1/9. 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 = 1keywords = intoxication (Clic here for more details about this article) |
2/9. hypothermia and undressing associated with non-fatal bromazepam intoxication.A 42-year-old woman with a history of depression was found unconscious, lying near her car in an early autumn morning. The lower part of her body was undressed and there were multiple purple spots and excoriations on the body suggesting at first a sexual assault. On admission to the intensive care unit, she presented a hypothermia with a central temperature of 28.4 degrees C. The biological samples obtained at the hospital were analysed. Blood concentration of bromazepam was 7.7 mg/l, which is above the highest level reported till now in a case of fatal intoxication.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
3/9. Confounding factors in diagnosing brain death: a case report.BACKGROUND: brain death is strictly defined medically and legally. This diagnosis depends on three cardinal neurological features: coma, absent brainstem reflexes, and apnea. The diagnosis can only be made, however, in the absence of intoxication, hypothermia, or certain medical illnesses. CASE PRESENTATION: A patient with severe hypoxic-ischemic brain injury met the three cardinal neurological features of brain death but concurrent profound hypothyroidism precluded the diagnosis. Our clinical and ethical decisions were further challenged by another facet of this complex case. Although her brain damage indicated a hopeless prognosis, we could not discontinue care based on futility because the only known surrogate was mentally retarded and unable to participate in medical planning. CONCLUSION: The presence of certain medical conditions prohibits a diagnosis of brain death, which is a medicolegal diagnosis of death, not a prediction or forecast of future outcome. While prognostication is important in deciding to withdraw care, it is not a component in diagnosing brain death.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
4/9. rewarming from severe accidental hypothermia with circulatory arrest.This case report demonstrates successful cardiopulmonary and cerebral resuscitation (CPCR) of a young male explored 15 hours following a suicide attempt (carbamazepine intoxication) in deep hypothermia (19 degrees C) with circulatory arrest. An extracorporeal circuit was used to rewarm the patient's blood. weaning from extracorporeal circulation (ECC) was successful and without complications as was recovery from multiorgan dysfunction, severe rhabdomyolysis and carbamazepine intoxication. An excellent outcome was achieved without any neurological deficit at the time of discharge from the hospital.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
5/9. Thoracic lavage in accidental hypothermia with cardiac arrest--report of a case and review of the literature.BACKGROUND: Accidental hypothermia resulting in cardiac arrest poses numerous therapeutic challenges. cardiopulmonary bypass (CPB) should be used if feasible since it optimally provides both central rewarming and circulatory support. However, this modality may not be available or is contraindicated in certain cases. Thoracic lavage (TL) provides satisfactory heat transfer and may be performed by a variety of physicians. This paper presents the physiological rationale, technique, and role for TL in accidental hypothermia with cardiac arrest. methods: A patient with hypothermic cardiac arrest, treated by the author using TL, serves as the basis for this report. A search of the English language literature using pubmed (National Library of medicine, Bethesda, maryland) was conducted from 1966 to 2003 and 13 additional patients were identified. Demographic information, lavage method, rewarming rate, complications, and neurological outcome were analysed. RESULTS: There were numerous causes for hypothermia, with drug and alcohol intoxication being the most common (n = 4; 28.6%). Patient age ranged from 8 to 72 years (median = 36 years). Mean core temperature was 24.5 /-0.60 degrees C. Most patients were without blood pressure or pulse upon presentation to the Emergency Department and the predominant cardiac rhythm was ventricular fibrillation (VF) (n = 9; 64.3%). Thoracic lavage was accomplished by thoracotomy in seven patients and tube thoracotomy in the remaining seven. Median rewarming rate was 2.95 degrees C/h. Median time until sinus rhythm was restored was 120 min. Median length of hospital stay was 2 weeks. Four (28.6%) patients died. Complications were seen in 12 (85.7%) patients. Among survivors, neurological outcome was normal in 8 (80%) while two were left with residual impairments. CONCLUSIONS: patients presenting in cardiac arrest from accidental hypothermia may be rewarmed effectively using TL. Among survivors, normal neurological recovery is seen. Thoracic lavage should be strongly considered for these patients if CPB is not available or contraindicated.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
6/9. hypothermia among resort skiers: 19 cases from the Snowy Mountains.Even in relatively temperate environments, accidental hypothermia is a potentially lethal complication of exposure. We have reviewed our experience of accidental hypothermia among recreational alpine skiers at an Australian resort during the 1983 and 1984 seasons. There were 19 cases of accidental hypothermia, which occurred in 10 men and nine women who were aged between six and 47 years (mean age, 15.9 years) and who had rectal temperatures that ranged from less than 35 degrees C to 36 degrees C. The temperature at presentation to the Ski Injury Clinic was less than 35 degrees C in seven cases. One patient presented to the Clinic with a gastrointestinal haemorrhage in addition to hypothermia, and one was initially thought to be suffering from alcohol intoxication. Two patients were lost in the snow overnight. All patients were removed from the snow, changed into warm dry clothes where necessary, and their body temperatures allowed to return to normal spontaneously (17 patients), or were exposed to heat actively by means of inhaled, heated, humidified air (two severely obtunded patients). All patients responded satisfactorily. There were no deaths and no sequelae. We conclude that all skiers should be advised to wear effective thermal insulation, and to ski with a partner to ensure that adequate care is taken to prevent accidental hypothermia. Inhalational "warming" is effective in the treatment of hypothermia in obtunded patients.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
7/9. Successful resuscitation in severe accidental hypothermia: a case report.Accidental hypothermia has a mortality rate of 30-80% and should always be borne in mind with comatose, hypotensive patients. It is a preventable condition when adequate safety measures are ensured. One should act in the case of early symptoms, because collapse may soon follow and evacuation of a patient on a stretcher is time-consuming, dangerous and a major undertaking. In severe cases absence of respiration and circulation should not preclude resuscitation. resuscitation should be continued until the patient is warm and all biochemical abnormalities have been corrected and intoxication has been ruled out. resuscitation may be successful in primitive, adverse conditions, as illustrated by this case of a 13-year-old boy with cardiopulmonary arrest and a core temperature of only 25 degrees C, who was successfully reanimated.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
8/9. Chronic hypothermia and water intoxication associated with a neurodegenerative disease.We describe a 71 year old man with a neurodegenerative condition who developed chronic inappropriate antidiuretic hormone secretion and hypothermia resulting in recurrent episodes of impaired consciousness. This combination of abnormalities is attributable to hypothalamic disease and has not to our knowledge been previously reported with clearly documented antidiuretic hormone excess.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |
9/9. Hemodialysis for treatment of accidental hypothermia.Accidental hypothermia is defined as a spontaneous decrease in core temperature to 35 degrees C or below. Several techniques of active core rewarming have been described. We present the case of a 34-year-old man with severe hypothermia (27 degrees C) caused by cold environment exposure and barbiturate intoxication treated with general supportive measures and active core rewarming with hemodialysis. Core temperature increased by 2.15 degrees C/h with hemodialysis and became normal in 4 h. The clinical situation clearly improved during the hemodialysis session and the patient recovered without any defect. Hemodialysis is a rapid and effective treatment for accidental hypothermia.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |