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Hypothermia

Introduction

Core (rectal) T < 35^oC

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Causes

Hypothermia in the elderly is usually caused by hypothalamic failure plus any of:

Illness
- infection
- MI

Endocrine
- thyroid dysfunction
- Diabetes Mellitus (DM)

Drugs
- EtOH
- diuretics
- tranquillizers

Autonomic neuropathy
- DM
- Parkinson's

Low ambient temp falls
- poverty
- poor housing, etc.

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Complications

Arrhythmias
- bradycardia
- AF
- VT < 32^oC
- VF

Coma

Severe
- pancreatitis
- DIC

Other
- pneumonia
- ARF

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Investigation

Rectal temperature
- < 35 ^oC
- use low-reading thermometer (PR) if oral / axillary temp < 36^oC

ECG
- J waves
- arrhythmias

Bloods
- FBC, U&Es
- BM
- amylase
- TFTs
- cultures

ABGs

CXR

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Management

A: ventilate
B: oxygen
C: slow warmed fluids, catheter, bladder-washouts
D
E: slow rewarming (1/2 ^oC/hr), thermal blankets

Monitor ABP and avoid rapid re-warming leading to vasodilatation ++ and shock.

Also consider:
- prophylactic antibiotics (?pneumonia)

Before discharge:
- review drug chart
- MDT risk assessment

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