Accidental Hypothermia

Duguid, Helen; Simpson, Robin; Stowers, J. M.

doi:10.1016/s0140-6736(61)92588-0

Cited by 192 publications

(69 citation statements)

References 17 publications

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“…26,27 Due to the almost universal presence of shivering, it was difficult to obtain clear, high-quality ECG tracings in hypothermic patients. 20,26,32,33 The persistence of ECG abnormalities for a period beyond the time of rewarming has been found in animals and humans. 6,11,12,20,26,32 In the present study, 13 ECGs obtained at temperatures Ն97ЊF showed persistent Osborn waves.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Evaluation of the Electrocardiographic Manifestations of Hypothermia

Vassallo

Delaney

Hoffman

et al. 1999

Academic Emergency Medicine

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Abstract. Objective: To determine the effects of body temperature, ethanol use, electrolyte status, and acid-base status on the electrocardiograms (ECGs) of hypothermic patients. Methods: Prospective, two-year, observational study of patients presenting to an urban ED with temperature Յ95ЊF (Յ35ЊC). All patients had at least one ECG obtained. Electrocardiograms were interpreted by a cardiologist blinded to the patient's temperature. J-point elevations known as Osborn waves were defined as present if they were at least 1 mm in height in two consecutive complexes. Results: 100 ECGs were obtained in 43 patients. Presenting temperatures ranged between 74ЊF and 95ЊF (23.3ЊC-35ЊC). Initial rhythms included normal sinus (n = 34), atrial fibrillation (n = 8), and junctional (n = 1). Osborn waves were present in 37 of 43 initial ECGs. Of the six initial ECGs that did not have Osborn waves present, all were obtained in patients whose temperatures were Ն90ЊF (Ն32.2ЊC). For the entire group, the Osborn wave was significantly larger as temperature decreased (p = 0.0001, r = Ϫ0.441). The correlation between temperature and size of the Osborn wave was strongest in six patients with four or more ECGs (range r = Ϫ0.644 to r = Ϫ0.956, p = 0.001). No correlation could be demonstrated between the height of the Osborn waves and the serum electrolytes, including sodium, chloride, potassium, bicarbonate, BUN, creatinine, glucose, anion gap, and blood ethanol levels. Conclusions: The presence and size of the Osborn waves in hypothermic patients appear to be a function of temperature. The magnitude of the Osborn waves is inversely correlated with the temperature. Key words: hypothermia, electrocardiograph; Osborn waves. AC-ADEMIC EMERGENCY MEDICINE 1999; 6:1121-1126 T HE EFFECTS of hypothermia on cardiac conduction were first described in 1892.1 Since then, observations of the physiologic changes that occur with cooling of the heart have been reported in animals 2-14 and in humans undergoing craniotomy for subarachnoid hemorrhage, 15 surgery for cardiac anomalies, [16][17][18][19] and anti-cancer therapy. 20,21The first observation of the changes in the electrocardiogram (ECG) in a patient with unintentional hypothermia was reported in 1938. 22 In the following study, the changes in the ECGs of patients with unintentional hypothermia presenting to a large urban hospital ED are described, and the relationship of these changes to common laboratory parameters are analyzed. A review of the literature focuses on the development of the understanding of the effects of cold on the electrical conduction system of the heart and the resultant physiologic and ECG alterations. METHODSStudy Design. This was a prospective, two-year observational study of hypothermia patients presenting to an urban ED. The study was approved by the institutional review boards of New York University School of Medicine, Bellevue Hospital, and the New York City Health and Hospital Corporation.Study Setting and Population. For the purposes of this study, patients were sele...

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Section: Discussionmentioning

confidence: 99%

A Prospective Evaluation of the Electrocardiographic Manifestations of Hypothermia

Vassallo

Delaney

Hoffman

et al. 1999

Academic Emergency Medicine

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“…Respiratory infections are the most common. In the present series, there were 6 cases of pneumonia at the onset of the crisis. In C atz [1961] series there were 9 cases of pneumonia, 1 of mastoiditis and 1 of pyelonephritis.…”

Section: Stress Factorsmentioning

confidence: 48%

Myxoedema Crisis

Hausmann¹

1970

Horm Res Paediatr

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Fourteen cases of myxoedema crisis have been reportedand 93 additional cases have been collected from the literature. Hypothermia, coma and shock have been identified as the main clinical features of crisis. It has been pointed out that while clouding of consciousness is universal, coma is of doubtful prognostic significance. The importance of hypothermia in prognosis has been stressed. Various stress factors have been described which may initiate crisis especially respiratory infections and epileptic fits. The urgency of adequate treatment has been emphasised but overenthusiastic treatment is only slightly less dangerous than delay and inadequate treatment. However, even the best available treatment will only lead to a moderate improvement in outlook and the only successful way is prevention.

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“…Similar findings have been reported by others. [36][37][38] Hypothermia has also been used to add to the preservation of the organs in transplantation, even in the case of pancreas transplantation, on account of decreased organ metabolism. 39,40 Several experimental studies showed an attenuation in ischemia and reperfusion injury, in different organs (liver, lung, neuron), with hypothermia in different degrees.…”

Section: Discussionmentioning

confidence: 99%

Oxidative Stress Is Enhanced by Hypothermia Imposed on Cerulein-Induced Pancreatitis in Rats

Andraus

Jukemura

Dutra

et al. 2007

Clinics

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MC. Oxidative stress is enhanced by hypothermia imposed on cerulein-induced pancreatitis in rats. Clinics. 2007;62(4): 483-90. BACKGROUND:Hypothermia is a frequent event in severe acute pancreatitis (AP) and its real effects on the normal pancreas have not been well demonstrated. Moreover, neither have its effects on the outcome of acute pancreatitis been fully investigated. One hypothesis is that oxidative stress may be implicated in lesions caused or treated by hypothermia. Aim of the study: To investigate the effect of hypothermia in cerulein-induced acute pancreatitis (CIAP) in rats and the role played by oxidative stress in this process. METHODS: Male Wistar rats were divided into hypothermic and normothermic groups. Hypothermia was induced with a cold mattress and rectal temperature was kept at 30 o C for one hour. Acute pancreatitis was induced with 2 doses of cerulein (20 ìg/kg) administered at a one-hour interval. Serum amylase, pancreas vascular permeability by Evan's blue method, pancreas wet-to-dry weight ratio and histopathology were analyzed in each group. RESULTS: When compared with normothermic rats, hypothermic animals, with cerulein-induced acute pancreatitis, showed higher levels of pancreatic vascular permeability (P < 0.05), pancreas wet-to-dry weight ratio (P = 0.03), and histologically verified edema (P < 0.05), but similar serum amylase levels. The hypothermic group showed a higher oxidized-reduced glutathione ratio than the normothermic group. CONCLUSION: Moderate hypothermia produced a greater inflammatory response in established acute pancreatitis induced by cerulein in rats. Moreover, this study suggests that oxidative stress may be one of the mechanisms responsible for the worse outcome in hypothermic rats with cerulein-induced acute pancreatitis.

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Accidental Hypothermia

Cited by 192 publications

References 17 publications

A Prospective Evaluation of the Electrocardiographic Manifestations of Hypothermia

A Prospective Evaluation of the Electrocardiographic Manifestations of Hypothermia

Myxoedema Crisis

Oxidative Stress Is Enhanced by Hypothermia Imposed on Cerulein-Induced Pancreatitis in Rats

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