubated and hypothermic patients]. 317 32

We report the occurrence of the adult respiratory distress syndrome (ARDS) in association with uncontrolled diabetes in nine patients. In reviewing the literature we found nine similar cases reported in little over a decade. In most cases no condition known to precipitate ARDS was discovered. The evidence suggests that the severely uncontrolled diabetic state in some way may initiate pathologic events leading to the capillary leak of ARDS. This description of the association of these two entities not commonly recognized as occurring simultaneously has important clinical implications: the entity should be anticipated in uncontrolled diabetic patients who present with acidosis, hypotension, hypothermia, and/or coma. The clinical or radiologic diagnosis of pneumonia or fluid overload should not be made in the uncontrolled diabetic patient in the absence of unequivocal evidence of infection or congestive heart failure. The development of dyspnea, hypoxemia, rales, or infiltrates in the otherwise routine resuscitation of these patients should lead the clinician to suspect the development of ARDS. Prompt invasive monitoring in these cases is indicated to aid in their management and may help to improve survival. We found calculation of the A-a gradient to be useful in patients with uncontrolled diabetes. Although not necessarily predictive, widened gradients were the earliest detectable abnormality found in all patients who developed ARDS.
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PMID:Adult respiratory distress syndrome complicating severely uncontrolled diabetes mellitus: report of nine cases and a review of the literature. 682 90

The clinical application of high frequency jet ventilation (HFJV), especially in pediatrics, has been hindered by the lack of adequate heating and humidification of the delivered gas. A technique of injecting particulate water into the gas from the jet ventilator has been described in the literature. However, it has been used primarily on adults and may cause fluid overload or hypothermia when used on infants. We describe a device for use during HFJV that provides gas (free of particulate water) to the patient at or near body temperature, with a relative humidity of 91%. This system has been used on 34 persons (14 premature infants, 17 small children, and 3 adults) without complications associated with improper conditioning of inspired gas.
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PMID:A heat and humidification system for high frequency jet ventilation. 1031 86

Peritoneal dialysis is a technique that has been used to treat acute renal failure in humans since 1923. Peritoneal dialysis is used in people to manage acute and chronic renal failure, as well as to remove dialyzable toxins (ethylene glycol, barbiturates, and ethanol), reduce severe metabolic disturbances, and for the treatment of peritonitis, pancreatitis, uroabdomen, hypothermia, and fluid overload. In veterinary medicine, acute renal failure is the prevailing indication for dialysis. This report will discuss the pathophysiology of peritoneal dialysis, indications, and contraindications. Catheter selection and placement will be reviewed. Types of dialysate solution will be discussed and the protocol established for instituting peritoneal dialysis. The report will conclude with a discussion of potential complications and methods to minimize them.
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PMID:Peritoneal dialysis in emergency and critical care medicine. 1110 14

The treatment of vasospasm after subarachnoid hemorrhage remains a formidable challenge. The prompt recognition of this complication is essential to prevent ischemic damage. Initial orders should include adequate fluid and sodium supplementation to avoid volume depletion. Prophylactic hypervolemia is not effective in reducing the incidence of vasospasm and may be deleterious. Oral nimodipine (60 mg every 4 hours for 21 days) should be started on admission because it protects against delayed ischemic damage. Increasing blood flow velocities on serial transcranial Doppler studies are reliable indicators of early development of vasospasm. When symptomatic vasospasm occurs, hemodynamic augmentation therapy should be instituted. Crystalloids and colloids may be used to promote hypervolemia. Colloids may provide additional benefit by producing hemodilution. However, the rheological benefits of hemodilution may be offset by reduced oxygen carrying capacity when hematocrit drops below 28%. Hypertension may be induced by administering inotropic drugs and, in certain cases, cardiac output optimization using dobutamine also is necessary. When aggressive medical therapy fails to reverse ischemic deficits, prompt endovascular intervention is indicated. Focal vasospasm of larger vessels may be effectively treated with angioplasty and the benefits of this procedure are durable. Diffuse vasospasm involving smaller arterial branches may be treated with intra-arterial infusion of vasodilators, such as papaverine, verapamil, or nicardipine. Unfortunately, these dilatory effects tend to be short-lasting. In refractory cases, hypothermia may be considered, although value of this strategy remains largely unexplored.
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PMID:Cerebral Vasospasm in Subarachnoid Hemorrhage. 1567 13

Gastric ulcers are an important cause of morbidity and mortality in the critically ill, especially those with CNS injury. We used cervical spinal cord transection (CCT) in the rat to model these ulcers and examined the effect of core body temperature and vascular volume on gastric ulcerogenesis. Hypothermia significantly increased ulcerogenesis compared to euthermia, while maintained euthermia produced ulcer indices not different from sham surgery. Hypovolemia (10% blood volume withdrawal) significantly increased ulcerogenesis compared to hypervolemia (10% of blood volume crystalloid infusion) or sham surgery. These results support crystalloid infusion and maintenance of core body temperature in the clinical setting.
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PMID:Temperature and vascular volume effects on gastric ulcerogenesis after cord transection. 1624 Feb 12

Pulmonary artery hypertension is defined as persistent elevation of mean pulmonary artery pressure > 25 mm Hg with pulmonary capillary wedge pressure < 15 mm Hg or elevation of exercise mean pulmonary artery pressure > 35 mm Hg. Although mild pulmonary hypertension rarely impacts anesthetic management, severe pulmonary hypertension and exacerbation of moderate hypertension can lead to acute right ventricular failure and cardiogenic shock. Knowledge of anesthetic drug effects on the pulmonary circulation is essential for anesthesiologists. Intraoperative management should include prevention of exacerbating factors such as hypoxemia, hypercarbia, acidosis, hypothermia, hypervolemia, and increased intrathoracic pressure; monitoring and optimizing right ventricular function; and treatment with selective pulmonary vasodilators. Recent advances in pharmacology provide anesthesiologists with a wide variety of options for selective pulmonary vasodilatation. Pulmonary hypertension is a major determinant of perioperative morbidity and mortality in special situations such as heart and lung transplantation, pneumonectomy, and ventricular assist device placement.
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PMID:Management of pulmonary hypertension in the operating room. 1753 16

The case of intrathoracic extravasation of irrigation fluid after hip arthroscopy in a 21-year-old woman is presented. In this patient intraperitoneal and retroperitoneal fluid collection developed, as seen in other case reports documenting irrigation fluid extravasation during hip arthroscopy. The patient presented to the emergency department on the first postoperative day complaining of shortness of breath. Computed tomography of the chest, abdomen, and pelvis showed retroperitoneal fluid, extensive abdominal ascites, and bilateral pleural effusions within the chest. The fluid diminished pulmonary volume by elevating the diaphragm and causing compression atelectasis of both lungs. The patient's hemodynamic status was stable and unaffected. She developed hypothermia during the procedure, which is consistent with other reports on extravasated irrigation fluid during arthroscopy. She was able to rapidly compensate for fluid overload and eliminated it uneventfully, with resolution of her symptoms. A similar procedure was performed on the contralateral hip 6 months later. During that procedure, there was a suspected (not confirmed) recurrence of intraperitoneal extravasation of the pump fluid as well as transient hypothermia, which resolved by the first postoperative visit. The physiologic effects of intrathoracic fluid accumulation and the literature regarding extravasation of irrigation fluid during hip arthroscopy are also reviewed.
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PMID:Intrathoracic fluid extravasation after hip arthroscopy. 2069 63


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