1/90. 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.- - - - - - - - - - ranking = 1keywords = accident (Clic here for more details about this article) |
2/90. 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- - - - - - - - - - ranking = 6keywords = accident (Clic here for more details about this article) |
3/90. Accidental hypothermia in a child.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.- - - - - - - - - - ranking = 1keywords = accident (Clic here for more details about this article) |
4/90. 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.- - - - - - - - - - ranking = 1keywords = accident (Clic here for more details about this article) |
5/90. Activated cytokine production in patients with accidental hypothermia.We have demonstrated recently that therapeutic moderate hypothermia of 32-33 degrees C, induced by surface cooling under the administration of narcotics, sedatives and muscle relaxant, suppresses cytokine production after traumatic brain injury. We present here the first documented case report of augmented cytokine production in two accidental hypothermia patients, unconscious 84- (acute immersion) and 87- (non-immersion) year-old women, whose rectal temperatures were below 28 degrees C. The victims were artificially ventilated after sedation with midazolam and buprenorphine in accordance with our protocol. rewarming at the rate of approximately 1 degrees C/h was done by blowing forced-air with appropriate fluid resuscitation. plasma interleukin(IL)-6 and/or IL-8 levels were measured using ELISA in the patients. In both patients, plasma IL-6 levels on admission were already elevated and the cytokine levels further increased during and after the rewarming period. In the patient with the poorer prognosis, the plasma IL-8 level on admission was not elevated remarkably but after rewarming the level rose significantly. Augmented IL-6 production in accidental hypothermia was sustained for 6 days in the patient with the poorer prognosis but not in the subject with good recovery, who was treated with anti-thrombin III in the early phase. Since the mechanisms for developing accidental hypothermia were different, simple comparisons between the two cases should be limited. But, these findings may suggest a need for testing a hypothesis whether cytokine modulation could be a therapeutic approach worthy of consideration. The results presented here also suggest that in hypothermia, changes in cytokine release may vary depending on procedures such as the anesthetic drugs used, the duration of the therapy, or the rate of rewarming from hypothermia.- - - - - - - - - - ranking = 7keywords = accident (Clic here for more details about this article) |
6/90. hypothermia: a natural cause of death.Deaths due to hypothermia are usually accidental and are the result of exposure to extreme environmental temperatures. Often these individuals are intoxicated, elderly, or exposed to severe cold temperatures. We report the case of a blind, nonambulatory, elderly man who was found alive in his home in an unresponsive state. Core body temperature at hospital was 24 degrees C (75 degrees F). At autopsy, punctate hemorrhages were present in the stomach mucosa. A 4- x 7-cm pituitary adenoma extended from a dilated sella turcica, obliterated the optic chiasm, and compressed the base of the brain in the region of the hypothalamus. Compression in this region of the brain would disrupt the temperature regulatory function of the hypothalamus and create an individual who would be susceptible to minor fluctuations in ambient temperature. The manner of death was designated as natural. This is an unusual presentation of a pituitary adenoma in the current era of advanced imaging techniques in which microadenomas are often detected and treated.- - - - - - - - - - ranking = 1keywords = accident (Clic here for more details about this article) |
7/90. Resuscitation from accidental hypothermia of 13.7 degrees C with circulatory arrest.In a victim of very deep accidental hypothermia, 9 h of resuscitation and stabilisation led to good physical and mental recovery. This potential outcome should be borne in mind for all such victims.- - - - - - - - - - ranking = 5keywords = accident (Clic here for more details about this article) |
8/90. Extracorporeal rewarming in a severely hypothermic patient using venovenous haemofiltration in the accident and emergency department.Severe hypothermia is a medical emergency and requires active and occasionally rapid core rewarming to prevent cardiac arrhythmias and death. In the accident and emergency department rewarming is often limited to warmed intravenous fluids, heated blankets, gastric and bladder lavage. Extracorporeal methods, which rewarm core blood directly, for example haemodialysis and cardiopulmonary bypass, require expertise and equipment not always found in a district general hospital. Venovenous haemofiltration is now commonly found in district general hospitals around the country and can be used safely for core rewarming. A case is reported of a severely hypothermic elderly patient successfully rewarmed using venovenous haemofiltration, in an accident and emergency department, when other conventional methods had failed.- - - - - - - - - - ranking = 6keywords = accident (Clic here for more details about this article) |
9/90. Electrocardiographic issues related to action potential phases 1 and 2 on the occasion of a case of accidental mild hypothermia.A 29-year-old man was accidentally exposed to cold and his mild hypothermia uniquely resulted in the transient exaggeration of his normothermic electrocardiographic findings, which were consistent with early repolarization. A unifying concept of clinical entities with similar J wave and ST segment elevation (J-ST syndrome) is proposed.- - - - - - - - - - ranking = 5keywords = accident (Clic here for more details about this article) |
10/90. Accidental hypothermia in the elderly.Accidental hypothermia is known to be a hazard to elderly people in temperate and cold climate. This is a review of the literature focusing on risk factors, clinical presentation and treatment of hypothermia in the elderly. The most important risk factors are connected to ageing itself and to the morbidity often found in elderly hypothermia victims. knowledge about treatment of severe accidental hypothermia in elderly people is based on experience from few cases and some minor prospective studies mainly on rewarming of younger patients. Clinical treatment protocols seems to be based on experience from younger patients. Based on general knowledge in geriatric medicine and experience from three recent cases of hypothermia in the elderly, the use of careful, active external rewarming and a low stress strategy are recommended for elderly patients.- - - - - - - - - - ranking = 1keywords = accident (Clic here for more details about this article) |
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