Hypothermia and ecg changes

Hypothermia:

Hypothermia is defined as body temp below 95 F or 35 C + altered mental status and neurodeficit (i.e. Ataxia)

Hypothermic heart is prone to arrythmias, incl V fib

Importently ::: most acurate way to determine a patients temp is via Esophageal thermometer (better than rectal or bladder) !!!

Cold Stress:

Something hypothermia do to the system:: We can say it as Cold stress

Cold stress>> Slowing of Physiologic functions (metabolism, enzymatic reactions)>> it will result in 2 things

1.. Decreased automaticity

2. Decreased Conduction ability of cardiac tissue

1 & 2 >> will lead to conduction delay

As a result of this mechanism> Related ECG findings will be found as in the above case i.e: PR prolongation, QRS widening, Bradyarrythmias, J (OsBorn) wave, irregular baseline (shivering induced)

Difference between STE and J wave is given in this picture

Next Question comes in mind, what are the major Culprits in Hypothermia

There are few::

1. Heat Loss (accidental cold exposure may be ;)

2. Vasodilation: - Drugs, -Alcohol, - Sepsis

3. Impaired Heat Production: -Endocrine disorder, - malnutrition, - Hypoglycemia

4. Iatrogenic: -Massive Transfusion, - Dialysis, -Intentional Hypothermia protocol goes wrong

5. Impaired Thermoreglation:: -SPinal cord injury, - CVA, Hypothalamic injury

Now i am going to explain some pathophysiology and hemodynamics in Hypothermia

Initially there will be increase in SVR via vasoconstriction to prevent heat loss and maintain core temperature.

This will result in increased central blood volume>> causing an inhibition of ADH release>> resulting into large quantities od dilute urine (cold induced Diuresis)>> resulting into HYPOTENSION

This cold results into these changes above, so while treating these patients we should be careful as our patient may need/ has>> Labile Vital Signs (possible pressor needs), Fluid requirements accordingly

Credits: IMCore

I hope we learnt today something. More facts to come soon

Evaluation of Pseudocoma VS Coma

Evaluation of Pseudocoma

Difference Pseudocoma VS Coma

Here is a short table to quickly differentiate a patient with pseudocoma from true coma

Erythema Multiforme

●Erythema multiforme (EM) is an acute, immune-mediated disorder that involves the skin and/ormucosal surfaces. The treatment of acute EM varies according to the severity of the acute eruption and the presence or absence of recurrent disease.

●Many cases of EM occur secondary to herpes simplex virus (HSV) infection. In patients with HSV-induced EM, treatment with oral antivirals in the acute setting does not alter the course of EM, and is not indicated.

●Most patients with EM can be managed with symptomatic therapy alone. For patients with cutaneous disease and/or mild oral mucosal involvement, treatment with topical corticosteroids, oral antihistamines, and/or an anesthetic mouthwash is sufficient.

●Severe oral mucosal involvement may be accompanied by intense pain and an inability to eat or drink. For patients with severe oral mucosal involvement, we suggest treatment with oral prednisone (40 to 60 mg/day) tapered over the course of two to four weeks (Grade 2C). Patients with disabling symptoms may require hospitalization for nutrition and pain control.

●Ocular involvement rarely may lead to keratitis, conjunctival scarring, or visual impairment. Patients with ocular symptoms should be referred to an ophthalmologist.

●Some patients with EM develop recurrent disease. When feasible, the inciting agent should be identified and eliminated. For patients with HSV-induced or idiopathic EM that recurs ≥6 times per year, or who have fewer, but disabling episodes, we recommend treatment with continuous antiviral therapy (Grade 1B).

●For patients with severe, recurrent EM who fail to respond to continuous systemic antiviral therapy, we suggest treatment with azathioprine, mycophenolate mofetil, or dapsone (Grade 2C). Other options for therapy include other immunomodulatory drugs.

Epiblepharon & Euryblepharon

Epiblepharon

 Extra fold of skin in the lower lid with inturning of eyelashes

 Nasal 1/3rd is most commonly affected

 Treatment: Plastic repair if necessary to prevent recurrent infection.

Euryblepharon

Rare, congenital, bilateral, not so serious condition

•  Palpebral apertures are larger than normal 

              and may be with epicanthus

• Excessive watering may be a problem due to more exposure

 Treatment:

 No treatment for most of the cases; lateral tarsorrhaphy for symptomatic cases.