Akzidentelle urbane Unterkühlung

Abstract

In emergency medicine accidental hypothermia (<35 degrees C) is a common epiphenomenon of many medical conditions. In contrast, severe hypothermia (<28 degrees C) occurs very seldom and presents a difficult medical situation. Here we present a female patient with severe urban hypothermia (core temperature of 20.7 degrees C) and circulatory arrest. An overview of the emergency treatment, rewarming strategy with extracorporeal circulation and the clinical course will be given. The survival of the patient and the favorable neurological outcome will be discussed considering the current literature. Due to the paucity of treatment guidelines or clear prognostic criteria of withholding or withdrawing treatment in severe hypothermia, the decision of prolonged resuscitation and rewarming strategy is solely dependent on the individual judgement and medical experience of the physician. The positive clinical outcome which can be gleaned from case reports or single retrospective studies should encourage the emergency physician to selectively rewarm a severe hypothermic patient with extracorporeal circulation under prolonged CPR.

Der Lawinennotfall

“…B. stabile/instabile Hämody-namik) und der Erfahrung des Notarztes im Umgang mit den Narkosemitteln abhängen. Patienten im Hypothermiestadium III sollten daher eine Analgosedierung mit reduzierter Dosis erhalten, Patienten im Hypothermiestadium IV brauchen präklinisch aufgrund ihrer tiefen Bewusstlosigkeit mit Areflexie keine Narko- [36]. Da in der präklinischen Phase bis zu 10 aller Intubationen schwierig sind [22], sollte der Notarzt alternative Beatmungsmethoden beherrschen; der Goldstandard bleibt aber die endotracheale Intubation [15,22].…”