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Hypothermia Management in the Wilderness

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1. Hypothermia Management in the Wilderness

Hypothermia Management in the Wilderness Hypothermia Management in the Wilderness Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 (...) Hypothermia Management in the Wilderness Hypothermia Management in the Wilderness Aka: Hypothermia Management in the Wilderness From Related Chapters II. Management: Methods of rewarming in wilderness ral Move the patient to warm, dry environment Remove wet clothing Avoid excessive movement (risk of arrhythmia) Passive external rewarming Warm dry blanket Hot water bottle Wrapped hot rocks Warm next to another body Radiant heat source Heat pads Immersion Active core rewarming Heated airway inhalation

2018 FP Notebook

2. CRACKCast E140 – Accidental Hypothermia

28-22 degrees Celsius Profound Hypothermia 20-9 degrees Celsius 9 degrees Celsius is defined as the lowest therapeutic hypothermia survival level Note: There is a five level “Swiss staging” system that is used in some places (also supported by the International Commission for Mountain Emergency Medicine). This system is used by the International Commission of Alpine Rescue (ICAR). However, it’s not favored by all experts in the field of wilderness medicine because the clinical (especially (...) ) NOTE: Some experts recommended against providing CPR to patients with PEA arguing that the patients may have a small amount of cardiac output (without a palpable pulse) that would be disrupted with CPR. The goal in these cases is to WARM the patient up and thereby direct all human efforts to correcting the main underlying problem (i.e. not the pulselessness, but the hypothermia!). Defibrillation: Not a lot of evidence to guide our management on this, so consensus seems to support: Trial

2018 CandiEM

3. Hypothermia Management in the Wilderness

Hypothermia Management in the Wilderness Hypothermia Management in the Wilderness Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 (...) Hypothermia Management in the Wilderness Hypothermia Management in the Wilderness Aka: Hypothermia Management in the Wilderness From Related Chapters II. Management: Methods of rewarming in wilderness ral Move the patient to warm, dry environment Remove wet clothing Avoid excessive movement (risk of arrhythmia) Passive external rewarming Warm dry blanket Hot water bottle Wrapped hot rocks Warm next to another body Radiant heat source Heat pads Immersion Active core rewarming Heated airway inhalation

2015 FP Notebook

4. Accidental Hypothermia Management

indicated in suspected May be used if refractory to all other measures XII. References Civitarese and Sciano (2018) Crit Dec Emerg Med 32(2): 3-16 Herbert and Brown in Herbert (2014) EM:Rap 14(1):1-4 Danzl in Marx (2002) Rosen's Emergency Med, p. 1979-96 Danzl in Auerbach (2001) Wilderness Med, p. 135-77 Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Accidental Hypothermia Management." Click on the image (or right click) to open (...) Accidental Hypothermia Management Accidental Hypothermia Management Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Accidental

2018 FP Notebook

5. WHO Guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents

WHO Guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents ISBN 978 92 4 155039 0 20 Avenue Appia CH-1211 Geneva 27 Switzerland www.who.int/ 9 789241 548397 WHO GUIDELINES FOR THE PHARMACOLOGICAL AND RADIOTHERAPEUTIC MANAGEMENT OF CANCER PAIN IN ADULTS AND ADOLESCENTS WHO GUIDELINES FOR THE PHARMACOLOGICAL AND RADIOTHERAPEUTIC MANAGEMENT OF CANCER PAIN IN ADULTS AND ADOLESCENTS WHO GUIDELINES FOR THE PHARMACOLOGICAL AND RADIOTHERAPEUTIC (...) MANAGEMENT OF CANCER PAIN IN ADULTS AND ADOLESCENTSWHO GUIDELINES FOR THE PHARMACOLOGICAL AND RADIOTHERAPEUTIC MANAGEMENT OF CANCER PAIN IN ADULTS AND ADOLESCENTSWHO guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents ISBN 978-92-4-155039-0 © World Health Organization 2018 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org

