A homeless man is admitted unresponsive after being found by police on a park bench. He has no external signs of injury. An oesophageal temperature probe records his core body temperature to be 34 degC. Which of the following management options is not routinely indicated in this case?
Hypothermia Hypothermia is classified into : mild (35-32degC), moderate (32-30degC) and severe (less than 30degC). C/F - decreased consciousness, decreased respiratory rate and decreased hea rate. - Cardiac output also falls propoional to the severity of hypothermia, and a patient who initially lacks any signs of life may make a full recovery with appropriate suppoive therapy. - The main cause of death is cardiac arrhythmia; the myocardium becomes increasingly irritable below a temperature of 33degC and patients are at paicular risk of fibrillation. Because of this, all hypothermia patients require cardiac monitoring and should be rewarmed using 'passive external warm-ing techniques' including blankets, external heat sources and warmed IV fluids. The possibility of confounding causes of unresponsiveness should not be overlooked, and evidence of alcohol, drug use or sepsis should be excluded. - Hypoglycaemia is another cause of reduced responsiveness that also frequently occurs secondary to hypothermia; therefore blood glucose monitoring and IV dextrose should be initiated as standard. - Rx -'Active core rewarming methods' are the reserve of severe hypothermia or hypothermia in high-risk patients (i.e. in conjunction with other injuries) and would not therefore be indicated in this scenario. Such techniques include warmed peritoneal lavage, warmed pleural lavage, warmed bladder irrigation, aeriovenous rewarming and cardiopulmonary bypass.
Cardiac monitoring
Warmed peritoneal lavage
Warmed intravenous fluids
Intravenous dextrose
Miscellaneous