Determinism, Coincidental or Multiple Concurrent Ischemic Events in Severe Hypothermia – Case Report

Introduction Accidental hypothermia produces a multitude of complex issues in the evaluation plan, investigative strategy, tactics and choice of therapeutic resources and the development and prognosis of the patient, especially in a plurilessional context. Case study We examined the case of a 79 years old patient, assisted at ED Craiova in November 2012 with severe hypothermia, found down the street. On admission to the ED, he appeared confused, disoriented in space and time, GCS = 10, no focal signs with generalized rigidity, tremor. Killip III cardiogenic shock, peripheral pulses hardly perceptible. Cold extremities, mottled. The patient with severe hypothermia (central T 29.1 ° C) had multiple confounding aspects of cerebral ischemia, peripherical of the limb and myocardial, possible attributable to both hypothermia, cardiogenic shock (acute coronary syndrome in the comment), an evolving ischemic stroke, an acute peripheral left limb ischemia with severe rhabdomyolysis, acute bilateral pneumonia, or association in different degrees and their sequences,with the prognosis of extreme gravity. The determinism, primary or secondary of the cardiac rhythm disorders in relation to hypothermia, give also rise to discussions and the possibility of little peripheral embolism can be neglected. Conclusions • Cardiogenic shock was the turning point in determining the evolution of this case and its double determinism conditioned most likely the poor prognosis of the patient. • Pneumonia was the second severe impairment that influenced survival, limiting refilling and affecting oxygenation optimization Vol 63, No. 7;Jul 2013 107 Jokull Journal • The question of etiology of heart disrhythmia, its seniority and role in the induction of cerebral and peripheral ischemia •The myocardial vulnerability maintained both during hypothermia and after reheating • A number of clinical syndromes may have particular aggravating evolution in the context of hypothermia • Therapeutic response was affected by hypothermia • A series of subclinical suffering became manifests in these circumstances, such as renal suffering and peripheral arterial disease • It is always difficult to distinguish the primary event in a clinical context complicated by the presence of hypothermia.