WikEM - User contributions [en]

Tubo-ovarian abscess

2021-05-25T17:48:57Z

Doctorm9: /* Outpatient */

==Background==
*Typically a complication of [[PID]], although inflammatory bowel, [[appendicitis]], and hematologic nidius have been reported
*Mortality if not ruptured: <1% if treated; 2-4% if untreated
*Infections are often polymicrobial
**Common organisms: [[Escherichia coli]], aerobic streptococci, [[Bacteroides fragilis]], Prevotella, Peptostreptococcus
**[[N. gonorrhoeae]] and [[C. trachomatis]] are rarely culprit organisms

===Risk factors===
*Multiple sex partners
*Age 15-25 years old
*Prior history of [[PID]]
*[[IUD]] (within 21 days of insertion<ref>https://www.cdc.gov/std/tg2015/pid.htm</ref>)
*[[HIV]] infection

==Clinical Features==
*+/-[[Fever]]
*[[Vaginal discharge]]
*Dyspareunia
*Disproportionate unilateral adnexal tenderness or adnexal mass or fullness
*Suspect in patient who does not respond after 72hr of treatment for [[PID]]

==Differential Diagnosis==
{{Pelvic pain DDX}}

==Evaluation==
[[File:PMC4603210 usg-15013-f11.png|thumb|Dilated, complex, fluid-filled tubular structure is consistent with hydro/pyosalpinx (A, B). Short-axis image (C) demonstrates the “cog-wheel” pattern of the endosalpingeal folds, indicative of tubal inflammation in pelvic inflammatory disease with a pyosalpinx or a hydrosalpinx. (arrows).]]
*CBC
*ESR/CRP
*Transvaginal pelvic ultrasound (Sn 75-82%)
*CT pelvis (Sn 78-100%) - preferred in patients in whom associated GI pathology must be excluded

==Management==
*OB/GYN consult for possible operative drainage.
*Majority (60-80%) resolve with [[antibiotics]] alone
*Predictors of antibiotic treatment failure and possible indications for IR drainage upon admission to Ob<ref>Huma F et al. Inpatient Management of Tubo-Ovarian Abscesses: What Is the Threshold of Parenteral Antibiotic Treatment Failure? Obstetrics & Gynecology: May 2015</ref>
**WBC > 16,000
**TOA size > 5.2 cm

===Outpatient===
*[[Ceftriaxone]] 500mg IM once '''PLUS''' [[doxycycline]] 100mg PO BID x14 days
*[[Metronidazole]] 500mg PO BID x14 days now recommended empirically by European guidelines <ref>Ross J, Guaschino S, Cusini M, Jensen J, 2017 European guideline for the management of pelvic inflammatory disease. Int J STD AIDS. 2018 Feb;29(2):108-114. doi: 10.1177/0956462417744099. Epub 2017 Dec 4.</ref>. Supported by CDC. Definitely give if suspicion of bacterial [[vaginitis]] or gynecological instrumentation in preceding 2-3 wks

===Inpatient===
*[[Cefoxitin]] 2gm IV q6hr '''OR''' [[cefotetan]] 2gm IV q12hr) + [[doxycycline]] PO or IV 100mg q12hr '''OR'''
*[[Clindamycin]] 900mg IV q8h + [[gentamicin]] 2mg/kg QD '''OR'''
*[[Ampicillin-sulbactam]] 3gm IV q6hr + [[doxycycline]] 100mg IV/PO q12hr

==Disposition==
*Decision should be made in conjunction with gynecological colleague
*Patient with fevers, elevated WBC, abscess greater than 5 cm, or systemic toxicity demand admission
*Hemodynamically stable, afebrile patients with a relatively small [[abscess]] can be safely discharged with close gynecological follow up on antibiotics

==See Also==
*[[PID]]

==References==
<references/>

[[Category:ID]]
[[Category:OBGYN]]

Pericarditis

2018-06-10T19:53:02Z

Doctorm9: /* Initial Treatment */

==Background==
[[File:Pericarditis.jpg|thumbnail|Pericarditis compared with normal pericardium]]
===Etiology===
*Idiopathic (25-85%)
*Infection (up to 20%, including viral, bacterial, TB)
*Malignancy: heme, lung, breast
*[[Uremia]]
*Post radiation
*[[Connective tissue disease]]
*Drugs: [[procainamide]], [[hydralazine]], methyldopa, anticoagulants
*Cardiac injury (can see up to weeks later): post [[MI]] (Dressler's syndrome), [[thoracic trauma]], [[aortic dissection]]