2019 World Health Organisation Guidelines

6. Accidental Hypothermia

Accidental Hypothermia Accidental Hypothermia Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Accidental Hypothermia Accidental (...) ) Increased risk with electrolyte abnormalities (e.g. or ) XVI. Management See See See Field Triage Mild Hypothermia Initiate passive and Transport to hospital if any associated injury (e.g. , , ) Moderate to severe Hypothermia Initiate passive and Transport to hospital capable of invasive rewarming If hemodynamic instability or core <82 F (28 C) Transport to capable facility if available (otherwise to nearest hospital with ICU) ral Feel for a pulse for 1 minute at femoral or carotid (weak, slow pulses

2018 FP Notebook

7. Rewarming Methods in Hypothermia

Rewarming Methods in Hypothermia Rewarming Methods in Hypothermia Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Rewarming Methods (...) not available within 6 hours Direct lavage after thoracotomy Increases core temp by 14.4 F (8 C) X. References Civitarese and Sciano (2018) Crit Dec Emerg Med 32(2): 3-16 Danzl in Marx (2002) Rosen's Emergency Med, p. 1979-96 Danzl in Auerbach (2001) Wilderness Med, p. 135-77 Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Rewarming Methods in Hypothermia." Click on the image (or right click) to open the source website in a new browser

2018 FP Notebook

8. Acute pain management: scientific evidence (3rd Edition)

Acute pain management: scientific evidence (3rd Edition) ? ? ? ? Acute Pain Management: Scientific Evidence Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine ? ? ? Endorsed by: Faculty?of?Pain?Medicine,?Royal?College?of? Anaesthetists,?United?Kingdom?? Royal?College?of?Anaesthetists,? United?Kingdom?? Australian?Pain?Society? Australasian?Faculty?of?Rehabilitation?Medicine? College?of?Anaesthesiologists,?? Academy?of?Medicine,?Malaysia? College (...) and New Zealand College of Anaesthetists, 630 St Kilda Road, Melbourne, Victoria 3004, Australia. Website: www.anzca.edu.au Email: ceoanzca@anzca.edu.au This document should be cited as: Macintyre PE, Schug SA, Scott DA, Visser EJ, Walker SM; APM:SE Working Group of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine (2010), Acute Pain Management: Scientific Evidence (3rd edition), ANZCA & FPM, Melbourne. Copyright information for Tables 11.1 and 11.2 The material

2015 National Health and Medical Research Council

9. Accidental Hypothermia Management

indicated in suspected May be used if refractory to all other measures XII. References Civitarese and Sciano (2018) Crit Dec Emerg Med 32(2): 3-16 Herbert and Brown in Herbert (2014) EM:Rap 14(1):1-4 Danzl in Marx (2002) Rosen's Emergency Med, p. 1979-96 Danzl in Auerbach (2001) Wilderness Med, p. 135-77 Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Accidental Hypothermia Management." Click on the image (or right click) to open (...) Accidental Hypothermia Management Accidental Hypothermia Management Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Accidental

2015 FP Notebook

10. Acute Pain Management: Scientific Evidence

Acute Pain Management: Scientific Evidence ACUTE PAIN MANAGEMENT: SCIENTIFIC EVIDENCE Fourth Edition 2015 Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine Edited by: Stephan A Schug Greta M Palmer David A Scott Richard Halliwell Jane T rinca© Australian and New Zealand College of Anaesthetists 2015 ISBN Print: 978-0-9873236-7-5 Online: 978-0-9873236-6-8 This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced (...) and Faculty of Pain Medicine (2015), Acute Pain Management: Scientific Evidence (4th edition), ANZCA & FPM, Melbourne. Copyright information for Tables 10.1 and 10.2 The material presented in Table 10.1 and Table 10.2 of this document has been reproduced with permission from Prescribing Medicines in Pregnancy, 2015, Therapeutic Goods Administration. It does not purport to be the official or authorised version. © Commonwealth of Australia 2015 This work is copyright. You may download, display, print

