Shock due to profound hypothermia and alcohol ingestion

Raheja, Ramesh; Puri, Vinod K.; Schaeffer, Richard C.

doi:10.1097/00003246-198109000-00006

Cited by 9 publications

(5 citation statements)

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“…Five patients of the eight with shivering were colder than the temperature indicated by clinical staging, and most were young and active. The lowest temperature recorded in presence of recorded shivering was 21 °C (core) in a 44 year-old patient [ 12 ]. The ‘reassuring’ nature of the presence of shivering should perhaps be reconsidered, with rescuers considering the possibility of deep hypothermia even in the presence of shivering, and being careful with resuscitation.…”

Section: Discussionmentioning

confidence: 99%

An evaluation of the Swiss staging model for hypothermia using case reports from the literature

Deslarzes

Rousson

Yersin

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundCore body temperature is used to stage and guide the management of hypothermic patients, however obtaining accurate measurements of core temperature is challenging, especially in the pre-hospital context. The Swiss staging model for hypothermia uses clinical indicators to stage hypothermia. The proposed temperature range for clinical stage 1 is <35-32 °C (95-90 °F), for stage 2, <32-28 °C (<90-82 °F) for stage 3, <28-24 °C (<82-75 °F), and for stage 4 below 24 °C (75 °F). However, the evidence relating these temperature ranges to the clinical stages needs to be strengthened.MethodsMedline was used to retrieve data on as many cases of accidental hypothermia (core body temperature <35 °C (95 °F)) as possible. Cases of therapeutic or neonatal hypothermia and those with confounders or insufficient data were excluded. To evaluate the Swiss staging model for hypothermia, we estimated the percentage of those patients who were correctly classified and compared the theoretical with the observed ranges of temperatures for each clinical stage. The number of rescue collapses was also recorded.ResultsWe analysed 183 cases; the median temperature for the sample was 25.2 °C (IQR 22-28). 95 of the 183 patients (51.9 %; 95 % CI = 44.7 %-59.2 %) were correctly classified, while the temperature was overestimated in 36 patients (19.7 %; 95 % CI = 13.9 %-25.4 %). We observed important overlaps among the four stage groups with respect to core temperature, the lowest observed temperature being 28.1 °C for Stage 1, 22 °C for Stage 2, 19.3 °C for Stage 3, and 13.7 °C for stage 4.ConclusionPredicting core body temperature using clinical indicators is a difficult task. Despite the inherent limitations of our study, it increases the strength of the evidence linking the clinical hypothermia stage to core temperature. Decreasing the thresholds of temperatures distinguishing the different stages would allow a reduction in the number of cases where body temperature is overestimated, avoiding some potentially negative consequences for the management of hypothermic patients.

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Section: Discussionmentioning

confidence: 99%

An evaluation of the Swiss staging model for hypothermia using case reports from the literature

Deslarzes

Rousson

Yersin

et al. 2016

Scand J Trauma Resusc Emerg Med

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“…Shivering is mentioned in the first stage of the original Swiss staging model [1]. It has, however, been reported in patients with deep hypothermia [25, 26]. Furthermore, it might be misleading to use shivering additionally to the state of consciousness, since patients could be classified in two different stages depending on their clinical findings.…”

Section: Discussionmentioning

confidence: 99%

An evaluation of the Swiss staging model for hypothermia using hospital cases and case reports from the literature

Pasquier

Carron

Rodrigues

et al. 2019

Scand J Trauma Resusc Emerg Med

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Background The Swiss staging model for hypothermia uses clinical indicators to stage hypothermia and guide the management of hypothermic patients. The proposed temperature range for clinical stage 1 is < 35–32 °C, for stage 2 is < 32–28 °C, for stage 3 is < 28–24 °C, and for stage 4 is below 24 °C. Our previous study using 183 case reports from the literature showed that the measured temperature only corresponded to the clinical stage in the Swiss staging model in approximately 50% of cases. This study, however, included few patients with moderate hypothermia. We aimed to expand this database by adding cases of hypothermic patients admitted to hospital to perform a more comprehensive evaluation of the staging model. Methods We retrospectively included patients aged ≥18 y admitted to hospital between 1.1.1994 and 15.7.2016 with a core temperature below 35 °C. We added the cases identified through our previously published literature review to estimate the percentage of those patients who were correctly classified and compare the theoretical with the observed temperature ranges for each clinical stage. Results We included 305 cases (122 patients from the hospital sampling and the 183 previously published). Using the theoretically derived temperature ranges for clinical stages resulted in 185/305 (61%) patients being assigned to the correct temperature range. Temperature was overestimated using the clinical stage in 55/305 cases (18%) and underestimated in 65/305 cases (21%); important overlaps in temperature existed among the four stage groups. The optimal temperature thresholds for discriminating between the four stages (32.1 °C, 27.5 °C, and 24.1 °C) were close to those proposed historically (32 °C, 28 °C, and 24 °C). Conclusions Our results provide further evidence of the relationship between the clinical state of patients and their temperature. The historical proposed temperature thresholds were almost optimal for discriminating between the different stages. Adding overlapping temperature ranges for each clinical stage might help clinicians to make appropriate decisions when using clinical signs to infer temperature. An update of the Swiss staging model for hypothermia including our methodology and findings could positively impact clinical care and future research.

