1/334. Successful resuscitation of a child with severe hypothermia after cardiac arrest of 88 minutes. A 4-year-old boy broke through the ice of a frozen lake and drowned. The boy was extricated from the icy water by a rescue helicopter that was dispatched shortly after the incident. Although the boy was severely hypothermic, no cardiac response could be induced with field resuscitation measures, including intubation, ventilation, suction, and cardiopulmonary resuscitation. On admission, the primary findings included fixed, nonreacting pupils and asystole. The first core temperature measured was 19.8 degrees C (67.6 degrees F). During active, external warming, the first ventricular beats were observed 20 minutes after admission, and changed 10 minutes later to a sinus rhythm. Continuous monitoring included repeated arterial blood gas and electrolyte tests; prophylaxis for cerebral edema was performed with hyperventilation and administration of sodium Brevimytal and dexamethasone. Seventy minutes after admission, hemodynamics stabilized and the boy was transferred to the pediatric intensive care unit (PICU), where active external warming was continued to raise the core temperature at a rate of 1 degree C/hour. adult respiratory distress syndrome developed, and the boy had to be ventilated in the PICU for 10 days. He was discharged home after another two weeks. He recovered fully. The rapid heat loss with the induction of severe hypothermia (< 20 degrees C; 68 degrees F) was the main reason for survival in this rare event of a patient with cardiac arrest lasting 88 minutes after accidental hypothermia. ( info) |
| hypothermia may occur in association with hypoglycemia, and indeed may be the only sign. Two cases are presented. In one, the patient presented with hypoglycemic encephalopathy. In the insulin dependent diabetic, the condition is life-threatening. Subnormal temperature is a clue to hypoglycemia in the alcoholic. The mechanism of hypothermia has been extensively studied, but remains unclear. ( info) |
3/334. The Mt. Tyndall incident. The authors describe the 53-hour rescue of a 6-foot, 1-inch tall, 250-pound hiker in the face of harsh environmental conditions in sequoia National Park. This 43-year-old man fell 25 feet, injured his leg, and was noted to be hypothermic and hypovolemic. weather, altitude, and the patient's size delayed and complicated his evacuation. After being carried down 1,500 vertical feet, he was hoisted into a hovering helicopter and flown to University Medical Center in Fresno, california. On arrival, the patient was determined to have a comminuted subtrochanteric right femur fracture, which was ultimately repaired surgically. The authors also discuss some of the unique aspects of wilderness and National Park Service EMS. ( info) |
4/334. Severe accidental hypothermia: rewarming strategy using a veno-venous bypass system and a convective air warmer. OBJECTIVE: To study a rewarming strategy for patients with severe accidental hypothermia using a simple veno-venous bypass in combination with a convective air warmer. SETTING: Eighteen beds in a university hospital intensive care unit. patients: Four adults admitted with a core temperature less than 30 degrees C. hypothermia was caused by alcoholic intoxication in three patients and by drug overdose in one patient. MEASUREMENTS AND MAIN RESULTS: All patients were rewarmed by a venovenous bypass and in three cases a convective air warmer was also used. At a bypass flow rate of 100-300 ml/min the mean increase in core temperature was 1.15 degrees C/h (Range: 1.1-1.2 degrees C/h). One patient died 2 days after rewarming as a consequence of a reactivated pancreatitis. The other three patients survived without neurological sequelae. CONCLUSION: This rewarming technique seems safe and effective and allowed the controlled rewarming of our patients who suffered from severe accidental hypothermia ( info) |
| Transurethral incision (TUI) is a simple and safe procedure. We, herein, present a case undergoing transurethral incision procedure during which he developed transurethral resection of prostate syndrome (TURP syndrome) and hypothermia precipitating an acute perioperative myocardial infarction attack. The potential risk of development of TURP syndrome in settings other than TURP surgery as well as its prevention are reviewed and discussed. ( info) |
| We report a case of severe accidental hypothermia (24.8 degrees C) in a seven-year-old child due to prolonged exposure to low temperatures and temporary contact with river water. When the patient was seen in hospital, bradycardia (30.min-1), bradypnoea (5. min-1), scarcely reacting pupils, and glasgow coma scale=3 were noted. For rewarming minimally invasive techniques (humidified warmed gases and intravenous solutions at 40 degrees C) were employed with a very successful outcome. ( info) |
7/334. Childhood deaths and cargo barriers in cars. To analyse features of childhood deaths associated with the absence or presence of car cargo barriers, three cases were taken from the files of the Department of Histopathology at the women's and Children's Hospital and State Forensic science Centre, Adelaide, australia, over a 5-year period from January 1993 to December 1997. Case 1: A 6-year-old boy who was a rear passenger sustained fatal crush injuries from unrestrained luggage moving forward after an accident. No cargo barrier was in place. Cases 2 and 3: Two children aged 3 and 9 years, respectively, died from acute hyperthermia after they became trapped in the back of a station wagon with a fixed cargo barrier in place. Although car cargo barriers are excellent devices for preventing injury from unrestrained objects striking or crushing passengers, designing barriers that can be opened easily from the rear of the cabin would prevent children being trapped in potentially dangerous circumstances. ( info) |
8/334. What happens in freezing bodies? Experimental study of histological tissue change caused by freezing injuries. In order to evaluate histological features of freezing damages to human tissue after death, we froze samples of liver and heart tissue to temperatures of -12 degrees C, -28 degrees C and -80 degrees C, and stored them for 24 and 72 h, respectively, at those temperatures. After thawing and routine preparation for histology, the samples were evaluated both by microscope and with an electronic image analyzer. In all cases, we found extended extracellular spaces and shrunken cells resulting from the freeze-thaw cycle. These features were more pronounced in tissues stored for longer durations. Such findings seem to be typical of tissue that has been frozen prior to examination. Two cases of dead bodies found outdoors at subzero temperatures demonstrate that formerly frozen and unfrozen tissues can be distinguished histologically. The findings are examined in relation to the fundamental laws of cryobiology. ( info) |
| Fetal bradycardia is a recognized response to maternal hypothermia but has not previously been reported in conjunction with diabetes. A 30-year-old insulin-dependent diabetic was admitted at 35 weeks gestation for control of her diabetes. She developed maternal hypothermia and hypoglycemia and the fetal heart rate fell to 100 beats per minute (b.p.m.). However, the fetal heart rate gradually returned to normal after rewarming the patient. ( info) |
| Accidental hypothermia has been described in the forensic literature but reports of occurrence in hospitalized patients are rare. Associated anatomic lesions include acute hemorrhagic pancreatitis and characteristic acute gastric ulcers termed Wischnewski ulcers. We report here two patients with cirrhosis and ascites; one also had hepatocellular carcinoma. portal vein thrombosis, acute hemorrhagic pancreatitis and Wischnewski ulcers were present in both. The clinical records documented hypothermia that progressed over several days. temperature nadirs of 31.0 degrees C (87.8 degrees F) and 32.2 degrees C (90.0 degrees F) were recorded in each patient, respectively, one day before death, although each transiently reached temperatures that did not register on standard monitoring devices. This is the first report that chronicles antemortem body temperatures in hypothermic patients with Wischnewski ulcers and pancreatitis at autopsy. Also, the association of these findings with portal vein thrombosis and cirrhosis has not been previously described. We discuss this constellation of findings with regard to possible mechanistic interrelations. ( info) |