1/23. 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.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/23. 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 = environment (Clic here for more details about this article) |
3/23. Hemodialysis in management of hypothermia.hypothermia is defined as a core body temperature of less than 35 degrees C and is divided further into mild, moderate, and severe depending on the temperature level. Several active internal rewarming modalities have been described in the management of moderate-to-severe accidental hypothermia. We report a 73-year-old black man with underlying end-stage renal failure and ischemic cardiomyopathy who was admitted with severe accidental hypothermia (core body temperature, 24.9 degrees C) secondary to environmental cold exposure. The patient was resuscitated initially with warm intravenous fluids and peritoneal dialysis with warm fluids with an average temperature rise of 1 degrees C. The patient was switched to hemodialysis that brought his temperature from 30.2 degrees C to 36.7 degrees C during a 3.5-hour dialysis with an average rise of 1.9 degrees C/h. Hemodialysis is a rapid and efficient modality of rapid internal rewarming for moderate-to-severe accidental hypothermia.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
4/23. hypothermia-related deaths--utah, 2000, and united states, 1979-1-998.hypothermia is a medical emergency that is completely preventable. hypothermia occurs when persons are exposed to ambient cold temperatures without appropriate protection for extended periods of time. The clinical definition of hypothermia is a core body temperature < or = 95 F (35 C). This report describes cases of hypothermia-related deaths in utah during 2000 and describes unintentional hypothermia-related deaths in the united states during 1979-1998. The utah cases illustrate risk factors and environmental conditions associated with hypothermia.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
5/23. A case report of hypothermia in the wilderness.Accidental hypothermia due to environmental exposure is a common condition encountered in the wilderness setting. I report a case of hypothermia that occurred in new hampshire to a 42-year-old, poorly prepared mountaineer. He presented with ataxia, impaired judgment, oliguria, and slight confusion, suggestive of mild to moderate hypothermia. He was treated in the field using passive and active external rewarming methods and 1 active internal method. The signs, symptoms, and progression of hypothermia are reviewed, and treatment options are discussed, with an emphasis on management of hypothermia in the wilderness setting. Additionally, more complicated treatment modalities are canvassed, as these are of use to rescue teams and expeditions. Current controversies regarding the treatment of hypothermia, resuscitation efforts, and potential complications are also mentioned.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
6/23. Electrocardiographic manifestations of hypothermia.hypothermia is generally defined as a core body temperature less than 35 degrees C (95 degrees F). hypothermia is one of the most common environmental emergencies encountered by emergency physicians. Although the diagnosis will usually be evident after an initial check of vital signs, the diagnosis can sometimes be missed because of overreliance on normal or near-normal oral or tympanic thermometer readings. The classic and well-known electrocardiographic (ECG) manifestations of hypothermia include the presence of J (Osborn) waves, interval (PR, QRS, QT) prolongation, and atrial and ventricular dysrhythmias. There are also some less known (ECG) findings associated with hypothermia. For example, hypothermia can produce ECG signs that simulate those of acute myocardial ischemia or myocardial infarction. hypothermia can also blunt the expected ECG findings associated with hyperkalemia. A thorough knowledge of these findings is important for prompt diagnosis and treatment of hypothermia. Six cases are presented that show these important ECG manifestations of hypothermia.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
7/23. Pediatric nonenvironmental hypothermia presenting to the emergency department: Episodic spontaneous hypothermia with hyperhidrosis.Cases of pediatric nonenvironmental hypothermia are uncommon. When presenting to the emergency department, these patients are often evaluated for possible sepsis/shock, brain tumors, endocrine disorders, and drug ingestions. We report a case of a 5-year-old girl who presented to the pediatric emergency department on two occasions with hypothermia and lethargy. She was found to have an unusual cause of her symptoms: episodic spontaneous hypothermia with hyperhidrosis.- - - - - - - - - - ranking = 5keywords = environment (Clic here for more details about this article) |
8/23. Osborn waves in the electrocardiogram, hypothermia not due to exposure, and death due to diabetic ketoacidosis.hypothermia usually occurs because a patient has been exposed to a cold environment; however, a number of nonenvironmental conditions may produce hypothermia. This report relates the clinical course of a patient whose hypothermia was due to severe diabetic ketoacidosis. In addition, we review the causes of hypothermia and Osborn waves beyond exposure to cold temperature. hypothermia due to diabetic ketoacidosis is an uncommon complication of a common disease that carries with it clinically significant consequences. Accordingly, we believe that all clinicians should be aware of this potential complication of diabetic ketoacidosis and should be able to recognize the importance of the electrocardiogram in such patients.- - - - - - - - - - ranking = 2keywords = environment (Clic here for more details about this article) |
9/23. hypothermia: risk factors and guidelines for nursing care.hypothermia occurs when heat loss from the body exceeds heat gain and the core temperature of the body falls below 35 degrees C. Although death from hypothermia is rare, 80 per cent of associated mortalities are in older people. There are many underlying conditions that increase a person's susceptibility to cold and this includes not having the ability to make appropriate environmental adjustments to maintain body temperature. The nursing management of a patient with hypothermia depends upon the severity of the condition. The nurse's primary concern is to treat the symptoms and re-warm the patient appropriately.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
10/23. J wave and hypothermia.hypothermia can result from exposure to a cold environment (e.g., accidental drowning) or it can be induced and used as a brain protection strategy (e.g., therapeutic hypothermia). One common ECG presentation with hypothermia is the J wave, which is related to the altered cellular activities during hypothermia. A case study is used in this article to illustrate the presentation of a J wave with a patient experiencing hypothermia.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
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