《hypothermia：低温》ppt课件

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1、Hypothermia–WhyAmISoCold?DavidFeldstein,MDPrimaryCareConference5/26/04ObjectivesEtiologiesofhypothermiaClinicalmanifestationsofhypothermiaCausesofhypothermiainpsychiatricpatientsIhavenotreceivedanyfinancialcompensationforthistalkCaseCC:DeleriumHPI:48y.o

2、.institutionalizedmanwithhxschizophreniabehavioralchangesX2weeksslurringofspeechanddecreaseinambulationandeatinglaboredbreathingdayofadmission.temperature33.3orallyathisinstitution.Case(cont)PMHGunshotwoundtotheheadParanoidschizophreniaHTNNMSsecondaryto

3、ClozarilMeds:Aripiprazole(Abilify),ClonazepamSHInstitutionalizedfor20yearsNoaccesstotobacco,alcoholorillicitdrugsCase(cont)PE:T33.2rectal;HR60;129/76;RR16;95%RAGen:Spontaneouslyopeningeyesandmovingextremities.NADHEENT:Pupils1mmandsluggishNeck:Nonpalpabl

4、ethyroidLungs:BibasilarcrackleswithpooreffortCVS/Abd–WNLNeuro:Notfollowingcommands,Nmltone,1+DTRs,NoclonusSkin:Cooltotouch,norashesExt:1+pittingedematokneesbilaterallyHospitalCourseHeadCTandLPwereperformedBloodculturessentVancomycinandZosynstartedempiri

5、cally12hoursafterarrivalinEDpatientwasfoundtobecompletelyunresponsivetopainfulstimuliTemp33.3rectal;HR52;BP125/72DefinitionofHypothermiaMild32-35°C(90-95°F)Moderate28-32°C(82-90°F)Severe<28°C(82°F)CausesofHypothermiaDecreasedHeatProductionIncreasedHeatL

6、ossImpairedThermoregulationMiscellaneousDecreasedHeatProductionEndocrineHypopituitarismHypoadrenalismHypothyroidismInsufficientFuelHypoglycemiaMalnutritionNeuromuscularInefficiencyExtremeAgeImpairedShiveringInactivityIncreasedHeatLossEnvironmentalExposu

7、reInducedVasodilationEtOHDrugsSkinBurnsPsoriasisIatrogenicColdInfusionsImpairedThermoregulationPeripheralFailureNeuropathiesCentralFailureMetabolicDrugsTraumaCVAHypothalamicdysfunctionMSWernicke’sMiscellaneousSepsisPancreatitisCarcinomatosisUremiaKramer

8、etal.Retrospectivescreeningofpatientsover60withhypothermiainacommunityhospitalinJerusalem(1983-86)PrognosisofHypothermia(Kramer)Inhospitalmortality–74%Acuterenalfailure–12%DIC–9%BackToMyPatientWBC1.9–nmldiffHct37Plts65INR1.1/PTT4