Tasty Morsels of EM 129 – #FRCEM Hypothermia and Frostbite

26 Aug

I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.

You can find more things on the FRCEM on this site here.

Define hypothermia?

  • core temp (rectal, oesophageal…)
    • <30 severe
    • 30-32 moderate
    • 32-35 mild

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How should we rewarm?

  • passive
    • ambient room temp
    • blankets
    • forced air blanket
  • active
    • IV fluids warmed (not great)
    • bladder/pleural/peritoneal irrigation
    • Bypass/ECMO

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How is CPR different in hyothermia?

  • As per ERC guidance
    • careful intubation and movement
    • check signs of life for 1 minute
    • hold drugs until above 30 degrees then double the interval between doses
    • 3 shocks below 30 degrees and then focus on rewarming

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What are the ECG changes in hypothermia?

  • bradycardia
  • AF
  • J waves
  • ST/T changes
  • QRS broadening

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What is frostbite?

I’ve seen these Alaskan guidelines references a few times

  • tissues freezing at sub zero temperatures
  • Frostnip = nose, face or fingers white on exposure but with rapid recovery when removed from cold exposure. Paraesthesiae but no long term tissue damage
  • Superfical frostbite = skin and subcut tissues. numb and waxy appearing. Painful rewarming with later blistering
  • Deep frostbite = muscles, nerves and even bone. White and hard appearing. Remains white even after rewarming. Becomes necrotic and separates.

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How should we manage frost bite?

  • don’t rewarm until in a definitive environment. Refreezing of something partially thawed a disaster
  • warm (37-39) water
  • give NSAID (something to do with prostaglandins…)
  • allow to dry in air, don’t towel
  • avoid early debridement and allow to naturally separate
  • thrombolysis has been done early in severe cases

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