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Hypothermic Heart on POCUS

April 21, 2014 0 Comments

This never-ending winter reminded me of hypothermia case that I saw a number of years ago. It was an elderly female in her mid-70s with an unclear history. She was found on the ground at the entrance to her home by family one morning in the middle of winter. EMS was activated. She was found to be unconscious with a heart rate in the 30s and systolic blood pressure in the 70s range. Aside from some bruising to the right torso, there were no apparent signs of trauma. We initiated the usual rewarming treatment in the ED and started to give her IV fluid boluses. We started arranging for bypass even before the patient arrived. Careful evaluation including POCUS made a traumatic cause of her hypotension less likely. Her hypotension was felt to be primarily related to her hypothermic state. The bedside ultrasound of her heart was interesting (see below). It provides a nice glimpse into the pathophysiology of the hypothermic heart. The heart looks like it is beating in slow motion. If the video was sped up, it might look like her heart was beating just fine. The contractions seem good, but they’re just too darn slow. Reminds me of how my muscles feel after watching my kids play a hockey game on an outdoor rink!
Steve

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