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· Signs: hypotension, bradycardia, J wave on ECG, SV arrhythmias, VF at 28 C, metabolic acidosis, loss of consciousness at 28 – 30 C, shivering replaced by rigidity at 33 C, pupils dilated.
· Lengthens tolerance of arrest: don‟t discontinue till they‟ve been warmed
· Arrest prevention:
o Prevent further heat loss
o Transport avoiding rough movement, which can precipitate VF
o If core temperature < 34 C, can rewarm with oesophageal rewarming tubes, peritoneal lavage (warmed saline or gas). Warm trunk not peripheries. Reduce movement (risk of VF). Rewarm slowly – 0.5 degrees/hour (unless fit and sudden hypothermia)
· During arrest:
o Take 30 – 45 secs to confirm cessation of ventilation and pulselessness
o Don‟t assume death until resuscitation has failed in an adequately rewarmed patient
o If < 30 C give maximum of 3 shocks until core temperature increases
o Reduced responsiveness to defibrillation and drugs. Impaired drug metabolism ® watch for toxicity
o Monitor fluids during rewarming
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