Gaurav Prabhu
MD
AtlantiCare Regional Medical Center, United States
Disclosure information not submitted.
William Adams
MD
AtlantiCare Regional Medical Center, United States
Disclosure information not submitted.
Sahil Mamtani
MD
AtlantiCare Regional Medical Center, United States
Disclosure information not submitted.
joseph drogo
APN
AtlantiCare Regional Medical Center, United States
Disclosure information not submitted.
Azka Sadik
MD
AtlantiCare Regional Medical Center, United States
Disclosure information not submitted.
Cecelia Allison
Medical Student
Geisinger commonwealth school of medicine, United States
Disclosure information not submitted.
Title: The Case of a Frozen Heart: Reversing Severe Hypothermia using the Arctic Sun
Introduction: Hypothermia can be described as a core body temperature below 35 C, which can be further characterized as mild, moderate, and severe depending on the body temperature. Limited guidelines exist regarding the management of moderate to severe hypothermia. We present a patient with severe hypothermia who was rewarmed successfully using noninvasive rewarming techniques (Arctic Sun). When taken into comparison to extracorporeal membrane oxygenation, active external rewarming can prove to be a non-invasive, cost-effective method, which should be considered as a first-line treatment in severe hypothermia in a controlled environment.
Methods: A 59-year-old African-American female with a medical history significant for Schizophrenia presented to the emergency department after being found unresponsive by emergency medical services lying under a bench at a bus station. It was unclear for how long the patient was unresponsive. On arrival at the emergency department, her temperature was noted to be 25 degrees celsius (77 °F) and her heart rate was in the 30s with Osborne waves on EKG. Pupils were noted to be dilated and preferential left gaze was present. The patient was given 100 mg of hydrocortisone and was started on stress-dose steroids. There was no apparent acute seizure-like activity and no response to verbal or painful stimuli. Glasgow Coma Scale score was < 7, appeared obtunded therefore a decision was made to intubate the patient and was placed on PRVC. Rewarming was started with Arctic Sun to increase the patient's temperature by 1°C per hour and after reaching 30 °C was geared to be 0.5 °C per hour thereafter. Once normothermic the patient became awake, alert, and responsive the next morning.
Results: This case suggests that the successful use of active external rewarming in a controlled environment can be used as a means of treating severe accidental hypothermia. At temperatures below 25 °C, enzymes begin to denature, metabolic acidosis can occur which is often associated with life-threatening electrolyte derangements. Thus, we often tend to use invasive methods of active internal rewarming methods in severe hypothermia. We propose that slow external rewarming can present as a safe and effective means to rewarm individuals and prevent mortality.