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Rewarming hypothermia in rural Navajo Reservation |

Rewarming hypothermia in rural Navajo Reservation

| May 1, 2016

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following title with names and credential each person, primary employer and location of each author

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Abstracts of case report must report on uncommon clinical case or a new improved method of management or treatment and must include:

Introduction: Relevant basic information important to understanding the case.

Case summary: patient data and response , details of interventions

Discussion: Should relate results to what is already known in literature.

MY report on clinical findings:
65 year old male found my highway unconscious, brought in by EMS to small rural hospital, very thin in appearance.
vitals: blood pressure 184/64, heart rate 129, SP02 74% room air, temperature 29.4 degrees Celsius, mental status disorientated combative at times. smells of alcoholic like beverage on breath. very cold to touch History per family: asthma and hit by lightening twice earlier years

intervention: removed clothing, warmed IV fluids, warmed highflow nasal cannula 50% oxygen, bear hugger, chem 7, drugs of abuse (negative), sputum sample, WBC, troponin, electrolyes panal, arterial blood gas, PT/INR, small volume nebulizers PRN, EKG sinus tachycardia,

admit to adult care unit: 5000 ml fluid infused; output 300 foley to gravity.

Chest Xray next day: groundglass opacities, chest pain, pt given morphine IV.

levaquin 250IV q day, lovenox 40 mg QDay, aspirin 81 mg per day, oxycodone 5 mg PRN, IV fluids Normal salaine 1 liter and 2 amps of bicarb, total IV solution administered 920ml out put 1200 ml out.
fluid overload 5920 ml in output of patient 1500 ml. creatine kinase 14451 u/l high value level tired to flush patients kidneys not successful. White blood count 13.07, anion gap 30.6, sodium 140, potassium 4.1, chloride 101, lactic acid 11.2, troponin <0.05, CKMB >80.0u/l,
currently on 4LPm via nasal cannula, red frothy sputum noted, pt given solu-medrol, and diuretics to remove excess fluids. may have been from alveolar hemorrhage. CK on admit 28000 and dropped to 400. blood cultures negative, positive for rhinovirus/enterovirus, sputum culture grew yeast, rapid strep positive, and urine negative legionella.

pleural effusions suggestive of congestive heart failure.

patient sent home on oxygen and follow up care after seven days in hospital.

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Category: Healthcare

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