Severe Hypothermia Complicated by Home Heating Fuel Oil Contamination

A 50-year-old African American man was brought to a tertiary care emergency department (ED) after being found lying on the ground next to a leaking home heating fuel oil tank on which he had been working for an unknown amount of time. His clothing was immersed in home heating oil and his skin smelled strongly of these fumes. First responders were paramedics followed by basic emergency medical technicians. Prehospital personnel disrobed the patient, wiped him down, and wrapped him in warm blankets. Vital signs in the field included a tympanic temperature of 21◦C, respiratory rate of 20 breaths/min, weak carotid pulses, and absent peripheral pulses. The patient initially opened his eyes to verbal stimuli and was noted to have some purposeful movement. Cardiac tracings revealed organized complexes without associated pulses, which progressed to asystole within 2 minutes of emergency medical services arrival. Advanced Cardiac Life Support protocol was initiated and included intubation, cardiopulmonary resuscitation (CPR), and cardiotropic medications per direct medical oversight at the receiving hospital. Upon arrival at the tertiary hospital, the patient remained asystolic. The fuel oil aroma permeated the resuscitation room. The inhalational exposure was intense, and four health care providers needed 5-minute breaks during the resuscitation effort. The only medical history that could be obtained was a questionable history of alcohol abuse. Vital signs in the emergency department (ED) included a rectal temperature of 21◦C and an unobtainable oxygen saturation due to the patient’s cold extremities. Additional rewarming techniques were administered; active external rewarming included heat lamps and a Bair Hugger #500 (Arizant Healthcare, Inc., Eden Prairie, MN), and active core rewarming included heated intravenous (IV) fluids, gastrointestinal tract lavage, bladder lavage, and warmed humidified air through the endotracheal tube. The patient’s rectal temperature improved to 23.3◦C after a 45-minute interval. Initial significant laboratory values included: pH 7.29, partial pressure of carbon dioxide (pCO2) 18.6 mm Hg, partial pressure of oxygen (pO2) 425 mm Hg, bicarbonate HCO3 8.8 mmol/L, oxygen