==Clinical Features==
*Pleuritic [[chest pain]]
**Radiates to chest, back, left trapezius
**Diminishes with sitting up/leaning forward
*[[Shortness of breath]]
**Especiallyif concommitant [[pleural effusion]]
*Hypotension/extremis if [[cardiac tamponade]]
*[[Fever]], chills, myalgias (systemic signs with viral infection)
*Friction rub

==Differential Diagnosis==
*[[CHF]]
*[[PE]]
*[[Pneumothorax]]
*[[Aortic dissection]]
*[[Pneumomediastinum]]
*[[Pleuritis]]

{{ST elevation DDX}}

==Evaluation==
===Diagnostic Criteria for Acute Pericarditis<ref>Imazio M, Gaita F, LeWinter M. Evaluation and Treatment of Pericarditis: A Systematic Review. JAMA 2015;314(14):1498–506.</ref>===
*Need 2 of the following
**Chest pain (typically sharp and pleuritic, improved by sitting up and leaning forward)
**Pericardial friction rub
**New or worsening pericardial effusion
**Suggestive ECG changes

===Work-Up===
*[[ECG]]
*Labs
**WBC, CMP, ESR, CRP
**Consider TSH, ANA based on clinical suspicion
**[[Troponin]] elevation may indicate a concurrent [[myocarditis]] which predispose to risk of [[CHF]] or [[arrhythmias|arrhythmia]]. <ref>LeWinter MM, et al. Clinical practice. Acute pericarditis. N Engl J Med. 2014 Dec 18;371(25):2410-6. PMID: 25517707.</ref>
*[[CXR]]
*Bedside Ultrasound to rule out effusion
**~2/3 of cases will have pericardial effusion<ref>LeWinter MM. Clinical practice. Acute pericarditis. N Engl J Med. 2014 Dec 18;371(25):2410-6. doi: 10.1056/NEJMcp1404070. Review. </ref>
*Can consider CT or cardiac MRI if workup non-diagnostic and clinical suspicion persists

===ECG===
[[File:ECG000026-2.jpg|thumb|Acute pericarditis with clear diffuse ST elevation and some PTa depression]]
====Classical Teachings with Caveats Below====
*Must differentiate from [[STEMI]] (classical teachings are not specific enough to do that)
*Classically pericarditis has diffuse ST-elevations
**However, pericarditis may generate localized ST-elevations
**Pericarditis '''should never produce ST-depressions''' (suggestive of reciprocal changes), except in V1 and aVR
*Classically pericardidits has concave upwards STE
**However, [[STEMI]] may have concave upwards ST-segment morphology as well
**Rather, it is '''STE convex upwards or horizontal''' that favors [[STEMI]]
*Classically pericardititis has PR-depression in ''viral pericarditis'' (or PR-elevation in AVR)
**Less reliable in post-MI patients and those with baseline ECG abnormalities
**PR-depression is often early and transient in pericarditis
**In [[STEMI]], PR-depression is associated with atrial injury, though usually not as marked as in viral pericarditis<ref>Wang K, Asinger RW, and Marriott HJL. ST-segment Elevation in Conditions Other than Acute Myocardial Infarction. N Engl J Med 2003;349:2128-35.</ref>
**PR-elevation in aVR may also be present in [[STEMI]] and is infrequently seen in constrictive pericarditis

====Other Findings====
*Leads II and III
**STE II > STE III favors pericarditis
**'''STE III > STE II very strongly''' favors [[STEMI]]
*STD not in aVR or V1 (reciprocol changes) suggestive of [[STEMI]]
*May see low voltage/alternans if effusion present
*If [[early repolarization]] confounding interpretation check ST:T ratio
**If (STE)/(T height) in V6 or I > 0.25, then it is likely pericarditis
*If predominantly inferior STE, ST-depression in aVL is sensitive for STEMI<ref>Bischof JE, Worrall C, Thompson P, et al. ST depression in lead aVL differentiates inferior ST-elevation myocardial infarction from pericarditis. Am J Emerg Med. 2016; 34(2):149-154.</ref>
*Spodick's sign, purportedly in ~80% - downsloping TP segment, often best seen in lead II and lateral precordial leads<ref>Chaubey VK and Chhabra L. Spodick’s Sign: A Helpful Electrocardiographic Clue to the Diagnosis of Acute Pericarditis. Perm J. 2014 Winter; 18(1): e122.</ref>
[[File:ST-T ratio.jpg|thumbnail]]
[[File:Spodick's_sign.JPG|thumbnail|Spodick's sign]]

