Q: What is the major hurdle for cardiopulmonary resuscitation (CPR)in severe hypothermic patients?


Answer: A frozen chest wall

Severe hypothermia may cause chest wall to freeze up to the point that it is not compressible. In such instances, bedside echocardiography combining with doppler ultrasound may help. If cardiac contractions can be seen with 'echo' and if pulses can be detrmined by 'doppler' - it may be more safe to avoid CPR. Endotracheal intubation to assist chest wall movement may help, along with hhumidified oxygen to rewarm the patient. Severly hypothermic patients who are in cardiac arrthymias actually may respond better to bretylium.