2015 Clinical Practice Guidelines Portal

11. Hypothermia (Treatment)

Hypothermia (Treatment) Hypothermia Treatment & Management: Prehospital Care, Emergency Department Care, Complications Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNzcwNTQyLXRyZWF0bWVudA== processing (...) > Hypothermia Treatment & Management Updated: Nov 08, 2018 Author: James Li, MD; Chief Editor: Joe Alcock, MD, MS Share Email Print Feedback Close Sections Sections Hypothermia Treatment Prehospital Care Prehospital management focuses on preventing further heat loss, rewarming the body core temperature, and avoiding precipitating ventricular fibrillation or another malignant cardiac rhythm. This should be the preeminent concern. Conscious patients can develop ventricular fibrillation suddenly; prehospital

2014 eMedicine Emergency Medicine

12. Hypothermia (Follow-up)

Hypothermia (Follow-up) Hypothermia Treatment & Management: Prehospital Care, Emergency Department Care, Complications Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNzcwNTQyLXRyZWF0bWVudA== processing (...) > Hypothermia Treatment & Management Updated: Nov 08, 2018 Author: James Li, MD; Chief Editor: Joe Alcock, MD, MS Share Email Print Feedback Close Sections Sections Hypothermia Treatment Prehospital Care Prehospital management focuses on preventing further heat loss, rewarming the body core temperature, and avoiding precipitating ventricular fibrillation or another malignant cardiac rhythm. This should be the preeminent concern. Conscious patients can develop ventricular fibrillation suddenly; prehospital

2014 eMedicine Emergency Medicine

13. Therapeutic Hypothermia After the Return of Spontaneous Circulation

Therapeutic Hypothermia After the Return of Spontaneous Circulation Therapeutic Hypothermia After the Return of Spontaneous Circulation - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Therapeutic (...) Hypothermia After the Return of Spontaneous Circulation The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT01617291 Recruitment Status : Terminated (A similar study was recently published with definitive results.) First Posted : June 12, 2012 Last Update Posted : February 14, 2014 Sponsor: University

2012 Clinical Trials

14. Accidental Hypothermia

Accidental Hypothermia Accidental Hypothermia Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Accidental Hypothermia Accidental (...) ) Increased risk with electrolyte abnormalities (e.g. or ) XVI. Management See See See Field Triage Mild Hypothermia Initiate passive and Transport to hospital if any associated injury (e.g. , , ) Moderate to severe Hypothermia Initiate passive and Transport to hospital capable of invasive rewarming If hemodynamic instability or core <82 F (28 C) Transport to capable facility if available (otherwise to nearest hospital with ICU) ral Feel for a pulse for 1 minute at femoral or carotid (weak, slow pulses

2015 FP Notebook

15. Rewarming Methods in Hypothermia

Rewarming Methods in Hypothermia Rewarming Methods in Hypothermia Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Rewarming Methods (...) not available within 6 hours Direct lavage after thoracotomy Increases core temp by 14.4 F (8 C) X. References Civitarese and Sciano (2018) Crit Dec Emerg Med 32(2): 3-16 Danzl in Marx (2002) Rosen's Emergency Med, p. 1979-96 Danzl in Auerbach (2001) Wilderness Med, p. 135-77 Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Rewarming Methods in Hypothermia." Click on the image (or right click) to open the source website in a new browser

2015 FP Notebook

16. Initial Evaluation and Management of the Burn Patient

Initial Evaluation and Management of the Burn Patient Initial Evaluation and Management of the Burn Patient: Overview, Initial Evaluation and Resuscitation, Evaluation of the Burn Wound Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNDM1NDAyLW92ZXJ2aWV3 processing > Initial Evaluation and Management of the Burn Patient Updated: Jan 10, 2018 Author: Robert L Sheridan, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF Share Email Print Feedback Close Sections Sections Initial Evaluation and Management of the Burn Patient Overview Overview Outcomes for burn patients have improved dramatically over the past 20 years, yet burns still cause substantial morbidity and mortality. [ , ] Proper evaluation and management, coupled with appropriate early