====Stages of Progression====
[[File:Stadia pericarditis.png|thumb|Stages of pericarditis]]
[[File:Ptadepressie.png|thumb|PTa depression]]
*Stage I:
**Global concave up [[ST elevation]] in all leads (esp V4-6, I, II) in all leads except in aVR, V1 and III
**PTa depression (depression between the end of the P-wave and the beginning of the QRS- complex)
*Stage II:
**"pseudonormalisation," ST to baseline, big T's, PR dep
*Stage III:
**T wave flatten then inversion
*Stage IV:
**Return to baseline

{{STEMI vs pericarditis}}

==Management==
===Initial Treatment===
*'''NSAIDS or Aspirin (ASA)'''first line treatment (in absence of contraindications) for viral or idiopathic pericarditis.<ref>Imazio M. A randomized trial of colchicine for acute pericarditis.N Engl J Med. 2013 Oct 17;369(16):1522-8 [http://www.nejm.org/doi/pdf/10.1056/NEJMoa1208536 PDF]</ref>
**[[Aspirin]] 800mg every 8 hours for 7 to 10 days, followed by tapering during a period of 3 to 4 weeks '''OR'''
**[[Ibuprofen]] 600mg every 8 hours for 7 to 10 days, followed by tapering during a period of 3 to 4 weeks
*'''Colchicine''' add cholchicine to NSAIDs as first line treatment for viral/idiopathic acute and recurrent pericarditis to improve remission rates and prevent recurrence.<ref>ImazioM, BobbioM, Cecchi E, et al. Colchicine in addition to conventional therapy for acute pericarditis. Circulation. 2005;112(13):2012-2016.</ref>
**Patients >70kg - 0.6mg PO BID x 3 months
**Patients<70kg - 0.6mg PO Daily x 3 months
*'''Glucocorticoid therapy''' second line agent for viral/idiopathic pericarditis, can consider low-moderate doses for patients with contraindications to [[NSAIDs]] or persistent symptoms despite appropriate therapy with NSAIDs + colchicine for at least 1 week. Also used for etiologies that are steroid responsive diseases.
**[[Prednisone]] 0.2 to 0.5mg/kg of body weight per day for 2 weeks with gradual tapering<ref>Imazio M, Brucato A, Cumetti D, et al. Corticosteroids for recurrent pericar- ditis: high versus low doses: a nonran- domized observation. Circulation 2008; 118:667-71.</ref>

===Recurrent or Refractory===
''For recurrent or refractory cases consider colchicine and or steroids although literature suggests it can be used as first line''<ref>Imazio M.Colchicine as first-choice therapy for recurrent pericarditis: results of the C'''OR'''E (COlchicine for REcurrent pericarditis) trial. Arch Intern Med. 2005 Sep 26;165(17):1987-91.</ref>

*'''[[Colchicine]]'''
**Patients >70kg - 0.6mg PO BID x 6 months
**Patients<70kg - 0.6mg PO Daily x 6 months
**If patients develop serious diarrhea decrease their dosing to the next weight class or stop treatment.

====Contraindications to Colchicine<ref>Imazio M. Controversial issues in the management of pericardial diseases.Circulation. 2010 Feb 23;121(7):916-28.[http://circ.ahajournals.org/content/121/7/916.long PDF] </ref>====
*Tuberculous
*Neoplastic pericarditis
*Liver disease or aminotransferase levels ≥1.5x upper limits of normal
*Creatinine >2.5mg/dL (>221 umol/L)
*Myopathy or CK > upper limits of normal
*Inflammatory bowel disease
*Life expectancy ≤18 months
*Pregnancy or lactation

===Uremic Pericarditis===
*The definitive treatment is dialysis

===[[Pericardial effusion and tamponade|Tamponade]]===
*Tamponade requires [[Pericardiocentesis]]

==Disposition==
*Hospitalization is not necessary in most cases
*Consider admission for:
**Patients likely to have a specific cause (i.e. uremia, malignancy)
**Subacute onset over weeks
**[[Fever]] >100.4
**Large effusion (echo-free space>20mm)
**Cardiac tamponade
**Immunosupressed
**Anticoagulant use
**Failure to respond to [[NSAID]]s (>7dy)
**Elevated cardiac enzymes (suggesting myopericarditis)
**Trauma

