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ENDGAMES: W G Headdon, P M Wilson, and Harry R Dalton The management of accidental hypothermia BMJ 2009; 338: b2085 [Full text]

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Error in the management of accidental hypothermia

Evan L Lloyd   (18 June 2009)

Error in the management of accidental hypothermia 18 June 2009
Evan L Lloyd, retired 72 Belgrave Road Edinburgh EH12 6NQ Send response to journal: Re: Error in the management of accidental hypothermia	I have some criticisms about one point. 1. Why was endotracheal intubation attempted? The respiratory rate was 8 breaths per minute, and oxygenation could have been maintained with a face mask. 2. There is no mention of pre-oxygenation prior to attempting endotracheal intubation. This is normal practice even in normothermic patients and is used to reduce the risk of hypoxia during the intubation since hypoxia increases the risk of ventricular fibrillation (VF). 3. Endotracheal intubation per se is not a risk factor for VF in hypothermia. Many patients have been intubated without inducing VF [1] but in all cases the patient was pre-oxygenated. 4. Why was the airway suctioned? There is no mention of excess secretions in the case report. This stimulation in a hypothermic, non-pre-oxygenated patient would be almost guaranteed to trigger VF. Otherwise I agree with the management and the answers to the questions. Reference. 1. Lloyd EL Accidental hypothermia. Resuscitation. 1996;32;111- 124. Competing interests: None declared