This case comes to us from Dr. Katie Maguire with content expertise from Drs. Doug Brown and Jan Trojanowksi.
Dr. Maguire is a PGY4 Emergency Medicine resident at the University of British Columbia. Her interests include medical education, disaster medicine and simulation. She is particularly interested in simulation as an educational technique to develop communication and crisis resource management skills. She completed her undergraduate degree at Queen’s University and her medical degree at the University of Manitoba.
WHY IT MATTERS
Accidental hypothermia occurs with seasonal regularity and is increasingly more common as more and more people venture into the back country for recreational purposes.
There are several notable difference in managing a hypothermic arrest when compared with traditional ACLS. This case gives an important chance to practice managing a hypothermic arrest as a team leading into the winter season.
CLINICAL VIGNETTE
24-year-old male previously healthy is brought in by search and rescue to your ED in cardiac arrest. He was found awake and cold in a ravine and subsequently lost his pulse.
CASE SUMMARY
A 24-year-old previously healthy male presents to the ED with absent vital signs. He is out for a trail run when he becomes trapped in waist deep cold water. When he is found by search and rescue, he is awake with altered mental status. He has a cardiac arrest on retrieval and is found to be severely hypothermic. CPR and ACLS is initiated and he is transferred to the nearest community ED. The resuscitation team is expected to perform ACLS specific to hypothermic arrest. The patient will require intubation, active rewarming, defibrillation and discussion with the ECMO physician on call for transport and ECMO assisted rewarming.
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