==Complications==
*[[Pericardial Effusion and Tamponade]]
*Recurence
**Usually weeks to months after initial episode
**Management is same
*Constrictive Pericarditis
**Related to etiology; increased risk with bacterial pericarditis, rare with viral/idiopathic etiology
**Restrictive picture with pericardial calcifications on CXR, thickened on TTE
**Treat with pericardial window

==External Links==
*[https://www.youtube.com/watch?v=XVCEPy5KH_w Mattu ECG Case: Sept 3, 2012 - Pericarditis vs. STEMI]

==See Also==
*[[ST segment elevation]]
*[[STEMI]]
*[[Myocardial infarction complications]]

==References==
<references/>

[[Category:Cardiology]]

Blast injury

2016-12-08T17:35:48Z

Doctorm9: PBI abbreviation used without being written out

==Background==
*Primary blast wave increased in closed space - detonation in corner has potential to increase blast yield to 8x
*Recent enhanced-blast weapons (EBW) disperses gas before explosion - larger blast wave with lower pressure amplitude that diffuses around corners

===Spalling Effect===
Due to blast pressure forces, Injuries are to organs with air-fluid interfaces (spalling effect)
*TMs
*Alveoli
*GI tract

===Situational Examples===
*Military - young healthy soldiers with body armor reducing thoracic/abdominal injuries but significant groin and lower extremity injuries
*Civilian - children to elderly, higher rates of penetrating thoracic/abdominal injury

===Injury Classifications===
{|class="wikitable"
|+ Classification
|-
! scope="col" | '''Blast Type'''
! scope="col" | '''Injury Cause'''
! scope="col" | '''Injuries'''
! scope="col" | '''Example'''
|-
| Primary||Direct effect from shockwave||Sheer and stress forces||[[TM rupture]], Ocular Injury, [[concussion]], blast lung
|-
| Secondary||Impact of fragments|Penetrating trauma, amps, lacs||
|-
| Tertiary ||Blast propels body or large object into body||[[Crush injury]] and blunt trauma||Similar to MVC: Fractures, [[Pneumothorax]], Hemopneumothorax
|-
| Quaternary ||Environmental||Burns, Toxins, Weather||
|-
| Quinary ||Bodily absorption of contaminates||Hypermetabolic state||
|}

{{Department of navy blast effects}}

==Clinical Features==
===Pulmonary===
*Blast lung is the most common fatal primary blast injury (PBI)
*[[Pulmonary contusion]]
*[[Pneumomediastinum]] due to alveolar rupture - [[pneumothorax]], subcutaneous emphysema, [[pneumopericardium]], pneumoretroperitoneum, pneumoperitoneum, [[air embolus]]
*Thrombosis, [[DIC]], [[ARDS]]
===EENT===
*[[TM rupture]] most common - not a marker of PBI severity or prognosis
*Hemotympanum
*Ossicle injury
*Direct ophthalmic injury, foreign bodies, or ophthalmic artery air embolus
===Thoracic===
*Cardiovascular collapse (within seconds)
*Hypotension due to impaired reflex that increases SVR
===Infectious Disease===
*Transmission of disease due to penetrating trauma is rare but possible with HIV, HCV, HBV
===Musculoskeletal===
*[[Amputations]]
*[[Burns]]
===Markers of severe blast injury===
*> 10% TBSA burn
*Skull, facial fracture
*Penetrating injury to head or thorax
*Traumatic amputations

==Differential Diagnosis==
{{MCI types}}

==Evaluation==
*[[CXR]], CT chest
*FAST, comprehensive CT
*Repeat clinical abdominal exams looking for peritonitis - X-rays, US, CT insensitive except in perforation
*Initial CT head may not be enough - may require MRI for DAI
*Labs
**Consider carboxyhemoglobin and electrolytes
**Screening UA for significant explosions
**Burn labs (rhabdomyolysis, compartment syndrome, severe burns)
**DIC labs (PT, aPTT, CBC, D-dimer, thrombin time, fibrinogen)
**White phosphorous labs ([[hypocalcemia]], [[hyperphosphatemia]], LFTs)

==Management==
*pRBCs and FFP in 1:1 ratio with platelets for hemodynamically unstable patients
*[[TM rupture]] - initial treatment supportive and enough for 75% with spontaneous healing; operative repair may be necessary for others
*Operative exploration for peritonitis
*[[Air embolus]] (rare) - isolate air in apex of LV by placing patient in left decubitus, head down, feet up position

