TuesNEJMCase412

Case41-:A16-Year-OldBoywithHypothermiaandFrostbite

16岁男孩体温过低伴冻伤

PresentationofCase

A16-year-oldboywasadmittedtothehospitalafterbeingfoundunconsciousinasnowbankat6a.m.onNewYear’sDay.Hehadbeenwelluntilthenightbeforeadmission,whenheattendedapartywherealcoholwasconsumed.Hewaslastseenatapproximately11p.m.Approximately2hourslater,hisfriendsandfamilynoticedhisabsenceandnotifiedpolice;asearchwasbegun.Atapproximately6a.m.,hewasfoundunconsciousinasnowbankbylocalfirefightersandpoliceofficers.Theambienttemperaturewas?15°C(5°F),withawind-chillfactorofapproximately?29°C(?20°F).Hewaspartiallyundressed,withhispantsdownandhisrightbootoff;hislimbswereburiedinthesnow,andalayeroficesurroundedhisrightfoot.Intheambulance,anintravenouscatheterwasplaced,andmlofcrystalloidwasinfused.Hewasbroughttotheemergencydepartmentofthishospital,arrivingat6:50a.m.

在元旦那天早上6点，一名16岁的男孩在雪堆上被医院。截止到他被收入院的前一天晚上他参加一个充满着酒气的聚会的时候，他一直都很好。人们最后一次看到他是在晚上11点左右。大约2小时后，他的朋友和家人注意到他不在，并通知了警方；开始了搜索。大约早上6点，当地消防员和警察在雪堆上发现了昏迷的他。环境温度为?15°C(5°F)，风寒系数约为?29°C(?20°F)。他半裸着，裤子脱了，右靴子掉了；四肢埋在雪里，右脚周围覆盖着一层冰。在救护车上他被放置静脉导管，注入毫升晶体液。医院的急诊科，到达时间是早上6点50分。

Oninitialexamination,hewasdrowsyandslowtorespondbutoriented,withspontaneousrespirationsandnoshivering.Therectaltemperaturewas31.3°C(88.3°F),thebloodpressure/62mmHg(20minuteslater,/56),thepulse72beatsperminute(20minuteslater,52),andtherespiratoryrate20breathsperminute;apulseoximetershowedanoxygensaturationof93%whilehewasbreathingambientair.Therewereabrasionsonhisforehead.Thedistalrightfootwasencasedinice,bothhandswerecoldandhardtopalpation,andtheleftfootwascoldbutsoft.Thearms,buttocks,andlegs(uptothethighs)werepurplish-red,andthetoesandfingerswereblue.Therewereabrasionsonthedorsalsurfacesofthehands,legs,andfeet.Neurologicexaminationshowednofocalabnormalities.Thewhite-cellcountwas14,percubicmillimeter(referencerange,to13,),with81%neutrophils(referencerange,40to62),16%lymphocytes(referencerange,27to40),and3%monocytes(referencerange,4to11);thelevelofpotassiumwas3.2mmolperliter(referencerange,3.4to4.8),carbondioxide18.3mmolperliter(referencerange,23.0to31.9),glucose60mgperdeciliter(3.3mmolperliter)(referencerange,70tomgperdeciliter[3.9to6.1mmolperliter]),aspartateaminotransferase58Uperliter(referencerange,10to40),lipaseUperliter(referencerange,13to60),amylaseUperliter(referencerange,3to),andcreatinekinaseUperliter(referencerange,60to).Theremainderofthe

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