1/38. 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 = water (Clic here for more details about this article) |
2/38. 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 = water (Clic here for more details about this article) |
3/38. Cold water submersion and cardiac arrest in treatment of severe hypothermia with cardiopulmonary bypass.In the paediatric population, submersion injury with drowning or near-drowning represents a significant cause of morbidity and mortality. This study reviews retrospectively our own experiences and the literature on the use of cardiopulmonary bypass (CPB) to rewarm paediatric victims of cold water submersion who suffer severe hypothermia (<28 degrees C) and cardiac arrest (asystole or ventricular fibrillation). In addition to three children treated at our institution, nine other victims were found in the literature. In this cohort of 12 children aged between 2 and 12 years, there was a tendency to better outcome with lower core temperature at the beginning of extracorporeal circulation (mean temperature in nine survivors, 20 degrees C; in three non-survivors, 25.5 degrees C). The lowest temperature survived was 16 degrees C. Neither base excess, pH nor serum potassium levels were reliable prognostic factors. The lowest base excess in a survivor was -36.5 mmol/l, the lowest pH 6.29. We consider CPB as the method of choice for resuscitation and rewarming of children with severe accidental hypothermia and cardiac arrest (asystole or ventricular fibrillation). Compared with adults, children, especially smaller ones, require special consideration with regard to intravenous cannulation as drainage can be inadequate using femoral-femoral cannulation. In hypothermic children we advocate, therefore, emergency median sternotomy. Until more information regarding prognostic factors are available, children who are severely hypothermic and clinically dead after submersion in cold water--even if for an unknown length of time--should receive cardiopulmonary resuscitation (CPR) and be transported without delay to a facility with capabilities for CPB instituted via a median sternotomy.- - - - - - - - - - ranking = 6keywords = water (Clic here for more details about this article) |
4/38. amnesia during cold water immersion: a case report.This report describes a case of amnesia during a cold-water experiment. The volunteer was exposed three times in 1 day (120 min duration each time) to 20 degrees C water. During the third immersion, from min 95 to min 115, the subject experienced transient global amnesia for 20 min. The rectal temperature during this time was 35.6 degrees C. This single case demonstrates that memory loss in a young individual apparently can occur after cold-water exposure and at core temperatures above 35 degrees C.- - - - - - - - - - ranking = 7keywords = water (Clic here for more details about this article) |
5/38. hypothermia from prolonged immersion: biophysical parameters of a survivor.We report a case of survival following prolonged immersion and hypothermia. The patient survived for over 9 h in open water, after his vessel capsized and sank in the pacific ocean off the coast of Northern california. water temperature on the day of the sinking was 14.4 degrees C (58.0 degrees F). Although he did have adequate flotation, the patient did not wear a survival suit. On initial physical examination in the Emergency Department (ED), the patient's rectal temperature was 30.0 degrees C (86.0 degrees F). With active rewarming, his temperature returned to normal (37.0 degrees C (98.6 degrees F)) within 5 h. Body fat of the patient was 19.6%, near the 50th percentile for his age (19.0%). Surface/volume ratio of the patient (.0228 m(2)/L) was 19% smaller than a predicted average (.0282 m(2)/L). We believe that the patient's large body habitus contributed to survival and that surface/volume ratio was likely the biophysical variable most closely associated with decreased cooling.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
6/38. Somatosensory and skin temperature disturbances caused by infarction of the postcentral gyrus: a case report.Somatosensory functions are subdivided into 2 large groups: the elementary somatosensory functions, which consist of light touch, pain, thermal sensation, joint position sense, and vibration sense, and the intermediate somatosensory functions, which include 2-point discrimination, tactile localization, weight, texture, and shape perception. In this report, we describe a patient with somatosensory dysfunction after infarction of the postcentral gyrus. On physical examination a month after the onset of the infarction, voluntary movements were skillful, and both the elementary and intermediate somatosensory functions were disturbed in the right hand. The patient also displayed a decrease in the skin temperature of the right hand. The sensory-evoked potential in response to electrical stimulation of the right median nerve was normal, and brain MRI showed that the infarction was located in the posterior half of the left postcentral gyrus. These findings suggested that the lesion was situated at areas 1 and 2, and that area 3b was preserved. thermography revealed that the skin temperature of the right hand was decreased predominantly on the ulnar side, and that recovery from cooling with ice water was delayed. By comparing the results of our patient with a case report that showed no disturbance of the elementary somatosensory functions with a localized lesion in the postcentral gyrus, we suggest that area 1 participates in the elementary somatosensory functions and that skin temperature may be controlled somatotopically in the somatosensory cortex.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