==Disposition==
*Ambulatory patient with normal TM evaluation at low risk for occult blast injury - discharge with precautions

==See Also==
*[[Explosions]]

==References==
<references/>

==Video==
{{#widget:YouTube|id=4Q208UposjQ}}

[[Category:Trauma]]

Template:Abortion types

2016-11-13T18:17:02Z

Doctorm9: Complete Abortion Fetal Tissue Passage: "No" to "Yes"

===[[First trimester abortion|Abortion]] Types===
{| class="wikitable"
! style="font-weight: bold;" | Classification
! style="font-weight: bold;" | Characteristics
! style="font-weight: bold;" | OS
! style="font-weight: bold;" | Fetal Tissue Passage
! style="font-weight: bold;" | Misc
|-
| Threatened
| Abdominal pain or bleeding; < 20 weeks gestation
| Closed
| No
| If < 11 weeks 90% progress to term. If between 11 and 20 weeks 50% progress to term
|-
| Inevitable
| Abdominal pain or bleeding; < 20 weeks gestation
| Open
| No
|
|-
| Incomplete
| Abdominal pain or bleeding; < 20 weeks gestation
| Open
| Yes, some
|
|-
| Complete
| Abdominal pain or bleeding; < 20 weeks gestation
| Closed
| Yes, complete expulsion of products
| Distinguish from ectopic based on decreasing hCG and/or decreased bleeding
|-
| Missed
| Fetal death at <20 weeks without passage of any fetal tissue for 4 weeks after fetal death
| Closed
| No
|
|-
| Septic
| Infection of the uterus during a miscarriage. Most commonly caused by retained products of conception
| Open
| No, or may be incomplete
| Uterine tenderness and purulent discharge from the OS may be present
|}

Accidental hypothermia

2015-11-13T22:23:06Z

Doctorm9:

==Background==
'''Definition: Core Temp <35C (95F)'''
*50% who die of hypothermia are >65 years old<ref>1. Centers for Disease Control and Prevention: Hypothermia-related deaths—United States, 2003–2004. MMWR Morb Mortal Wkly Rep 54: 173, 2005</ref>

==Clinical Features==
{{Swiss staging system}}

==Differential Diagnosis==
===Impaired thermoregulation===
*Central failure
**[[Anorexia nervosa]]
**[[CVA]]
**[[Head trauma (adult)|Head trauma]]
**Hypothalamic dysfunction
**Metabolic failure
**Neoplasm
**[[Parkinson's disease]]
**Drugs-[[Ethanol]], Sedatives-hypnotics
**[[SAH]]
**[[Toxins]]
*Peripheral failure
**[[Acute spinal cord transection]]
**Decreased heat production
**[[Neuropathy]]
*Endocrine
**[[DKA]] or [[alcoholic ketoacidosis]]
**[[Hypothyroidism]]
**[[Adrenal crisis|Hypoadrenalism]]
**Hypopituitarism
**[[Lactic acidosis]] (Sepsis)
*Insufficient energy
**Extreme physical exertion
**[[Hypoglycemia]]
**Malnutrition
*Neuromuscular compromise
**Recent birth or advanced age
**Impaired shivering

===Increased heat loss===
*Dermatologic
**[[Burns]]
**Exfoliative dermatitis
*Iatrogenic
**Massive fluid or [[Blood transfusions|blood resuscitation]]
**[[Emergency childbirth]]
**[[Heat stroke]] treatment
*Other
**Carcinomatosis
**Cardiopulmonary disease
**Multisystem [[Trauma (main)|Trauma]]
**[[Shock]]

==Diagnosis==
*Use low-reading thermometer
**Some standard thermometers record only to 34C
===[[ECG]]===
*Typical sequence is sinus brady > a fib with slow ventricular response > v-fib > asystole
*Other ECG findings:
**Osborn (J) wave
**T-wave inversions
**PR, QRS, [[QT prolongation]]
**Muscle tremor artifact
**AV block
**[[PVC]]s

