A 53-year-old man with alcohol use disorder is brought to the emergency department after being found in a park on a cold day in winter. He was unresponsive when found and was intubated in the field by paramedics. On arrival, his body temperature is 31 C (88 F), blood pressure is 77/48 mm Hg, and pulse is 31/min. ECG shows sinus bradycardia and QT interval of 560 msec. Which of the following is the best next step in managing this patient's hemodynamic status?

Question

A 53-year-old man with alcohol use disorder is brought to the emergency department after being found in a park on a cold day in winter.  He was unresponsive when found and was intubated in the field by paramedics.  On arrival, his body temperature is 31 C (88 F), blood pressure is 77/48 mm Hg, and pulse is 31/min.  ECG shows sinus bradycardia and QT interval of 560 msec.  Which of the following is the best next step in managing this patient's hemodynamic status?

Quizplus · Accepted Answer

11ec25c8_d1c4_91dd_bc81_1d3a848df874_MD0003_00 This patient's unresponsiveness, temperature of 31 C (88 F), and bradycardia are consistent with moderate hypothermia from cold exposure. Mild hypothermia (32-35 C [90-95 F]) causes an increase in heart rate with peripheral vasoconstriction. Moderate hypothermia (28-32 C [82-90 F]) causes progressive bradycardia and hypotension due to decreased reactivity of pacemaker cells and salt/water loss from cold-induced diuresis. Primary therapy for moderate hypothermia is active external rewarming, which includes use of warmed blankets, warm baths, and warmed intravenous fluids. (Choices B and E) Due to decreased reactivity of the pacemaker cells, the bradycardia associated with hypothermia is often refractory to treatment with atropine and cardiac pacing. However, it usually will improve with treatment of the hypothermia. (Choice C) Levothyroxine is used to treat hypothermia caused by myxedema. (Choice D) Intravenous magnesium sulfate is typically used to treat polymorphic ventricular tachycardia associated with acquired QT prolongation (torsades de pointes). torsades de pointes Educational objective: Primary therapy for moderate hypothermia includes active external rewarming and warmed intravenous fluids. Bradycardia associated with hypothermia is often refractory to treatment with atropine and cardiac pacing, but it usually improves with correction of hypothermia. References: Diagnosis and treatment of hypothermia. (http://www.ncbi.nlm.nih.gov/pubmed/15617296)

A 53-Year-Old Man with Alcohol Use Disorder Is Brought to the Emergency