2014 eMedicine Surgery

17. Hypothermia

to move independently. With rising interest in wilderness exploration, and outdoor and water sports, the incidence of hypothermia secondary to accidental exposure may become more frequent in the general population. Alcohol Alcohol consumption increases the risk of hypothermia in two ways: and temperature controlling systems in the brain. Vasodilation increases blood flow to the skin, resulting in heat being lost to the environment. This produces the effect of an individual feeling warm, when (...) conditions can build an or to shelter. The promotes using life vests to protect against hypothermia through the 50/50/50 rule: If someone is in 50 °F (10 °C) water for 50 minutes, he/she has a 50 percent better chance of survival if wearing a life jacket. [ ] A can be used to increase survival in cold water. Babies should sleep at 16-20 °C (61-68 °F) and housebound people should be checked regularly to make sure the temperature of the home is at least 18 °C (64 °F). Management Degree Rewarming technique

2012 Wikipedia

18. CRACKCast E152 – Cardiovascular Drugs

and poisoning from digoxin, beta-blockers, or calcium channel blockers . 2. How does clonidine toxicity present and how is it managed? Binding to pre-synaptic α2-adrenergic receptors in the brain: Less norepinephrine release = Bradycardia, hypotension, decreased mental status, miosis, and occasionally hypothermia. Supportive care is the mainstay of management: Generous IV fluid boluses for hypotension Vasopressors – ideally norepinephrine for hypotension Naloxone: Recommend escalating doses of naloxone (...) an electrocardiographic diagnosis. What rhythm is NOT associated with Dig toxicity = rapidly conducted SVTs (e.g. rapid a. fib). The specific ones! Afib with AV dissociation (slow ventricular rate) Atrial tachycardia with a block Bidirectional VT Junctional Tachycardia 6. Describe the management priorities in digoxin toxicity The treatment of significant digoxin poisoning is the administration of digoxin-specific fragment antigen-binding (Fab) antibodies (DigiFab); all other interventions are considered complementary

2018 CandiEM

19. CRACKCast E147 – General Approach to the Poisoned Patient

ingestion and may just give you the tools to save a life on your next shift. Shownotes – Key Concepts Toxidromes are constellations of signs and symptoms based primarily on vital signs and neuropsychiatric functions that are characteristic manifestations of certain toxic exposures. Recognition of the presence of a toxidrome can suggest a potential intoxicant and guide early interventions and management strategies. Examples of toxidromes include sympathomimetic, antimuscarinic, cholinergic, sedative (...) -hypnotic, and opioid categories. Qualitative urine drug levels are inferior to quantitative serum levels in terms of guiding specific therapy. Syrup of ipecac is not indicated in the ED care of a poisoned patient. Gastric lavage is not part of routine care. When given in a timely fashion (1 hour post ingestion), activated charcoal may be indicated for potentially lethal agents in alert, cooperative patients. Whole-bowel irrigation is rarely useful for management of poisoned patients but is potentially

2018 CandiEM

20. CRACKCast E145 – Drowning

the duration of submersion tolerated without central nervous system (CNS) damage. The proposed protective effect of cold water immersion was unfortunately not seen in a study of 1094 drowning victims of all ages, where water temperature had no correlation. [4] Describe the management of a drowning patient with respiratory distress …if you’re on scene proceed with wilderness medicine principles* then initiate basic life support (get out of the water, start CPR when on a solid surface, only immobilize C (...) ) or other cardiac mutations Hypothermia Hyperventilation before a shallow dive Concomitant trauma, stroke, or myocardial infarction No adult supervision Risk taking behaviour Summer months, on weekends, water sports ETOH intake or drug intake Inexperienced swimmers and very experience swimmers [2] List 5 variables that portend poor outcome List from Rosen’s Age Very young LESS than 3 YEARS OLD (increased risk for hypothermia and more metabolic demands) Very old (comorbidities) Water temperature Cold

2018 CandiEM

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