Akzidentelle Hypothermie/schwere Unterkühlung^[1]

Zusammenfassung

Die Hypothermie bezeichnet grundsätzlich den Abfall der Körperkerntemperatur auf unter 35 °C. Die Hypothermie wird nach dem Schweregrad in mild (35 – 32°C), moderat (32 – 28°C) und schwer (< 28 °C) graduiert. Beim Polytrauma gilt eine abweichende Einteilung, da eine erhöhte Inzidenz posttraumatischer Komplikationen bereits bei geringerem Temperaturverlust ab 34 °C nachgewiesen wurde. Der Hypothermie kommt im Zusammenhang mit dem Traumamechanismus (Ertrinken, Unfall, Lawinenunfall) oder mit weiteren Aspekten (Mehrfachverletzung) eine besondere Bedeutung zu. Die präklinische Versorgung orientiert sich dabei an den besonderen Umständen (schwerer Seegang, Gebirge etc.). Grundsätzlich sind die allgemeinen pathophysiologischen Veränderungen durch die Hypothermie zu berücksichtigen, die präklinischen Maßnahmen können jedoch variieren. So divergiert die präklinische Versorgung beim Lawinenunfall zeitabhängig nach der Dauer der Verschüttung.

Der vorliegende Artikel bietet einen aktuellen Einblick zu Ursachen, Ausmaß und Auswirkungen der Hypothermie auf verschiedenen Organsysteme und konsekutiv potenzielle Therapieansätze.

Abstract

Hypothermia is defined as a body core temperature below 35°C. According to its extent hypothermia is classified into mild (35 – 32°C), moderate (32 – 28°C) and severe (< 28 °C). In case of multiple trauma a divergent classification is used due to a known increased incidence of posttraumatic complications in patients with a core temperature below 34 °C. Hypothermia has been described to impact outcome in accordance to its trauma mechanism (e.g. drowning, road traffic accident, avalanche accident) and other considerably related aspects (multiple trauma). Prehospital treatment of hypothermia has to consider the special accident circumstances (heavy sea, rescue in the mountains, etc.). In general, described pathophysiological effects of hypothermia should be known while prehospital treatment might vary referring to the special rescue conditions. For instance, prehospital treatment in case of avalanche accidents differs due to the duration of entombment.

This article intents to present a current view towards cause, extent and effect of accidental hypothermia on different organ systems and to review potential treatment options.

Schlüsselwörter

Hypothermie - Ertrinkungsunfall - Lawinenunfall

Keywords

hypothermia - drowining accident - avalanche accident

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