Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cardiac arrests (CA) occurring during anaesthesia and recovery can be classified into three groups: CA not related to anaesthesia (NACA), CA related to anaesthesia (ACA), whether partially (PACA) or totally (TACA). In the French survey, NACAs were three times more frequent than ACAs. Nearly 25% of ACAs occurred at induction and consisted mainly in TACAs. Another quarter of ACAs occurred during maintenance and consisted mainly in PACAs. About 50% of ACAs occurred after the end of anaesthesia and had the highest mortality rate. Cardiac arrest corresponds to the status of a heart unable to generate the minimum aortic blood flow required for functioning of vital organs. For the brain, a zero-blood flow of more than 4 seconds results in coma. Consequently CA exists when the time interval between two subsequent efficient systoles is greater than 4 seconds. Anaesthetic agents can result in CA by 1) overdose (absolute, relative), 2) anaphylactoid/anaphylactic reactions, 3) specific effects (acetylcholine-like effect, hyperkalaemia and malignant hyperthermia for succinylcholine; vagal effect of vecuronium and atracurium; cardiotoxicity of bupivacaine) and 4) drug interaction. In hypoxic CA, severe neurologic impairment often still exists at the time of onset of CA. The anaesthesia machine and controlled ventilation can induce CA by hypoxic ventilation, overdose of anaesthetic vapour, excessive CO2 reinhalation, hypoventilation, disconnection, excessive pressure in airways. Cardiac hypothermia can be a cause of CA as well as a cause of unsuccessful CPR. Massive infusion of unwarmed fluids and IPPV with unheated gases generate a temperature gradient within the heart which may result in severe arrhythmias and CA.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Cardiac arrest during anesthesia and recovery period]. 214 88

Trauma patients are at great risk of accidental hypothermia (body temperature [BT] < 36 degrees C). Hypothermia influences the functioning of all organ systems and can lead to pathological changes, which in turn additionally complicate the trauma. Furthermore, hypothermia can, e.g., by influencing blood coagulation (reduction of thrombocyte aggregation, increased fibrinolysis) have a markedly unfavourable impact upon the in-hospital surgical treatment of the trauma patient. In a prospective study involving 302 trauma patients treated during primary helicopter rescue missions over a 1-year period, we studied the following factors: (1) incidence and degree of severity of hypothermia; (2) seasonal influence; (3) possibility of individual risk groups within the study group; (4) changes in BT during the prehospital treatment phase; and (5) their consequences for emergency treatment. METHOD. BT was taken upon commencement of emergency treatment and upon release of the patient to the receiving hospital. To avoid possible damage to the patient's tympanic membrane by the thermometer probe, we excluded all patients under 16 years of age and those with an indication of an ear or temporal-bone injury. In all cases standardized patient positioning was applied. The statistical evaluation was performed utilizing descriptive presentations and the Mann-Whitney U test and chi-square test. RESULTS. During study period, a total of 302 trauma patients were treated. On 228 of these, prehospital temperature monitoring was performed (151 males and 77 females, average age 41.8 years). Because of the established criteria for exceptions and equipment malfunction, no monitoring was performed on 74 patients. Traffic accidents (69%) were the major cause of injury (Table 2), predominantly the group with NACA III (32%), followed by NACA IV (22%) and NACA V (18%) (Table 3); 27% had multi-system trauma. BT monitoring disclosed that 49.6% or almost every second trauma patient, had hypothermia. The proportion of hypothermia II degrees (BT 34 degrees-30 degrees C) versus hypothermia III degrees (BT < 30 degrees C) was 6.6% to 0.5%. Our statistical evaluation did not disclose any significant connection between season of the year and frequency of accidental hypothermia. Special risk factors in regard to frequency and degree of severity turned out to be "entrapment" (98.1% of patients with an entrapment trauma [ET] versus 34.5% without such; P < 0.001) and age (56.8% of patients > 65 years of age without ET and 100% with ET; P < 0.001) (Figs. 2, 3). No significant changes in BT were noted during the prehospital treatment phase. Clinical symptoms pointing to hypothermia or other indicators, i.e., shivering, were only noted in 4.4% of the cases where the patients BT was below normal. CONCLUSION. Based upon our findings, accidental hypothermia poses a relevant problem in the prehospital treatment of trauma patients. It is not limited to a special season of the year. The variability or total absence of definite diagnostic symptoms underlines the necessity for prehospital BT monitoring, whereby tympanic-membrane thermometry has proven to be a worthwhile method.
 ...
PMID:[Accidental hypothermia in trauma patients. Is it relevant to preclinical emergency treatment?]. 770 82

At the scene of an accident, the most severely injured patients need trauma care urgently. Bystanders are often present before the emergency medical service arrives and may be able to limit trauma-related damage by providing trauma care at the scene. The aim of this prospective study conducted in Mainz, Germany, and Vienna, Austria, was to compare the frequency and quality of bystander trauma care in moderately versus severely injured patients. Five specific measures (making the scene readily visible for oncoming traffic, extrication and positioning of the trauma patient, control of haemorrhage, and hypothermia protection) were assessed in a questionnaire and evaluated statistically. Bystanders were present at the scene in 58.7% of all accidents. Making the scene readily visible for oncoming traffic, patient extrication and patient positioning were initiated significantly more often than haemorrhage control and hypothermia protection. Extrication, patient positioning and hypothermia protection were initiated significantly more often in moderately (NACA I-II) compared to severely (NACA III-VII) injured patients. In severely injured patients, bystanders attempted measures less frequently and the measures performed were more often incorrect compared to those in moderately injured patients. Our findings show that severely injured patients received less and less appropriate bystander trauma care than moderately injured patients. In an effort to correct this serious problem and to improve trauma care on-scene, we advocate offering lay persons more extensive training in bystander trauma care.
 ...
PMID:Comparison of bystander trauma care for moderate versus severe injury. 1505 Jul 58