Hypothermia is a common problem for both pre and in-hospital clinicians. Understanding the underpinning physiology helps us deliver first class care to our patients, decreasing associated morbidity and mortality.
There is some extremely difficult decision making to be done in severe cases of hypothermia and the podcast gives us an opportunity to explore them further.
We'll cover the subject in depth with particular reference to the following categories of hypothermia; treatment, modifications in cardiac arrest and prognostication.
Simon, Rob & James
ERC 2015; Cariac arrest in specialist circumstances
Up to Date; Hypothermia
At the bedside, out of the cold: management of hypothermia and frostbite.BiemJ.CMAJ. 2003
The prehospital management of hypothermia - An up-to-date overview. Haverkamp FJC. Injury. 2018
Accidentalhypothermia-an update: The content of this review is endorsed by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). Paal P. Scand J Trauma Resusc Emerg Med. 2016
Accidental hypothermia. Brown DJ. 2012 N Engl J Med.
Ketamine and trauma are the topics for this months papers.
The three papers we cover are really important for all of us involved in the care of critically unwell patients. Hypotensive resuscitation in the context of trauma has been an evolving area of practice in the treatment of our acute trauma victims. A paper published in SJTREM this month meta-analyses the data that exists out there on the topic and looks to give us an idea of the benefits and potential risks associated with such an approach, the paper is available here and is well worth a full read.
Morphine has been a mainstay of the treatment of acute severe pain in the Emergency Department for decades, but as the popularity of ketamine grows we take a look at another meta-analysis, this time comparing the efficacy of ketamine versus morphine in this setting and group of patients.
And lastly, if you have ever had a patient become severely agitated with ketamine sedation, you'll be keen to avoid that happening again! The last paper we look at is a randomised control trial looking at the potential benefits of using either midazolam or haloperidol to achieve that.
We hope you find the podcast useful, as ever please go and take a look at the papers yourself and we'd love to hear any thought or comments you have either rat the bottom of the page, or via twitter @TheResusRoom.
Simon & Rob
Risks and benefits of hypotensive resuscitation in patientswith traumatic hemorrhagic shock: a meta-analysis. Owattanapanich N. Scand J Trauma Resusc Emerg Med.2018
A Systematic Review and Meta-analysisof Ketamine as an Alternativeto Opioids for Acute Pain in the Emergency Department. Karlow N. Acad Emerg Med.2018
Premedication With Midazolamor Haloperidolt o Prevent Recovery Agitation in Adults Undergoing Procedural Sedation With Ketamine: A Randomized Double Blind Clinical Trial. Akhlaghi N. Ann Emerg Med.2019
St Emlyns; JC: Should we premedicate for ketamine sedation?