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A 3 year old child sustains a cold water submersion injury. He is brought in with a core temperature of 30 degrees C, in ventricular fibrillation, and is successfully defibrillated and intubated. Rewarming is occurring by: removing wet clothes, forced air warming blanket, warmed IV fluids to 40-44C, warmed humidified oxygen at 42-46C. What rate and endpoint of rewarming is best?
Kelly March 6, 2018 - 10:52 am
A. 1-2 degrees C per hour to endpoint of 33-36 C. Mild hypothermia results in better neurologic outcomes, and more aggressive rewarming can worsen cerebral injury. External warming should be applied to the trunk more than the extremities, to avoid “afterdrop” in core body temperature from cold peripheral blood recirculating to the central core. For severe hypothermia, peritoneal and intrathoracic lavage with warmed fluids 39-41 C can be done as well. Hypothermic patients in asystole should be warmed to 32-34 C with continued resuscitation efforts before deciding that further resuscitation would be futile.