ITE review

Hypothermia

Modifications to standard ACLS algorithms in hypothermia

• Medications may fail to be metabolized and accumulate. Therefore, avoid repeated doses of medications.
• Defibrillation may be unsuccessful until the patient is rewarmed. Thus, serial shocks for VT/VF arrest are unlikely to add benefit. As the patient rewarms, further attempts may be made at defibrillation.

Rewarming patients with frostbite:

Goal for rapid rewarming. 40-42C is around 104-106F or about the temperature of a hot tub. This will rapidly rewarm but will not cause burns. Anything less will not rewarm tissue sufficiently. It is important NOT to rub/massage the affected digits, as the crystallized tissue is fragile and this will cause further cellular damage.

Tx: rewarm, liberal pain control, dressing/wounds care, reassess

High altitude cerebral edema (HACE) = always descend!

DERM

Rheumatic fever = Jones criteria = erythema marginatum (weeks later)

Core competencies

Interpersonal and communication skills: capacity

• not competence, an informed choice, alcohol use

Level A recommendation: established evidence, multiple RCT, meta-analysis

Level B recommendation: some evidence: single RCT; multiple population

Level C recommendation: limited evidence