7/38. hypothermia-related deaths--philadelphia, 2001, and united states, 1999.hypothermia is defined as the unintentional lowering of the deep body (core) temperature below 95.0 degrees F (35.0 degrees C). hypothermia can be mild (90.0 degrees F-<95.0 degrees F [32.2 degrees C-<35.0 degrees C]), moderate (82.5 degrees F-<90.0 degrees F [28.0 degrees C-<32.2 degrees C]), or severe (<82.5 degrees F [<28.0 degrees C]). Common risk factors for hypothermia include exposure to cold while under the influence of alcohol or drugs, altered mental status, and immersion in cold water. During 1979-1998, approximately 700 persons (range: 420-1,024) died annually in the united states from hypothermia; approximately half of these deaths were attributed to extremely cold weather. This report presents three cases of hypothermia-related deaths in philadelphia during 2001 as examples of risk factors for hypothermia and summarizes information about hypothermia-related deaths in the united states during 1999. hypothermia deaths are preventable; by avoiding hypothermia, persons also can prevent other adverse health effects of cold weather.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
8/38. survival after prolonged submersion in freshwater in florida.A 2-year-old boy was submerged for at least 20 min in a freshwater creek in Union County, FL. cardiopulmonary resuscitation (CPR) was administered for approximately 1 h at the scene and during transport to the hospital. On arrival, his glasgow coma scale score was 3 and rectal temperature was < or = 26.7 degrees C. He demonstrated respiratory failure, intense vasoconstriction, hemoglobinuria, anemia, hypercoagulability, thrombocytosis, leukopenia, and persistent coma. With intensive care, he began emerging from the coma after 72 h and progressively improved. Testing at the Developmental Evaluation Center and clinical observations showed him to be completely normal by 6 months after drowning. Thus, severe, rapid hypothermia can occur during drowning in cold water in any geographic location and at temperatures above those necessary for ice formation. hypothermia provides cerebral protection from hypoxia, permitting total recovery with appropriate CPR and intensive care.- - - - - - - - - - ranking = 6keywords = water (Clic here for more details about this article) |
9/38. hypothermia-related deaths--united states, 2003-2004.hypothermia, a reduction in the body's core temperature to <95.0 degrees F (<35.0 degrees C), is a preventable medical emergency usually caused by prolonged exposure to cold temperatures without adequate protective clothing. Warning signs and symptoms of hypothermia include lethargy, weakness and loss of coordination, confusion, uncontrollable shivering, and reduced respiratory or heart rate. Common risk factors are advanced age, substance abuse, altered mental status, and increased contact with substances that promote heat loss, such as water. This report describes three hypothermia-related deaths that occurred in the united states during 2003-2004, summarizes hypothermia-related mortality during 1979-2002, describes risk factors for and symptoms of hypothermia, and reviews measures to prevent hypothermia-related injury and death. public health strategies tailored to persons at increased risk for exposure to excessive cold might help reduce hypothermia-related morbidity and mortality.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
10/38. Is cardiopulmonary bypass effective for treatment of hypothermic arrest due to drowning or exposure?Various techniques have been advocated for resuscitation from hypothermic arrest caused by ice-cold freshwater drowning or exposure. We have resuscitated five such patients after emergency hospital admission using cardiopulmonary bypass initiated via median sternotomy. All patients presented to our facility with core temperatures less than 26 degrees C. Three patients had been in full cardiopulmonary arrest for more than 30 minutes prior to arrival. The fourth patient presented in ventricular fibrillation; the fifth was admitted to the hospital in sinus bradycardia that quickly deteriorated to asystole. All had cardiopulmonary bypass emergently initiated via median sternotomy. All were rewarmed on bypass to 37 degrees C and all survived at least 24 hours. Three of the five patients are currently alive and well with normal neurologic function. cardiopulmonary bypass is an effective technique for resuscitation after hypothermic arrest due to near drowning and/or exposure.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
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