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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