==Treatment==
===General===
*Handle pt gently
**[[V-fib]] may be induced by rough handling of pt due to irritable myocardium (anecdotal)
*O2
**Hypothermia causes leftward shift of oxyhemoglobin dissociation curve
*[[Intubation]]
**same indications as normothermic patients
**RSI medications may be ineffective at temperatures <30C
*[[IVF]]
**Reasons:
***Hypothermia > impaired renal concentrating ability > cold diuresis
***Pts are prone to [[Rhabdomyolysis|rhabdomyolysis]]
***Intravascular volume is lost due to extravascular shift
*[[CPR]]
**Only perform if pt truly does not have a pulse (unnecessary CPR may lead to [[V-fib]])
**Spend 30-45s attempting to detect respiratory activity and pulse before starting CPR
*[[Dysrhythmias]]
**Occur once temp <30C (86F)
**Rewarming is treatment of choice
***Most dysrhythmias (e.g. sinus brady, [[a-fib]]/[[flutte]]r) require no other therapy
****Activity of antiarrhythmics is unpredictable in hypothermia
****Hypothermic heart is relatively resistant to atropine, pacing, and countershock
**[[Ventricular tachycardia]] or [[Ventricular fibrillation]]
***May be refractory to therapy until pt is rewarmed
***Attempt defibrillation
****Value of deferring repeat defibrillation until a target temperature is reached is uncertain<ref>Hoek T. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010. 122:5829-5861</ref>
****Reasonable to perform further defibrillation attempts concurrent with rewarming<ref>Hoek T. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010. 122:5829-5861</ref>
*[[Antibiotics]]
**Give if suspect [[sepsis]] (e.g. hypothermia fails to correct w/ rewarming measures)
*[[Thiamine]]
**Consider if [[Wernicke disease]] is possible cause of hypothermia (e.g. alcoholic pt)
*[[Hydrocortisone]]
**Consider if pt has history of adrenal suppression or insufficiency
**100mg Hydrocortisone
*[[Thyroxine]]
**Consider if any suspicion for [[hypothyroidism]]/[[myxedema coma]]
**Could cause dysrhythmia or cardiac ischemia if not in myxedema coma

===Rewarming===
*Passive
**Consider in pt w/ mild hypothermia who is able to generate intrinsic heat
**Techniques
***Removal from cold environment
***Insulation
*Active
**Consider in:
***Moderate-severe hypothermia
***Mild hypothermia in pt who is unstable or cannot generate intrinsic heat
***Failure to respond to passive external rewarming
***May be ineffective in pts w/ poor perfusion or in cardiac arrest
**Techniques
***Rewarm trunk BEFORE the extremities
****Otherwise may lead to hypotension ("core temperature afterdrop")
*****Warmed vasodilated peripheral tissue allows cooler blood in extremities to circulate back to core
***Warm water immersion
***Heating blankets
***Radiant heat
***Forced air - Bair hugger
***Warm humidified air
*Active Internal
**Consider alone or along with active external warming in:
***Cardiovascular instability / life-threatening dysrhythmias
***Severe hypothermia
***Moderate hypothermia which fails to respond to less aggressive measures
**Techniques
***Heated IV fluids: 38°C -42°C.
****Two animal studies have shown fluids given through a central line at 65°C warmed subjects faster without side effects, but this has not been tested in humans.
****If central line is placed avoid irritating the heart
***GI tract lavage
***Bladder lavage
***Pleural lavage
***Peritoneal lavage
***Bypass/ECMO<ref>Ginty C, et al. Extracorporeal membrane oxygenation rewarming in the ED: an opportunity for success. American Journal of Emergency Medicine. 2014 December 3 (ahead of print).</ref>/AV Dialysis

==Complications==
*[[Acid-base disorders]]
*[[Aspiration pneumonia and pneumonitis|Aspiration pneumonia ]]
*Bleeding
**Decreased platelet function and inhibition of coagulation cascade
*[[Cold injuries]]
*[[Dysrhythmias]]
*[[Disseminated Intravascular Coagulation (DIC)|Disseminated Intravascular Coagulation]]
*[[Pancreatitis]]
*[[Rhabdomyolysis]]
*[[Thromboembolism]]
**Secondary to hemoconcentration, increased blood viscosity, and poor circulation
*Ineffective Drugs
**Protein binding increases as body temperature drops, and most drugs become ineffective
**Pharmacologic manipulation of the pulse and blood pressure generally should be avoided
**Orally meds poorly absorbed because of decreased gastrointestinal motility
**Intramuscular route avoided due to poor absorption from vasoconstricted sites

==External Links==
*[http://lifeinthefastlane.com/ecg-library/basics/hypothermia/ LITFL Hypothermia]

==See Also==
*[[Therapeutic hypothermia]]
*[[Water-related injuries]]

==References==
<references/>

[[Category:Environ]]