Emergency medicine (Fremantle, W.A.)
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This review considers several recent concepts regarding aetiology and treatment of accidental hypothermia. The importance and effectiveness of shivering heat production in the attenuation and reversal of hypothermia is described. Immediately following removal from cold stress, the patient is in danger of a deteriorating condition that may be due to collapse of arterial pressure and/or continued decrease of core temperature. ⋯ In the emergency department, several factors should be considered before deciding on a treatment regimen. These factors include level of consciousness, cardiovascular stability, core temperature and the direction of change of core temperature. It may be advantageous to transport the more severely hypothermic patient to a more advanced care facility even though transport time may be greater.
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The differential diagnosis of the hyperpyrexic patient in the emergency department is extensive. It includes sepsis, heat illness including heat stroke, neuroleptic malignant syndrome, malignant hyperthermia, serotonin syndrome and thyroid storm. ⋯ However, establishing the correct diagnosis is a challenge in the setting of the obtunded emergency patient who gives no history and where there may be limited access to any past medical or drug history. This paper presents such a case and reviews the features of the differential diagnoses and management of the hyperpyrexic patient.