Thermal injury caused by hot pack application in hypothermic children

Abstract

A three-year 1 l-month-old boy fell through a layer of ice into a pond. When retrieved about 15 minutes later, he was apneic and pulseless. Cardiopulmonary resuscitation (CPR) was begun. and two varieties of hot packsS§ were placed on his abdomen and back to initiate field rewarming. On arrival at the emergency department a physician noticed that one hot pack was painfully hot and removed the packs. After 20-30 minutes of continued CPR, a heart beat without perfusion was noted. After 45 minutes in the emergency department, effective perfusion and spontaneous respiration returned, but core temperature had fallen to 29°C. Further warming was done in a bath of 38-39°C water. Burns were noticed at the sites of one type of hot pack+ prior to transfer to intensive care (Fig. 1). Subsequent therapy included intracranial pressure monitoring and therapy with hyperventilation, paralysis, mannitol, and pentobarbital coma. During a 1 ‘iz-month hospitalization, he slowly regained speech and ambulation, but developed a hyperactive behavior disorder and did not regain his pre-injury mental development. Several well-circumscribed third degree burns were present on his anterior and posterior trunk and inner arms. They required serial excision, pigskin coverage, and eventual homografting.