Book contents
- Frontmatter
- Contents
- Introduction
- 1 Hypothermia as a Disorder
- 2 Epidemiology and Estimating Preventable Deaths in Accidental Hypothermia
- 3 Facts and Myths about Hypothermia and its Treatment
- 4 Measurement of Patient's Body Temperature
- 5 Prehospital Management of Hypothermia
- 6 Thermal Insulation
- 7 Airway Management in Hypothermic Patients
- 8 ECG in Hypothermia
- 9 Hypothermia as a Reversible Cause of Cardiac Arrest
- 10 The Role and Tasks of Polish Medical Air Rescue
- 11 Trauma and Hypothermia
- 12 Prehospital Management of Avalanche Victims
- 13 Prehospital Rewarming in Hypothermia. Indications, Methods, Problems and Pitfalls
- 14 Coagulopathies in Hypothermic Patient
- 15 Changes of Pharmacokinetics and Pharmacodynamics of Medications in Hypothermic Patients
- 16 Extracorporeal Therapy in Patients in Severe Hypothermia
- 17 Vascular Access for Extracorporeal Circulation
- 18 Problems and Pitfalls of Qualification for Extracorporeal Treatment of Patients in Severe Hypothermia
- 19 Procedure of Extracorporeal Treatment of Hypothermic Patients
- 20 Recommendation of National Consultant in the Field on Emergency Medicine
- 21 Accidental Hypothermia: the Need for the International Hypothermia Registry
- 22 Qualification for Extracorporeal Rewarming Medical Report
7 - Airway Management in Hypothermic Patients
Published online by Cambridge University Press: 03 January 2018
- Frontmatter
- Contents
- Introduction
- 1 Hypothermia as a Disorder
- 2 Epidemiology and Estimating Preventable Deaths in Accidental Hypothermia
- 3 Facts and Myths about Hypothermia and its Treatment
- 4 Measurement of Patient's Body Temperature
- 5 Prehospital Management of Hypothermia
- 6 Thermal Insulation
- 7 Airway Management in Hypothermic Patients
- 8 ECG in Hypothermia
- 9 Hypothermia as a Reversible Cause of Cardiac Arrest
- 10 The Role and Tasks of Polish Medical Air Rescue
- 11 Trauma and Hypothermia
- 12 Prehospital Management of Avalanche Victims
- 13 Prehospital Rewarming in Hypothermia. Indications, Methods, Problems and Pitfalls
- 14 Coagulopathies in Hypothermic Patient
- 15 Changes of Pharmacokinetics and Pharmacodynamics of Medications in Hypothermic Patients
- 16 Extracorporeal Therapy in Patients in Severe Hypothermia
- 17 Vascular Access for Extracorporeal Circulation
- 18 Problems and Pitfalls of Qualification for Extracorporeal Treatment of Patients in Severe Hypothermia
- 19 Procedure of Extracorporeal Treatment of Hypothermic Patients
- 20 Recommendation of National Consultant in the Field on Emergency Medicine
- 21 Accidental Hypothermia: the Need for the International Hypothermia Registry
- 22 Qualification for Extracorporeal Rewarming Medical Report
Summary
Challenges
• Severe hypothermia causes grave disorders of respiratory system. Major decrease in body temperature causes disturbance of brain function, depression of respiratory centre in brain stem and impairment of defence reflexes of the airways [1].
• Severe stages of hypothermia are associated with increasing stiffness in skeletal muscles, what may cause difficulties in airways management [2]. The rescuer must be ready to face difficulties in tilting the head of the patient, limited degree to which mouth of the patient opens during insertion of oropharyngeal airway (OP), laryngeal mask airway (LMA) or laryngoscopy [3].
• Because of low incidence rate of hypothermia it cannot be unequivocally stated that hypothermic patients constitute a group of patients with expected difficulties in intubation, yet such statement may fi nd grounds in pathophysiology of the disorder [2, 4].
• Hypothermic patients who are unconscious or in cardiac arrest constitute the group particularly threatened by aspiration of gastric contents. Passive movement of gastric contents to larynx (regurgitation) is a dangerous complication, which may lead both to mechanical obstruction of the airways as well as aspiration (chemical) pneumonitis [3]. In physiological conditions the stomach is emptied within 6 hours. Hypothermia may prolong this process.
• Stiffness of skeletal muscles increasing with hypothermia may cause decrease in chest compliance and lead to ventilation disorders. Reduced elasticity of chest walls may favour occurrence of atelectasis, disorders of ventilation/perfusion ratio (V/Q ratio) and pulmonary shunt [2, 5]. Lowered partial pressure of oxygen in blood may result.
• Settings where medical care is provided (prehospital setting, emergency ward) and competence of providers are important factors that determine scope of airway management.
Procedure
The goals of medical team dealing with patient in severe hypothermia are provision of adequate oxygenation and ventilation as well as protection from aspiration [3]. Definitive airway protection and implementation of efficient mechanical ventilation may present a major challenge for medical practitioners, particularly in prehospital setting. This is caused by time pressure, circumstances of CPR, varied experience of team members, as well as limited equipment. In such situations, proper and organised functioning of medical team is crucial.
- Type
- Chapter
- Information
- Hypothermia: Clinical Aspects Of Body CoolingAnalysis Of Dangers Directions Of Modern Treatment, pp. 69 - 74Publisher: Jagiellonian University PressPrint publication year: 2016