Hypothermia with Trauma

This case is written by Dr. Stephen Miller. He is an emergency physician in Halifax. He is also the former medical director of EM Simulation and the current director of the Skilled Clinician Program for UGME at Dalhousie University. He developed his interest in simulation while obtaining his Masters of Health Professions Education.

Why it Matters

Moderate to severe hypothermia can be quite challenging to correct. This case highlights several important features of hypothermia management:

  • The importance of searching for concurrent illness that may be causing the hypothermia or working against rewarming efforts
  • The effect of hypothermia on trauma management
  • Modifications to ACLS as required during hypothermic resuscitation
  • The multitude of ways in which one can attempt to actively re-warm a patient

Clinical Vignette

An approximately 30 year old female is brought into the ED at 4 AM by a man who found her lying at the side of the road. It is minus 30 degrees Celsius outside and she has no coat or shoes. The man does not know her and is unable to provide any additional history except that she was blue and having trouble breathing when he found her. She is noted to have a decreased LOC and laboured breathing. She has obvious deformities of her left forearm and right leg.

Case Summary

30 year-old female is brought into the ED at 4 AM by a man who found her lying at the side of the road with no coat or shoes. It is minus 30 degrees Celsius outside. On arrival she has a reduced LOC, laboured breathing, a right-sided pneumothorax, cyanotic extremities, a left radius & ulna fracture, and a right tib-fib fracture. The team is required to use both active and passive rewarming strategies. Regardless of the team’s efforts, the patient in this case will arrest. Upon ROSC, they are required to continue rewarming as well as to address the other traumatic injuries.

Download the case here: Hypothermia

CXR for the case found here:

PTX R with rib fractures

(CXR source: http://radiopaedia.org/cases/pneumothorax-due-to-rib-fractures-1)

ECG for the case found here:

hypothermia-shiver-artefact

(ECG source: : http://cdn.lifeinthefastlane.com/wp-content/uploads/2011/03/hypothermia-shiver-artefact.jpg)

Right lung U/S found here:

Left lung U/S found here:

RUQ FAST image found here:

RUQ FF

Pericardial U/S found here:

(All U/S images are courtesy of McMaster PoCUS Subspecialty Training Program.)

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