Hypothermia and hot shower.

[fisherdvm]

I always thought DVM was for veterinarians.

I tried to change it to fisherMD, but they canned my twin for being a sockpuppet

 

[fisherdvm]

To translate- for severe hypothermia, flush warm stuff through all your orifices and rinse with hot water inside and out. You gotta be pretty weak to get whooped by a hot shower. (just translating )

PADI divemasters are my heros!! Finally talking a language that I can understand!!

 

[fisherdvm]

Honestly, for rapid core rewarming, we use warm IV fluids, warmed ventilator air, warm bladder flushes through a catheter, peritoneal lavage with warm saline, and in the last extremity, extracorporeal circulation with warming.

Rapid external rewarming permits further core temperature drop, because it reverses the protective vasoconstriction, allowing blood to come out to the still relatively cool extremities.

In the case of someone who was merely chilled from a pool, and probably not significantly hypothermic, I would think the lightheadedness from a shower was more a reversal of vasoconstriction combined with mild volume depletion, in a person with a normal/low resting BP. I doubt there was enough total heat loss here to induce shock.

Honestly, and not kidding, TSM...

What temperature do you warm the IV fluid to, and what rate? (I assume you have a bladder cath in place).

Warm bladder flushes? Wow, I didn't know that such a small volume can make a difference?

Peritoneal lavage sounds like a good deal, you would have to do a minor surgical cut down... In the midline at the belly button?? Probably can do that with local anesthetic, huh? While the dude is under sedation and on a vent?

And extracorporeal circulation warming?? Wow, I didn't even think that would be worth it, pumping the blood out, warm it up, and pump it back in??

Why don't we just do a warm water enema?? Cheap, quick, and just a little messy!!!

 

[fisherdvm]

If the patient was in cardiac arrest, and severely hypothermic (60 degree or less).... Would you continue CPR while warming him up. How fast do you want to warm him up? When do you start ACLS and defibrillation??

I know, I should read my ACLS book.... But haven't bought one yet. Borrowed the last one from the library... I'll have to renew my cert in a few months.

 

[Oregon Duck]

Yeah, fisher, I've had a similar experience - but following weight lifting and with no hypothermia. I lifted hard and then got into a hot tub. I crawled out after 5 minutes and lay on the floor with a terrible headache for 20 min. I felt like crap. Now I sometimes steam or sauna before a workout, but never after. I see guys I swim with get into a hot tub after a workout, but I keep on walking to a lukewarm or even cool shower and I feel fine after.

 

[LIVES4SHARKS]

http://www.emedicine.com/emerg/topic279.htm
I think everything you can ever want to know can be accessed on WEBMD. This is where most of us Rad Techs in our CT dept. get our information. Mayo Clinic and the CDC are also very useful sites.

Happy diving!
Carolyn :sharks:

Based on some of your commentaries...were you looking for real information or just a joke? Just curious.

 

[TSandM]

As the linked article implies, trying to restore a normal cardiac rhythm below 30 C is not likely to be productive. CPR would continue until that point, or, for really severe hypothermia, cardiopulmonary bypass (where available). IV fluids are generally warmed to 40 C -- above that, blood cells are damaged. Ventilator air is also at 40.

The warm bladder flushes are useful not because of the volume, but because of the amount of vascularity in the bladder wall -- a lot of heat transfer can occur here. Same with the peritoneal washes, which are done through the same kind of catheter used for peritoneal lavage in trauma patients, and through a small midline incision below the umbilicus.

Hypothermia is a frequent and sometimes severe problem with trauma patients, who are often exposed to the elements for some time during extrication and transport, so I'm very familiar with the issues.

 

[DocVikingo]

Hi TSandM,

I found your responses quite educational. Thanks for taking the time.

Regards,

DocVikingo

 

[Drewski]

Hi Lynn:

I'm thinking fisherDVM was probably just having a little fun and didn't mean his remarks to be taken TOO seriously. As usual, your advice is always GREAT.

Personally, HOWEVER, my goal is always to have a dive buddy who is a member of the Swedish Bikini Team or models for Henderson. You know, those women that STARE at you with that "look of longing" in those Henderson wetsuit ads. Trust me when I say, they ALWAYS keep me HOT! That probably explains why I have 3 Henderson wetsuits hanging in my garage...

BUT, hey, I don't get cold!

 

[mania]

As for me TSM posts were very interesting. Just one question....(stupid)
BP=blood preasure?

Remember I'm not an English native speaker....
Mania
Or BP=backplate?