小结
定义
病史和体格检查
关键诊断因素
- presence of risk factors
- cold exposure and body temperature <35°C (<95°F)
- cognitive impairment
- shivering
- frostbite
其他诊断因素
- tachypnoea, tachycardia, hypertension
- respiratory depression, bradycardia, hypotension
- coma and apnoea
- cold-induced diuresis
危险因素
- general anaesthetic use
- older age
- very young age
- immobility
- substance misuse
- impaired cognition
- hypothyroidism
- stroke
- Parkinson's disease
- homelessness
- gram-negative septicaemia
- neuroleptic medication
- beta-blocker medication
- sedative hypnotic medication
诊断性检查
首要检查
- core temperature measurement
- 12-lead ECG
- blood glucose
- blood gas
- serum urea, electrolytes, and creatinine
- FBC
- clotting screen
- chest x-ray
需考虑的检查
- serum creatine kinase
- myoglobin levels
- end-tidal CO₂
- ultrasound
治疗流程
moderate or severe hypothermia in cardiac arrest: ≤32°C (≤90°F)
moderate or severe hypothermia not in cardiac arrest: ≤32°C (≤90°F)
mild hypothermia: >32°C to 35°C (>90°F to 95°F)
撰稿人
专家顾问
Alexander Alexiou, MBBS, BSc, DCH, FRCEM, Dip IMC RCSEd
Emergency Medicine Consultant
Barts Health NHS Trust
Physician Response Unit Consultant
London’s Air Ambulance
Royal London Hospital
London
UK
利益声明
AA declares that he has no competing interests.
Melvyn Jenkins-Welch, MBBS, BSc, MSc, FRCA, FFICM
Consultant Critical Care Medicine
Cardiff and Vale ULHB
Cardiff
UK
利益声明
MJW declares that he has no competing interests.
鸣谢
BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:
Emmanuel Atta Agaba, MD, FRCSEd, FACS
Attending Surgeon
Assistant Professor of Surgery
Montefiore Medical Center at Albert Einstein College of Medicine
Bronx
NY
Rafael Barrera, MD, FACP
Director
Surgical Intensive Care Unit
Long Island Jewish Medical Center
New Hyde Park
NY
利益声明
EAA and RB declare that they have no competing interests.
同行评议者
Patrick Morgan, MBChB, FRCA, FFICM, Dip IMC RCSEd, DiMM
Consultant in Anaesthesia
North Bristol NHS Trust
Bristol
Pre-hospital and Retrieval Doctor
Emergency Medical Retrieval and Transfer Service (EMRTS) Cymru
UK
利益声明
PM is Medical Director, HM coastguard (UK). PM has been a medical expert witness in hypothermia, cold water-immersion and drowning. PM is a Research Associate/student at the Extreme Environments Laboratory, University of Portsmouth.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Dow J, Giesbrecht GG, Danzl DF, et al. Wilderness Medical Society clinical practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2019 update. Wilderness Environ Med. 2019 Dec;30(4 Suppl):S47-69.全文 摘要
Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation. 2021 Apr;161:152-219.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Sepsis
- Hypothyroidism
更多 鉴别诊断指南
- European Resuscitation Council guidelines for resuscitation 2021
- Clinical practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia
更多 指南医学计算器
Glasgow Coma Scale
更多 医学计算器登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明