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“…Because alcohol has been shown to impair the perception of cold, cloud the sensorium, and act as a direct vasodilator, individuals under the influence of alcohol are less likely to perceive danger and respond appropriately to cold; moreover, they are unable to conserve heat properly by vasoconstriction [ 13,14]. Alcoholics are also felt to be more susceptible to exposure because of debility (a state of relative starvation), increased conductive losses from decreased subcutaneous fat, and high levels of blood alcohol that potentially impair the metabolic response to hypothermia by decreasing blood sugar and increasing acidosis.…”

Section: Cause and Pathogenesismentioning

confidence: 99%

“…The stimulus for this dilute diuresis may be the triggering of volume receptors as central volume increases with peripheral vasoconstriction [64]. An alternative explanation is that hypothermia might produce a relative insensitivity to antidiuretic hormone (ADH) [70] or a direct suppression of ADH release [14]. Although kaliuresis and glucosurea may accompany the dilute diuresis, the net result for the patient is dehydration and a relatively hyperosmolar serum.…”

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confidence: 99%

Disorders of Temperature Control: Hypothermia, Part III

Curley

Irwin

1986

J Intensive Care Med

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Hypothermia, defined as a body core temperature below 35°C, results from exposure to cold, drugs, metabolic dysfunction, or nervous system or skin disorders. The diagnosis and clinical assessment of patients with hypothermia should be based on a thorough knowledge of the characteristic physiologic changes that accompany hypothermia and affect all organ systems. Morbidity and mortality resulting from hypothermia may be reduced when physicians anticipate the well-known complications of hypothermia and carefully rewarm the patient.The rate and method of rewarming must be individualized, taking into account available resources and the patient's cardiopulmonary status and underlying disease.In Parts I and II of this review, the normal physiology of temperature regulation and three hvperthermic syndromes-heat stroke, malignant hyperthermia, and neuroleptic malignant syndrome-were reviewed. This section focuses on unintentional hypothermia and reviews in detail its pathogenesis, pathophysiologic factors, diagnosis, and management. Iatrogenic and intentional hypothermia in the perioperative setting is briefly discussed.Hypothermia, defined as a core temperature below 35°C, is not uncommon; it occurs at all ambient temperatures and in patients of all ages, although more commonly in the elderly. During the winter in Great Britain, 0.7% of all hospital admissions [1], 3% of elderly patients admitted [2], and at least 10% of otherwise healthy elderly individuals examined at home [3] had core temperatures in the hypothermic range. Review of death certificates in the United States reveals an average mortality rate for hypothermia of 0.22 per 100,000 individuals; white women have the lowest rates, and nonwhite men, the highest [4]. When all data are reviewed, the overall mortality from hypothermia in the United States has been conservatively estimated at 17 deaths per million of the general population peryear {5]. The mortality rate for treated hypothermia ranges from 12% [6] to 73% [7]. Cause and PathogenesisAlthough hypothermia can occur in all climates, at nearly all ambient temperatures, and at every age, the most frequent causes (vide infra) appear to be exposure, use of depressant drugs, and hypoglycemia. The elderly, because of a &dquo;normal&dquo; impairment of regulatory function, constitute a large portion of the patients who become hypothermic. A brief review of the causes of hypothermia (Table 1) at UNIVERSITE LAVAL on July 1, 2015 jic.sagepub.com Downloaded from 271 Table 1. Causes of Hypothermia and their pathogenesis will help develop a rational approach to treatment.Exposure to Cold Fatal hypothermia occurs frequently, even in the healthy young adult who simply has been overexposed to the elements. Wet, wind, and exhaustion contribute to increased loss of body heat. Wet clothing loses 90% of its insulating value [8], rendering soaked individuals effectively nude. Exposure to rain or snow was believed to contribute greatly to the development of hypothermia in 15 of 23 incidents in hikers discussed in one rev...

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Shock due to profound hypothermia and alcohol ingestion

Cited by 9 publications

References 0 publications

An evaluation of the Swiss staging model for hypothermia using case reports from the literature

An evaluation of the Swiss staging model for hypothermia using case reports from the literature

An evaluation of the Swiss staging model for hypothermia using hospital cases and case reports from the literature

Disorders of Temperature Control: Hypothermia, Part III

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